RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI 3rd AUGUST, 2010 STRUCTURE OF THE PRESENTATION 1. Good / innovative practices adopted by the state in the focus areas Assured Service Delivery 2. Current status (Facility operationalisation and VHNDs) 3. Key issues 4. Way forward Programme Management 5. Current status (supportive supervision system) 6. Key issues and way forward Monitoring and Evaluation 7. Current status (maternal death review and name based tracking) 8. Key issues and way forward 10.Gender and Social Equity PRESENTATION ON FACILITY OPERATIONALISATION AND VHNDs : CURRENT STATUS , KEY ISSUES AND WAY FORWARD HEALTH INDICATORS SN CATEGORY 1 2 3 4 Crude Birth Rate (SRS 2008) Total Fertility Rate (SRS 2008) NFHS-III (2005-06) Death Rate (SRS 2008) Sex Ratio at Birth (SRS 2008) 5 Sex Ratio (0 to 4 years) (SRS 2007) (SRS 2008) 6 Maternal Mortality Ratio (SRS data of 2001-03) (SRS data of 2004-06) INDIA PUNJAB 22.8 17.3 2.7 2.7 1.9 2.0 7.4 7.2 904 836 914 915 838 841 301 254 178 192 4 HEALTH INDICATORS: ANTE NATAL CHECK UP SN CATEGORY INDIA PUNJAB 57 53 42 41 7. Infant Mortality Rate NFHS-III (2005-06) (SRS 2008) 8. Any Ante Natal Care DLHS – III (2007-08) 75.2 83.3 9. Full Ante Natal Checkup DLHS – III (2007-08) 18.8 14.3 10. Ante Natal Care (3 or more visits) NFHS-III (2005-06) DLHS – III (2007-08) 50.7 75.3 72.5 65.1 11. Institutional deliveries NFHS – III (2005-06) DLHS – III (2007-08) 41 47 53 63.3 HEALTH INDICATORS : CHILD HEALTH SN CATEGORY 12. Pregnant women who are anemic (%age) NFHS – III (2005-06) 13 Breast Feeding (%age) (i) Children under 3 years breast fed within one hour of birth NFHS-III(2005-06) DLHS-III (2007-08) 14 Exclusive breast-feeding (0-5 months) NFHS-III (2005-06) DLHS-III (2007-08) 15 %age of children fully immunized NFHS-III (2005-06) DLHS-III (2007-08) INDIA PUNJAB 57.9 41.6 23.4 40.2 10.3 44.6 46.3 46.8 36.0 32.4 44.0 54.1 60.0 79.9 TARGETS FOR PUNJAB UNDER NRHM Target by 2011-12 Indicators Present Status Total Fertility Rate 2.0 1.8 NFHS III (2007-08) Infant Mortality Rate (per 1000 live births) 41 SRS 2008 <30 Maternal Mortality Ratio (per 100000 live births) 178 192 (SRS 2008) <100 Institutional Deliveries 63.3 DLHS III (2007-08) 80% ANC Check-up contacts with 03 65.1 100% DLHS III (2007-08) 7 FINANCIAL REPORT FOR THE YEAR 2005-10 ` in lakhs Approved Plan State Share GOI 15% Total from 2007-08 Releases Year Opening Balance 1 2 3 4 5 6 7 2005-06 283 9821 Not Required 9821 8103 0 2006-07 2415 16272 16272 14194 2007-08 Funds Funds released released by by GOI State Others 9 9 10 11 (8-9) 8386 5971 61% 2415 0 16609 8326 51% 8283 8283 16197 2841 19038 11516 0 19799 10469 55% 9330 2008-09 9993 17324 2600 19924 17917 2884 204 30998 18697 94% 12301 2009-10 12301 21805 3271 25245 22128 1699 131 36259 22084 87% 14175 2010-11 14175 24633 1756 16 25262 4377 15% 20885 Not Required 4347 28980 9315 8 Unspent Balance % of Total Expenditure (Bank Incurred Utilization Funds Balance Available SHS) (2+6+7+8) * Committed expenditure is ` 7781 lakh so actual opening balance will be ` 6394 lakh 8 FINANCIAL REPORT FOR THE YEAR 2005-10 2010-11 Details of Activities Approved & Resourse Envelop Activities Approved for the F/Y 2010-11 Rs. 364.24 Cr. Resourse Envelope : GoI : Basic 246.33 Cr. 15% Over Planning 36.96 Cr. Total 283.29 Cr. State Share 43.77 Cr Uncommitted Unspent Balance 55.77 Cr. Grand Total 382.53 Cr. FINANCIAL REPORT FOR THE YEAR 2010-11 upto JUNE Opening Balance 14-10 Componen ts Sr.No. Funds released Approve d Out with Advance Lay by SHS s GOI Releases to Expendi Districts ture Up Total & To Funds Agencie June by State Availabl s 2010 e Unspent Balance with SHS Advance Total s 3 4 5 6 7 8(3+6+7 ) 9 10 11 12 13(11+ 12) FW 0.00 0.00 70.24 0.00 17.56 17.56 17.56 17.56 0.00 0.00 0.00 A RCH II 17.10 33.00 94.42 36.14 