7th joint review mission - punjab

Transcript 7th joint review mission - punjab

RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010

AT NIRMAN BHAWAN, NEW DELHI 3

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

1 2 3 4

CATEGORY

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 6 Sex Ratio (0 to 4 years) (SRS 2007) (SRS 2008) Maternal Mortality Ratio (SRS data of 2001-03) (SRS data of 2004-06)

INDIA

22.8

2.7

7.4

904 914 915 301 254

PUNJAB

17.3

1.9

2.0

7.2

836 838 841 178 192 4

HEALTH INDICATORS: ANTE NATAL CHECK UP

CATEGORY

Infant Mortality Rate NFHS-III (2005-06) (SRS 2008) 8.

Any Ante Natal Care DLHS – III (2007-08) 9.

10.

11.

Full Ante Natal Checkup DLHS – III (2007-08) Ante Natal Care (3 or more visits) NFHS-III (2005-06) DLHS – III (2007-08) Institutional deliveries NFHS – III (2005-06) DLHS – III (2007-08)

INDIA

57 53 75.2

18.8

50.7

75.3

41 47

PUNJAB

42 41 83.3

14.3

72.5

65.1

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

57.9

PUNJAB

41.6

23.4

40.2

46.3

46.8

44.0

54.1

10.3

44.6

36.0

32.4

60.0

79.9

TARGETS FOR PUNJAB UNDER NRHM

Indicators

Total Fertility Rate Infant Mortality Rate (per 1000 live births) Maternal Mortality Ratio (per 100000 live births) Institutional Deliveries

Present Status

2.0

NFHS III (2007-08) 1.8

41 SRS 2008

Target by 2011-12

<30 178 192 (SRS 2008) 63.3

DLHS III (2007-08) <100 80% ANC Check-up contacts with 03 65.1

DLHS III (2007-08) 100% 7

FINANCIAL REPORT FOR THE YEAR 2005-10

Year 1 Opening Balance GOI Approved Plan State Share 15% from 2007-08 Total 2 3 4 5

` in lakhs

Funds Funds released released by by GOI State Others 6 7 Releases 8 Total Funds Available Expenditure Incurred % of Utilization Unspent Balance (Bank Balance SHS) 9 (2+6+7+8) 9 10 11 (8-9) 2005-06

283 9821 Not Required 9821 8103 0 8386 5971 61% 2415

2006-07

2415 16272 Not Required 16272 14194 0 16609 8326 51% 8283

2007-08

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%

2010-11

14175 24633 4347 28980 9315 1756 16 25262 4377 * Committed expenditure is ` 7781 lakh so actual opening balance will be ` 6394 lakh 15% 14175 20885 8

FINANCIAL REPORT FOR THE YEAR 2005-10

2010-11 Details of Activities Approved & Resourse Envelop

Rs. 364.24 Cr.

Activities Approved for the F/Y 2010-11 Resourse Envelope : GoI :

Basic 15% Over Planning

Total State Share

246.33 Cr.

36.96 Cr.

283.29 Cr.

43.77 Cr

Uncommitted Unspent Balance Grand Total

55.77 Cr.

382.53 Cr.

FINANCIAL REPORT FOR THE YEAR 2010-11 upto JUNE

Sr.No.

Componen ts Opening Balance 1 4-10 with Advance Approve d Out Lay SHS s by Funds released GOI Releases to Expendi Total Funds by State Availabl e Districts & ture Up To Agencie s June 2010 Unspent Balance with SHS Advance s Total

Part I

A B

2 F W RCH II NRHM 3 4

0.00

17.10

32.89

0.00

33.00

35.57

5 6

70.24

0.00

94.42

36.14

167.39 56.71

17.56

8(3+6+7 )

17.56

0.00

53.24

89.60

7.05

30.12

10 11

17.56

9.98

14.99

0.00

46.19

59.48

0.00

13(11+ 12)

