PRESENTATION NATIONAL RURAL HEALTH MISSION FOR HON BLE

PRESENTATION NATIONAL RURAL HEALTH MISSION FOR HON’BLE HEALTH MINISTER 13 TH DECEMBER 2008

NATIONAL RURAL HEALTH MISSION (2005 -2012) • NRHM launched by Hon’ble Prime Minister on 12/4/2005. As of now to conclude in 2012. • Aimed to ensure affordable, quality health care to the poorest house holds in remotest areas. • Special focus on 18 low performing States which have weak public health indicators and weak infrastructure. • Punjab is among the nine high performing States- Punjab, Haryana, Gujarat, Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, West Bengal. 2

HISTORICAL PROSPECTIVE • RCH-II (2005 -2010) aimed at reducing IMR and MMR was already in progress. • Programme for control of various diseases were already in progress for the last more than 15 -20 years. • Government felt the need to integrate all ongoing health programme into one programme and consolidate the work being done by other departments. • NRHM encompasses – – RCH – II including immunization – All individual disease control programme – Flexi-pool as per requirement of the State – Convergence with other departments like AYUSH, Water Supply and Sanitation, Nutrition, Woman and Child Development, Rural Development and Panchayats • NRHM can be summarized as : Reducing IMR and MMR through institutional deliveries, involvement of Panchayati Raj institutions and convergence with other departments.

NRHM OBJECTIVES • Universalized access to quality health care especially to rural poor with focus on women and children. • Reduced Infant Mortality Rate and Maternal Mortality Rate. • Ensuring population stabilization & gender equity. • Prevention and control of communicable and non-communicable diseases. • Access to integrated comprehensive primary health care. • Mainstream AYUSH- Integration of AYUSH with mainstream health institutions. • Promotion of Healthy life style. • Emphasis on potable drinking water, hygiene, sanitation and nutrition. 4

KEY COMPONENTS OF NRHM System strengthening Community Partnership Infrastructure development Village level planning Monitoring through computerisation ASHA Improved financial management & Human Resource Village Health & Nutrition Days Public Private Partnership Improved services Village Health & Sanitation Committees Telemedicine Mobile Medical Units Intra & inter sectoral convergence Increased involvement of PRIs 24 -Hour- delivery services Emergency Obstetric Services Specialist Services – On call/contract Immunization strengthening IMNCI Adolescent health Family welfare services Accessibility, Approachability and Quality

NRHM STRATEGIES • Decentralization of the process of health planning and management from Village to District level. • Involvement of PRIs and Village Health & Sanitation Committees. • Up-gradation of existing health institutions from Sub Centres to District Hospitals as per Indian Public Health Standards (IPHS). • Flexible financing- untied funds for filling up the gaps in infrastructure and other related activities. • Manpower requirement- recruitment of doctors, and paramedical staff in relation to Woman & Child Health. • Improved management through capacity building- provision of computers, computer operators, establishment of State, District and Block Programme Management Units (PMUs). • Integration of AYUSH with the mainstream health institutions including recruitment of Ayurvedic/Homeopathy doctors at PHC and CHC level. • Intersectoral Convergence with Nutrition, water and sanitation programmes. • Promotion of Public Private Partnership for achieving public health goals.

NRHM – ILLUSTRATIVE STRUCTURE Health Manager BLOCK LEVEL HEALTH OFFICE –-------- Accountant Store Keeper Accredit private providers for public health goals 100, 000 Population 100 Villages BLOCK LEVEL HOSPITAL Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; 30 -40 Villages Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4 -5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests 5 -6 Villages GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5 -6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic VILLAGE LEVEL – ASHA, AWW, VH & SC ASHAs, AWWs in every village; Village Health & Nutrition Day Drug Kit, Referral chains

NRHM FIVE COMPONENTS (PART- A) (PART- C) (PART- B) RCH AND RELATED ACTIVITIES (RCH FLEXI POOL) INITIATIVES UNDER NRHM OTHER THAN RCH (MISSION FLEXI POOL) (PART- D) NATIONAL DISEASE CONTROL PROGRAMMES IMMUNIZATION STRENGTHENING PROGRAMME (PART- E) INTER SECTORAL CONVERGENCE SCHEMES

INSTITUTIONAL ARRANGEMETS UNDER NRHM STATE LEVEL • State Health Mission chaired by Hon’ble Chief Minister. • State Health Society chaired by Chief Secretary. • Merger of all vertical societies into State Health Society. • Signing of Mo. U with Go. I. • State Level Planning and Monitoring Committee headed by Hon’ble Health Minister

INSTITUTIONAL ARRANGEMETS UNDER NRHM DISTRICT LEVEL • District Health Mission chaired by Chairman Zila Parishad. • District Health Society chaired by Deputy Commissioner. • District Planning and Monitoring Committee headed by Zila Parishad Chairman. • Rogi Kalyan Samities in District/Sub Divisional Hospitals. • Merger of all vertical societies into District Health Society.

. . contd. . INSTITUTIONAL ARRANGEMETS UNDER NRHM BLOCK LEVEL • Block Planning and Monitoring Committees at Block PHC. • PHC Planning and Monitoring Committees at PHC level. • Rogi Kalyan Samities for CHCs VILLAGE LEVEL • Village Health & Sanitation Committees in each village. • Accredited Social Health Activist (ASHA) for every 1000 population.

