1 Presentation to National Program Coordination Committee On State PIP of Madhya Pradesh for 2011-12...

1

Presentation to National Program Coordination Committee

On State PIP of Madhya Pradesh for 2011-1218 March, 2011

MADHYA PRADESH - Demographic Profile

Area (in sq.kms.) 3,08,000Estimated Population (2011) 7,50,86,196Male 3,91,11,879Female 3,89,73,317Scheduled Tribes 1,52,19,769 (20.27%)Scheduled Castes 1,13,97,932 (15.18%)Development Blocks 313 (Tribal blocks - 89)Populated villages 52,117Gram Panchayats 23,040Literacy 64.1 percent Male 76.5 percent Female 50.6 percentDensity of Population 196 per sq. kms.Sex Ratio 920 : 1000Child Sex Ratio 919

2

Goals- 2012

Madhya Pradesh INDIA

Current status Target Current status Target

2012 2012

MMR 335(SRS 2006)

220 254 (SRS 2006)

<100

IMR 67(SRS 2009)

60 50(SRS 2009)

<30

TFR 3.3 (SRS 2008)

3.0 2.6(SRS 2008)

2.1

3

4

Financial Status : 2010-11

S. N0

Scheme/ Programme ROP2010-11

Fund Received from GoI and

State Government

Expenditure Up to Feb 2011

1 RCH Flexible Pool 392.04 220.34 325.51

2 NRHM Flexible Pool 321.20 259.86158.48

3 AYUSH

4 Routine Immunization 20.32 10.86 11.35

5 Pulse Polio 15.06 15.00 0.95

6 National Programs 41.59 26.38 25.44

7 Treasury Transfer (Family Welfare Establishment) 220.27 220.27 218.57

8 Total 1010.48 - 740.30

(73.26%)

9 State Share 127.08

10 Unspent balance under NRHM as on 01.04.2010 148.58

Total 1010.48 1028.37 740.30

Rs. In crores

Overall expenditure expected by March 2011 - 95%

Year PIP (RCH/NRHM/Immu.)

GOI Release State Share

2007-08 552.50 472.79 -

2008-09 554.31 478.94 90.00

2009-10 659.20 361.10 113.00

2010-11 733.56 491.06 127.08

Total 2499.57 1803.89 330.08

• State has contributed Rs. 330.08 Cr. as against the requirement of Rs. 318.33 Cr.

State Share

5

6

Comparative Budget Provision : 2010-11 & 2011-12

S. N0

Scheme/ Programme Approved Budget2010-11

Amount Proposed 2011-12

1 RCH Flexible Pool 392.04 392.03

2 NRHM Flexible Pool 321.20 303.09

3 AYUSH 18.23

4 Routine Immunization 20.32 21.52

Sub Total 733.56 734.87

5 Pulse Polio 15.06 17.28

6 National Disease Control Programs 41.59 104.34

7 Treasury Transfer (Family Planning Establishment) 220.27 260.00

Total 1010.48 1116.49

Rs. In crores

BUDGET OVERVIEW: RCH flexi pool

Sr. No. BUDGET HEAD 2010-11

BUDGET

2010-11EXPENDITURE

Up to Feb 2011

2011-12BUDGET

% CHANGE OVER 2010-11

1. MATERNAL HEALTH 2263.84 1262.93 2275.09 0.50

2. CHILD HEALTH 1763.38 2008.79 1812.30 2.77

3. FAMILY PLANNING 196.99 193.26 874.50 343.93

4. ARSH 114.76 56.62 107.83 -6.04

5. URBAN RCH 153.32 55.64 236.00 53.93

6. TRIBAL RCH 24.00 11.85 0.00 -100.00

7. VULNERABLE GROUPS 200.07 0.22 100.00 -50.02

8. Gender/PC&PNDT/Studies 128.24 106.75 260.51 103.14

9. Human Resource 3738.13 2299.46 2581.90 -30.93

(Rs. Lakhs)


BUDGET2010-11

EXPENDITURE2011-12BUDGET


10. INSTITUTIONAL STRENGTHENING 620.76 358.38 558.83 -9.98

11. TRAINING 1362.77 987.40 1238.85 -9.09

12. IEC/ BCC 919.52 682.20 972.50 5.76

13. FINANCIAL MANAGEMENT - - 42.00 100.0

14. PROGRAMME MANAGEMENT 1907.98 1251.88 2146.26 12.49

15. JSY 20077.58 18241.51 18808.48 -6.32

16. STERILISATION, IUD COMPENSATIONS & NSV CAMPS 5730.00 5033.99 7187.50 34.22

TOTAL RCH FLEXI POOL 39204.05 32550.87 39202.54 0.00

BUDGET OVERVIEW: RCH flexi pool


BUDGET2010-11


% CHANGE OVER 2010-

111. ASHA 3464.06 1248.43 4460.70 28.77

2. VILLAGE HEALTH & SANITATION COMMITTEE (VHSC)

5539.30 1939.02 4996.58 -9.80

3. STRENGTHENING OF SHCs 4158.32 2143.19 4105.20 -1.28

4. STRENGTHENING OF PHCs 1979.75 637.68 1580.50 -20.17

5. STRENGTHENING OF CHCs 1351.00 415.52 1164.50 -13.80

6. ROGI KALYAN SAMITI 1519.00 584.09 1684.00 10.86

7. PREPARATION OF DISTRICT PLAN 50.00 13.60 48.74 -2.52

8. STRENGTHENING OF ANM, MPW, LHV TRAINING CENTRES

288.00 168.10 201.50 -30.03

9. SWABLAMBAN YOJANA 504.80 343.30 648.50 28.47

10. STRENGTHENING OF IN-SERVICE TRAINING FACILITIES

430.00 39.24 205.00 -52.33

11. HEALTH MELA 218.40 96.37 249.00 14.01

BUDGET OVERVIEW: NRHM flexi pool


BUDGET2010-11


% CHANGE OVER 2010-

11

12. MOBILITY SUPPORT FOR SPECIALISTS, MEDICAL, PARA-MEDICAL & PROGRAMME STAFF

871.20 530.09 871.20 0.00

13. LOGISTICS 500.00 9.61 300.00 -40.00

14. PROCUREMENT 1117.56 1901.21 2073.11 85.50

15. QUALITY ASSURANCE 207.00 13.94 330.75 59.78

16. DIFFICULT AREA PERFORMANCE BASED ALLOWANCE

1000.00 - 200.00 (Rs. 300 lakhs under MCH Sub-plan)

-80.00

17. UP-GRADATION OF HEALTH FACILITIES AS PER IPHS

3774.47 1561.53 2082.00 -44.84

18. MOBILE MEDICAL UNIT 1006.00 1490.50 895.02 -11.03



BUDGET2010-11

EXPENDITURE

2011-12BUDGET

% CHANGE OVER 2010-

11

19. EMERGENCY MANAGEMENT SERVICES SYSTEM

1118.50 1411.46 1485.00 32.77

20. COMMUNITY MONITORING 20.00 0.67 95.14 375.70

21. IMPROVING ACCESS TO MDR-TB SERVICES UNDER RNTCP

- - 101.92 -

22. OPERATING COST FOR RCH/NRHM INTERVENTIONS

- - 715.40 -

23. DISTRICT SPECIFIC INTERVENTIONS

350.00 93.89 100.00 -71.43

24. NRHM MANAGEMENT COST @ 6% OF SANCTIONED ACTIVITIES

1212.02 616.31 1715.63 41.55

TOTAL NRHM FLEXI POOL 30719.38 15257.83 30309.38 -1.33


S. NO. STATE HIGH FOCUS DISTRICTS

% OF TOTAL

1. NO. OF DISTRICTS 50 34 68

2. POPULATION (in lakhs) 750.86 485.13 64.6

3. PROPOSED RCH II BUDGET FOR 2011-12 (Rs. Lakhs)

39204.05 26914.82 68.6

4. PROPOSED NRHM BUDGET FOR 2011-12 (Rs. Lakhs)

30309.38 19223.98 63.4

DIFFERENTIAL FINANCING FOR HIGH FOCUS DISTRICTS

S. No.

INDICATOR EXPECTED Planned REPORTEDUp to Feb

2011

% ACHIEV.