0.00 53.24 7.05 9.98 46.19 30.07 76.26 B NRHM 32.89 35.57 167.39 56.71 0.00 89.60 30.12 14.99 59.48 50.70 110.18 C Immunizati 2.75 on & PP 2.13 14.01 0.30 0.00 3.05 5.00 1.24 -1.95 5.89 3.94 D NDCP 9.35 1.07 18.18 0.00 0.00 9.35 0.00 0.00 9.35 1.07 10.42 E Inter Sectoral Convergen ce 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.17 2.73 0.16 0.00 5.33 0.51 0.00 4.82 3.24 8.06 67.26 74.50 93.31 17.56 178.13 60.24 43.77 117.89 90.97 208.86 1 2 Part I Part II Other Activities Total 364.24 1. GOOD/ INNOVATIVE PRACTICES Reproductive and Child Health Programme focus on reducing MMR and IMR. Strategies: • Infrastructure and Manpower Strengthening •Ensure Complete ANC Coverage • Promoting Institutional Deliveries 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Institutional Deliveries - Free: Data of DLHS-III shows that 36.1% pregnant women are not going to health institutions for delivery because of cost factors. To promote institutional deliveries, the State Govt. has initiated the following steps: • Deliveries and delivery related services have been made free at all Govt. Hospitals from December 2008 by the State Govt. • • • • Provision of referral transport, ` 200/- to PW for referral transport Surakshit Janepa Yojna – PPP initiative The average fixed rate for delivery to be reimbursed to the API (Accredited Private Institution) has been revised to ` 2500/- from earlier rate of ` 1700. Approx. 600 deliveries conducted Incentive to ASHA for institutional deliveries Family Health camp in all blocks- 200 camps 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY • Maternity Wards- maternity Wards in all the districts hospitals to be renovated/ constructed. The work has already started at most of the places. • 24 Mobile Medical Units functional in the State • 8 Mobile Units by Ranbaxy to serve in un-served areas. • Emergency Response System in place by March 2011 • Availability of drugs and other consumable in sufficient quantity at all levels. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY SPECIAL PROJECT INFRASTRUCTURE FOR UPGRADATION OF HEALTH Hon’ble Chief Minister, Punjab have approved a special project for upgradation of Health Infrastructure • A major upgradation project worth ` 346 crores has been prepared for the upgradation of Health Infrastructure.. Under this project new blocks are to be added to the existing hospitals, new districts and Sub Divisional Hospitals and Community Health Centres will also be constructed. The details of spending are- cost of the construction - Equipments ` 280 crores ` 66 crores • The works for these projects would be allotted by 30.09.2010 and are likely to be completed by 31.08.2011. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Upgradation of District Hospitals: • Upgradation of 2 District hospitals- District hospital Muktsar & Tarn Taran will be upgraded to 100 bed hospital (` 14.40 Crore)and equipment worth ` 1.35 Crore. • New District Hospital-- District hospital Nawanshahar (` 16 Crore) and equipment worth ` 1.50 Crore. Upgradation of SDHs: • Upgradation of 2 existing CHCs to SDH – 20 bed each will be added in SDH Dera Bassi (Mohali) and SDH Budhlada (Mansa)at the cost of ` 6.40 Crore. • Construction of 5 new 50 bedded SDH- Khadoor Sahib(Tarntaran), Bholath (Kapurthala), Moonak (Sangrur), Tapa (Barnala) and Ghudda (Bathinda) at the cost of ` 40 Crore. Equipment worth ` 3.75 Crore. will be provided. • Major repair and renovation of 22 existing SDH will be undertaken. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Upgradation of CHCs: • New building of 3 CHCs Ballianwali (Bathinda), Naushera Majjha Singh (Gurdaspur) and Dudhan Sadan (Patiala) at the cost of ` 14.40 Crore. • New CHCs- 29 PHCs will be upgraded to CHCs and new construction of these CHCs will be undertaken at the cost of ` 139.20 Crore. Equipment worth ` 13.05 Crore will be provided. Upgradation of 204 PHCs: • ` 44.86 Crore have been earmarked out of which ` 34.68 Crore for civil work and ` 10.18 Crore for equipments. 