HEALTH INDICATORS India Punjab 23. 1 17. 6 14. 7 Manipur Kerala 7. 4 7. 0 4. 4 4. 8 Manipur Delhi 62. 15 68. 25 73. 5 Kerala 933 876 1001 1058 Pondicherry Kerala 55 43 12 13 Manipur Kerala TFR (SRS 2005) 2. 9 2. 1 1. 7 Kerala Maternal Mortality Ratio (SRS 2005) 301 178 110 Kerala 50. 7 72. 5 96. 5 T. Nadu Institution Delivery (%) (NFHS III) 41 53 100 Kerala Contraceptive Use (%) 56 63. 3 73 HP 44 60 81 T. Nadu Birth Rate (SRS 2007) Death Rate (SRS 2007) Life Expectancy at birth Sex Ratio (Census 2001) IMR (SRS 2007) Ante Natal Care (at least 3 checkup) (%) (NFHS III) Vaccine coverage (%) (NFHS III) Best State

TARGETS FOR PUNJAB UNDER NRHM At the start of RCH SRS 1998 -1999 Present Status 2007 -2008 Target by 2009 -2010 Total Fertility Rate 2. 5 2. 1 1. 8 Infant Mortality Rate 49 44 <30 199 178 <100 Institutional Deliveries 37. 5% (NFHS II) 52. 5 80% ANC Check-up with 03 contacts 58. 4% (NFHS II) 72. 5 100% Indicators (per 1000 live births) Maternal Mortality Ratio (per 100000 live births)

HEALTH INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR MEDICAL COLLEGES 3 5 DISTRICT HOPITALS 20 SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78) 38 COMMUNITY HEALTH CENTRES 127 INSTITUTIONS BLOCK PHCs (112 PHSC, 15 DHS) 118 BLOCK PHCs AND SDH 6 BLOCK PHCs AND CHCs 70 ONLY (EXCLUSIVE) BLOCK PHCs 42 983

HEALTH INSTITUTIONS PUBLIC SECTOR PHCs (MINI PHCs) – EXCLUSIVE 352 PHCs BLOCK – EXCLUSIVE PRIVATE SECTOR 42 TOTAL PHCs – EXCLUSIVE + AT CHC/SDH 394 + 76 = 470 SUBSIDIARY HEALTH CENTERS 1187 SUB-CENTRES AT VILLAGE LEVEL 2858 CLINICS /DISPENSARIES 3046

NRHM BUDGET OVER THE YEARS

PROGRAMME IMPLEMENTATION PLAN • • • NRHM is a centrally sponsored scheme. For Year 2005 -06 and 200607, Go. I contribution was 100%, & from Year 2007 -08, Go. I contribution is 85% and state contribution is 15%. Every year State Health allocation to increase at least 10% of the previous year. State Govt. is required to prepare a Programme Implementation Plan (SPIP). It is discussed with Ministry of Health, Go. I and then approved by it. After approval of SPIP the funds are released by Go. I and the Sate Govt. Minor changes in PIP can be made and major changes are allowed only with the approval of Go. I.

FINANCIAL REPORT FOR THE YEAR 2005 -09 Approved Plan Rs. in lakhs Releases Expendit % of Unspent Funds Total ure Utilizati Balance released Funds Incurred on by GOI by State Available GOI State Share 15% from 200708 Total 2 3 4 5 6 7 8 (2+6+7) 9 10 11 (8 -9) 283. 20 9820. 78 Not Required 9820. 78 8103. 25 0. 00 8386. 45 5971. 37 61% 2415. 08 2006 -07 2415. 08 16271. 85 Not Required 16271. 85 14194. 06 0. 00 16609. 14 8326. 24 46% 8282. 90 2007 -08 8282. 90 16196. 72 2841. 00 19037. 72 11516. 27 705. 00 20504. 17 16657. 93 84% 3846. 24 2008 -09 (Up to Oct 3846. 24 19923. 00 08) 3000. 00 22923. 00 9138. 75 79% 2005. 91 Year Op Balance 1 2005 -06 5292. 51 0. 00 7132. 84

FINANCIAL STATUS UPTO OCTOBER 2008 (DISTRICT LEVEL) Rs. in lakhs SN Component Releases Expenditure 1 1968. 24 1133. 70 2 NRHM Additionalities 1790. 21 1183. 95 3 Immunization & PP 164. 05 91. 63 4 NDCP 366. 61 5 Inter Sectoral Convergence 0. 00 6 RCH II CSS Family Welfare Head 2211 2540. 13 TOTAL 6829. 20 5316. 02

STATE OBLIGATIONS UNDER NRHM State signed Mo. U with Govt. of India in December 2005 for implementation of NRHM SN INITIATIVES DISTRICT BLOCK LEVEL / LEVEL VILLAGE LEVEL On 26 th On 17 th August Not applicable October 2005 constituted. Block Health Committees notified on 11/12/2007 Incorporated on th from 26 Village Health 26 th February August 2005 to Sanitation 2007 January 2006 Committees constituted on 21/10/2007. STATE LEVEL REMARKS 1 Setting up of the Health Missions 2 Incorporation of Health Societies 3 Integration of all vertical programmes of Health & Family Welfare Department. Already Integrated Completed 4 Merger of different societies with State Health Society. Done on 21/12/2007 Being Done Not required Yet to be completed Already notified and are operational At Block Level Community Health Centres already notified and are operational. Completed upto CHC but yet to be done in 484 PHCs 5 Constitution of Rogi Kalyan Samities in all Health Institutions upto PHCs Not required Completed

…contd. STATE OBLIGATIONS UNDER NRHM SN INITIATIVES 6 Recruitment of staff for Programme Management Units. 7 State and District Health Plans STATE LEVEL Recruitment completed 2007 -08: PIP submitted on 10 th July 07 PIP approved on 25/9/07 Outlay-Rs. 16196 lacs 2008 -09: PIP submitted on 27 th Feb 08 Approval of PIP received Outlay- Rs. 22923 lacs DISTRICT LEVEL BLOCK LEVEL / VILLAGE LEVEL REMARKS Recruitment completed Recruitment under process at block level. Being discussed separately Facility Survey completed. Integrated District Health Action Plan ready for 20 districts. Facility survey upto Sub centre level completed. District Action Plans completed in all 20 districts The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed. .