1 Institutional delivery 2066120 1549590 1194183 77.06

2 Full immunisation 1928314 1542652 1378073 89.33

3 Sterilisation 700000 550000 599461(upto 17.03.2011)

109.00

4 IUD insertion 620300 516917 325250 62.92

SERVICES OVERVIEW

Maternal Health

14

Impact of Interventions in reduction of MMR

408

301254

498

379335

0

100

200

300

400

500

600

1998 2003 2006 2012

MM

R

Years

India MP

220

100

Average 23.8 points decline per annum

Average 8.8 points decline per annum

Required average 19.2 points decline per annum

15

• Service Delivery • Percentage of ANC registration in First Trimester – 33.8% (DLHS III), 41.43% (JSY 2008) • Percentage of PW with 3 ANC - 34.3% (DLHS), 60% (CES 2009)• Institutional Delivery – 47.1% (DLHS III), 80.28% (JSY 2008) , 81% (CES 2009)

• Quality • Percentage of Birth Assisted by SBA – 52.8% (DLHS III), 82.9% (CES 2009)• Percentage of C-section – 3% (JSY 2008) 4.1% (HMIS) • Percentage of Still Birth – 18 per thousand total birth (HMIS)

• Output• Percentage of 24x7 operationalized – 86%• Percentage of CEmONC operationalized – 65%

Maternal Health - Challenges

16

Estimated P

W

PW re

gd. for A

NC

Estimated Deliv

eries

reported Deliv

eries

0.0010.0020.00

20.83 18.18 18.9314.26

MP- Performance against estimated targetsApril-Feb.'11

78.27% 75.33%

75.33%

Reporting of deliveries – Bottlenecks and steps initiated

1. Implementation of pregnancy tracking mechanism2. Reporting of Home deliveries by ASHA 3. Co-relating JSY beneficiaries with institutional and home deliveries.

1. SBA training of ANMs for ensuring safe delivery at home 2. Strengthening referral transport facilities for institution deliveries

Status of Deliveries

Deliveries at Pub.Inst.;

1083802; 57%

Deliveries at Pvt.Inst.; 110381; 6%

unreported deliveries;

467418; 25%

SBA; 72552; 4%Non SBA; 159790; 8%

MP-Deliveries performanceApril-Feb. '11

Facility Cumulativetarget (2012)

Cum. Progress

Till Mar. 2011

IncrementalTarget

(10-11)

Progress 10-11

till Mar’11

Incr. Target(11-12)

FRU – DH 50 45 6 1 5

FRU – SDH - CH 35 20 10 3 8

FRU – CHC 35 19 6 1 3

24x7 FACILITIES 500 430 82 12 70

Sub-centres conducting deliveries, with adequate infrastructure, incl. LR

300 189 250 189 111

Sub-district facilities providing safe abortion services

389 169 50 25 220

Sub-district facilities providing RTI/ STI services

389 244 145 46 145

MATERNAL HEALTH

• Shortage of Specialist and Staff Nurses in proportion to case load and bed strength of hospitals.

• Inadequate residential accommodation for service providers.

• Maternity wing ill-equipped to provide quality services. • Poor utilization of Blood Storage facilities.• Scarcity of HIV testing kit at field level. • All service providers at sub district level not trained for

provision of RTI/STI services. • Skill based trainings not taken on priority.• Post training follow up needs strengthening.

Bottlenecks in operationalizing EmONC Services

Category Sanctioned Available Gap (%)Medical Officer

3790 3583 5

Specialists 3057 1177 61Staff Nurse 7309 3603 51LHV 1973 1680 15ANM 10492 12183 Surplus 16%

Lab Technician 1415 1058 25

Radiographer 667 427 36

Steps initiated for strengthening EmONC service


• HR issue addressed by planning increase salary package for staff Nurses and Specialist.

• Performance based management system will be introduced.

• Hiring of Private Sector specialists.• 72 MOs are trained in EmOC and 40 in LSAS.• No. of ANM and GNM Schools are being Increased


• 690 Compulsory Rural Posting of Graduates and PG Doctors under Bond being intensively pursued

• 442 Doctors appointed under RCH with provision of 2-4 LMO and 6-8 SNs in maternity wing of DH.

• 571 Doctors Recruited through PSC. Posting being done in accordance with facility specific vacancy information

• 1810 ANMs Recruited under RCH and 1100 ANMs on Regular basis

• 347 Staff Nurses under RCH and 1026 on Regular Basis Recruited

• Model maternity wing proposed in all DH with support from 13th finance commission.

• Extension of maternity ward and upgradation of labour room and provision of residential quarters, proposed in MCH sub plan.

• Provision of construction of prefabricated Level 1 MCH centers SHC.

• Provision of solar volotike power backup system in 128 level 3 MCH centers.

Strengthening infrastructure

• GoMP extended its MoU with IPAS for another 4 years.

• Refresher TOTs Master trainers (76 Doctors and 39 nursing staff reoriented)

• 774 doctors and 650 nursing staff trained as certified providers.

25

INITIATIVES FOR STRENGTHENING OF CAC SERVICES

• Coordination with MPSACS for establishing and optimum utilization of BB and BSUs.

• Total Blood Bank – 127• Govt. Blood Bank – 47• GOI/PSU Blood Bank – 07• IRCS Blood Bank – 04• Private Blood Bank – 69

• Blood Storage Centers – 61

26

BLOOD SAFETY PROGRAM

• Total ICTC – 159• Medical Colleges – 11• District Hospitals – 50• CH/CHC – 79• Other Hospital – 03• PPP ICTC - 16

• FICTC (Level II & Level III ) – 195• Provision of HIV testing kits for FICTCs, consumables

and one time grant for FICTCs and support to quality assurance for 4 SRL made in PIP.

Expansion of quality PPTCT services

27

Maternal Death Review Implementation Process…….

• District MCH Officers designated as district nodal officer for maternal death review

• FBMDR committees constituted in all 50 DH and 5 MCs• State Level Orientation of Gynecologists and MCH

Officers completed.• Orientation of field staff at block level in process.• Total No. of maternal deaths reported – 639 • MDR conducted - 179

– FBMDR – 179– CBMDR – 163

28

Maternal Death Review – Causes of MD Year 2010-11

Eclampsia23%

PPH20%

Anemia 16%

Rapture Uterus12%

Sepsis 7%

Malaria 3%

APH3%

Hapatities 2%

Unsafe Abortion 2%

Pulmonary Embolism

2%Others

9%

CAUSES OF MATERNAL DEATHS APRIL – Jan 2011 (HMIS)

30

Abortion4%

Obstructed/pro-longed labour

8%

Severe hyper-tesnion/fits

12%

Bleeding21%

High fever6%

Other Causes (in-cluding causes not

known)48%

FREE & ASSURED REFERRAL TRANSPORT

Facility Status 2010-11(till Feb 2011)

Proposed2011-12

No. of high focus districts having referral transport / EMRI

34 (33 Janani Express and 1 EMRI)

-

Call centre at State/ district level 45 (44 at District level for Janani Express & 1 for

EMRI at State level)

-

No. of EMRI ambulances 87 in 6 dist. 13 in 3 districts planned

Total - 100

50 in 4 districts 40 small ambulances

in 6 districtsNo. of Ambulances in Govt. Institutions 531 108-type

from state budget

Whether ambulances fitted with GPS (Y/N) No Being PlannedTotal no. of patients using referral transport 430551 850000No. of pregnant women using referral transport 357154 650000No. of sick newborns using referral transport 8863 32500

FREE & ASSURED REFERRAL TRANSPORT

Janani Express Yojana and EMRI-108

• JEY linked with call center in 44 districts • Remaining 6 districts covered under EMS• Free Transport to All from home to facility and facility to higher facility in case of

referral• Drop back facility for pregnant women not being provided.• IEC activities being carried out • Budget provision for operationalizing call center @ Rs. 30000 PM and running cost of

JEY vehicles @ Rs. 18000-22000 PM under JSY fund.

32

FREE & ASSURED REFERRAL TRANSPORT – EMRI 108

• Operational with 87 ambulances in 6 districts, being expanded in 3 more adjoining districts with 13 ambulances.

• Provision of 40 small ambulances in 6 EMRI districts @ Rs. 7.00 lacs and operating cost @ Rs. 12.00 lacs per annum

• Strengthening of EMRI-108 Call center for JEY ambulances @ Rs.

