JHARKHAND STATE REPORT

Jharkhand

1

Jharkhand

Index

S. No. Content Page No.

1 Summary of approvals 2 – 6

2 Demographic Profile 7 – 8

3 Progress of NRHM 9 – 12

4 Reproductive & Child Health 13 – 16

5 Immunization 17 – 17

6 Revised National Tuberculosis Control Programme (RNTCP) 18 – 21

7 National Vector Borne Disease Control Programme (NVBDCP) 22 – 23

8 National Leprosy Eradication Programme (NLEP) 24 – 24

9 Integrated Disease Surveillance Project (IDSP) 25 – 26

10 National Programme for Control of Blindness (NPCB) 27 – 27

11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 28 – 28

12 RoP approval under Mission Flexible Pool 29 – 34

13 Analysis of some RCH Indicators 35 – 35

Jharkhand

2

JHARKHAND

Summary of approvals

Financial Management under NRHM (Rs. in crore)

Years Allocation Release Expenditure % Release

against Allocation

% Expenditure against Release

2005-06 157.69 143.51 63.74 91.00 44.41 2006-07 229.20 191.59 128.44 83.59 67.04 2007-08 262.92 158.28 121.77 60.20 76.94 2008-09 270.34 234.13 325.25 86.60 138.92 2009-10 299.08 0.00

Total 1219.24 727.50 639.21 59.67 87.86

S. No. Timeline Activities Achievement %

1 ASHA Selection 39556 189 Training 38764

2 VHSC 30011 92 3 24X7 PHCs 194 59 4 Mobile Medical Unit 24 100 5 Rogi Kalyan Samiti 429 76

Budget Allocations (2005-09) ( Amount in Crores) Jharkhand

Allocation Releases Expenditure RCH Flexipool

2005-06 42.17 40.60 9.92 2006-07 56.89 21.41 12.95 2007-08 47.33 22.16 25.98 2008-09 69.46 81.55 162.28 2009-10 81.77

Total (A) 297.62 165.72 211.13 NRHM Flexipool

2005-06 No separate allocation 32.48 0.95

2006-07 47.63 46.53 0.90 2007-08 83.26 66.47 33.00 2008-09 60.51 90.23 108.56 2009-10 72.16

Total (B) 263.56 235.71 143.41

Jharkhand

3

National Disease Control Programme 2005-06 36.09 21.90 25.65 2006-07 45.47 38.52 35.71 2007-08 44.42 13.24 9.67 2008-09 41.77 23.09 7.56 2009-10 58.84 0.00 0.00

Total (C) 226.59 96.75 78.58

Grand Total (A + B + C) �������

�������

������

Record of Proceedings (2005-2009) for Mission Flexible Pool

Approval for Infrastructure (Rs. in Crore)

S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10 1 Sub C 5.11 0.00 7.44 10.95

2 PHC 0.00 14.01 5.00

3 CHC 17.60 0.00 18.25 6.50

4 DH 15.72 24.40 0.00 0.00

5 Equipment 0.27 0.00 0.00 11.85

6 Transport 0.00 6.78

7 Others 1.15 0.00 4.40 0.80

Total 22.71 17.14 24.40 44.10 41.88

Approval for Human Resources(Rs. in Crore)

S. No Personnel 2005-06 2006-07 2007-08 2008-09 2009-10 1 Doctors 0.00 0.00 3.37

2 Specialists 3.60 4.50 4.00

3 Staff Nurses 5.59 5.83 3.00

4 ANM 30.45 25.20 46.00

5 Others 0.00 0.00 6.61

Total 0.00 0.00 39.64 35.53 62.98

Approval for other activities (2005-2009) in Rs. Lakh

S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10

Remarks Released Approved Approved Approved Approved

ASHAs 1 ASHA 514 500 2379.21 1906.52 829.7

2

Performance Based Recognition and Awards

1.44

Jharkhand

4

3

Block level quarterly meeting of Sahiyyas (Rs.2000 per block per meeting)

8.48

4

State level quarterly meeting of Sahiyya mentoring group (Rs. 25000 per meeting)

1

5 Sahiyya Sammelan (Division wise)

15

TOTAL 514 500 2379.21 1906.52 855.62

Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters

6 Rogi Kalyan Samiti

300 199.23

682

7 Rogi Kalyan Samiti @ PHC, CHC, DH

Rogi Kalyan Samiti- DH 95.00

8 Rogi Kalyan Samiti- SDH 6.00

Rogi Kalyan Samiti- Referral hospital 32

Rogi Kalyan Samiti- CHC 194

Rogi Kalyan Samiti-PHC/APHC 330

Untied Fund

2575.3

Untied Fund for CHC 97 97

Untied Fund for PHC 140.25 82.5 82.5 Untied Fund for SC 511 395.5 395.8 382

Untied Fund for VHSC 384 119 1000

Annual Maintenance Grant- SDH

530.4

Annual Maintenance Grant - CHC 83 194

Annual Maintenance Grant -PHC 280.5 97 165

Annual Maintenance Grant- SC 175

TOTAL 511 1680.25 893.53 2752.50 3787.70

Jharkhand

5

Infrastructure related matters (physical infrs, equipments, mobile clinics, drugs, kits, consumables)

9

MMU 50 80 600

10 Operational cost of MMU 360

TOTAL 50.00 440 600.00

Status of Infrastructure 2005-2010 As per RHS 2008 New Construction Upgradation / Renovation Number of Sub Centre 3958 264 0 Number of PHC 330 146 7 Number of CHC 194 107 0 Number of DH 24

As per State Data Sheet, NRHM

17 0

Status of NRHM as on 15.05.2009

States/Uts Jharkhand

1 ASHA Selection 39556 Training 38764

2 VHSC 30011

3 Joint A/C 10000

4 24X7 Facility 226

5 FRU 32

6 Contractual Manpower

Doctors & Specialist 707

AYUSH Doctors 163

Staff Nurse Paramedics 1200

ANM 3204 7 JSY Beneficiaries (in Lakhs) 7.56

Jharkhand

6

National Disease Control Programme Leprosy

Although state has reached elimination of the disease, still large numbers of new cases are being detected every year indicating active transmission in the community. An in-depth situational analysis with steps to complete treatment etc be started.

IDSP

It is a Phase III state. The recruitment of key human resources (Data managers, Epidemiologists, microbiologists etc) needs to be fast tracked and completed in a time bound manner. The data reporting should start from all the districts.

Blindness

Reporting of utilisation of GoI grants need to be accelerated. Cataract performance and IOL implantation percentage needs to be improved.

NVBDCP

Fill up the human resources (Male MPW, Lab Tech, Malaria Technical Supervisors) gaps. RNTCP

Total Case Detection and cure rate (83%) need to be improved. This appears to be due to gaps in key HR (STO, DTO, other levels ), weak supply chain management and supervision.