WORK DONE - FUNDS Component Mobile Phones for ANMs 2858 SCs Funds Released Rs. 25, 000 484 PHCs Funds Released Nil 128 CHCs Funds Released Rs. 20 Lacs 20 DHs Nil Funds Released Rs. 20 Lacs 116 CHCs Nil Funds Released Rs. 50, 000 484 PHCs 100 PHCs Funds Released Rs. 1 Lac Nil 112 CHCs Funds Released 20 DHs Nil One Time Grant 1 Lac 36 SDHs Nil One Time Grant 1 Lac Rogi Kalyan Samitis Remarks Rs. 5 Lac Annual Maintenance Grant 2008 -09 Rs. 50, 000 IPHS 2007 -08 Rs. 10, 000 Untied Funds Amount/Scope 110 CHCs Nil One Time Grant 134 Lacs 4000 In Process Application Solution for on line data transfer from ANMs to State

WORK DONE– MCH – 24 x 7 PHCs • 75 PHCs upgraded to 24 x 7 PHCs in 2007 -08 and 26 PHCs in 2008 -09 for 24 hrs. delivery. • 24 x 7 PHC – 1 MO (F) and 3 Staff Nurses on contract basis. • Out of 101 MO(F), 60 posts filled up leaving 41 posts vacant. • 34 Staff Nurses yet to be appointed. • Posts advertised. Last date 20/12/2008 • Generator set provided at 75 and for remaining 26 in process. • Labour room etc. constructed

WORK DONE – MCH - FRUs • 50 CHCs in 2007 -08 and 10 in 2008 -09 upgraded to First. Referral Units (FRUs). Facility for a complicated delivery including blood transfusion. • 1 Gynaecologist, 1 Paediatrics and 5 Staff Nurses to be appointed. • So far 21 Gynaecologist, 22 Paediatrics in position and advertisement for remaining 39 and 38 given. Last date 20/12/2008. • Advertisement for remaining Staff Nurses 13 given. • Through rationalization of posting of Gynaecologist, 21 regular Gynaecologists posted in the FRUs i. e. 42 FRUs are having Gynaecologist and only 18 are without Gynaecologist.

WORK DONE – 24 x 7 PHCs and FRUs • Signages for these 101 and 60 institutions being developed. Tender floated • On line monitoring of performance of these institutions through PEC, work given. • Biometric based on-line attendance system. Tender already received.

WORK DONE - MMUs • 20 MMUs deployed in districts. 4 districts – Amritsar, Jalandhar, Ludhiana and Mohali not provided with MMUs. 4 districts Faridkot, Bathinda, Mansa and Barnala have one additional MMUs. • Cost of each MMU Rs. 36. 00 lacks. Full Bus chassis used for MMUs. Has the facility of ECG, X-Ray and Lab. • 1 MO(F), 1 MO(M), 1 Radiographer, 1 Lab Technician, 1 Staff Nurse, 1 Pharmacist (Regular) and 1 Driver and 1 Helper provided. • 12 posts of MO(F) and 10 MO(M) vacant. Advertisement given. • Instruction issued for free treatment and medicine (Rs. 7500 per month) issued. • Tenders for GPS enabled tracking system invited and last date 15/12/2008. • Decision regarding MMUs for the remaining 4 districts yet to be taken.

WORK DONE - VHSCs • NRHM implementation planned within the frame work of PRIs at different levels. • Village Health & Sanitation Committees formed in coordination with PRIs at each village level. The committee consists of ideally 11 member under the chair of Sarpanch/Panchayat Member and ANM or AWW as Member Secretary with 50% representation of women and due representation from weaker sections. • 11418 VHSCs formed and remaining 1161 yet to be formed. • Committee provided with annual grant of Rs 10, 000/- to be used as untied grant to meet village level public health activities. Funds already released to VHSCs (Total – Rs. 11. 31 Cr. In 2007 -08) • Headed by Panch / Sarpanch.

WORK DONE - ASHA • • 15400 ASHAs selected in the State, 2356 yet to be selected ASHA - a female health activist in the community to create awareness on health and mobilize the community for utilization of the existing health services. One ASHA to cover 1000 population. ASHA to be a woman resident of the village-Married/Widow/Divorced preferably in the age group of 25 to 45 years with the formal education up to eighth class. Selection of ASHA to be made by the District Health Society under the supervision of Deputy Commissioner, and Civil Surgeon to be as District Nodal Officer. SMO at block level to be the Block Nodal Officer. Performance based incentive money of Rs. 3. 96 crore has already been released to District Health Societies for ASHAs for the year 2008 -09 & Rs. 1. 3 crore in 2007 -08.

WORK DONE - TRAINING OF ASHAs • • • Training of ASHAs in Module 1 is scheduled to be conducted during the current financial year. Training at the State Level for District Trainer completed in July 2008. Training at the District Level for Block Level Trainers completed in August 2008. Training at the Block Level for ASHAs to be taken up now. ASHA books have been translated and are under print. Training of ASHA for 6 districts being given to NGO. Matter under process Tenders for ASHA kit have been received and would be made available by 31/12/2008.