10.00 lacs

Highlights :-

• 35%. Pregnancy related cases

• 549 Deliveries in Ambulance

• Average reach time 19 minutes

PROVISION OF FREE SERVICES FOR DELIVERY & NEWBORN CARE FOR ALL CASES

Facility Current Status(Y/ N)

Plan for 2011-12(Y/ N)

Provision of free drugs Yes Yes Provision of free blood during complications Yes YesProvision of free diet DH and CH 150 MCH-L3 centresProvision of free diagnostics Free for BPL,

Subsidised charges through RKS for APL

Free specialized diagnostics services

through PPP or through hospital strengthening in

MCH centres

• Free delivery services including C-Sections in all Government institutions for BPL

• Subsidized charges through RKS for admission, diagnostic services, surgery for APL.

• Rs. 30 for diet for Indoor patients from State Budget. • Provision of modular kitchen from NRHM budget made in PIP. • IEC activities through wall writing, posters, hoardings and local IEC being

done.

JANANI SURAKSHA YOJANA

Target‘10-11

Achv. ‘10-11 (till Jan 2011)

Proposed‘11-12

Budget ‘10-11

(Rs. lakh)

Exp. ‘10-11

(till Jan 2011)

Budget ‘11-12

(Rs. lakh)

Home Deliv. 40000 14226 80000 200.00 68.82 400.00

Inst. Deliv. – Rural

905328 809179 952000 15843.24 14475.94 13325.00

Inst. Deliv. – Urban

279616 152472 179827 5355.39 1883.90 1798.27

C-sections Included in HR

ASHA incentive

1184944 1052000 2699.00

Admin. Costs

- - - 678.95 359.59 583.21

Janani Suraksha Yojana

• Directives issued for verifications of 2% cases at divisional and 5% district level. • Total 46635 beneficiaries of JSY verified at various level and corrective

measures taken accordingly. • Payment to beneficiaries by bearer cheques.• Payment to ASHAs through e-transfer/ account payee cheques.• Grievance redressel mechanisms at State/Division and District level. • 31 private institutions accredited under Janani Sehyogi Yojana . • BPL beneficiaries are given free treatment but JSY benefit is not extended

under janani Sehyogi . • Payment to BPL home delivery beneficiaries through bearer cheque/Cash is a

matter of concern. • Proposal of Cash assistance under JSY to motivators and beneficiaries after 3

ANC check-up under consideration.

Child Health

Shift in IMR

8074 72

6460

5550

26

101 98 98

85 82

70 67

34

0

20

40

60

80

100

120

1990 1994 1998 2002 2005 2008 2009 2015

India Vs MP

Projected Path India Projected Path MP

Source : SRS Data

57

39

CHILD HEALTHFacility Cumulative

target (2012)Cum.

progress till Mar ‘11

Incremental Target (10-

11)

Progress 10-11 till Mar’11


12)

SNCU – DH 45 23 21 10 22

NBSU – SDH, CHC, etc.

70 24 50 24 46

NBCC – DH, SDH, CHC, PHC, etc.

965 620 200 120 345

NBCC – Sub-centre 623 - 50 - 55

NRC 277 234 47 32 28

13 SNCU 23 SNCU

12.6%

0

5000

10000

15000

20000

25000

2009-10 2010-11 Till Jan. 2011

16019

22274

20122751

Admission

Death

Status of Newborn treated in SNCU

12.3%

Total Admission Inborn Outborn

22274

13572

8702

Neonates Treated : Inborn v/s Outborn

39%61%

April 2010 - Jan. 2011

NBSU

At CEmONC CHC Beenagaj, District Guna

20 NBSU functional and 1100 Newborns Treated

NBCC

• New Born Care Corners planned at all delivery points (CEmONC & BEmONC)• 620 New Born Care Corners operational & 345 planned in 2011-12

New Born Care Corner, CHC Tendukheda, Dist. Damoh

989942

795805871

569

Medical Officer Health Supervisor

ICDS Supervisor

4709

24956

16199

4262

17803

4592

ANM & MPW AWW ASHA

TotalTrained

81% 92%

72%

88%

71%

28%

Status of IMNCI

• IMNCI programme in 18 district scale up planned in 7 high focus district • Training completed in 12 districts

Now ASHAs will be trained in module 6 & 7

IMNCI implementation status: (Till Jan. 2011)

0100002000030000400005000060000

0-2 month Assessed

0-2 month Referred

2 month-5 year Assessed

2 month-5 year Referred

47636

4934

54688

630710.35 % 11.53 %

Total IMNCI Implementation %age

District 18 18 100

Block 103 93 90

Sector 588 442 75

SHC 2903 2137 74

Village 18186 11119 61

IYCN Indicators

12.6%

82.3%

39.6%

51.5%

43.1%

Severe wasted (W/H <-3SD)

<3y with anaemia

6-9m receiving CF

0-5m EBF

Breastfed within 1 hr of birth

Source : DLHS -3

Source : NFHS-3

Existing Interventions under IYCN

Management of SAM children through NRC Strengthening IYCF practices

– Training of frontline workers (ANM/AWW) on IYCF practices

– Accreditation of DHs as Baby Friendly Hospitals Micronutrient supplementation to 9m-5y children

– Bal Suraksha Maah (BSM)• Vitamin A supplementation• Deworming

– IFA supplementation

47

Bal Shakti Yojna – The Flagship Programme

NRC Dist. Hoshangabad 48

Scaling up of NRCs

Technical & Gap filling support by UNICEF

2006 2007 2008 2009 Till Feb. 2011

8

47

100

202234

Counseling mothers for correct positioning and attachment to achieve successful lactation

Supplementary suckling technique (SST) for mothers with lactation failure (insufficient or no milk output)

Management of <6m SAM children in NRCs

Total NRCs NRCs practicing SST

234

93 (40%)

2006-07 2007-08 2008-09 2009-10 2010-11 (Till Feb. '11)

718211953

24614

34369

46836

SAM Children Managed in NRCs

Establishment of 28 additional NRCs planned with 21 in High Focus districts in 2011-12

Running Cost of NRC including

Follow UpHR Cost in NRC (Para-

medical Staff)

Establishment Cost of NRC

• Female Feeding Demonstrator, Cook & Caretaker

• Approx. Rs. 20,700/- for 10 bedded NRC & Rs. 30,000/- for 20 bedded NRC

Rs. 1,50,000/-• Wage loss compensation

to mother Rs. 100/day• Rs. 50/day spent on child’s

food as per protocols

Rs. 3000/- per SAM Child

Proposed Financial Guidelines Under Bal Shakti Yojna (2011-12)

NRHM fund

Mother-Baby Friendly Hospital Initiative

Lancet series on Child survival, India analysis, 2004: Early childhood nutrition is the single most important child survival intervention

Intervention Child survival rate (%)Breastfeeding 15.6Complementary feeding 5.0Newborn temperature management 2.4Clean delivery 4.8Zinc 4.1Vitamin A 3.4Measles vaccine 0.6

District level committees for M-BFHI formed IYCN Cell operational since 2009 in Rewa Division with UNICEF support 10 breastfeeding counsellors appointed in 10 districts with NIPI & UNICEF support >80% newborns initiated breastfeeding within 1 hr of birth in these districts

HBNC

• ASHAs will be trained in module 6 & 7 across the state for provision of

home based newborn care

• 19 Master trainers trained at Gardhchiroli

• 419 district level trainers trained

• 162 training sites identified

• Incentives to ASHA for provision of HBNC planned under ASHA

programme

Bottle Necks

SNCU & NBSU

• Lack of suitable space within DH/ SDH/ CHC adjoining LR/MW

• Slow progress of civil works• Crunch of Staff Nurses and Paediatricians for SNCU &