0.00

30.07

76.26

50.70 110.18

Part II

Immunizati on & PP

2.75

2.13

14.01

0.30

0.00

3.05

5.00

1.24

-1.95

5.89

3.94

D E

NDCP Inter Sectoral Convergen ce Other Activities Total

9.35

0.00

5.17

67.26

1.07

0.00

18.18

0.00

2.73

74.50

0.16

364.24

93.31

0.00

17.56

9.35

0.00

5.33

178.13

0.51

60.24

0.00

9.35

0.00

1.07

0.00

10.42

0.00

4.82

43.77

117.89

3.24

8.06

90.97

208.86

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

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 deliveries conducted ` 2500/- from earlier rate of ` 1700. Approx. 600 Incentive to ASHA for institutional deliveries Family Health camp in all blocks- 200 camps

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.

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

SPECIAL PROJECT INFRASTRUCTURE FOR UPGRADATION OF HEALTH

Hon’ble Chief Min

r, 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.

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 ( ` equipment worth ` 1.50 Crore.

16 Crore) and • • •

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.

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

and 24x7 PHCs.

for the FRUs

Protocol for EmOC

room for reference.

by UNICEF displayed at labour IEC material on services for community.

available TOP

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

Service Guarantee

• Pamphlets for community on information regarding service availability at sub-centres regarding availability of services, medicines etc.

equipments,

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

Service Guarantee

• Charter at Sub-Centre: facilities available at Sub-Centre

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

Service Guarantee

• Duties of ANM displayed at Sub-Centre

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

Service Guarantee

• Display of IEC material for community on Care during pregnancy, JSY and Care of Neonates.

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

Service Guarantee

• Protocols developed by UNICEF displayed as reference in labour rooms and Gynecologists OPD.

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

GOOD/ INNOVATIVE PRACTICES

ASSURED SERVICE DELIVERY

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

 No. of planned FRUs

Status on 1 st July, 2010 (No. of facilities)

170 ( 21 DHs + 35 SDHs + 114 CHCs)  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 131 (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)  * No. of operational FRUs, with - male sterilization services (not camp based) - female sterilization services (not camp based) - * Safe Abortion Services – MTP *

Desirable services

170 (21 DHs + 35 SDHs + 114 CHCs)

2. CURRENT STATUS:

24x7 PHCs Status

24 x 7 PHCs : Current Status

st (CONTD ..) (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   No. of

operational 24X7 facilities,

with  * IUCD services * Early and safe abortion services (including MVA) * RTI / STI treatment or counseling 219 205 205 178 *

Desirable services

2. CURRENT STATUS:

NEWBORN CARE FACILITIES Status

24 x 7 PHCs : Current Status

st (CONTD ..) July, 2010 (No. of facilities)

 No. of SNCUs currently functional at DH level  No. of SNCUs planned for 2010-11  No. of Newborn and child stabilsation units (NBSUs) currently functional at FRU level  No. of NBSUs planned for 2010-11 3 55  No. of newborn baby care corners (NBCCs) currently functional at facilities where deliveries are conducted (PHCs, CHCs, sub-centres, etc.)  No. of NBCCs planned for 2010-11 114 236

2. CURRENT STATUS:

FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos) Facility

OBG specialist Anaestheti st Paediatricia n MOs trained in

EmOC

MOs trained in

LSAS

MOs trained in blood storage MOs trained in

BEmOC

Staff nurses DH R 34 A 34 R 26 A 21 R 27 A 29 A A A A R A FRUs (SDH) 42 35 32 32 39 30 FRUs (CHC) 112 92 Empanelled 112 61 14 936 864 Facilities other than FRUs (above PHC level) 24x7 PHC (FMO) Other PHCs 236 189 1 3

Total 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

944 730

2. CURRENT STATUS:

FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos) Facility

MOs trained in RTI/ STI mgmt.

A Staff nurses trained in RTI/ STI mgmt.