Jharkhand

7

Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF JHARKHAND

The Total Fertility Rate of the State is 3.2. The Infant Mortality Rate is 48 and Maternal Mortality Ratio is 312 (SRS 2004 - 06) which are higher than the National average. The Sex Ratio in the State is 941 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows:

Table I: Demographic, Socio-economic and Health profile of Jharkhand State as compared to India figures S. No. Item Jharkhand India

1 Total population (Census 2001) (in million) 26.9 1028.61 2 Decadal Growth (Census 2001) (%) NA 21.54 3 Crude Birth Rate (SRS 2007) 26.1 23.1 4 Crude Death Rate (SRS 2007) 7.3 7.4 5 Total Fertility Rate (SRS 2007) 3.2 2.7 6 Infant Mortality Rate (SRS 2007) 48 55 7 Maternal Mortality Ratio (SRS 2004- 2006) 312 254 8 Sex Ratio (Census 2001) 941 933 9 Population below Poverty line (%) - 26.10 10 Schedule Caste population (in million) 3.19 166.64 11 Schedule Tribe population (in million) 7.09 84.33 12 Female Literacy Rate (Census 2001) (%) 38.9 53.7

Table II: Health Infrastructure of Jharkhand Particulars Required In position shortfall Sub-centre 5057 3958 1099 Primary Health Centre 806 330 476 Community Health Centre 201 194 7 Multipurpose worker (Female)/ANM at Sub Centres & PHCs

4288 5011 -

Health Worker (Male) MPW(M) at Sub Centres 3958 1922 2036 Health Assistant (Female)/LHV at PHCs 330 - - Health Assistant (Male) at PHCs 330 660 - Doctor at PHCs 330 330 0 Obstetricians & Gynaecologists at CHCs 194 30 164 Physicians at CHCs 194 0 194 Paediatricians at CHCs 194 0 194 Total specialists at CHCs 776 40 736 Radiographers 194 0 194 Pharmacist 524 348 176 Laboratory Technicians 524 381 143 Nurse/Midwife 1688 429 1259 (Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)

Jharkhand

8

The other Health Institution in the State are detailed as under:

Health Institution Number Medical College 3 District Hospitals 24 Referral Hospitals City Family Welfare Centre Rural Dispensaries Ayurvedic Hospitals 1 Ayurvedic Dispensaries 122 Unani Hospitals - Unani Dispensaries 30 Homeopathic Hospitals 2 Homeopathic Dispensary 54

Jharkhand

9

Note on Progress of NRHM in Jharkhand (June 2009)

Jharkhand is one of the newly formed States. Jharkhand has implemented the activities of National Rural Health Mission but Jharkhand is committed to make efforts towards identifying gaps and adopting measures to align with the national mainstream. NRHM has transformed public health service delivery in the State. The decentralization, responsiveness to local needs, paradigm shift in health system management and availability of untied funds has improved the facilities and their credibility among members of the public. Brief information on progress of activities is as follows: Institutional Framework of NRHM

Meeting of State & District Health Mission held regularly. State Health Mission held 3 times and of District Health Mission meeting held 50 times. Merger of societies is completed in 24 districts. A total of 30, 011 VHSCs constituted & 10,000 Joint Accounts operationalised at sub centre and VHSC. Rogi Kalyan Samitis are operational at 24 DH, 170 CHCs & 231 PHCs. Out of 24 districts, 22 districts have started developing their own IDHAP.

Infrastructure Improvements

In total 194 PHC are strengthened with three Staff Nurse to make them functional for 24x7 and 32 CHC are functioning on 24X7 basis to provide quality health services & facility survey completed in 186 health institutions below district level. Overall 4 SDH, 16 CHC & others equal to and below district level including 12 District Hospitals are functioning as FRUs. All districts have functional Mobile Medical Unit (MMU)

Human Resources

A total of 39,556 ASHAs have been selected & 23733 are trained upto 4th Module. 36659 ASHAs have been provided with drug kits. There are 4291 Sub-centres functional with an ANM and 3958 SCs strengthened with 2nd ANM. Under NRHM 163 contractual AYUSH Doctors have been appointed. Manpower augmentation through contractual appointments of 707 MBBS Doctors, 3204 ANMs, and 1200 Para Medics have been done under NRHM and need to strengthen the positioning of specialists and Staff Nurse. Services Institutional deliveries have declined from 0.69 lakhs (2006-07) to 0.52 lakhs (2007-08). During the year 2008-09 there were 1.94 lakhs Institutional deliveries in the state. JSY beneficiaries increased from 1.23 lakhs (2006-07) to 2.01 lakhs (2007-08). The numbers of JSY beneficiaries were 4.78 lakh during the year 08-09. Female sterilizations has remained same at 0.94 lakh (2006-07) to 0.94 lakh (2007-08) and male sterlisation has increased from 6461 (2006-07) to 15977 (2007-08). During the year 2008-09, a total of 113726 female & 12123 male sterilization have been reported so far. 15 districts are implementing IMNCI & 4500 people trained so far. 290801 VHND held since the launch of NRHM. First Phase of Community Monitoring has been operationalised in the state.

Jharkhand

10

General Comments Overall improvement in health system since NRHM. Achievements made:-

• Improved Out Patient and In Patient attendance. • Sub Centre deliveries have improved. • Immunisation performance has improved • Almost 40,000 Sahiyas (ASHAs) are in position, 34,000 trained upto 4th module and 37,000

with drug kits. • Absorptive capacity for fund utilization has increased. • Untied Funds, Annual Maintenance Grants, Rogi Kalyan Samitis (RKS) funds being utilized.

Capacity for innovative utilization to be built. • Community monitoring has been piloted in 15 villages • MMUs are serving unreached population.

Areas for further Improvement:-

• RKSs are operational at most places and their capacity for decentralised use of funds should be augmented.

• Institutional delivery & family planning services need improvement. • Recruitment through the Public Service Commission be completed on priority (interviews held

in October 2008 for 1200 odd doctors). • Long term Human Resource Augmentation Plan has been requested from the state and may be

finalized on priority. • Focus on facility strengthening; Non-functional PHCs to be revived • Hospital quality management needs to be strengthened • Residential accommodation for staff at facilities. • Special Plans for Tribal and Naxal areas are needed.

Infrastructure

• Sub centres are doing very well and may be further strengthened. • Need to rationalise and fast track upgradation of public health Infrastructure being funded

under NRHM & Finance Commission grants. • Need to optimise utilisation of existing infrastructure through HR rationalisation and better

supervision to ensure accountability. • Make residential accommodation for doctors & paramedics functional.

Human Resources

• Substantial augmentation approved under NRHM, hard area incentives also. • Create more posts and complete the selection process to fill them. • Finalise Cadre rules & undertake Cadre review (make gradation list) , rationalise transfer and

promotion policy, control private practice. • Rationalise remunerations introduce blended payments for difficult areas. • Increase training capacity – ANM Training Centres, Nursing Colleges • Multiskilling Training be scaled up • Expand performance incentives for Sahiyas and streamline the payment protocols, position

the Sahiya Mentoring Setup. Service Delivery

• Improve supply chain management • Improve Health MIS and create local capacity for data & evidence based policy making.