NBSU placement• High drop-out rates of trained manpower• Procuremental delays

Bottle Necks

NRC• Delay in civil works• Poor identification, mobilization and referral of SUW

to NRCs by AWW• Necessitation of long stay in NRC causes de-motivation

in parents/ guardians • High drop-out rates of trained manpower• Poor quality of locally available milk and lack of

micronutrients causes less than expected weight gain in SAM children

• Absence of community & facility based linkages in management of SAM

Corrective measures

• Site selection for SNCU in existing DH

• Proposition of new buildings adjoining to MMW, where space is unavailable

• Pre- fabricated buildings under consideration for expediting civil works

• Out of state & private colleges staff nurses allowed

• Salary package of contractual personnels (SN/ PGMO/ FD) made more attractive

• De-centreralized procurement policy and enhancement of financial powers of CM&HOs

for addressing procurement delays

• Training & usage MUAC tool by AWW for early & correct identification of SAM

• Proposal of hike in wage loss compensation for mothers of SAM children

• Procurement procedures for therapeutic F-75 & F-100 initiated

• IMSAM programme to be piloted in 2 select districts for linking community & facility

m/m of SAM children

Child Health Plan 2011-12

Activity Child Health

(Rs, In lakhs)Nutrition

(Rs. In lakhs)Total

CH 99.00 1713.00 1812.00

HR 501.24 704.84 1206.08

Training 258.34 56.32 314.66

Procurement 133.50 200.00 333.50

Civil 100.00 382.00 482.00

Total CH 1092.08 3056.16 4148.24

Family Planning

S.N Indicators Madhya Pradesh India

1. Total Fertility Rate ( SRS 2008) 3.3 2.6

2 CPR (any modern method) 52.8% 48.5%

3. CPR (limiting methods)

Male Sterilization 1.3% 1%

Female Sterilization 44.3% 37.3%

4. CPR (spacing methods)

Oral Pills 1.7% 3.1%

IUDs 0.7% 1.8%

Condoms 4.9% 5.3%

5. Unmet need for spacing 5.5% 6.3%

6. Unmet need for terminal methods

6.3% 6.8%

Source – NFHS-III

Family Welfare

60

FAMILY PLANNING

Fixed Day Static FP Services

Cum. target (2012)

Cum. progress till Feb. 2011


11)

Progress 10-11

till Mar’11

Incr. Target(11-12)

DH & SDH providing Lap ster. services

106 82 25 30 24

DH & SDH providing Minilap ster. services

66 46 25 9 20

DH & SDH providing NSV services

80 60 25 6 20

CHC & PHC providing Minilap services

200 150 25 9 50

CHC & PHC providing NSV services

240 200 25 6 40

STERILISATION BY METHODAPRIL-MARCH

2005-2010

Sr.No. Year LTT TT NSVT Total

1 2005-06 272,268 64,037 30,625 366,930

2 2006-07 300,515 54,758 11,569 366,842

3 2007-08 367,843 59,537 30,816 458,196

4 2008-09 348,606 62,034 29,891 440,531

52009-10

332,281 54,100 18,607 404,988

6 2010-11 479,518 80,187 35,568 5,95,273

Family Planning Achievement

STERILISATION BY METHOD

APRIL-15 MARCH 2011

Sr.No. Year LTT TT NSVT Total

1 Gwalior 70,857 4,299 2,578 77,734

2 Ujjain 39,549 31,601 5,951 77,101

3 Bhopal 72,547 9,934 4,288 86,769

4 Rewa 55,276 1,695 8,587 65,558

5 Indore 85,881 21,513 2,794 110,188

6 Jabalpur 89,580 9,079 7,295 105,954

Sagar 59,487 1885 1776 63,148

TOTAL 473,177 80,006 33,269 586,452

Family Planning Achievement

FAMILY PLANNING

Key issues in operationalisation of FDS services and steps proposed: Irrational placement of trained providers. Reluctance of trained providers and lack of confidence.

Strategy: Strong political commitment and interdepartmental

coordination. Rational posting of trained providers. Re-orientation and training to regain confidence. Focus on minilap and NSV through training to MBBS doctors. No. of training sites for minilap and NSV increased.

FAMILY PLANNING

Post-partum FP services: Post-partum sterilisation (Feb 2011) – 27773 (5.8%), planned to

achieve 30% PP sterilization to take leverage of increasing ID.

Accredited private institutions/NGOs providing FP services - 84

Total sterilisations conducted - 9053 (1.9%) (Feb 2011)

Training to field workers, counsellors and ASHAs/AWWs on

counselling skills.

-

FAMILY PLANNING

IUD Services: 257 Master Trainers (MO, SNs, DPHNs, Sister Tutors, LHVs)

trained

438 (43.8%) MOs/SNs trained against the target of 1000

1722 (68.9%) ANMs trained against the target of 2500

Close monitoring & supportive supervision to facilitate

insertions

Compensation to acceptors for IUD acceptance proposed in

plan 2011-12.

-

ARSH & SCHOOL HEALTH (SHP)

Facility Target 10-11

Progress10-11

Target 11-12

AFHS clinic – DH 32 27 18

AFHS clinic – SDH, etc. - - -

AFHS clinic – CHC 54 40 -

AFHS clinic – PHC - - -

Districts covered under SHP 50 50 50

Schools covered 106315 102850 110495

Students covered 9750000 3726967 10407306

Students given IFA/ de-worming tablets

9750000 2720650 10407306

ARSH & SCHOOL HEALTH (SHP)

• Lack of separate space in hospitals for ensuring privacy for providing ARSH services

• Regular orientation needed for district level officers regarding ARSH program

• Distribution of IFA & de-worming tablets through school teachers, consumption is difficult to monitor

• Additional Rs. 10 cr. would be required to cover all children Under mid-day meal scheme

Activity Budget in lac

Formation of ARSH Club and Orientation and incentive to members

43.50

Adolescent clinic in 18 districts hospital 9.00Awareness creation of adolescents by NGO in 2 identified districts

25.00

Promotion of Menstrual hygiene in Adol. girls of 1 identified district ( for Production centres)

9.00

Telecast of weekly Phone-in Programme on All India Radio for orientation of youth on ARSH issues and addressing their queries across the state

21.33

107.83

ARSH 2011-12

69

URBAN RCH Health

• GIS mapping of health facility in public and private along with AWCs in 8 identified districts.

• Fixed day health activities in urban slums in 14 identified cities with referral mechanism for seriously ill patients and for NCDs.

• Capacity building of link worker (USHA & CBOs)

Activity Budget in lacGIS Mapping of health facilities in identified 8 cities and situation analysis

9.00

Capacity Building of USHAs and CBOs 37.50Organization of bi monthly health camp in urban slums and provision of vouchers

186.00

Exposure visits for observation on Best Practices 3.50Total 236.00

GENDER & SEX RATIO

• Nodal officer designated for gender equity at state and district level.

• PNDT cell functional at state and district level• Monitoring of Sex ratio at birth is being done. Sex

ratio at birth showing increasing trend (HMIS Data)• Focused IEC interventions being implemented to

"Save the girl child" - Bitiya Campaign launched at State and district level. Parents with one and only daughter club formed Awareness generation workshops held.

GENDER & SEX RATIO

Regular monitoring and review meetings held involving member of district level supervisory committee.

Meetings and consultations with various stake holders held and review of enforcement of PC&PNDT act at district level through Video Conferencing.

Regular meetings of supervisory and advisory boards at state and district level are ensured.

Regular inspections of USG centres as per provision in the Act.

Status of Implementation of PC&PNDT

No. Activities Achievements

1 No. of registered bodies 1424

2 No. of court cases 15

3 Inspection up to September 2010 549 institutions

4 Cancellation 26

5 Suspension 7

73

Activities & Budget for 2011-12

Activities Budget (Rs. in lacs)

State level workshop of Club of parents only daughter 5.00

Divisional level Workshop for media personnel and service providers

14.00

Hiring services(contractual staff) 6.30 PC & PNDT supervisory and advisory board meetings 4.96

Awareness generation on PC & PNDT Act among common people and inspection of USG centers.

160.25

Other Activities (Evaluation of JEY & Impact assessment of NRC)

70.00

Total 260.51

74

Facility based reporting in HMIS portal

• Online data entry for monthly report being done for all 313 Blocks & 50 Districts

• Facility master data base created in web portal for all the districts.

• Training workshop of District and Block Level Health officials regarding online uploading of facility based HMIS Data will be planned in April 2011

• Online facility based HMIS Data uploading in web Portal process will be piloted in 2 districts from April 2011

• Online facility based HMIS Data uploading in web Portal process will be started from All districts after the successful implementation of pilot in 2 districts.

• Printed formats made available at all levels.

Plan for roll-out of MCTS and uploading data

• Training of district and block level health

funtonaries/managers conducted.