A LTs trained in RTI/ STI diagnos is MOs trained in MTP LTs trained in blood storage MOs trained in F IMNC I SNs trained in F IMNC I A A A A A Doctors trained in NSV Doctors trained in Lap Ligatio n A A Staff nurses trained in SBA ANMs / LHVs trained in SBA A A 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 50 298 458

2. CURRENT STATUS: NSSK TRAININGs

State Level

TOT - to be conduct

District Level

No. of NSSK Trainers Total Training load Training completed (2009-10) Training completed 2010-11( April – June)

Medical Officers

800 Training will be completed by September

Staff Nurses

800

Total Total

1600

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

SN Institute/ Category Institutiona l Deliveries 2007-08 Institutiona l Deliveries 2008-09 Difference In No. of Deliveries Institution al Deliveries 2009-10 Difference In No. of Deliveries

1 DH 19991 22209 2218 26274 4065 2 SDH 12922 14151 1229 16923 2772 3 CHCs a) CHCs (PHSC) 8434 13964 5530 22097 8133 4 5 6 7 a) CHCs (DHS) 24x7 PHCs RURAL HOSPITAL SATELLITE HOSPITAL OTHER GOVT. INSTITUTIONS

Total

281 1049 179 309 1320

44485

874 6859 431 553 7492

66533

593 5810 252 244 6172

22048

1595 13872 832 775 5586

87954

721 7013 401 222 -1906

21421

INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2010-11

SN Institute/ Category

1 DH 2 SDH 3 CHCs a) CHCs (PHSC)

Institutional Deliveries Institutional Deliveries (2009-10 upto (2010-11 upto June 09)

5023

June 2010)

5649

Difference in No: of Deliveries

626 3339 3568 229 4359 5432 1073

%age Increase in 10-11 12.46

6.86

24.62

b) CHCs (DHS) 4 PHCs a) 24X7 PHCs 5 Others

STATE TOTAL

280 2672 2623 1395

17068

408 4016 4083 1195

20268

128 1344 1460 -200

3200 45.71

50.30

55.66

-14.34

18.75

C-SECTION IN GOVT. INSTITUTIONS: 2010-11

Type of Health Institutions

District Hospital Below DH level

No. of public institutions conducting C sections No. of C- sections conducted

21 out of 21 DHs

2009-10

8818 110 (35 SDHs +75 CHCs) 4049+3060 =7109

2010-11 (April to June )

1855 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 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 6010 5157 3342 2762 April 6542 5689 3838 3043 May June 8781 8252 8334 7717 7457 6222 5458 4465 6067 4164 4395 6159 4641 6101 4364 7938 6055 3974 3301 July 8132 6781 3864 7696 6586 3640 6834 5848 3227 August September October November December January February 7462 5830 3110 March

DELIVERIES IN CHCs AS FRUs (2007-08, 2008-09, 2009-10 & 2010-11)

2500 2249 2000 1674 1500 1361 1926 1469 1669 2007-08 1973 1115 1000 669 500 529 799 623 861 603 746 2078 808 2008-09 2215 1224 1285 825 2177 1343 756 2009-10 2035 1345 772 2175 1415 737 2010-11 2067 1522 755 1843 693 2040 1433 1454 690 0 April May June July August September October November December January February March

DELIVERIES IN 24x7 PHCs (2007-08, 2008-09, 2009-10 & 2010-11)

1800 1600 1400 1200 1000 800 600 400 200 0 1252 738 452 74 1304 826 444 77 1527 895 445 77 2007-08 1017 408 86 1151 521 91 2008-09 1237 477 88 1274 527 84 2009-10 1241 610 77 632 99 2010-11 1391 1332 1285 1382 730 95 726 105 813 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 Institutional Delivery ` 500 ` 600/ 700 for Urban and Rural women

TOP

JANANI SURAKSHA YOJANA

Yearly Progress JSY : Year

2005-06 2006-07 2007-08 2008-09

Number of Beneficiaries For Home/ Non Institutional Delivery No.s

7489

% of total beneficiarie s

65%

For Institutional Delivery No.s

4106

% of total beneficiarie s

35% 9466 16453 40350 59% 56% 59% 6613 12823 27561 41% 44% 41% 2009-10 2010-11 54132 9041 56% 48% 42589 9790 44% 52%