204 PHCs which are yet not covered by NRHM will be taken. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • IEC & reference material for service guarantee designed and displayed for the service provider and community. • Unique Signages for the FRUs and 24x7 PHCs. • Protocol for EmOC by UNICEF displayed at labour room for reference. • IEC material on available services for community. TOP 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • Pamphlets for community on information regarding service availability at sub-centres regarding availability of services, equipments, medicines etc. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • Charter at Sub-Centre: facilities available at Sub-Centre 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • Duties of ANM displayed at Sub-Centre 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • Display of IEC material for community on Care during pregnancy, JSY and Care of Neonates. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY Service Guarantee • Protocols developed by UNICEF displayed as reference in labour rooms and Gynecologists OPD. 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY 1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY 1. GOOD/ INNOVATIVE PRACTICES: PROGRAMME MANAGEMENT • State Health Systems Resource Centre (SHSRC) established: Consultants of different fields (Public Health Planning, Health – HRD, BCC/IEC, Quality Assurance, Community Participation) placed. • State Programme Management Unit, District Programme Management Units , Block Programme Management Units fully functional. • Hospital Administrator for five major District Hospitals. • Supervisory structure of LHVs strengthened. 1. GOOD/ INNOVATIVE PRACTICES: MONITORING & EVALUATION • Biometric based online attendance system for health institutions. • Daily online OPD monitoring mechanism. • Utilization of equipments monitored online. • Mobiles to all 4000 ANMs planned for systematic monitoring of their performance in respect of important parameters. • Registration of all 5 lakh pregnant women in the state is planned. Tracking of all new born children for full immunization is also planned with Government of India assistance under NRHM. • Maternal Death Review initiated, guidelines issued. • Community hotline. • Mobile Medical Units are monitored through GPS. • GIS is being developed 1. GOOD/ INNOVATIVE PRACTICES: GENDER & SOCIAL EQUITY • More focus on NSVs, special camps are being organized successfully • Strict enforcement of PC-PNDT Act. - Prizes announced for decoy customers, informers and for sting operations in regard to violation of PNDT Act. - Award to Panchayats. 83 Panchayats with sex ratio 1000 and above have been honored with Rs1.50 Lac each. - Community hotline to curb female foeticide. • Free deliveries, free referral, free treatment to children suffering from CHD/ RHD. • Jan Aushadhi Stores in all the 20 District Hospitals and 3 SDH to provide cheap generic medicines to the people have been started and more in process. • Free treatment for BPL families • Special outreach programme for minorities 2. CURRENT STATUS: FRUs Status on 1st July, 2010 (No. of facilities) No. of planned FRUs No. of functional FRUs, with Cesarean sections conducted 24 X7 Blood storage facility (or adequate linkages to one) available New born care services available on 24 hr basis All of the above 3 criteria * No. of operational FRUs, with - male sterilization services (not camp based) - female sterilization services (not camp based) - * Safe Abortion Services – MTP * Desirable services 170 131 (21 DHs + 35 SDHs + 114 CHCs) (21 DHs + 35 SDHs + 75 CHCs) 81 (21 DHs + 35 SDHs + 25 CHCs) 170 (21 DHs + 35 SDHs + 114 CHCs) 81 (21 DHs + 35 SDHs + 25 CHCs) 170 (21 DHs + 35 SDHs + 114 CHCs) 2. CURRENT STATUS: 24x7 PHCs 24 x 7 PHCs : Current Status Status on 1st July, (CONTD ..) 