• Master data base created for all the facilities.

• Data entry started from December 2010. so far more than

23000 records entered.

Capacity Building

• HMIS data for 2008-09 & 2009-10 have been validated

• Quaterly review meetings are held at State/Divisional level

to review the Physical & Financial progress using HMIS data.

• Regular release of monthly health bulletin on various key

process indicators is being done and also uploaded on

departmental website along with graphical analysis.

• Consultants visiting districts and blocks frequently to

ascertain consistency and quality of data.

• Training of DPMU/BPMUs staff will be planned in April-May

2011

Proposed Activities 2011-12• To strengthen Maternal Child Tracking System - post of MCTS

consultant• Laptops for all 313 BPMUs• For customization of MCTS and maintenance of website- post of

Programmer cum web manager

78

Budget Head Budget (Rs. in lakhs)

Strengthening of M & E/HMIS 136.59

Procurement of Hardware (Laptops & Desktops)and Software and other equipments

330.30

Workshops/Training on M & E/HMIS 86.94Printing of Formats 5.00

Total 558.83

Training

TRAININGS.

No.TRAINING 10-11

Target10-11

Achiev.11-12Target

1 SBA - SN 400 196 3362 SBA – ANM/ LHV 600 588 5363 BEmOC – MO 400 121 40

4 BEmONC Foundation 128 87 -

5 EmOC, incl. c-section – MO 32 13 32

6 LSAS – MO 16 17 167 MTP – MO 150 101 1608 RTI/ STI – MO 631 101 150

9 RTI/ STI – SN 90 83 7510 RTI/ STI – LT11 IMNCI – ANM/ Supervisor 3840 724 1536

12 IMNCI – AWW/ ASHA 4706

13 F-IMNCI – MO/MC Faculty/PGMO 730 202 52814 F-IMNCI – SN 360 81 19215 NSSK – MO 1193 980 213

NSSK – SN 1124 920 204

TRAININGS.

No.TRAINING 10-11

Target10-11

Achiev.11-12Target

16 NSSK – ANM/ LHV 2022 1800 222

17 Lap Ster. 50 31 50

18 Minilap Ster. 100 42 100

19 NSV 100 17 100

20 IUD – MO1000

205250

21 IUD – SN 233

22 IUD – ANM/ LHV 2500 1722 1500

23 ARSH – MO 400 97 200

24 ARSH – SN 400 263 200

25 ARSH – ANM

26 ARSH - Counsellor 44 44 -

27 ARSH – Prog. Mgr. 26 distt. 26 distt. 24 distt.

Training Budget -: 2011-12

Activities Budget (Rs. in lacs)

Maternal Health Training 461.14

Child Health Training 314.66

Family Planning Training 70.01ARSH 38.80

Public Health & Other Health Management Training including Financial Management

349.25

CME for doctors and Nurses 5.00

Total 1238.86

82

TRAINING

• 5 Government Medical College, SIHMC, 3 RHFWTCs and 47 district hospitals have been identified as training site for skilled based health trainings.

• Master trainers available in adequate numbers. • Shortage of faculty in training centres • To monitor quality of training and post training skills utilization

training coordinators have been positioned under MH, CH and FW program.

• 32 ANMTC, 3 RHFWTC, 1 SIHMC and 34 DTC will be strengthened and Rs. 4.06 Cr. have been proposed in PIP

TRAINING

• Quality assurance committee has also been assigned responsibility for monitoring of trainings

• Due to Shortage of manpower (Medical officers, Staff Nurse & ANM) in the district, nominated candidate are not relieved for the training for CMHO/BMO

• Post training placement of EmONC and LSAS trained doctors is being ensured.

• SIHMC and RHFWTC faculty also involved in follow up of training.

IEC/BCC

Main Activities Amount Proposed

Expected output

Implementation of specific interventions including innovations on BCC strategies/plans at district level

125.00

Change in health seeking behavior of people i.e. rise in demand for services.

Implementation of specific interventions including innovations on BCC strategies/plans at block level

469.50

Implementation of specific IEC activities at state level (Maternal health/JSY/Child health/FP/ARSH & others) including printing, hoardings, wall paintings, news paper advertisements etc.

300.00

Capacity building of state IEC bureau staff & distt./block/field level functionaries

35.00 IEC functionaries at state/ dist./block level become more capable.

Total 929.5

MCH CENTERSPLANNING & OPERATIONALIZATION

86

B TL

S VP

S NI

S DH

S AG

C DB L G

C TP

K R G

R S

N

MDL

S TN

VDS

DHRJ B A

PAN

S J P

K ND

DMH

S HE

S OP

UJ N

R J GS DL

DWS

J B P

HS B

GUNR WATK M

NS P

MDS

K TN

DDR

AK N

B HD

IDR

GL R

MR N

R TM

ANP

B R W

UMR

NMC

HR D

B HP

B PL

DTA

High focus Districts

Non High focus Dist.

DEW

*

*

** *

**

**

***

****

***

* Tribal Districts

Differential Planning – Focus on 34 High Focus Districts

87

Sr. No.

Type of Health Institution

Total Inst. Level III Level II Level I Total

1. Medical College 5 Govt.5 Pvt.

10 0 0 10

2. District Hospital 50 50 0 0 50

3. Civil Hospital 56 36 13 0 49

4. CHCs 333 64 243 0 307

5. PHCs 1156 0 558 0 558

6. SHCs 8659 0 0 623 623

7. PPP - 24 0 0 24

Total 10263 184 814 623 1621

Total MCH Centers

88

Sr. No. Type of Health Institution

Level III Level II Level I Total

1. Medical College 1 0 0 1

2. District Hospital 34 0 0 34

3. Civil Hospital 16 05 0 21

4. CHCs 48 179 0 227

5. PHCs 0 395 0 395

6. SHCs 0 0 455 455

7. PPP 15 0 0 15

Total 114 579 455 1148

MCH Centre in 34 High Focus Districts

89

• Construction of Model Maternity wings in DH: Budget support through 13th Finance Commission

• Upgradation of other Infrastructure under NRHM (MCH Sub Plan)

• Phasing of infrastructure upgradation for MCH centers in HFD Level-I (SHCs) – 2 years Level-II PHCs – 2 Years Level-II CHCs – 3 Years Level-III CHCs – 3 Years Level-III DHs – 3 Years

• Provision of essential equipments in MCH centers on need basis.

Infrastructure Upgradation: MCH Centers

90

Budget Provisions in MCH Sub Plan: Civil Work

MCH CenterFinancial Requirement

2011-12

Level – 1 (SHCs) 56.97

Level – 2 (PHCs) 79.00

Level – 2 (CHCs) 35.80

Level-3 (DH/CH/CHC) 34.00

Level-3 (Medical College) 3.84

Total Infrastructure 209. 61

91

In Crores.

MCH CenterFinancial

Requirement 2011-12

Level 1 MCH centers equipments 111 @1.37Lac per centre

1.52

Level 2 MCH centers equipments -288 @12.25 Lac per centre

35.28

Level 3 MCH centers equipments - 100 @24.22 Lac per centre (DH being equipped by 13th finance commission)

24.22

Total Equipment 61.02Difficult area allowance for staff posted in difficult Level - 3 MCH centers 3.00

Grand Total 273.64

Budget Summary Sub Plan MCH Year 2011-12

92

In Crores.

MISSION FLEXIPOOL

ASHA -Selection & Training Status

Activity

Physical

Target Achiev. %

Selection of ASHA 52117 50113 96.15

Training on Module 1 50113 49041 97.86




Training on Module 5 50113 10570 21.09Refresher training (Module 1-4) 50113 18992 37.90

Training of ASHA - Module 6 &7

• Training of state level trainers – 19• Identification of State training sites - 5

Training started at 4 places• No. of State level ToT batches planned - 16• No. of State level ToT batches completed - 16• Identification of District training sites - 160• No. of district level trainers trained - 419

• ASHA Kit procurement – Tender floated. • ASHA Module and Manual printing - in process• Reporting Formats - finalized by

Technical committee

ASHAsActivity Status

Total Number of ASHAs in the State 50,113

Population Per ASHA Appx. 1,000

Drug Kits (Norm: Rs 600/Kit)• Amount proposed per kit• Total Number of Kits to be procured-• Total Amount proposed

Rs. 600/Kit 45552 Rs. 273.31 lacs

Expenditure on Selection, Training • Total amount proposed• Amount proposed per ASHA

Rs 2150.19 lacs Rs 10069

Total amount proposed for paying incentives Rs 1874.35 lacs

Non monetary incentives Provision of Rs. 100.00 lacs

VHSC Plan -2011-12

• Constitution of VHSCs - 44438 as Swastha Gram Samiti

• Untied fund to SGSs - 44438

• Development of Training Module for SGS members

• TOT for SGS trainers - 450

• SGS Training batches - 1017

• Development of integrated village health plan

Untied Fund

Facility Type /

No. of facilities(As per RHS/No.