WORK DONE – RECRUITMENT • No recruitment done in 2005 -06, 2006 -07. • Fresh recruitment at the State Level made in November 2007 and State Programme Management Unit set up. • Fresh recruitment of doctors and nurses started in March 2008. • Great emphasis given on recruitment of Staff in the Hospitals and Sub-Centres. • 3 recruitment drives launched – July 2008, October 2008 and December 2008. Recruitment has been made a monthly features. • All vacant posts of ANMs for last 5 -6 years at Sub-Centres (514) filled up under 2211 scheme. 2 nd ANM provided at 954 bigger Sub. Centers. • For Gynaecologist and MO(F), advertisement given for increased pay packages. Basic pay increased from 15, 000/- and 20, 000/- to 20, 000/- and 25, 000/-.

WORK DONE – RECRUITMENT • Letter written to Civil Surgeons on 8/12/2008 for identifying remote/extremely remote areas. We will give the regular and contractual lady doctor special incentive during 2009 -10. • Recruitment at 4 levels – • State Programme Management Unit • District Programme Management Unit • Block Programme Management Unit • Doctors, Nurses, ANMs etc. in the Health Institutions • 1 Medical Officer appointed in PHCs in the Malwa Districts of the State where there was no doctors. Against 95 posts, 59 posts filled up. Remaining posts advertised. We should try to provide at least one doctor in each PHC in the PIP 2009 -10.

RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Director Finance 1 1 0 On Deputation 2 State Programme Manager 1 1 0 From State Govt. 3 Maternal Health Specialist 1 0 1 4 Family Welfare Specialist 1 1 0 5 Procurement Manager 1 0 1 40, 000 Rs 30, 000/- from Dec Services have been terminated 40, 000 Rs 30, 000/- from Dec 25, 000 6 Manager (HRD) 1 0 1 20, 000 7 Manager (F&A) 1 1 0 25, 000 8 Manager (M&E) 1 1 0 20, 000 9 State NGO Coordinator 1 1 0 30, 000 10 Programme Coordinator (ARSH & Gender) 1 1 0 20, 000 Advertisement for recruitment issued on 1/12/2008 Officer Resigned Advertisement for recruitment issued on 1/12/2008

…contd… SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM 11 Programme Coordinator (BCC) 1 1 0 20, 000 12 Consultant (Admn) 1 0 1 20, 000 13 Consultant (M&E) 1 1 0 20, 000 14 System Analyst 1 0 1 15, 000 15 Accounts Officer 2 2 0 15, 000 16 Statistical Assistant 4 4 0 10, 000 17 Hardware Supervisor 1 1 0 10, 000 19 Accountant-cum-Cashier 2 2 0 10, 000 Remarks Candidate resigned Officer Resigned Advertisement for recruitment issued on 1/12/2008

…contd… SN Name of the Post Sanctioned Filled Post Vacant Consolidated Salary PM Remarks Selection has been done for the vacant position candidate is yet to join 20 Computer Assistant 4 4 0 8, 000 21 Office Assistant 9 9 0 7, 000 23 Graphic Designer 1 1 0 10, 000 24 Procurement Assistant 2 1 1 8, 000 Candidates have been adjusted at State HQ from the districts 25 Drivers 2 0 2 5, 000 Action is being initiated 26 Class-IV 3 2 1 3, 000 44 35 9 Total Action is being initiated

RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 District Programme Manager 20 18 2 20, 000 Selection has been Done. 2 District Accounts Officer 20 17 3 15, 000 Advertisement for recruitment issued on 1/12/2008 3 District Monitoring & Evaluation Officer 20 20 0 15, 000 4 Procurement Officer 20 4 16 15, 000 5 Maintenance Engineer 20 17 3 12, 000 6 Statistical Assistant 20 18 2 8, 000 Advertisement for recruitment issued on 1/12/2008 7 Procurement Assistant 20 0 20 8, 000 No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification 8 Accountant-cum-Cashier 20 17 3 8, 000 Advertisement for recruitment issued on 1/12/2008 9 BCC Facilitator 20 20 0 8, 000 Total 180

RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS SN Name of the Post 1 Block Statistical Assistant 2 Block Accountant cum Cashier 3. Sanctioned Filled Post 118 98 93 Vacant 20 25 Computer Operator 173 155 18 Total 409 346 63 Consolidated Salary PM Remarks 8, 000 Advertisement for recruitment issued on 1/12/2008 5, 000 Advertisement for recruitment issued on 1/12/2008

RECRUITMENT - FRUs SN 1 2 3 4 5 Name of the Post Obstetricians Paediatricians Anaesthesia Staff Nurses OT Assistant Sanctioned Post 60 60 60 300 60 Filled 21+21 22+3 Vacant Consolidated Salary PM 39 Rs. 25000/- + Rs. 3000/- HRA+ Rs. 1000/ Em. OC + Rs. 500/- per delivery conducted + Rs. 200/ MTP 35 Rs. 25000/- + Rs. 200/- per Emergency Case during off duty hours + Rs. 3000/- HRA Remarks 28 Recruited, 7 resigned. Advertisement issued for 39 posts on 1/12/2008 31 Recruited, 9 resigned. Advertisement issued for 35 posts on 1/12/2008 60 Rs. 1500/- on call per case + TA Rs. 6/KM upto 50 KM Empanelment for CHCs at District level 287 13 Rs. 8500/- + Rs. 1500/- (if accommodation is not provided) Advertisement for recruitment issued on 1/12/2008 50 Rs. 4000/- + 300/- evey Major OT Case + Rs. 1500/- HRA Not required to recruit 10

