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