Jharkhand

11

An Analysis of Financial Monitoring Report for the year 2008-09

RCH Flexible Pool Component wise expenditure & Utilization under RCH against the approved PIP for 2008-09

Rs. In Lakhs

Activities SPIP Expenditure % Utilization against PIP

Maternal Health 5381.09 5290.97 98.33 Child Health 3794.20 1642.64 43.29 Family Planning Services 2260.09 2203.42 97.49 Adolescent Reproductive and Sexual Health/ ARSH 161.85 161.85 100.00 Urban RCH 261.00 261.00 100.00 Tribal RCH 6.30 6.30 100.00 Vulnerable Groups 3.55 3.55 100.00 Innovations/PPP/ NGO 0.00 0.04 Training 369.00 807.38 218.80 BCC / IEC 794.72 798.78 100.51 Procurement 3313.27 4731.59 142.81 Programme Management 0.00 320.12 Error Total 16345.07 16227.64 99.28

Based on table above and records available in FMG, the observations and areas of concern are as under:- General Observation:

1. Almost 100% (162.28 Crores) against the PIP approved (163.45 Crores) has been utilized under RCH-II as compared to average national level expenditure of 71%.

2. There is 680% increase in expenditure as compared to 2007-08. 3. Since the Launch of RCH-II, 205.96 crores i.e. 124% has been utilized by the state

against the total release Rs.165.72 crores during the period 2005-06 to 2008-09. 4. 100% expenditure has been reported under the head ARSH, Urban RCH, Tribal RCH,

Vulnerable Groups and BCC/IEC against the approved PIP. Areas of Concern:

1 Bifurcation of Home & Institutional Deliveries under JSY expenditure of Rs. 4985.39 lakhs is not provided.

2 The expenditure on formation of State/Distt./Block level Quality Assurance Cell of Rs. 14.89 is booked under Maternal Health instead of Quality Assurance expenditure.

3. Expenditure of Rs. 44.80 lakhs on RCH Camps in Tribal Area is booked under Child Health instead of Tribal RCH.

4. Expenditure of Rs. 24.96 lakhs on Monitoring & Evaluation is booked under Management Cost instead of Monitoring & Evaluation head.

5. Minor expenditure of 0.04 lakhs is reported under Innovation/PPP/NGO their NPCC approval was nil.

6. Child Health component expenditure is very low. 7. The expenditure under programme Management, Rs. 320.12 lakhs is to be looked into

as no provision was made in PIP. 8. Very high expenditure, 218% of the approved PIP, under the head. Training is to be

looked into.

Jharkhand

12

Mission Flexible Pool:- Component-wise expenditure under NRHM for the year 2008-09 Rs. in Lakhs

Activities SPIP Expenditure %Utilization against PIP

ASHA 1906.52 1896.00 99.45 Untied Funds 1561.50 1547.31 99.09 Annual Maintenance Grants 534.00 530.81 99.40 New Constructions/ Renovation and Setting up 2500.00 2559.60 102.38 Corpus Grants to HMS/RKS 657.00 645.50 98.25 IEC-BCC NRHM 0.00 51.25 Error Mobile Medical Units 300.00 471.71 157.24 Additional Contractual Staff (Selection, Training, Remuneration) 3553.00 2515.38 70.80

PPP/ NGOs 0.00 123.14 Error

Training 200.00 3.27 1.64

Planning, Implementation and Monitoring 25.00 35.96 143.84 New Initiatives/ Strategic Interventions (As per State health policy) 320.00 190.00 59.38

NRHM Management Costs/ Contingencies 260.05 285.84 109.92 Other Expenditures (Power Backup, Convergence etc) 31.78 0.00 0% Total 11848.85 10855.77 91.62

Based on table above and records available in FMG, the observations and areas of concern are as under:- General Observation:

1. Out of Rs.118.49 crores approved by the NPCC and Rs. 90.23 Crores released, the state has utilized Rs.108.55 crores i.e. 91.62% of approved PIP, while the average national expenditure against PIP is 68.14%.

2. There is 266% increase in expenditure as compared to 2007-08. 3. Since the launch of the programme, Rs.235.71 Crore was released to the state, the utilization

is only Rs.140.07 Crores (59%) and Rs.95.64 Crores (41%) remains unutilized. 4. More than 100% expenditure against the approved PIP has been incurred under New

Construction/Renovation, MMU, Planning/Implementation/Monitoring and Management Cost.

5. The expenditure under ASHA, Untied Funds, Annual Maintenance Grants and Corpus Grants to HMS/RKS is more than 99 % , which is a significant achievement.

Areas of Concern: 1. Expenditure of Rs. 645.50 lakhs under RKS has not been bifurcated. 2. The expenditure under Training component is very low. 3. The expenditure under IEC/BCC, PP/NGO to be looked into as no provision made in PIP.

Jharkhand

13

BRIEFING NOTE ON RCH II: JHARKHAND A. Background/ current status

1. RCH II Goals Jharkhand’s (including Bihar) MMR at 312 (SRS 04-06) has improved from 371 in SRS 01-03, but is still way above the national average of 254. The IMR (SRS 2007) at 48 is considerably better, compared to the other erstwhile EAG states. TFR at 3.2 (SRS 2007) is nowhere close to the target of 2.1 for the year 2012 (refer Annex 1). 2. RCH II Outcomes Jharkhand’s progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) is mixed (refer Annex 1):

• Mothers having full ANCs decreased from 9.3% to 9.1%. • Institutional deliveries decreased from 21.2% to 17.8%. • Full immunisation in children 12-23 months more than doubled, from 25.7% to 54.1%. • Exclusive breastfeeding for at least six months, in children 6-35 months age, increased more

than six times, from 7.8% to 49.5%. • Children with diarrhoea receiving ORS has decreased from 24.9% to 21.3%. • There is no progress on family planning indicators, with unmet need for family planning

(34.2% to 34.7%, amongst the highest in the country), and use of modern contraceptives (31.1% to 30.8%).

3. Expenditure Audited expenditure has increased from Rs. 9.92 crores in 2005-06 to Rs. 12.95 crores in 2006-07 and Rs. 20.81 crores in 2007-08; reported expenditure in 2008-09 is Rs. 162.28 crores i.e. 99% of allocation (Rs. 163.45 crores). JSY accounted for 31% of the reported expenditure in 2008-09. B. Key achievements 1. Maternal Health, including JSY

• Number of JSY beneficiaries in the state has nearly doubled in each of the past three years: from 1.24 lakh in 2006-07 to 2.52 lakh in 2007-08, and 4.78 lakh in 2008-09. The state has reportedly accredited 139 private institutions to provide services under the scheme.