RECRUITMENT - PHCs 24 x 7 SN 1 2 Name of the Post Female Medical Officer Staff Nurses Sanctioned Post 101 303 Filled 50 269 Vacant Consolidated Salary PM Remarks 51* Rs. 20000 PM + Rs. 500 per Delivery+ Rs. 200/ MTP + Rs. 3000/- HRA 34* Rs. 5000/- + Rs. 500/- per delivery conducted + Rs. 100/- per delivery *Advertisement for recruitment assisted and Rs. issued on 1/12/2008 1500/- HRA (if accommodation is not provided) *Advertisement for recruitment issued on 1/12/2008

RECRUITMENT - Mobile Medical Unit (MMU) SN Name of the Post Sanctioned Filled Post 20 10 Vacant 10 Consolidated Salary PM Remarks 22, 000 20 recruited 10 resigned/ not joined Advertisement issued for 10 posts on 1/12/2008 1 Medical Officer (Male) 2 Medical Officer (Female) 20 8 12 22, 000 20 recruited 12 resigned/ not joined Advertisement issued for 12 posts on 1/12/2008 3 Nurses 20 17 3 8, 000 Advertisement for recruitment issued on 1/12/2008 4 Radiographer 20 12 8 8, 000 Advertisement for recruitment issued on 1/12/2008 5 Lab Technician 20 17 3 8, 000 Advertisement for recruitment issued on 1/12/2008 6 Driver 20 20 0 7, 000 *Placement agency hired 7 Helper 20 20 0 4, 000 *Placement agency hired

RECRUITMENT – MO (Mini PHC) & ANM for Urban Slum Area & Sub-Centres SN Name of the Post Sanctione d Post Filled Vacant Consolidated Salary PM 1 Medical Officer for Mini PHC 95 61 34 20, 000 1 MPHW (Female) for urban slums 230 *0 ANM for vacant subcentres (2211) 514 Advertisement issued for the recruitment on 1/12/2008 6, 000 2 Remarks 6, 000 1265 3 2 nd ANM for 954 subcentres 954 203 6, 000 Mainly reserved posts Advertisement for recruitment issued on 1/12/2008

WORK DONE - SCHOOL HEALTH • 32, 64, 926 of students are in Primary and Secondary level School No. of Students Primary 6, 29, 510 13, 39, 257 Middle-Secondary 10, 39, 509 8, 86, 160 19, 25, 679 Total • 7, 09, 747 17, 49, 256 15, 670 32, 64, 926 Special Campaigns under School Health Programme held – 13 th August (held in slum areas of key districts) – 14 th August (held in CHCs and SDHs) – 2 nd October (held in CHCs, SDHs, & DHs) • Requirement of Drugs : – IFA Tablets- Pediatric with 2 0 mg elementary iron Adult with 60 mg elementary iron 60 mg – Deworming Tablets Procured and distributed 12356 person examined 110888 school children examined Eye checkup camps under which free spectacles distributed to school children 7 Crore Tabs 32. 64 lakh Tabs

WORK DONE - SCHOOL HEALTH Free Treatment of School Students for CHD & RHD • Decision taken on 4/11/2008 for free treatment of students (upto +2 level) studying in Govt. & Govt. aided schools suffering from Congenital Heart Disease (CHD) and Rheumatic Heart Disease (RHD) in PGI Chandigarh. So far 16 students referred to PGI and Rs. 10. 00 lacks deposited. • Directions given to heads of PHCs, CHCs and dispensaries to diagnose school students suffering from RHD and CHD and refer to PGI. • Work of examination of School Children – not so systematic. Students cards are under print and would be supplied to the Schools. • Civil Surgeons have been directed to fix the target and show achievement alongwith certificates from the School Headmaster that the health team has visited the school and examined the children.

WORK DONE - COMMUNITY MONITORING & PLANNING COMMITTEES • To involve the community in the decision making and monitoring of initiatives and ongoing health programmes, Health Monitoring & Planning Committees are being constituted at Village, PHC, Block, District and State level with the following objectives – provide systematic info about community needs – provide feedback according to • locally developed yardsticks • key indicators. – increase involvement and participation of community – Validate sector wide data from other sources – Triangulation

WORK DONE – SEX RATIO • Survey for sex ratio commissioned in September 2008. Report likely to be received by 28/2/2009.

STATE PROGRAMME IMPLEMENTATION PLAN 2008 -09

PIP 2008 -2009 COMPONENTS DESCRIPTION OUTLAY (Rs. In crores) PART A RCH 56. 95 PART B NRHM ADDITIONALITIES 80. 80 PART C IMMUNIZATION & PPI 12. 34 PART D NATIONAL DISEASE ONTROL PROGRAMME 14. 73 PART E INTERSECTORAL CONVERGENCE 5. 33 TOTAL NRHM 170. 15 CENTRALLY SPONSORED SCHEMES (Already under Implementation but now merged with NRHM) 59. 34 GRAND TOTAL 229. 49

PIP 2008 -2009 • Go. I contribution Rs. 180 Cr. , Go. P contribution Rs. 30 Cr. • Previous funds available – Go. I- Rs. 31. 41 Cr. ; Go. P – Rs. 7. 05 Cr. = TOTAL – Rs. 38. 43 Cr. • TOTAL FUNDS AVAILABLE FOR 2008 -09 Rs. 210 Cr. + Rs. 38 Cr. = Rs. 248 Cr.