Proposed in PIP)

Norm ( Rs. in lacs) Total ( Rs. in lacs)

Untied funds to Facilities

VHSC

CHC 333 / 333 0.50 166.50

PHC1156 / 1156 0.25 289.00

SC8869 / 8869 0.10 886.90

Villages521117 / 44438 0.10 4438.00

Total 5780.40

AMG

Facility Type / No. of facilities(As per RHS/No.

Proposed in PIP)

Norm Total( Rs. in lacs)

CHC 333 / 333 1.00 333.00

PHC1156 / 961 0.50 480.50

SC8869 / 6926 0.10 692.60

Total 1506.10

RKS - Corpus Grant

Facility Type / No. of facilities(As per RHS/No. Proposed in PIP)

Norm Total( Rs. in lacs)

DH50 5.00 250.00

CH 56 1.00 56.00

CHC 333 / 328 1.00 328.00

PHC 1156 / 1050 1.00 1050.00

Total 1684.00

Type of Health

Institution

Total No. Functioning

Available Buildings

as per norms

Functioning in buildings

less than norms

Buildings Under

Construction

No. of Buildings

Required to be

Constructed

District Hospitals

50 41 9 5 4

CHC 333 190 143 71 72

PHC 1156 994 162 97 65

SHC 8869 6443 2426 912 1514

INFRASTRUCTURE

Infrastructure Development 2010-11

Particular of Work No. Of Works Sanctioned

Completed Under Progress

District Hospitals (Total 50) Upgradation of District Hospital Building as per IPHS (ongoing)

5 1 4

Construction of level II SNCU at DH 17 12 5Construction of 20 Bedded Maternity Wards at DH

17 4 13

Construction of 20 Bedded Paediatric Wards at DH

7 0 7

Construction of Blood Bank Building at DH

1 0 1

Construction of Drug store cum CMHO office Building at DH (ongoing since 2009-10)

14(ongoing)

7 7

Construction of Model Labour Room at DH

4 3 1

Particular of Work No. Of Works Sanctioned

Completed Under Progress

Upgradation works as per IPHS in CHC/CH (ongoing)

40 4 36

Construction of CHC Buildings 6 (ongoing)

2 4

Construction of Labour Rooms at FRU (CHC level)

40 (ongoing)

13 27

Construction of Staff Duty Room with Female Toilet in 60 FRU (CHC level)

20(ongoing)

14 6

Construction pf PHC Building 61 31 30

Construction of SHC Building 484 (ongoing) 328 156

Infrastructure Development 2010-11

INFRASTRUCTURE

• Infrastructure budget as % of total budget- 17.93%• Amt. for block and below level facilities (as % of Infra Budget)-

53.20%

Activity SC PHC CHC DH Others

No Amt. No Amt. No Amt. No Amt. No Amt.

New Const.

156 150 26 411 3 245 - - - -

Up-gradation

34 901 10 400 47 620 50 1282 43 877.50

Amt. in lacs

INFRASTRUCTURE

Sub-Centre rentNo. of SC Amt @ Rs 250/SC Amt proposed in PIP

1035 31.05 From untied fund

Amount proposed for other activities

Hospital Strengthening Mobility Support Others (pl specify)

300 From NRHM Mgt. cost Nil

Amt. in lacs

Procurement of Equipments & Drugs

Category Drugs Equipment Others Total (In Lakhs)

Units

Amount

Units

Amount

Units

Amount

MH 10.00 62.55 303.94 376.49

CH 200.00 133.50 -- 333.50

ARSH 217.16 217.16Infrastructure Strengthening

255.00 255.00

ASHA 273.31 21.60 294.91

PROMIS 38.76 4.28 43.04

Warehouse racks/ Vacc. Cleaner

273.00 273.00

Small Ambulances for Janani Exp

280.00 280.00

Total 2073.10

MMU

Category No. of Districts Existing number

New Propose

d

Capital Cost (per unit)

Operational Cost (In

Lakh)

Amount

Proposed (In

Lakh)

0 MMU

1 MMU

>1 MMU

Unit Cost (Annual)

Total

MMU 28 07 15 91 32Total 123

Nil 16.66(Revised)

2049.88

895.02

• Cost of MMU (per unit per month) – Rs1.39 Lakh (revised)• Cases per MMU per month – 2158 (current)

MMU

• Being upscaled to areas with high % of SC population & LWE area – work orders issued, services expected to start by end of April 2011

• Total 122 blocks covered through 123 MMUs - • Tribal blocks - 90 MMUs in 89 blocks• Blocks with high SC pop. - 31 MMUs in 31 blocks• LWE blocks - 02 MMUs in 02 blocks

• Blocks divided into Clusters; Pathology services added.

• Effective monitoring through GPS and Bio-metric attendance.

• Provision of Rs. 7 Cr. in State budget for SC blocks.

MMU

Activity Physical Target

Budget (Rs in

Lakhs)

MMUs in 89 tribal, 02 LWE affected blocks and 01 for Primitive Baiga tribe

92 863.04

MMUs in SC blocks 31 State Budget

State monitoring unit for Mobile Medical units 01 06.98

GPS Monitoring of MMUs -- 25.00

Total MMU 895.02

Category Sanctioned Available Gap (%)Medical Officer

3790 3583 5

Specialists 3057 1177 61Staff Nurse 7309 3603 51LHV 1973 1680 15ANM 10492 12183 Surplus 16%

Lab Technician 1415 1058 25

Radiographer 667 427 36

HUMAN RESOURCE

HUMAN RESOURCE

Category Existing (in 2010-11)

Proposed (in 2011-12)

Unit cost proposed

Total Amount (in lacs)

Specialists- PG’S

150 100 40,000 100.00

Diploma 37500

Doctors 292 170 30,000 138.60

Ayush Doctors 164 600 18000 137.52

Nurses 347 315 15000 99.30ANMs 1810 520 6000 139.80

Lab Tech 106 30 7000 9.52Ayush Pharmacist

164 - 8000 13.12

Others (specify)

Total 3033 1735 637.86

HR Initiatives

• HR Database for Doctors Created• HR Deployment in terms of Graduates and PG being

Rationalized, Specialists being relocated as per institutional requirements

• 950 posts of M.O.’s being created for Deputation and Training Reserve

• Contractual Doctors are being Progressively Regularised• Cadres Reforms: Clinical/Public Health in Progress• One Year Diploma Course in Public Health Management

Initiated in Collaboration with PHFI

112

HR Initiatives

• Increased Honorarium for all cadres. • Hiring of Private Sector specialists.• 72 MOs are trained in EmOC and 40 in LSAS.• Provision of performance based incentives for EmOC and

LSAS trained Doctors. • No. of ANM Schools Increased from 29 to 32 • Additional 18 ANM Schools planned so as to reach target of

one ANM School per district• Two B.Sc. Nursing Schools added to take the total to three,

next year four more are to be added• Seven G.N.M. Schools to be added next year to take the

total to twenty

113

Programme Management Staff

Category Existing (in 2010-11)

Proposed (in 2011-12)

Unit cost proposed

Total Amount (in lacs)

DPMUDPM, DAM,DA 95 150 12000-30000 346.56

BPMU

BPM, Block & PHC BeMONC Accountant, Data Entry Operator

996 1189 6000-14000 1277.04

DECENTRALIZED HEALTH PLANNING

• No. of districts in the State - 50• No. of high focus districts - 34• No. of DHAP prepared and sent to Ministry - 50• Has resource envelop indicated to all districts - Yes