• For multiskilling of medical officers in life saving anaesthesia skills (LSAS): 3 Medical Colleges have been identified, and 8 MOs have completed Anaesthesia training at RIMS and MGMMCH, Jamshedpur in 2 batches of 4 doctors.

• Multiskilling of medical officers in comprehensive Emergency Obstetric Care (EmOC) has progressed somewhat, with 4 Master Trainers and 8 District Level Trainers trained, and 21 MOs having completed EmOC training.

• 6 districts have been identified for Skilled Birth Attendant training, with 24 state level master trainers and 61 ANMs/SNs/LHVs trained.

• 2.91 lakh Village Health & Nutrition days have been carried out so far in the state. 3. Child Health

• IMNCI implementation is underway in 15 districts in the state.

Jharkhand

14

C. Key issues 1. Maternal Health, including JSY

• While number of institutional deliveries under JSY has increased to 4.78 lakhs in 08-09, Jharkhand is yet to adequately gear up facilities to meet the load:

− State has not been able to operationalise any of the First Referral Unit and 24x7 PHC for providing a comprehensive Maternal and Child health Services.

− A comprehensive Action Plan for operationalising FRUs and 24x7 PHCs was discussed for implementation during program officers visit to the state but has not yet been implemented.

− To overcome the shortage of manpower, there is a need to augment multi skilling training of M.B.B.S Doctors in Anaesthesia and Obstetric Care. 6 Master trainers for LSAS were trained a long time back, but they have not been adequately utilised. Further, EmOC trained doctors are not posted at facilities designated as FRUs.

− To make SNs/LHVs/ANMs proficient in identification and management of basic Obstetric Complications, the State needs to expedite implementation of Skilled Birth Attendant (SBA) Training.

− There is need to link the skilled based trainings with operationalisation of facilities. The trained doctors have not yet been posted to the designated FRUs.

• Jharkhand is the only state where DLHS-3 (2007-08) results show a decline in institutional deliveries, compared to DLHS-2 (2002-04). State needs to take urgent steps to promote JSY/ MMJSSY (Mukhya Mantri Janani evam Sishu Suraksha Yojana):

− Package is broken down into too many components of payment, through vouchers, which can be difficult to administer and lead to delays in payments.

− No. of registrations is high, however it is not translating into improved outcomes, with poor progress seen on outputs, e.g. institutional deliveries and full immunization of child.

− Use of referral transport is not encouraging, highlighting the need to strengthen referral systems.

− Awareness of the scheme among potential beneficiaries is low. 2. Child Health

• Neonatal mortality rate (NMR – infant deaths within 4 weeks of life per 1000 live births) at 31 (SRS 2007) accounts for 53% of the IMR, while early NMR (infant deaths within one week of life per 1000 live births) at 27 (SRS 2007) accounts for 87% of the NMR. The recent review of the state highlighted that post-delivery stay of at least two days was not ensured, and that the concept of neonatal care as a planned interventions was missing. The current single SNCU functioning is inadequate. State needs to focus on basic newborn care through newborn baby care corners at all PHCs, and training of Sahiyyas to provide post natal care.

• The pace of IMNCI implementation is slow, with only 4500 persons trained so far.

Jharkhand

15

ANNEX 1 A. Progress on Key Indicators

1. RCH II Goals

INDICATOR JHARKHAND INDIA Trend (year & source) Current status RCHII/NRHM

(2012) goal Maternal Mortality Ratio (MMR)

371 (SRS 01-03)

312 (SRS 04-06)

254 (SRS 04-06)

<100

Infant Mortality Rate (IMR) 51 (SRS 2003) 48 (SRS 2007) 55 (SRS 2007) <30 Total Fertility Rate (TFR) 3.5 (SRS 2004) 3.2 (SRS 2007) 2.7 (SRS 2007) 2.1

2. RCH II Outcomes

S. No. RCH OUTCOME INDICATOR

JHARKHAND INDIA* DLHS–2 (2002–04)

DLHS–3 (2007–08)

DLHS–2 (2002–04)

DLHS–3 (2007–08)

1. Mothers who received 3 or more antenatal care checkups (%) 30.7 31.6 50.4 51.0

2. Mothers who had full antenatal check-up (%) 9.3 9.1 16.5 19.1 3. Institutional deliveries (%) 21.2 17.8 40.9 47.0

4. Children 12-23 months age fully immunised (%) 25.7 54.1 45.9 54.1

5. Children age 6-35 months exclusively breastfed for at least 6 months (%) 7.8 49.5 22.7 24.9

6. Children with diarrhoea in the last 2 weeks who received ORS (%) 24.9 21.3 30.3 33.7

7. Use of any modern contraceptive method (%) 31.1 30.8 45.2 47.3

8. Total unmet need for family planning - both spacing methods and terminal methods (%) 34.2 34.7 21.4 21.5

* - Provisional results for DLHS-3 B. Trends in Financial Expenditure

(Rs. crores) FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 Release 40.60 21.41 22.15 81.55 Audited Expenditure 9.92 12.95 20.81 162.28* * - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided. - Allocation for 2008-09: Rs. 163.45 crores.

C. Progress on Key Strategies

1. Demand side interventions

S. No.

Indicators

Achievement (no. of beneficiaries) 2005–06 2006–07 2007–08 2008–09

1. Janani Suraksha Yojana NA 1,23,910 2,51,867 4,77,890 a. Total Sterilisation 84,613 1,01,297 1,06,383 na b. IUD Insertions 71,583 73,673 85,376 na

(Source: M&E Division reports, and JSY reports from the states)

Jharkhand

16

2. Technical interventions

S. No.

Indicators

Achievement upto March 2009 Number %

1. No. of First Referral Units (FRUs) operationalised 32 14.8 (against the target of 216 FRUs)

2. No. of PHCs operationalised to provide 24-hour services 194 117.6 (against the target of 165 PHCs)

3. No. of private institutions accredited under JSY 139 4. No. of districts implementing Integrated Management of

Neonatal & Childhood Illness (IMNCI) 15 62.5 (out of 24

districts) 5. No. of people trained in IMNCI 4500 NA 6. No. of Village Health & Nutrition Days (VHNDs) held 2,90,801 NA

(Source: NRHM MIS report, April 2009)

Jharkhand

17

Immunization

Evaluated Immunization Coverage

Survey Indicator

NFHS 1 (1992-93)

NFHS 2 (1998-

99)

NFHS 3 (2005-

06)

CES (2005)

CES (2006)

DLHS 2 (2002-

04)

DLHS3 (2007-

08) FI NA 8.8 34.5 45.7 52.1 25.7 54.1

BCG NA 44.3 72.9 76.5 83.8 50.8 85.0 Measles NA 18.2 48.0 58.0 62.2 31.2 70.5

DPT 3 NA 21.6 40.3 57.8 57.9 35.6 62.6

Progress

� As per the various evaluated surveys the immunization coverage shows an improving trend with

full immunization increasing from 8.8 % in 1998-99 (NFHS-2) to 54.1 % in 2007-08 (DLHS 3)

� There has been a very good progress in immunization trainings of the health workers (4965/5576)

with 89 % of training completed.