PART A- RCH FLEXI POOL SN Sub Components Rs. In lakhs Allocation Releases/ Expenditure 2008 -09 2 3 4 5 6 7 Maternal Health Janani Suraksha Yojna ASHA Child Health & IMNCI Family Planning ARSH Urban RCH PNDT Sex Ratio Innovations / PPP/NGO 235. 00 186. 00 334. 50 86. 15 920. 60 27. 07 135. 60 64. 84 442. 50 52. 50 171. 50 440. 00. 67 937. 71 10. 02 32. 90 21. 57 0 Infrastructure & Human Development 1 1558. 50 221. 87 323. 34 95. 35 461. 88 276. 70 9 Logistic Management Quality Assurance and Infection Control Programme HMIS Monitoring and Evaluation Training 10 Behaviour Change Communications 291. 76 40. 75 11 Procurement Programme management Units SPMU and DPMUs Flexi pool Total A (RCH II) 122. 50 125. 91 347. 26 264. 35 157. 50 5695. 00 11. 70 2703. 50 8 13 12

. . contd. . PART A • Digitization of Civil Registration Systems (CRS). RFP under preparation. Under e-Governance Project of the State on pilot basis CRS is being implemented in district Kapurthala & Nawanshahar. Work has been allotted to WIPRO. Work allotment for digitization of CRS for whole Punjab is under process. • Sex Ratio Survey. The work has been allotted to AMS, Luckhnow. First inception report of the survey submitted. • City Specific GIS mapping for Urban Health Mission for three cities i. e. Amritsar, Jalandhar and Ludhiana which was assigned to Punjab Engineering College, Chandigarh has been completed • To ensure dissemination of information relating to NRHM to field level functionaries and to ensure immediate reporting, steps have been taken to finalize website of the NRHM. The work will be completed by the end of this month.

PART B- NRHM ADDITIONALITIES Allocation SN B a b c d e f g h I j k l m n o p q r s Sub Components NRHM Additionalties Village Health & Sanitation Committees Rs. In lakhs Releases/ Expenditure 2008 -09 1230. 00 286. 20 285. 80 CHC Untied Fund & Maintenance Annual Maintenance Grant 121. 00 64. 00 162. 00 121. 00 64. 00 655. 80 Mobile Medical/ Health Units 397. 40 111. 20 Upgradation of CHC 1091. 80 0. 00 Upgradation of PHC 821. 43 0. 00 Upgradation of SC 725. 38 0. 00 Upgradation of SHC 600. 00 Upgradation on SDH/ FRUs Upgradation of DH School Health 100. 00 370. 00 500. 00 100. 00 12. 45 Strengthening of Programme Management 476. 56 0. 00 Strenthning of Logistics Management 50. 00 Rogi Kalyan Samitiis 12. 33 0. 00 937. 50 134. 00 8079. 60 0. 00 1350. 30 ASHA - proposed under RCH II SC Untied Fund & Maintenance PHC Untied Fund & Maintenance Emergency Response Services Mobile Phones for ANMs Total B 0. 00

. . contd. . PART B Extension of New Institutions • • 40 New Sub Centre's is to be constructed at a cost of Rs. 2. 5 crore. One new CHC to be constructed at Zirakpur at a cost of Rs. 2. 5 crore Up-gradation of Institutions 77 Sub Centres to be renovated at a cost of Rs. 1. 00 Lakh each 10 PHCs to be repaired / renovated at cost of rs. 60. 00 Lakh. PHC at Adampur and Rural Hospital Morinda to be completely renovated. Following Sub Divisional Hospitals to be upgraded with an outlay of Rs. 6. 00 Crore – Batala (50 to 80 beds). . . Rs. 1. 5 crore – Patti (50 to 80 beds). . . Rs. 1. 5 crore – Nabha (100 to 130 beds) ……… Rs. 1. 5 crore – Pathankot (100 to 130 beds) …… Rs. 1. 5 crore

. . contd. . PART B • Following District Hospitals to be upgraded – Mohali (70 to 120 beds) … – Mata Kaushalya Hospital Patiala … (154 to 250 beds) – Gurdaspur (100 to 150 beds) … – Ludhiana (addition of 30 beds burnh Unit)… – Bathinda (Renovation). . . Rs. 3. 00 Crore Rs. 2. 50 Crore Rs. 1. 00 Crore Rs. 0. 50 Crore • Equipment and furniture worth Rs. 6. 50 Crore to be provided in CHCs as per IPHS Norms • Equipment and furniture worth Rs. 1. 83 Crore to be provided in the PHCs as per IPHS norms • Drugs and consumables as per following details to be given: - CHCs … Rs. 3. 60 Crore - PHCs … Rs. 4. 84 Crore - SHCs … Rs. 6. 00 Crore

PART C- IMMUNIZATION Rs. In lakhs Allocation SN Sub Components a Alternative vaccine Delivery b Mobilization of Children by AWW/TBA/ASHA Strengthening of Monitoring and Supervision Computer Assistant to DIO, Provision for Additional Support, Slums and underserved area Total C c d Releases/ Expenditure 2008 -09 103. 34 68. 59 9. 18 79. 58 260. 69 91. 63

PART D- NATIONAL DISEASE CONTROL PROGRAMME Rs. In lakhs Allocation SN Sub Components Releases/ Expenditure 2008 -09 a RNTCP 522. 16 201. 52 b Leprosy 0. 76 26. 35 c IDSP 79. 91 43. 86 d 20 0. 00 e National Iodine Deficiency Disorder Control Programme. - NIDDCP Malaria & Vector Borne 212. 36 19. 88 f Blindness Control 637. 5 75. 00 Total D 1472. 69 366. 61