• Is higher weightage of 1:1.3 given

to high focus districts - No

• No. of blocks where Block Plan

made - 313

• No. of Villages - 52117

• No. of villages with VHSCs - 44437

NRHM Part – C

IMMUNIZATION

S. NO.

BUDGET HEAD 2010-11BUDGET

2010-11EXPENDITUR

E

2011-12BUDGET


1 RI strengthening project (Review meeting, Mobility support, Outreach services etc)

1619.9 997.89 1631.94 0.74

2 Salary of Contractual Staff 52.8 34.64 52.8 0.00

3 Training under Immunisation 342.9 79.35 257.96 - 24.77

4 Cold chain maintenance 12.71 14.12 259.71 * 1943.35

5 Pulse Polio operating costs 1500.08 187.61 1728.35 15

TOTAL IMMUNISATION 3528.39 1313.61 3930.76

11.40

* Rs 240 lacs for POL for Gen sets have been included Under cold chain maintenance head for the year 2011-12

BUDGET OVERVIEW

IMMUNISATION - Training

Indicators Target (10-11)

Progress 10-11

Target(11-12)

No. of immunisation sessions

600000 568000 700000

Training of MOs 2500 756 1800

Training of HW 6500 4618 4250

Training of cold chain handlers

1450 1450 1450

Review meetings 1456 1038 1456

IMMUNISATION - AVD

• Mechanism for alternate vaccine delivery– Partially operationalized, tenders invited – rates

were 3 to 4 times higher.– AVD is done by JSRs, ANMs / ASHA relative, few NGO

volunteers.• Status of alternate vaccinators in urban slum

– Retired ANM/LHV/SN/Pharmacist are designated, but consistency & accountability lacks.

Status of cold chain maintenance• Sickness rate is below 2%.• NRHM funds insufficient, State resources were

utilized.• Funds for WIC/WIF maintenance have been

provisioned in addition to district budget.• EVM recommendations have been incorporated in

relevant sections of State PIP.

IMMUNISATION – Cold Chain

Systems for supervision and monitoring• Comprehensive VHND monitoring plan has

been implemented, wherein state, divisional, district & block officers were given minimum targets to supervise sessions.

• Revised checklist, with modifications to suit state needs is being used.

IMMUNISATION supervision & Monitoring

National Disease Control ProgramPart - DRNTCP

RNTCP Performance Indicators :- NSP CDR /TSR – 59%/88%

Name of the district/districts

NSP CDR/Treatment Success Rate (TSR)

Reasons for poor performance

Proposed solutions /Activities in PIP

Constraints

Poor Performing DistrictsBetul 35/87 -Suboptimal Priority to

RNTCP-Low referral-Suboptimal S&M-Suboptimal ACSM-Suboptimal Community Involvement

- Strengthening referrals and S&M-Designation of OICc for Intensive S & M-Contact Tracing-Involvement of ASHAs, Community, NGOs and PPs-Strengthening ACSM activities - Involvement of NRCs

-Suboptimal Involvement of Medical Colleges and PPs-Suboptimal Involvement of General Health System

Bhind 34/85Bhopal 76/76Chindwara 41/86Dindori 48/84Harda 37/80Morena 32/85Raisen 35/88Rajgarh 42/87Ratlam 47/87

*Poor performing Districts are Districts with Case Detection rate < 50% and Treatment Success rate < 80%Moderate performing Districts are Districts with Case Detection 50 – 59% and Treatment Success rate 80 – 85%

RNTCP Performance Indicators

RNTCP Performance Indicators :- NSP CDR /TSR – 59%/88% Name of the district/districts




Constraints

Poor Performing DistrictsSehore 39/87 -Suboptimal Priority to




Seoni 37/86Tikamgarh 35/84Ujjain 49/88Umaria 41/90



RNTCP Performance Indicators :- NSP CDR /TSR - 59%/88%

Name of the district/districts




Constraints

Moderate Performing DistrictsBalaghat 52/90 -Suboptimal Priority to




Barwani 56/86Dewas 57/86Guna 55/89Narsingpur 53/88Rewa 57/88Shahdol 56/89Sidhi 53/88Vidisha 55/89



Status of IRL and DOTS Plus

Districts Implementing

DOTS Plus/Proposed

Status of IRL and services offered

DOTS Plus Site

No of Patients

proposed to Put on DOTS Plus ( 2011-12)

Human Resource status for

DOTS Plus

Districts already implementing

Districts proposed for 2011-12

Solid Culture

Liquid culture

LPA Indore-Upgraded. Bhopal-Under up gradation process Proposed-Jabalpur, Ujjain and Gwaliar

Sr.DOTS Plus & TB-HIV Supervisor appointed at Indore. Recruitment of DPS-Sr.MO, Supervisors, DPS-SAs, in process0 25 _ _ _ 125

Mycobacterial Culture and DST Laboratory at Jabalpur (RMRCT) accredited. Two more C/DST labs – CHRC, Indore and BMHRC, Bhopal to be accredited on 18th and 19th March, 2011

Budget heads and Amount proposed

Sr. No. Budget heads Amount proposed (INR in lacs)

1 Civil works 125.142 Laboratory materials 112.053 Honorarium 116.304 IEC/ Publicity 89.45 Equipment maintenance 48.70

6 Training 96.307 Vehicle maintenance 54.668 Vehicle hiring 167.369 NGO/PP support 197.66

10 Miscellaneous 95.8111 Contractual services 906.9712 Printing 100.0013 Research and studies 1.0014 Medical Colleges 85.6115 Procurement –vehicles 63.0016 Procurement – equipment 15.60

17 Tribal Action Plan Included in respective heads

Total 2275.56

National Vector Born Disease Control

Programme

NVBDCP

Component

Provision for 2010-11

Sanction for2010-11

Proposed for 2011-12

Human Resource 519.98 655.30 903.33Training 141.70 66.70 123.10Infrastructure 0.00 0.00 0.00Procurement 1471.37 176.87 972.30IEC 168.00 65.00 168.14Untied funds 0.00 0.00 Honorarium & incentives 160.00 55.00 127.50RKS 0 0 0Other Mission 0 0 0PPP/NGO 0 0 10.00Operating Cost 217.40 200.25 510.64Financial aid/grant to institutions 3.00 3.00 8.00Grand Total ( A) 2681.45 1222.12 2823.01NRHM Management - Operational Cost 42.62 Grand Total ( B ) 2681.45 1264.74 2823.01

NVBDCP

Component


Sanction for2010-11


Human Resource 519.98 655.30 903.33

Honorarium and Incentive 100.00 55.00 55.00

Operating cost 93.00 85.00 375.04

IEC/BCC 56.00 35.00 73.12

PPP/NGO 10.00

Training66.70 66.70 77.00

Procurement 1436.37 176.87 854.00

Total Malaria (DBS + EAC) 2272.05 1073.87 2347.49

NVBDCP

Component


Sanction for2010-11


Operating Cost104.15 100.00 80.35

Training71.00 42.10

IEC44.00 42.90

Honorarium & Incentives 60.00 72.50

Total Filaria elimination 279.15 100.00 237.85

FILARIA

NVBDCP

Component


Sanction for2010-11


Financial aid/grant to institutions 3.00 3.00 8.00Operating cost

20.25 15.25 55.25IEC

68.00 30.00 52.12Training

4.00 0.00 4.00Fogging machine

35.00 0.00 118.30Total Dengue/Chikungunya 130.25 48.25 237.67

DENGUE & CHIKUNGUNYA

National Programme for Control of Blindness

Year Target Achievement Percentage IOL Percentage

2010-2011 (Up to February)

450000(387000) 364204 94.11% 98.67%

Cataract Operation in Madhya Pradesh

School Screening in Madhya Pradesh

Year Target No. of School

examined

No. of student

examined Achievement

Percent

No. of Student with

refractive errors

No. of Student given

Free Spectacles

2010-11(Up to

February)

4100000 37854 3452041 84.19% 84045 31303

NPCB

S.N.