� The state has constituted AEFI committees at the State and all the districts. The AEFI

sensitization workshop was also conducted in 2008.

� All the districts have been uploading data on RIMS.

Issues

� The State continues to have high dropout from BCG to DPT 3 which is critical for further

improvement in full immunization coverage. As per DLHS3 Survey there are 37.4 %

unimmunized children (based on DPT3 Coverage) which translates to around 4.6 lakh children

per year.

� The State continues to have disparity between the reported and evaluated coverage.

� The fund utilization under Immunization is low for the year 2008-09.

� The tracking of beneficiaries by the ASHA need to be improved.

Jharkhand

18

Brief on National TB Control Programme in Jharkhand 1. Infrastructure

Total Population - 304 lakh No. of Districts - 22 No. of Tuberculosis Units (Tus) - 68 No. of Designated Microscopy Centres (DMCs) - 298

2. Status of Implementation

• Implementing RNTCP since July 2005

3. State level performance (Based on quarterly reports for 1st quarter 09) • Referral of TB suspects is very low. Overall only 110 TB suspects/lakh are examined. • TCD rate of 121/lakh is also very low. However, NSP case detection rate of 53/lakh

(71%) is satisfactory but due to wrong categorization of sputum positive patients. • Sputum conversion rate of 91% is satisfactory but cure rate of 83% in NSP patients is

again on the lower side.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Qtr

1-00

Qtr

2-00

Qtr

3-00

Qtr

4-00

Qtr

1-01

Qtr

2-01

Qtr

3-01

Qtr

4-01

Qtr

1-02

Qtr

2-02

Qtr

3-02

Qtr

4-02

Qtr

1-03

Qtr

2-03

Qtr

3-03

Qtr

4-03

Qtr

1-04

Qtr

2-04

Qtr

3-04

Qtr

4-04

Qtr

1-05

Qtr

2-05

Qtr

3-05

Qtr

4-05

Qtr

1-06

Qtr

2-06

Qtr

3-06

Qtr

4-06

Qtr

1-07

Qtr

2-07

Qtr

3-07

Qtr

4-07

Qtr

1-08

Qtr

2-08

Qtr

3-08

Qtr

4-08

Qtr

1-09

Annualised New S+ve CDR Success rate

•Population projected from 2001 census

•Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)

Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, Jharkhand, 2000-2009*

Jharkhand

19

4. District wise Performance: (Based on quarterly reports for 1st Quarter 2009) • 8 (36%) of 22 districts have very low TCD rate of <102/lakh (50%) but only one district

(Godda) has low NSPCD rate of <38/lakh (50% of expected TB patients). • Sputum conversion rate is very low (<85%) in 2 districts of Godda and Koderma but the

cure rate is very low (<80%) in 5 districts (Chgatra, Godda, Hazaribagh, Koderma and Paschimi Singhbhum).

Name of the District

Suspects examined per

lakh population

Annualised total case detection rate (against

>144/lakh)

Annualised new sputum positive case

detection rate (against >53/lakh)

Sputum conversion

rate (against >90.0%)

Cure rate (against >85.0%)

Bokaro 131 136 52 70% 90% 88% Chatra 73 87 46 61% 94% 78% Deoghar 119 90 56 74% 95% 91% Dhanbad 117 118 59 79% 92% 86% Dumka 113 173 55 74% 93% 90% Garhwa 118 158 57 76% 94% 87% Giridih 102 103 52 69% 93% 85% Godda 61 63 30 40% 58% 44% Gumla 88 86 53 71% 90% 85% Hazaribagh 119 116 52 70% 85% 76% Jamtara 116 111 56 75% 93% 90% Kodarma 105 84 50 66% 84% 57% Lathehar 125 124 66 89% 92% 84% Lohardaga 110 105 52 70% 90% 89% Pakaur 107 97 42 56% 93% 85% Palamu 140 157 66 87% 93% 90% Pashchimi Singhbhum 76 135 57 76% 92% 76%

Purbi Singhbhum 107 123 55 73% 91% 87% Ranchi 111 138 52 70% 92% 81% Sahibganj 116 159 43 57% 97% 89% Saraikela-Kharsawan 117 99 53 70% 93% 85%

Simdega 102 98 58 78% 86% 81% Total 110 121 53 71% 91% 83%

5. Funds Status as on 31st March 2009 (Rs. in lakh)

C/F Release Expenditure Balance 164.00 465.00 498.26 130.74

6. Drugs

Drugs have been issued based on the requirement projected in the quarterly reports.

Jharkhand

20

7. Issues

• Human Resource o STO is not full time. State needs a full time STO preferably with 2-3 years service

left. o Post of DTO in Sabhiganj is vacant for more than 2 years and DTO is Lathehar,

Chatra, Pakur and Lohardagga are not full time. They all have additional charge of DTO alongwith their original posts.

o Post of 10 MO-TCs, 3 STSs, 2 STLSs and 25 LTs including 5 at IRL are also vacant. o Communication facilitators not appointed.

• Drugs and Logistics

o Poor drug management at every level. o Transportation of drugs from State to districts delayed due to no contract with

transport company. Tender published but no response from any transporter. o Supply of drugs from district level to TUs and PHIs is on an ad-hoc basis and not as

per guidelines.

• Supervision & Monitoring – Supervisory activities are sub-optimal at all levels. State & District level Officers are not making supervisory visits as per protocol. Involvement of MO-TCs is minimal.

• Performance

o Only 110 TB suspects examined/lakh pop in 1st quarter 2009 which is very low as compared to national average of 152/lakh. In 4 districts less than 100 TB suspects/lakh population examined.

o TCD rate of 121/lakh against expected case detection rate of 144/lakh is very low. 8 districts have very low TCD rate of <102/lakh (50%).

o NSP case detection rate of 53/lakh (71%) is good and only 1 district has NSP case detection rate of <38/lakh (50%). However, this appears to be due to wrong categorization of sputum positive patients.

o Retreatment sputum positive patients are only 14% of all sputum positive patients which indicates wrong categorization of sputum positive patients which has perhaps increased NSP case detection rate. In 20 districts retreatment sputum positive patients are <20%. It is why NSP case detection rate is good but TCD rate is low. All DTOs should ensure correct categorization of TB patients.

o Sputum conversion rate of 91% is satisfactory but and cure rate of 83% in NSP patients is low. Cure rate is very low (<80%) in 4 districts (Godda, Hazaribagh, Koderma and Paschimi Singhbhum).

• TB-HIV Collaboration

o State Level Coordination Committee and Technical Working Group are formed. Districts Level Coordination Committees also formed but Meetings of DCC not regularly held.

o Cross referral is happening only at some places but line listing and regular reporting has to begin.

• Intermediate Reference Laboratory (IRL)

o Instrument supplied from CTD, installed. o Culture and DST being done. o Lab is under process of accreditation (expected to be by September 09). o Civil work for walk in Cold Room and Incubator completed and work order for

equipment placed (expected functioning by end of June 09).