2010 (No. of facilities) No. of planned 24x7 facilities 236 No. of operational 24X7 facilities, with Normal deliveries conducted 24X7 Essential newborn care services available Availability of Referral transport 24X7 All the above 3 criteria 219 205 205 No. of operational 24X7 facilities, with * IUCD services * Early and safe abortion services (including MVA) * RTI / STI treatment or counseling * Desirable services 178 2. CURRENT STATUS: NEWBORN CARE FACILITIES 24 x 7 PHCs : Current Status Status st July, 2010 on 1..) (CONTD (No. of facilities) No. of SNCUs currently functional at DH level No. of SNCUs planned for 2010-11 3 No. of Newborn and child stabilsation units (NBSUs) currently functional at FRU level 55 No. of NBSUs planned for 2010-11 No. of newborn baby care corners (NBCCs) currently functional at facilities where deliveries are conducted (PHCs, CHCs, sub-centres, etc.) 114 No. of NBCCs planned for 2010-11 236 2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos) OBG specialist Anaestheti Paediatricia st n Facility R A R A R A DH 34 34 26 21 27 29 FRUs (SDH) 42 35 32 32 39 30 FRUs (CHC) 112 92 Empanelled 112 61 Facilities other than FRUs (above PHC level) 24x7 PHC (FMO) Other PHCs Total MOs trained in EmOC MOs trained in LSAS MOs trained in blood storage MOs trained in BEmOC A A A A Staff nurses R A 936 864 944 730 - 14 1 236 189 3 36 (18) 36 R: Required as per GoI guidelines/ norms of respective facility irrespective of number of positions sanctioned; A: Available, both regular and contractual EmOC refers to the Comprehensive EmOC training (including C-section); BEmOC refers to Management of common obstetric complications; LSAS refers to training in Life Saving Anaesthesia Skills 2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos) Facility MOs Staff LTs MOs LTs MOs SNs Doctors Doctors trained nurses trained trained trained trained trained trained trained in trained in RTI/ in in blood in F- in Fin NSV in Lap RTI/ in STI MTP storage IMNC IMNC Ligatio STI RTI/ diagnos I I n mgmt. STI is mgmt. A A A A A A A A A Staff nurses trained in SBA ANMs / LHVs trained in SBA A A 298 458 DH FRUs (other than DH) Facilities other than FRUs (above PHC level) 24x7 PHC Other PHCs Sub-centres Total 846 1409 A: Available, both regular and contractual 184 37 75 50 2. CURRENT STATUS: NSSK TRAININGs State Level No. of NSSK Trainers Total Training load District Level Total Medical Officers Staff Nurses Total 800 800 1600 TOT - to be conduct Training completed (2009-10) Training completed 2010-11( April – June) Training will be completed by September INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2009-10 Institutional Deliveries in Govt. Institutions: 2009-10 Institutional Deliveries increased to 49.56% in 08-09 over 07-08 and further 32.20% in 09-10 over 08-09 Institutiona Institutiona l Deliveries l Deliveries 2007-08 2008-09 Difference In No. of Deliveries Institution al Deliveries 2009-10 Difference In No. of Deliveries SN Institute/ Category 1 DH 19991 22209 2218 26274 4065 2 SDH 12922 14151 1229 16923 2772 3 CHCs a) CHCs (PHSC) 8434 13964 5530 22097 8133 a) CHCs (DHS) 281 874 593 1595 721 4 24x7 PHCs 1049 6859 5810 13872 7013 5 RURAL HOSPITAL 179 431 252 832 401 6 SATELLITE HOSPITAL 309 553 244 775 222 7 OTHER GOVT. INSTITUTIONS 1320 7492 6172 5586 -1906 INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2010-11 SN Institute/ Category 1 DH 2 SDH Institutional Institutional Difference in %age Deliveries Deliveries No: of Increase in (2009-10 upto (2010-11 upto Deliveries 10-11 June 09) June 