Total 11595 16079 29256 67911 96721 18831 %age Achiev ement (ELA 90000) (Rs. In Lakhs)

13% 18% 33% 75% 107% 21% 71 88.7

171 384 565 136

JSY BENEFICIARIES OVER THE YEARS

120000 Institutional Deliveries Home Deliveries 100000 80000 60000 40000 20000 0 4106 7489 2005-06 6613 9466 2006-07 Years 2007-08 2008-09 2009-10

JANANI SURAKSHA YOJANA

1 2

SN No. of JSY beneficiaries

Home Deliveries b c a Institutional Deliveries Rural Urban C- section (exclusive from above two) Sub-Total Institutional Deliveries

TOTAL 2009-10

54132

2010- 11 (April – June)

9041 32376 10213 42589

96721

7610 2180 9790

18831

FAMILY PLANNING

2 3 4 5 6 1

S. No.

1.a

No. of female sterilisations (total) Out of which, no. of minilap sterilisations No. of male sterilisations (total) No. of IUD insertions No. of IUD removals No. of sterilisation deaths No. of sterilisation failures

Status 2009-10

65577 35365 11127 272659 43844 0 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 especially those related to adolescent girls issues, •High prevalence of Anaemia especially among adolescent girls

3. KEY ISSUES:

VHNDs

• VHND in the state will be observed in the form of MAMTA Divas Wednesday.

• 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 & 2 nd ANM in the Sub-centres with population more than 6000.

• All Sub-Centres of high focused districts will be provided 2 nd 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 Patiala Hospital, Mata Kaushalya, 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.

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:

Medical Officers (Specialists) – 76 Medical Officers – 312

On Contract

Gynaecologists – 36 Paediatricians - 28 Medical Officers (NRHM)-102 Staff Nurse-1260 ANM - 954

4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs

Recruitment in Process Regular-

Medical Officers (Specialists) – 128 Interview starting in 8/8/2010 Medical Officers – 214 Medical Officer (Dental) – 34+48 Written Test of MOs on 8/8/2010 followed by interview

On Contract

Medical Officers (NRHM) – 100 Staff Nurse – 548 ANMs – 97

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 2 nd 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

Key Aspects

Whether a govt order issued for field supervision (e.g. officials identified for supervision, number of visits, etc): 2 Check-list prepared for field supervision: 3 Whether a format for visit report available: 4 System for action on key issues raised in field visit reports:

Status

Yes Yes Yes Yes 5 Provide details on frequency of visits by officials from each level and also the lowest level up to which they go for 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

Key Aspects

Organogram including reporting structure available: YES/NO

Status

Yes 2 HRD manual in place: YES/NO Yes, Provisionally approved service rules for contractual employees Yes 3 4 Job description available for all the supervisory staff (both contractual and regular): YES/NO Performance Appraisal system in place: YES/NO 5 Dedicated HR experts available: YES/NO Yes Yes

5. CURRENT STATUS SUPPORTIVE SUPERVISION: HR AVAILABILITY

Sn.

Key functions for supportive supervision State District/Divi sion (no.s) No. Avail .

No. Req.

No. Avail.

No. Req.

Block (no.s) No. Avail.

No. Req.

1 2 3 Assured Service Delivery: Operationalisation of facilities (such as FRUs, 24x7 PHCs, SHCs), referral services VHND) HR / Training (MH/CH/Imm./FP) Quality of Service Delivery (PHN/Nurse-Midwives etc. for MH/CH/Imm./FP) 4 Data Analysis / Monitoring 6 5 6 5 20 40 20 40 NA 117 NA 117

7. CURRENT STATUS: MATERNAL DEATH REVIEW (MDR)

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 Will be convened in August 2010 4 Issue of guidelines to districts and facilities 5 Constitution of MDR committees/ task force at state, district and facility level 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 e conferencing 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 7 th 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 2 nd 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.