Jharkhand

21

o IRL Lab requires uninterrupted power supply. Allotment of Budget for fuel of genset (available with sanatorium) is required.

o Visits by IRL team have reported problems with binocular microscopes, quality of reagents and slides.

o Approximately 47% of DMCs have reported high false errors during RBRC. Quality of sputum microscopy needs improvement.

• STDC – United Bihar has 2 STDCs (Patna and Darbhanga). After diversion of Bihar both

the STDCs went with Bihar and Jharkhand left with non. At present STDC is functioning with nomination of staff from Itki Sanatorium. For better Technical Support STDC needs to be established with sanction of Posts by Government.

• DOTS Plus – Final approval of DOTS Plus Site still awaited. • IEC Activities

o Advocacy, communication and social mobilization activities are minimal. IEC action plan is not being implemented.

o IEC materials in local tribal dialects need to be prepared by the State.

• Tribal Action Plan - Tribal action plan for tribal districts (except little progress in Gumla, Lohardaga and Simdega) is yet to be implemented.

• Involvement of NGOs and other sectors

o Involvement of Other Sector Health Facilities needs to be improved in Railways, Coal India, etc.

o Majority of NGOs and PPs are involved in unsigned schemes

Jharkhand

22

Fact Sheet on NVBDCP - Jharkhand Background Information • The State has 22 districts with a population of 26.9 million. There are 194 CHCs, 330 PHCs, 3958

Sub-centres and 32615 villages. There are 4372 Multipurpose worker (Female)/ANM, 4291 Health worker (Male) MPW (M), 278 Heath Assistant (Female (LHV), 118 heath Assistant (Male) and 239 Laboratory Technicians. In addition, state has 4274 functioning Fever Treatment Depots (FTDs). The high endemic districts have been covered under Global Fund (7 districts) and World Bank (15 districts) Supported Project for additional inputs to intensify malaria control activities.

Malaria Epidemiological Situation

Year Total Slide examined

Total Malaria Cases

Total Pf Cases Deaths

2006 2095301 193888 48388 4

2007 2000462 184878 45926 31

2008 2529898 212496 74178 25

2009 (Upto Mar) 538676 36275 13772 1

• State is being provided Rapid Diagnostic Kits for early diagnosis of Pf cases and ACT for effective treatment of P.falciparum cases.

• Under World Bank project, 15 district level VBD Consultant, 72 MTS, 36 LTs have been sanctioned to the state.

Elimination of Lymphatic Filariasis

• The goal of Elimination of Lymphatic Filariasis in the country is set to be achieved by 2015. In pursuance to achieve this, Government of India during 2004 initiated Mass Drug Administration (MDA) with annual single dose of DEC tablets to all the population living at the risk of filariasis excluding pregnant women, children below 2 years of age and seriously ill persons. The population coverage of MDA in the state was 46.13% in 2004, 73.72% in 2005, 73.60% in 2006, 80.03% in 2007 and 84.64% in 2008.

• Line listing of Lymphoedema and Hydrocele cases was also initiated in 2004 for morbidity management and as per updated report (2007), there are 73263 Lymphoedema and 27908 Hydrocele cases.

KALA-AZAR

• Kala-azar is the major problem in four districts namely Godda, Pakur, Sahibganj and Dumka. World Bank has agreed to support Catholic Missionary in Jharkhand through NVBDCP for the EDPT and case management of Kala-azar cases. Kala-azar incidence as reported is given below:

Year Cases Deaths 2006 7508 11 2007 4803 20 2008 3690 5 2009 (Upto March) 169 0

Jharkhand

23

Dengue, Japanese Encephalitis & Chikungunya are not reported in the state of Jharkhand. Central Assistance

(Rs. In lakhs) Year Allocation Release/Expenditure

Cash Kind Total Cash Kind Total 2004-05 156.59 1690.15 1846.74 136.74 1035.97 1172.71 2005-06 233.84 1504.66 1738.50 380.65 1366.06 1746.71 2006-07 778.85 2573.61 3352.46 505.64 2357.00 2862.64 2007-08 871.42 2103.66 2975.08 510.71 1566.04 2076.75 2008-09 1686.62 1761.81 3448.43 1211.06 2227.19 3438.25

2009-10(B.E.) 1575.25 2875.38 4450.63 Issues: Malaria

• The state has to yet to fill up 90 contractual male MPW against the 1116 sanctioned posts. Apart from the vacant posts of regular surveillance worker/MPW (Male) should be filled up.

• 6 posts of Lab. Technician are yet to be filled up against 16 sanctioned posts. All the ASHAs need to be trained in use of RDTs and delivery of antimalarials.

• Out of 95 malaria technical supervisor provided under GFATM (17) and World Bank Project (72) so far state has filled up only 51.

• Assistance is being provided for performance based incentive in seven high malaria endemic districts by the Centre. For remaining malaria high endemic districts, similar provision may be made through the funds provided to village sanitation committee.

• State needs to intensify efforts to reduce malaria mortality by establishing proper effective referral mechanism and treatment facilities for severe cases.

• The quality spray has to be ensured through intensive supervised spray activities.

Filaria

• State needs to gear up for hydrocele operation and complete the mapping to show the updated number of lymphoedema and hydrocele.

Kala-azar

• Provision of individual patient boxes for complete treatment compliance. • Strengthening of supervision and monitoring at District/PHC/Sub-centre level. • Provision of free diet to all indoor kala-azar patients to be ensured at all districts hospitals and

PHCs.

Jharkhand

24

National Leprosy Eradication Programme

• Epidemiological scenario- The state has achieved the goal of elimination of leprosy (i.e. prevalence rate of less than 1 case /10000 population) in 2008-09. There were 2941 leprosy cases on record as on March 2009.

• New case detection and treatment completion-

During 2008-09, a total of 5181 new leprosy cases were detected as compared to 6799 new cases detected during the corresponding period of previous year. Out of 5700 cases discharged during the year, 5369 cases (94.2%) were released as cured after completing treatment.

• Reconstructive Surgery for leprosy affected persons- There are 2 Govt. institutions and 3 NGO institution providing reconstructive surgery services to leprosy affected persons with disability in the state. In the year 2008-09, about 20 reconstructive surgeries were performed in these institutions.

• NLEP action plan for the year 2009-10 amounting to 172 lakhs has been approved for the state.

Issues -

1. The state has reported low level of fund utilization in 2008-09. During 2008-09, the state action plan was approved for Rs.201.5 lakhs, however the state could utilize only Rs. 114 lakhs.

2. Large numbers of new leprosy cases are being detected in the state every year which suggest active transmission of the disease in the community. The state is advised to carry out in-depth situational analysis in districts/blocks reporting large number of new cases and take suitable actions like –

(i) Ensuring completion of treatment in each of the new cases detected. (ii) Enhance awareness of the community to improve self reporting of suspected

cases to health facility and (iii) Carrying out family contact survey against all multibacillary and child cases.