2010) 5023 5649 626 12.46 3339 3568 229 6.86 3 CHCs a) CHCs (PHSC) 4359 5432 1073 24.62 b) CHCs (DHS) 280 408 128 45.71 4 PHCs 2672 4016 1344 50.30 a) 24X7 PHCs 5 Others STATE TOTAL 2623 1395 17068 4083 1195 20268 1460 -200 3200 55.66 -14.34 18.75 C-SECTION IN GOVT. INSTITUTIONS: 2010-11 Type of Health Institutions No. of public institutions conducting Csections No. of C- sections conducted 2009-10 2010-11 (April to June ) District Hospital 21 out of 21 DHs 8818 1855 Below DH level 110 (35 SDHs +75 CHCs) 4049+3060 =7109 867+734 = 1601 TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTES (2007-08, 2008-09, 2009-10 & 2010-11) 2007-08 2008-09 2009-10 2010-11 10000 8781 9000 7717 8000 6542 7000 6010 6000 7696 6067 6159 6101 6586 6055 7462 6834 5848 5830 3227 3110 February March 5458 4465 3838 3342 4164 3000 2000 8132 7457 6222 5689 5000 7938 6781 5157 4000 8334 8252 2762 3043 4395 4641 4364 3974 3864 3640 3301 1000 0 April May June July August September October November December January DELIVERIES IN CHCs AS FRUs (2007-08, 2008-09, 2009-10 & 2010-11) 2007-08 2008-09 2009-10 2010-11 2500 2249 2215 2177 2078 2000 1674 2040 1843 1669 1522 1469 1500 2067 2035 1973 1926 2175 1361 1224 1285 1343 1345 756 772 1415 1433 1454 693 690 February March 1115 1000 799 861 669 746 500 623 603 May June 529 808 825 737 755 0 April July August September October November December January DELIVERIES IN 24x7 PHCs (2007-08, 2008-09, 2009-10 & 2010-11) 2007-08 2008-09 2009-10 2010-11 1800 1527 1600 1391 1400 1252 1304 1237 1274 1332 1241 1382 1285 1151 1200 1017 1000 895 826 800 600 813 738 521 452 444 445 74 77 77 477 610 632 77 99 730 726 95 105 527 408 400 200 0 86 91 88 84 96 JANANI SURAKSHA YOJANA Estimated Number of Cases : Estimated number of deliveries in a year in the State of Punjab = 5,00,000 Estimated number of deliveries of BPL/SC/ST @ 35% = 1,75,000 Estimated number of Beneficiaries upto 2 living Children @ 50% = 87,500 Financial Assistance : Home Delivery - ` 500 Institutional Delivery - ` 600/ 700 for Urban and Rural women TOP JANANI SURAKSHA YOJANA Yearly Progress JSY : Year Number of Beneficiaries For Home/ Non Institutional Delivery % of total No.s For Institutional Delivery No.s % of total beneficiarie s beneficiarie s Total %age (Rs. In Achiev Lakhs) ement (ELA 90000) 2005-06 7489 65% 4106 35% 11595 13% 71 2006-07 9466 59% 6613 41% 16079 18% 88.7 2007-08 16453 56% 12823 44% 29256 33% 171 2008-09 40350 59% 27561 41% 67911 75% 384 2009-10 54132 56% 42589 44% 96721 107% 565 2010-11 9041 48% 9790 52% 18831 21% 136 JSY BENEFICIARIES OVER THE YEARS 120000 Institutional Deliveries Home Deliveries 100000 42589 27561 60000 20000 6613 7489 9466 2005-06 2006-07 2007-08 4106 54132 40350 12823 40000 16453 No. of Beneficiaries 80000 0 Years 2008-09 2009-10 JANANI SURAKSHA YOJANA SN No. of JSY beneficiaries 1 Home Deliveries 2 Institutional Deliveries 2009-10 2010- 11 (April – June) 54132 9041 a Rural 32376 7610 b Urban 10213 2180 c C- section (exclusive from above two) - - Sub-Total Institutional Deliveries 42589 9790 TOTAL 96721 18831 FAMILY PLANNING S. No. Status 2009-10 1 No. of female sterilisations (total) 65577 1.a Out of which, no. of minilap sterilisations 35365 2 No. of male sterilisations (total) 11127 3 No. of IUD insertions 272659 4 No. of IUD removals 43844 5 No. of sterilisation deaths 0 6 No. of sterilisation failures 6 FAMILY PLANNING • All 20 DH, 35 SDH & 114 CHCs providing sterilization services • Quality Assurance Committees constituted at all levels and are functional. • Fixed day Tuesday for NSV and Thursday for Vasectomy throughout State • Most of the District Quality Assurance Committees are Meeting regularly. • Regular meeting of QAC at State Level. • Consultant Quality Assurance, SHSRC has been appointed and will ensure the regular monitoring. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) (1) SHORTAGE OF MANPOWER Gynaecologists: • All the 20 District and 36 Sub-Divisional hospitals have Gynecologists. • Out of 117 CHCs, 34 CHCs are without Gynecologists. Paediatricians: • There is shortage of 63 Paediatricians. 6 in DHs, 13 in SDHs, 44 in CHCs Medical Officers (Female): • Out of 236 up-graded PHCs, there are Female Medical Officers in 189 PHCs and 47 PHCs are without Female Medical Officers. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) (2) BLOOD STORAGE UNITS OF PUNJAB • All the DH and SDH Hospitals have blood storage facilities. • 25 CHCs out of 107 CHCs have been provided staff and equipment for blood storage facilities. It would be made functional very soon. • The remaining 89 CHCs would be provided with Blood Storage facility in the current year. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) (3) EASY AND SUBSIDIZED ACCESS TO HEALTH SERVICES • Free deliveries in all Government Hospitals since December 2008. • Free treatment of school children in Government Hospitals since June 2009. • Free treatment of school children for congenital heart disease and cancer in PGI at a cost ranging from 1 to 1.5 lakh per student. • Jan Aushdi Stores for supply of generic medicines manufactured by Government PSUs setup in all District Hospitals in 2009. Punjab is the only State to cover all districts and out of 39 such stores in India 20 are functional in Punjab alone. • Effective implementation of Punjab Nirogi Scheme for BPL families for assistance upto Rs. 1.5 lakh. • Free treatment of BPL families without charging any user charges in all Government Hospitals. • Regular Supply of medicines in all Government Health Institutions. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) Major Challenges/ issues faced by the state relating to Adolescent Issues •Alcoholism /Drug addiction . •Socio Cultural barriers especially relating to honour and shame. •Lesser importance accorded to adolescent health issues, especially those related to adolescent girls •High prevalence of Anaemia especially among adolescent girls 3. KEY ISSUES: VHNDs • VHND in the state will be observed in the form of MAMTA DivasWednesday. • MAMTA Divas will provide holistic health services especially RCH to the masses. • To ensure participation of vulnerable social population i.e. BPL/SC/ST . • Services provided in VHND to be more strategized and strengthened. • All Sub-Centres of State have at least one ANM & 2nd ANM in the Sub-centres with population more than 6000. • All Sub-Centres of high focused districts will be provided 2nd ANM. • To enhance the publicity for VHND. 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Under Maternal Health Programme • RCH Camps in Districts • MAMTA Divas • During 10/11, 20 PHCs/ rural hospitals of High Focus Districts to be strengthened as 24x7 centres. • Human resource strengthening • During 10/11, all 114 CHCs will be made functional as FRU. • Monitoring of works done by Gynaecologists by setting benchmarks. Under Child Health Programme • Sick Neo Natal Care Unit at Women and Children Hospital, Bathinda, Jalandhar and MKH Patiala. • Baby Warmer and UV light units at all 24x7 PHCs 53 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Training • Navjaat Shishu Suraksha Karyakaram (NSSK) • Skill Birth Attendant Training in all Districts • Emergency Obstetric Care (EmOC) Training • IMNCI Training of LHVs, ANMs, AWWs, to continue and completed during this year • IUD Insertion Training using alternative methodology Drugs and Supplies • Drugs @ ` 12 lakh per DH per annum – ` 252.00 lakh • Drugs @ ` 3.00 lakh for per CHC per annum - ` 387.00 lakh • Drugs @ ` 5.00 lakh for 36 SDH – ` 180.00 lakh • Drugs @ ` 1.25 lakh per PHC/ RH/ SH per annum – ` 556.25 lakh 54 