PART E- INTERSECTORAL CONVERGENCE Rs. In lakhs Allocation SN Sub Components a Convergence with AYUSH b Co ordination & Orientation with PRIs c Special innovation for Minorities Total E Part II • • • CSS Family Welfare Head 2211 Releases/ Expenditure 2008 -09 424. 80 0. 00 75. 15 0. 00 33. 45 0. 00 533. 40 0. 00 5934. 00 2540. 13 Appointment of one Ayurveda MO & one Homeopathy MO in 121 PHCs & 112 CHCs respectively. 99 Ayurveda MOs already recruited. 22 MOs of reserved categories (9 SC, 1 FF, 2 Sports, 3 Handicapped, 6 Exn, 1 General) Written test & Counseling for appointment of 112 Homeopathy MOs done. Appointment letters being issued

DRINKING WATER SUPPLY There are numerous schemes for providing clean drinking water in rural and urban areas : • Under JNNURM, UIDSSMT and BSUP high priority has been given to providing drinking water supply. The total allocation for current year is Rs. 350 crore. • Under Municipal Development Fund a sum of Rs. 1 crore is to be spent in various towns. • For Rural Areas, there are various schemes – Accelerated Rural Water Supply Scheme (Rs. 110 crore), NABARD (Rs. 70 crore), World Bank (Rs. 132 crore), Rajiv Gandhi National Drinking Water Mission (Rs. 10 crore), RO Process (Rs. 25 crore) for clean drinking water. • Under SSA, funds can be provided for drinking water in elementary schools in the State.

SANITATION • Sewerage works will be executed in urban areas under JNNURM and JBIC Projects. • For Rural Areas there is a State Government schemes for providing individual toilets (Rs. 5 crore). • Under Total Sanitation Programme of Go. I we have Rs. 77 crore project for providing toilets in schools, Aanganwadi Centers, Community toilets and individual toilets. • Under World Bank Project, there is a provision for laying underground sewer in 1000 villages and cleaning of village ponds. • For cleaning of village ponds we have a State Scheme (Rs. 5 crore). NREGA funds can also be used for this purpose in all the districts without any limit.

SCHOOLS – WATER & TOILETS • Schools not having Water & Toilet facilities have been identified by a survey. • 480 Schools are without drinking water facilities Water & Sanitation Department would provide these facilities from their regular schemes like ARWSP. • 4447 schools are without Toilet facilities Water & Sanitation Department has been asked to prepare estimates. • Funds to the extent Rs. 40000. 00 per school will be provided from Total Sanitation Campaign (TSC) & above Rs. 40000. 00 from 12 th Finance Commission of Rural Development Department.

NUTRITION • Under ICDS Programme (50: 50) the State Government will be spending Rs. 55 crore in 2008 -09. • Under Kishori Shakti Yojana (Nutrition for adolescent girls) will spent Rs. 2. 50 crore through Woman and Child Development. • Under these 2 programmes a total of 13. 52 lakh children and mothers were provided nutrition.

VILLAGE HEALTH COMMITTES • The Village Health & Sanitation Committees has been constituted in all the villages. These committees are headed by Sarpanch/ Panches. • The new Panches and Sarpanches have been inducted in the already constituted VHSCs and the Health Department would thereafter coordinate these 3 programmes – Water Supply, Sanitation and Nutrition at block level. • The Agriculture Department would also be involved.

COORDINATION WITH OTHER DEPARTMENTS • We are holding regular meetings with WSS, Rural Development, Woman and Child Development Departments. • We are going to constitute Coordination Committees with these departments for greater synergy.

OTHER INITIATIVES

NATIONAL URBAN HEALTH MISSION • Go. I proposes to launch NUHM from 2008 -09 to 2011 -12 (4 years). Current year allocation is likely to be Rs. 1012 crore and Punjab would get about Rs. 25 crore. • The target population would be urban poor living in slum areas, homeless poor and construction workers. • 3 towns - Amritsar, Jalandhar and Ludhiana will be taken up from 2008 -09 and the remaining 10 towns – Patiala, Abohar, Batala, Bathinda, Moga, Malerkotla, Khanna, Pathankot, Hoshiarpur and Mohali from 2009 -10. • The programmes aims at upgradation of Primary Urban Health Centers in terms of infrastructure and man power. Urban Social Health Activist (USHA) will be provided for every 1000 population. • Private hospitals would be empanelled in case there are no government institutions in the slum areas. • There would be a separate Health Insurance Scheme for Urban Slum Poor's and they would be free to seek treatment from Government and Private referral hospitals. • State has already initiated the process for GIS mapping of the urban slums (notified & non notified) and health facilities (Private & public) in three cities, work has been allotted to Punjab Engineering College Chandigarh. The work will be completed in the first week of September 08.

EMERGENCY RESPONSE SERVICE IN THE STATE • 240 Ambulances equipped with medical facilities and medical technicians to be deployed. • 60 ambulances will have advance life saving equipment (cardiac care, highway trauma care, Em. OC) • 180 ambulances will have basic life saving equipment (Em. OC, highway trauma etc. ). • Patient to be shifted to nearest centre through the ambulance positioned with trained medical technician and expert driver. • Capital cost of the ambulances will be Rs. 29 crore and for establishing IT infrastructure and Emergency Response Centre the capital cost will be Rs. 12 crore. Total initial cost will be Rs. 41 crore. Recurring cost will be Rs. 25 cr. per annum • Emergency Call Centre with a common three digit toll free number. • Tenders have been received and work is being allotted.

