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

NATIONAL RURAL HEALTH MISSION FOR HON’BLE HEALTH MINISTER 13 TH DECEMBER 2008. PRESENTATION. NATIONAL RURAL HEALTH MISSION (2005-2012). NRHM launched by Hon’ble Prime Minister on 12/4/2005. As of now to conclude in 2012.

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

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

  2. 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.

  3. 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.

  4. 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.

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

  6. 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.

  7. 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 Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; 30-40 Villages 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

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

  9. 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 MoU with GoI. • State Level Planning and Monitoring Committee headed by Hon’ble Health Minister

  10. 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.

  11. ..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.

  12. HEALTH INDICATORS

  13. TARGETS FOR PUNJAB UNDER NRHM

  14. HEALTH INSTITUTIONS

  15. HEALTH INSTITUTIONS

  16. NRHM BUDGET OVER THE YEARS

  17. PROGRAMME IMPLEMENTATION PLAN • NRHM is a centrally sponsored scheme. For Year 2005-06 and 2006-07, GoI contribution was 100%, & from Year 2007-08, GoI 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, GoI and then approved by it. • After approval of SPIP the funds are released by GoI and the Sate Govt. • Minor changes in PIP can be made and major changes are allowed only with the approval of GoI.

  18. FINANCIAL REPORT FOR THE YEAR 2005-09 Rs. in lakhs

  19. FINANCIAL STATUS UPTO OCTOBER 2008 (DISTRICT LEVEL) Rs. in lakhs

  20. STATE OBLIGATIONS UNDER NRHM State signed MoU with Govt. of India in December 2005 for implementation of NRHM

  21. …contd. STATE OBLIGATIONS UNDER NRHM

  22. WORK DONE - FUNDS

  23. WORK DONE– MCH – 24x7 PHCs 75 PHCs upgraded to 24x7 PHCs in 2007-08 and 26 PHCs in 2008-09 for 24 hrs. delivery. 24x7 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

  24. WORK DONE – MCH - FRUs 50 CHCs in 2007-08 and 10 in 2008-09 upgraded to FirstReferral 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.

  25. WORK DONE – 24 x7 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.

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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. 2nd 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/-.

  31. 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.

  32. RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT

  33. …contd…

  34. …contd…

  35. RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS

  36. RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS

  37. RECRUITMENT - FRUs

  38. RECRUITMENT - PHCs 24x7

  39. RECRUITMENT - Mobile Medical Unit (MMU)

  40. RECRUITMENT – MO (Mini PHC) & ANM for Urban Slum Area & Sub-Centres

  41. WORK DONE - SCHOOL HEALTH 32,64,926 of students are in Primary and Secondary level Special Campaigns under School Health Programme held 13th August (held in slum areas of key districts) 12356 person examined 14th August (held in CHCs and SDHs) 110888 school children examined 2nd October (held in CHCs, SDHs, & DHs) Eye checkup camps under which free spectacles distributed to school children Requirement of Drugs :- IFA Tablets- Pediatric with2 0 mg elementary iron 7 Crore Tabs Adult with60 mg elementary iron 60mg 3 Crore Tabs Deworming Tablets 32.64 lakh Tabs Procured and distributed

  42. 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.

  43. 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

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

  45. STATE PROGRAMME IMPLEMENTATION PLAN 2008-09

  46. PIP 2008-2009

  47. PIP 2008-2009 • GoI contribution Rs. 180 Cr., GoP contribution Rs. 30 Cr. • Previous funds available – GoI- Rs. 31.41 Cr.; GoP – Rs. 7.05 Cr. = TOTAL – Rs. 38.43Cr. • TOTAL FUNDS AVAILABLE FOR 2008-09 Rs. 210 Cr. + Rs. 38 Cr.= Rs. 248 Cr.

  48. PART A- RCH FLEXI POOL Rs. In lakhs

  49. ..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.

  50. PART B- NRHM ADDITIONALITIES Rs. In lakhs

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