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Quality Assurance During the F/Y 2010-11, 5 big District Hospitals will be taken for accreditation of NABH. The 5 hospitals will be: SN 1 2 3 4 5 Name of Hospital Civil Hospital, Jalandhar Civil Hospital, Mohali Civil Hospital, Bathinda Civil Hospital, Ludhiana Special Hospital, Mata Kaushalya, Patiala Sanction Bed 400 150 200 200 200 The department has already negotiated contract with Quality Council of India & the contract is likely to be signed soon. 55 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Recruitment • State Government has taken out of the purview of the Public Service Commission the recruitment of Gynecologists and other specialists. We have held 2 rounds of recruitment and the third round is process. The Gynecologists are refusing to join CHCs. • About 33% of all Government Institutional deliveries taking place in District hospitals. One extra Gynecologist provided in the 6 District Hospital to meet the increased load. 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Recruitment of Specialists, MOs and Para Medicals The State Government gave special focus to recruitment of Medical Officers and other Paramedical Staff in the year 2009. Important posts that were filled up are– Regular: On Contract Medical Officers (Specialists) – 76 Gynaecologists – 36 Medical Officers – 312 Paediatricians - 28 Medical Officers (NRHM)-102 Staff Nurse-1260 ANM - 954 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Recruitment in Process Regular- On Contract Medical Officers (Specialists) – 128 Medical Officers (NRHM) – 100 Interview starting in 8/8/2010 Medical Officers – 214 Staff Nurse – 548 Medical Officer (Dental) – 34+48 ANMs – 97 Written Test of MOs on 8/8/2010 followed by interview 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Recruitment of ANMs and Staff Nurses • All posts of ANMs have been filled up. • Bigger 954 sub-centers (more than 6000 population) have been provided with 2 ANMs. • Most of the Sub-Centres in High Focused districts will be provided 2nd ANM • All the upgraded institutions have the requisite strength of Nurses. • The deputations of regular ANMs/Nurses have been cancelled and the new recruitments were district wise and made non-transferable. 4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs Rationalization of posting and transfers: • There was an acute shortage of doctors in PHCs and CHCs. • Part of this shortage was on account of irrational deployment of the doctors specially the specialists who were deputed in excess of the requirement at CHCs/PHCs/DH/SDH. • Deputation cancelled • As of now there is hardly any inconsistency in the posting and transfer, specially of Gynecologists. 4. STEPS TO ADDRESS KEY ISSUES: ARSH • Services of ICTC Counsellors at DH/SDH level for providing Counselling Services to adolescents on fixed day fixed time basis in afternoon sessions so that working of ICTC centers is not affected. • To operationalize multi-skill Adolescent Friendly Health Centres in Medical Colleges. • Special Adolescent Programme with NGOs. • Social Marketing of Sanitary Napkins. STEPS TO ADDRESS KEY ISSUES: VHNDs • Active involvement of PRI/VHSC members being encouraged. • VHND linked with immunization session across the state and named as MAMTA Divas. • Microplanning of sessions at the level of ANM/ASHA with the involvement of PRI/VHSC • Emphasis on Inter-sectoral convergence for effective organisation of VHND • Orientation of ANM to use untied fund at SC /VHSC for supplies and publicity. 