OTHER INITIATIVES • Web Site of Punjab NRHM – www. pbnrhm. org prepared and hosted • Service particulars of MOs – Service particulars with complete details including postings computerized and placed on the website for final checkup by Civil Surgeons. It would be easy to determine the status of postings, transfers and vacancies in the health institutions. Would be ready by 25/12/2008. • Administrative Maps – Maps being developed with the help of Punjab Remote Sensing Agency at Ludhiana. All details received except from District Gurdaspur, Jalandhar and Mohali. These maps are necessary for depiction of information on GIS, Tracking of MMUs and EMRI Ambulances. • Pregnancy Tracking – Pilot project being developed for Mohali and Ropar district for online registration of pregnancies. Tender for allotment of work being invited. • Mobiles phones for ANMs – Continuous contacts and information. • Special incentives for Remote and Extremely Remote Areas to MO(F) and Gynecologist.

MONITORING AND STATUS (31/10/2008) Institutional Deliveries • Annual pregnancies – 4, 80, 000 • Deliveries in health department institutions in 2007 -08 – 25269 • Total institutional deliveries – About 52% • Performance upto October 2008 (Health Department Institutions) – 2007 -08 2008 -09 25269 31357 Increase of 24. 10% • 4 Excel Sheets

INSTITUTIONAL DELIVERIES 60 Institutional births (%age) 52. 5 50 40 30 20 37. 5 24. 8 10 0 NFHS II 1992 -93 INSTITUTIONAL DELIVERIES 1997 -98 NFHS III 2005 -06 Year 2007 -08 & 2008 -09 (Up to October 08)

Trend of Institutional Deliveries – Month wise (Health Department Institutions) 24% 6000 5390 5373 5248 4923 5000 3959 4396 4000 3459 4171 3995 4132 2998 3000 2915 3131 2628 2000 1000 0 April May June 2007 -08 July 2008 -09 August September October

n Ta r n ra Ta r ur ng r Sa 599 865 1102 944 1068 934 1420 1791 2269 2262 2144 2569 3295 3500 op a 470 652 600 755 1755 2109 2185 3641 2008 -09 R la tia r ar ts al i ha ha Pa . S N M uk oh M a M og 344 1206 1009 1163 1549 2000 sa an a 1636 1438 1302 1239 2007 -08 M an Lu dh i a ar th al pu r Ka 510 2051 2500 la nd h ur rp hi a ur r 298 1582 1459 1324 1029 1164 1999 4000 Ja H os sp da ur G oz ep u 500 Fe r ko t da ga rh eh Fa t rid Fa in th a al 895 1500 Ba rn r 1000 Ba sa rit Am District wise Institutional Deliveries 2007 -08 & 2008 -09 (till Oct 08) 3000 0

Institutional Deliveries- District Hospitals 2007 -08 & 2008 -09 (till Oct 08)

Institutional Deliveries- Sub Divisional Hospitals 2007 -08 & 2008 -09 (till Oct 08)

Institutional Deliveries- FRUs 2007 -08 & 2008 -09 (till Oct 08)

Institutional Deliveries- 24 x 7 PHCs 2007 -08 & 2008 -09 (till Oct 08)

Institutional Deliveries- CHCs other than FRUs 2007 -08 & 2008 -09 (till Oct 08)

JANANI SURAKSHA YOJNA Cash assistance scheme for BPL and SCs/STs mothers (age 19 and above upto 2 living children) on birth in Public or Private accredited health units. Rural area Rs. 700/ Urban area Rs. 600/ Non Institutional delivery Rs. 500/Rs. 1500/- to be provided for hiring the services of specialists to carry out the caesarean in a Govt. Institution • 2007 -08 – 29256 beneficiaries covered against the target of 90, 000 per annum. • 2008 -09 – Till October 19, 949 beneficiaries covered constituting 22. 17% of the annual target. It should have been 60% at the end of October

JSY Performance District wise Beneficiaries covered (till Oct 08) 100% 90% Percentages 80% 70% 60% 50% 40% 30% 20% 10% 0% Moga, 78. 86 Nawanshaher, 72. 16 Mansa, 59. 18 Ferozpur, 55. 51 Bathinda, 53. 26 Ropar, 53. 22 Sangrur, 51. 37 F. G. Sahib, 46. 37 Kapurthala, 45. 08 Barnala, 44. 84 Mohali, 44. 16 Muktsar, 42. 61 Hoshiarpur, Amritsar, 37. 46 Ludhiana, 32. 12 Faridkot, 30. 96 Tarn Taran, 30. 29 Jalandhar, 25. 49 Patiala, Gurdaspur, 24. 09 16. 34 11. 11 % Beneficiaries covered Moga, 44. 84 Nawanshaher, 26. 88 Mansa, 17. 97 Ferozpur, 34. 62 Bathinda, 25. 13 Ropar, 23. 78 Sangrur, F. G. Sahib, 12. 35 14. 74 Kapurthala, 33. 78 Barnala, Mohali, 8. 93 25. 58 Muktsar, Hoshiarpur, 19. 84 13. 03 Amritsar, Ludhiana, 24. 55 Faridkot, 7. 53 24. 98 Tarn Taran, Patiala, Jalandhar, 15. 82 Gurdaspur, 6. 80 13. 10 2. 12 % Institutional Deliveries

UTILIZATION OF FUNDS • As per GOI condition funds upto 2006 -07 to be utilized and UC sent for further release of GOI funds during 2008 -09. • Similarly funds upto 2007 -08 to be utilized for release of funds during 2009 -10. • UCs to be sent for 2006 -07. • Utilization during 2008 -09 Rs. 68. 29 cr. was given to districts and various agencies.

District wise utilization of funds (till Oct 08)

Ranking of the districts To achieve more and to strengthen the NRHM programme the districts have been ranked on performance basis on different health parameters Ranking of the districts-

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