Components Proposed budget 2011-12

1 Grant in aid for Cataract Operations (for Govt. Sector+NGO's Sector) (3,00,000 @ Rs 750/-)

2250.00

2 Free Spectacles for School Children (73,800X200)

160.00

3 Infrastructure Strengthening 858.00

4 Maintenance of Ophthalmic Equipment

84.00

5 Human Resources 57.60

Total 3409.60

In Lacs

NPCB

Integrated Disease Surveillance Programme

Integrated Disease Surveillance Project (IDSP)PHYSICAL ACHIEVEMENTS 2010-11

Weeks S units P units L units

Number of

Reporting Unit

Reporting unit

% Number of

Reporting Unit

Reporting unit

% Number of

Reporting Unit

Reporting unit

%

Week 01

8546 4015 47 1636 596 36 898 397 44

Week 50

8981 5610 62 1825 857 47 899 519 57

1. Actual number of existing S,P and L units is stabilized and upgraded quarterly, as we are including private units as well.2. Number and percent of units reporting regularly has also increased.3. Regular& timely report of weekly report to CSU. Analyzed regularly & action taken accordingly.

No. of District No. of Outbreaks

2009 2010 2009 2010

30 41 141 163

Integrated Disease Surveillance Project (IDSP)OUTBREAK 2009-10

Sr. no. Name of Outbreak No. of

OutbreakNo. of Cases

No. of Death

1 Measles 62 439 11

2 Fever 9 283 0

3 Malaria 7 189 0

4 Chicken pox 3 26 0

5Diarrhoea & Vomiting, Loose Motion

57 2606 26

6 Food Poisoning 4 171 1

7 Cholera 2 3 0

8 Gastroenteritis 8 176 3

9 Chikungunya 11 13 0

10 Total 163 3467 30

Integrated Disease Surveillance Project (IDSP)OUTBREAKS REPORTED IN YEAR 2010

IDSP

S. N.

Activity proposed Budget 2010-11

Budget 2011-12

2011-121 Surveilance preparedness

Training & Staff Salary337.58 508.77

2 Outbreak Investigtion 11.00 5.00

3 Analysis & use of data 12.74 34.84

4 New innovation 0.00 4.60 Total 361.32 553.21

(In lacs)

National Leprosy Eradication Programme

COMPARISION OF NLEP INDICATORS

S.N.

Component INDIA(2009-10)

MADHYA PRADESH(2009-10)

2010-11(Nov' 2010)

1 ANCDR /100,000 population

133717 - 10.93 5592 - 7.8 5670-7.73

2 PR /10,000 population 87190 - 0.71 4589 - 0.64 4864-0.66

3 MB Proportion 50162 (48.5%) 3436 (61.6%) 2545 (62.18%)

4 Child Proportion 10532 (9.97%) 288 (5.16%) 214 (5.23%)

5 Female Proportion 36723 (35.14%) 1818 (32.59%) 1428 (34.89%)

6 Deformity Grade-I among NCD

4202 (4.02%) 950 (17.03%) 493 (12.04%)

7 Deformity Grade-II among NCD

3105 (3.1%) 294 (5.27%) 245 (5.99%)

8 Otherwise Deletion 7246 (6.93%) 319 (5.7%) 355 (8.66%)

9 SC among New cases 24789 (18.54%) 855(15.29%) 656 (16.03%)

10 ST among New cases 17818 (13.33%) 1666(29.79%) 1183 (28.90%)

NLEP

S. No.


Budget 2011-12

2011-121) Contractual Services 17.40 26.822) Services through ASHA/USHA 26.00 8.19

Honararium to ASHA, sensitization of ASHA

3) Office expenses & Consumables 16.30 16.96

4) Capacity building 21.00 62.33MO, Health Workers, Supervisors, Lab Technicians & Refresher Training of

MO's5) Behavioral Change Communication 40.00 12.43

(Rs. in lakhs)

NLEP

S. No.


Budget 2011-12

6) POL/Vehicle operation & hiring 37.50 38.35

7) DPMR 38.00 23.75

8) Material & Supplies 25.00 23.00

9) Urban Leprosy Control 16.80 16.79

10) Supervision, Monitoring & Review 4.00 3.20

11) Cash assistance 15.00 24.00

12) Special Activity in High Endemic Districts

41.79

TOTAL 257.00 297.61

(Rs. in lakhs)

Non Communicable Disease Control Programmes

Key activities carried out in year 2010-11 –

• Urinal Iodine extraction survey of school children was conducted in Sidhi, Shahdole, Badwani, Mandla and Chattarpur District by Gandhi Medical College, Bhopal.

• Message was published in leading news papers of the State on Global IDD Day on 21st October 2010.

• IEC Activities were conducted by Districts on Global IDD Day.

National Iodine Deficiency Disorder Control Programme

NIDDCP

S. N.

Proposed PIP 2010-12

Sanctioned PIP 2010-11

Allotment 2010-11

Proposed Budget 2011-12

1 17.40 20 0.00 17.40

Note :- Rs. 7 Lacs were released by GOI from 2002-07.

Mental Health

This programme is being conducted by Medical

Education Dept. In our State at present programme is

being run through 5 Medical Colleges in 5 Districts.

Medical College Bhopal - District Sehore. Medical College Indore - District Dewas. Medical College Jabalpur - District Mandla. Medical College Gwalior - District Shivpuri. Medical College Rewa - District Satna.

Mental Health

S.N. Districts Budget for District

Total

1 5 Existing Districts 26.37 131.85

2 22 New District 26.37 580.14

3 State Cell at DHS 20.39

Total 732.38

(Rs. in lakhs)

National Programme for Prevention and Control of Deafness - Progress

1 Districts Nodal officers have been nominated.

2 Audiological Assistants posted in -

1. Bhopal

2. Indore

3. Gwalior

3 Recruitment of Audiological Assistants for Jabalpur, Rewa and Khargone is under process.

4 Recruitment of Instructors is under process.

National Programme for Prevention and Control of Deafness– Progress

5 Awareness generation at dissability camps –Districts Camps Held1. Bhopal - 62

2. Indore - 59

3. Gwalior - 89

4. Jabalpur - 187

5. Rewa - 206

6. Khargone - 43

National programme for prevention and control of deafness (NPPCD)

S. N.



Allotment 2010-11


1 92.62 Nil Nil92.62

Note :- Rs. 61.42 were released in 2008-09. Expenditure till December 2010 Rs. 2 Lacs.

Programme is being run in 6 Districts, Indore, Bhopal, Gwalior, Khargone, Rewa & Jabalpur.

(Rs. in lakhs)

• Enforcement of Smoke Free Rules and display of no smoking signage.

• Universities requested to make their universities and affiliated colleges free from tobacco smoke and also make the Tobacco Control Policy of the University.

• State has notified additional officers to enforce the provisions of the Tobacco Control Act

• Flying squads in all the districts to monitor the enforcement and compliance of COTPA 03.

Key Activities done under the programme -

National Tobacco Control Programme

• Mechanism for compounding of offence has been established.

• State Level Task Force and District Level Task force in all the Districts have been constituted

• The State of MP was first among all States to draft Tobacco Free School guidelines on 20 June 2008.

• All IG of IG zones of Madhya Pradesh have been asked for strict enforcement of section 6 (a) and 6 (b) (Prohibition of sale to minors and prohibition of sale of tobacco products in 100 yards of educational institution.

Key Activities done under the programme -

National Tobacco Control Programme

• IEC – – World No Tobacco Day 31st May observed through out

the State in year 2008-09 and 2010.– Documentary on Tobacco Free Village Chinchgohan

produced and telecasted by Doordarshan Indore and Bhopal.

– Different IEC materials (like posters, pamphlets) on tobacco control

– Religious leaders were sensitized at Indore, Omkareshwar and Haridwar.

National Tobacco Control ProgrammeKey Activities done under the programme -

• Capacity building and training activities:−Training of school teachers was organized in

Khandwa and Gwalior Districts.−Orientation meeting with Administrative and

Police officials organized at Khandwa and Gwalior Districts.

−Students of different Government Schools educated about ill effects of tobacco use at Khandwa & Gwalior Districts.

National Tobacco Control ProgrammeKey Activities done under the programme -

National tobacco control programme (NTCP)

S. N.



Allotment 2010-11


1 7988000 Nil Nil7988000

Note :- Rs. 1724000 were released in 2008-09. Expenditure till December Rs. 9.00 lacs

Programme is being run in 2 Districts Khandwa & Gwalior.

THANKS

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1 Presentation to National Program Coordination Committee On State PIP of Madhya Pradesh for 2011-12...

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Transcript of 1 Presentation to National Program Coordination Committee On State PIP of Madhya Pradesh for 2011-12...