5. CURRENT STATUS SUPPORTIVE SUPERVISION: AVAILABILITY OF PROCESS SN Key Aspects Whether a govt order issued for field supervision (e.g. officials 1 identified for supervision, number of visits, etc): 2 Check-list prepared for field supervision: Status Yes Yes 3 Whether a format for visit report available: Yes 4 System for action on key issues raised in field visit reports: Yes Provide details on frequency of visits by officials from each level and also the lowest level up to which they go for 5 supervision (e.g. monthly/ weekly/daily and up to SHC/PHC/CHC/DH/Other levels): All officers from PSHFW to SMO at least 2 vsits per month 5. CURRENT STATUS SUPPORTIVE SUPERVISION: AVAILABILITY OF HR SYSTEMS SN 1 Key Aspects Organogram including reporting structure available: YES/NO Status Yes Yes, Provisionally approved service rules for contractual employees 2 HRD manual in place: YES/NO Yes 3 Job description available for all the supervisory staff (both contractual and regular): YES/NO 4 Performance Appraisal system in place: YES/NO Yes 5 Dedicated HR experts available: YES/NO Yes 5. CURRENT STATUS SUPPORTIVE SUPERVISION: HR AVAILABILITY State Sn. Key functions for supportive supervision Assured Service Delivery: Operationalisation of facilities 1 (such as FRUs, 24x7 PHCs, SHCs), referral services VHND) HR / Training 2 (MH/CH/Imm./FP) Quality of Service Delivery 3 (PHN/Nurse-Midwives etc. for MH/CH/Imm./FP) 4 Data Analysis / Monitoring District/Divi sion (no.s) Block (no.s) No. No. No. No. No. No. Avail Req. Avail. Req. Avail. Req. . 6 6 20 20 NA NA 5 5 40 40 117 117 7. CURRENT STATUS: MATERNAL DEATH REVIEW (MDR) SN 1 Key Functions Issue of Govt order making it mandatory for District Collector to implement Maternal Death Review Status Issued Identified 2 Identification of State & District Nodal officer 3 Orientation programme for state and district staff 4 Issue of guidelines to districts and facilities 5 Constitution of MDR committees/ task force at state, district and facility level Will be convened in August 2010 Guidelines Issued To be Constituted by August 2010 7. CURRENT STATUS: NAME BASED TRACKING SYSTEM • All Formats and guidelines disseminated to all districts since January 2010, Pilot Training with help of NHSRC provided to all ANMs in District Ropar. • Data capturing has already been started on Excel Sheet as provided by Government of India, reports of which have already been e-mailed to GOI (till May 2010). • Training on e-MAMTA (Model of Gujarat) through econferencing provided to all district MEOs, DSAs and State Manager (M&E). • One Information Assistant in each District Hospital, SDH and Blocks – Written Test on 22/8/2010. 8. KEY ISSUES & WAY FORWARD Name Based Tracking • From 7th August the training for Name Based Tracking with training on ANM Mobile Application will be started in all district simultaneously. • Order has been placed for printing of revised Sub-Centre Registers based on PW and Child Immunization Tracking formats. Maternal Death Review • Orientation of Stakeholders • Constituting, Activating and Sensitizing the District MDR Committees • Implementation as per GOI guidelines 9. GENDER & SOCIAL EQUITY The PNDT Act will be strictly enforced to check female foeticide in the state • 109 Court Cases/ FIRs have been launched. 371 centers have been suspended/ cancelled. • Prizes announced for decoy customers, informers and for sting operations in regard to violation of PNDT Act. • 83 Panchayats with sex ratio 1000 and above have been honored with Rs1.50 Lac each. • As per latest SRS survey of GOI, the child sex ratio which was 798 in 2001 has improved to 841 in 2008. • Balri Rakshak Yojna 9. GENDER & SOCIAL EQUITY Amount given to Backward Pockets • In the State PIP 10-11 special focus has been given to four high focused districts. In these districts 2nd ANM is being provided at all sub-centres to improve the service delivery at village level. All the PHCs of these districts are being strengthened for 24x7 services. • Sub Plan for these districts have been prepared and being submitted to GOI. Thanks