3. The state has listed around 1500 grade II disability cases in last 5 years. There are 2 Govt.

institutions and 3 NGO institution providing reconstructive surgery services to leprosy affected persons with disability. The state should send proposals of these centres to GOI for recognition and utilize the services of these institutions effectively for conducting RCS so that the backlog of leprosy cases with disability could be reduced.

4. There are about 48 leprosy colonies in the state. The state should ensure provision of proper health care facilities like ulcer care, provision of supportive drugs and dressing materials to the persons affected with leprosy residing in these colonies.

Jharkhand

25

Integrated Disease Surveillance Project (IDSP) The state of Jharkhand has an area of 79,714 sq. km. and a population of 26.9 million. There are 22 districts, 211 blocks and 32615 villages. There are 330 PHC &194 CHC in the state. The State has population density of 338 per sq. km. (as against the national average of 312). (source:www.mohfw.nic.in/nrhm.htm) Jharkhand is a Phase-III state under IDSP and has been inducted into the programme during 2007-08.The state PIP was received and MoU was signed with GoI on 28.9.07. Dr. Pradeep Baskey, Joint Director from Directorate Health Services, Govt of Jharkhand has been designated as the State Surveillance Officer. The first instalment of Grant in Aid in the project of Rs. 100 lakhs has been released on 18.11.07. The component wise action points are as under:

1. Manpower • Contractual staff at State surveillance unit and District Surveillance Units to be appointed. • Data managers have not been deployed in six districts. For recruitment of Data managers a letter

from CSU to SSO(Jharkhand) was sent vide letter no:T/18015/17/04-IDSP dated 26.3.09 to which SSO(Jharkhand)has communicated that the process of deployment of selected Data managers will be completed within one week.

• The offer letters to the recommended candidates for the positions of state /district epidemiologists (22),microbiologists(2) & State Entomologist(1) has been issued by State NRHM. Only 1 State Entomologist and 2 District Epidemiologists have joined till 29.5.09.

2. IT & EDUSAT

• Satellite Interactive Terminal (SIT) equipments are delivered and installed at the State

Surveillance Unit (SSU) but yet to be installed at 3 Medical Colleges at (Jamshedpur, Dhanbad and Ranchi).

• Broadband connectivity has been established at the SSU, all 3 medical colleges and 10 Districts Surveillance Units.

• Data Centre equipments are installed at SSU, all the three Medical Colleges and 20 DSUs except at Bokaro and Giridih due to non availability of sites.

• Training Centre Equipments has been installed at the SSU, and delivered at 3 medical colleges.

3. Training

• Proposed dates for ToT training for programme officers is June,2009. Confirmation is being obtained from Chatrapati Sahuji Medical University, Lucknow, which has been identified as the training institute for Jharkhand.

4. Laboratory Strengthening

• One Priority district laboratory at District Hospital, Deoghar has been identified for strengthening

under IDSP. • A network of 4-5 state reference laboratories (i.e Medical colleges/ICMR institutions) need to be

identified for strengthening for which one time contingency grant of Rs 2 lakhs per lab and Rs 3 lakhs for tests conducted on pro rata basis can be paid from IDSP fund on annual basis.

Jharkhand

26

5. Data Reporting • Data reporting has started from Gumla, Jamtara & Sareikella.Data reporting on S,P,L forms an for

outbreaks have to be intiated from all the reporting units of the other 19 districts in Jharkhand by using IDSP portal (www.idsp.nic.in) which is one stop portal & has data entry,data analysis and resource sections.

6. Outbreak

Year Number Type 2008 2 Acute Diarrhoeal Disease,

Malaria 2009 1 Malaria • Total no of outbreaks reported through Media Scanning &Verification Cell is 3 for 2008-09.

7. Finance: (in lakhs) Year Release Expenditure 2007-08 100.0 lakhs 0 2008-09 3.17 Balance - 96.83 lakhs • An amount of Rs 100.00 lakhs has been released as grant in aid in November 2007. The total

balance at present is 96.83 lakhs. • Audit report & utilization certificate for 2007-08 has been received at CSU. • Financial Monitoring Report (FMR) for quarterly ending March 2009, has been received at CSU.

Jharkhand

27

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

STATUS NOTE ON JHARKHAND Magnitude:

Prevalence of blindness 2003-04 1.41% Estimated blind persons 3.80 lakhs Cataract Performance

YEAR TARGET ACHIEVEMENT

2007-2008 75000 71516 2008-2009 75000 72037

School Eye Screening

YEAR TEACHER TRAINED IN SCREENING FOR REFRACTIVE ERRORS

SCREENED DETECTED WITH REFRACTIVE ERRORS

PROVIDED FREE

GLASSES

2007-2008 2685 885952 22168 6149 2008-2009 646 76118 6371 700

GIA released to Distt. Blindness Control Societies /State Blindness Control Society

(Rs in lakhs)

YEAR RELEASED EXPENDITURE BALANCE 2007-2008 169.00 217.44 -48.44 2008-2009 365.65 575.05 -209.40

Issues

• UCs for GIA released to State Blindness Control Society are not being • Received timely. • SOE for Cash Grant are also not being received timely. • Performance of School Eye Screening Programme needs to be improved. • Cataract performance is low compare to many other states IOL implementation percentage is

less than the National Average. • IOL implementation percentage is less than the National Average. • Lack of dedicated Ots/Eye Wards in most of the Dist. Hospitals.

Jharkhand

28

NIDDCP

Approval issued for the year 2009-10

Rs. Lakh

Activity Amount proposed

Amount Remarks

Approved

1 Establishment of IDD Control Cell 7.5 6

2 Establishment of IDD Monitoring Lab - 3.5

There is no fund provision for workshops, training and maintenance under

NIDDCP. The state government may carry out

activities as per fund allocation of GOI

3 Health Education and Publicity 6.95 12

4 IDD surveys 5 2.5

5 Workshop& training 9.55 -

6 Lab maintenance 1 -

Total 30 24

Jharkhand

29

Mapping of Record of Proceedings of the NPCC of NRHM for 2005-06 to 2009-10

This has been prepared to indicate allocations to the State in the previous years for different activities as per the State Programme Implementation Plan. The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in following broad thematic chapters.

1. ASHA (including selection, training, drug kits, mentoring, specific performance incentives and anything else associated with ASHA)

2. Infrastructure related matters (including construction, strengthening, renovation, new construction etc), equipments, transport (ambulances, EMRI, associated expenses) and others)

3. Human Resource related matters (including HR salary, contractual payments, incentives, etc)

4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC, IDHAP, M&E, Mobility support to SHS etc)

5. Untied funds, AMG & RKS related mattes 6. Training & Capacity Building related matters (including trainings, workshops, training

institutions including their upgradation or new construction, courses, etc) 7. Innovations (including Procurement of medicines, School Health, Health Mela,

Insurance, Accreditations, Monthly VHND etc)

NATIONAL RURAL HEALTH MISSION Jharkhand

Total MFP Approval 4904.77 12,11,058 11848.85 15899.38

RoP Approvals for Various Years in Rs. Lakh

S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10 Remarks Released Approved Approved Approved Approved

ASHAs

1 ASHA 514 500 2379.21 1906.52 829.7

2

Performance Based Recognition and Awards

1.44

3

Block level quarterly meeting of Sahiyyas (Rs.2000 per block per meeting)

8.48

4

State level quarterly meeting of Sahiyya mentoring group (Rs. 25000 per meeting)

1

5 Sahiyya Sammelan (Division wise) 15

TOTAL 514 500 2379.21 1906.52 855.62 Infrastructure related matters (physical infrs, equipments, mobile clinics, drugs, kits, consumables)

6 Construction of CHCs 176 1571.79 2440.00 1825

Jharkhand

30

7 Construction of PHC 1401 500

8 Construction of Sub-Centre 744 1095

9

Institutional strengthening

12

10 ANMTC strengthening 51.545 68

11 MMU 50 80 600

12 Operational cost of MMU 360

13 Telephone at CHC 27.16

TOTAL 176 1700.50 2440.00 4410 2275.00

Human Resources related matters 14 Human Resources

15 Specialists 360 450

400

16 Allowance to Specialists 42.6

17 Medical Officers

250

18 AYUSH- Salary of Contractual MOs 87.3

19 AYUSH- Paramedics 34.92 20 Hospital Managers 35 21 Staff Nurse 559.44 583 300 22 Radiologist 100 23 Lab Technician 100 24 Pharmacist 100

25 Contractual ANM 3045 2520

3000

26 Recruitment of ANM 1600

27 Recognition of Service providers 5

28 Consultant Quality

28.2

29 HR for Cold Chain

44.7

Jharkhand

31

30 Programme Coordinators 69.36

31 Institute of Public Health 30

TOTAL 0 3964.44 3553 6227.08

Programme Management related matters

32 Preparation of IDHAP 110

33 Programme Management

285.78

632.82 80.28 114.4

34

Block Programme Management Unit 235.05 234.78

35

District level quarterly meeting of master trainers and block facilitators (Rs. 5000 per district per meeting)

4.8

36

Preparation and printing of Handbook and other manuals for state, district and block level officers and managers

5

37

Recruitment process cost including advertisement in local daily and other recruitment cost

2

38

Outsourcing of services like Gen set, Diating etc.

100

39 Establishment cost-AYUSH 5

40

IEC Development, Sahiya diary etc 56.6

41 Establishment Costs 2

42 Provision for Mobile to HSCs & PHCs

15

43 Recurring Cost of Mobile 50

TOTAL 110 285.78 632.82 315.33 589.58 Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters

44 Rogi Kalyan Samiti

300 199.23

682

45 Rogi Kalyan Samiti @ PHC, CHC, DH

46 Rogi Kalyan Samiti- DH 95.00

Jharkhand

32

47 Rogi Kalyan Samiti- SDH 6.00

48 Rogi Kalyan Samiti- Referral hospital 32

49 Rogi Kalyan Samiti- CHC 194

50 Rogi Kalyan Samiti-PHC/APHC 330

51 Untied Fund

2575.3

52 Untied Fund for CHC 97 97 53 Untied Fund for PHC 140.25 82.5 82.5

54 Untied Fund for SC 511 395.5 395.8 382

55 Untied Fund for VHSC 384 119 1000

56 Annual Maintenance Grant- SDH

530.4

57

Annual Maintenance Grant - CHC 83 194

58 Annual Maintenance Grant -PHC 280.5 97 165

59 Annual Maintenance Grant- SC 175

TOTAL 511 1680.25 893.53 2752.50 3787.70 Training & Capacity Building related matters

60 Strengthening of Nursing Schools 200

61

VHND, Visioning workshops and performance related incentives

21.09 550.53

1 .

62

Selection, training remuneration of Specialist at CHC

55.92

63 Selecton, training and remuneration of MOs 76.56

64

Selection , training and remuneration of ANMs

392.415

65 Training of RMP/TBA 3.48

66 Capacity Building Needs 51.84

67

Orientation and training of state & district committee members on convergence issues

6.5

68 State Training of Trainers (5 days) 1

Jharkhand

33

69

AYUSH-State ToT; District level Training

2.15

70

Trainings for members of DHS & Rogi Kalyan Samitis

8.6

71 Induction training and exposure visit 4

TOTAL 601.305 550.53 200 23.25 Innovations related matters

72 Social mobilisation and advocacy 4.4

73 PHC Management through PPP 40 120

74

Promotion of health through Community Radio

18.15 25

75 Telemedicine 50 76 Health Melas 112

77 School Health Programme 10 633

78 Resources for surveys 163.1

79 Health Programme for Women Group 14.92

80 Procurement of Sanitary napkins 125 50

81

Procurement of Family Planning equipment

45

82 Drug Kit B for Sub centre 395.80 100

83 Essential Obstetric Care Drugs kit 23

84

Emergency Obstetric Care Drugs kit for CHC/ FRU 278

300

85 Kit for the Sub centre for SBA 100

86 Kit for PHC for SBA 28.75

87 SBA Kit for CHC / FRU 31.72

88 Kit A for Sub centre 500

89

Kit for Sick new born child / neo-natal resuscitation Kit for PHC

0.86

90 Kit for Sick new born child for FRU/CHC

7.14

91 First AID kit refilling 300

Jharkhand

34

92 Procurement of HBNC Kit 150

93 Monitoring & Evaluation

98.4

94 MIS 17 95 IDD control cell 22.1

96 Kala-azar (PPP) activities 19.6

97

Decentralised procurement of bed nets for NVBDCP

232.18

98 ISO certification of DH, CHC 111

TOTAL 278 136.92 1250.05 320 2141.15

Jharkhand

35

District wise Information on Jharkhand under some RCH indicators

Districts Mother received at least one TT

injection

Institutional Deliveries Full Vaccination Contraceptive

Use

India 73.5 47 69.6 54.1 Jharkhand 54.4 17.8 70.5 34.9

Bokaro 67 31.9 70.4 51.7 Chatra 43.1 14.4 59.9 32.3

Deoghar 44.3 16.2 55.9 37.4 Dhanbad 68.5 35.4 67.1 49 Dumka 62.6 9.2 71.3 36.5

East Singh Bhumi 82.6 49 98 47.7 Garhwa 52.7 10.8 84 44.7 Girdih 37.5 16.6 44.6 24.1 Godda 39.8 10.7 50.2 21.4 Gumla 62.6 10.3 84.9 32

Hazaribag 73.3 25.8 80.5 47.1 Jamtara. 45.3 17.8 53.5 29.7 Kodarma 50.4 27.1 60.3 30.7 Latehar 59.3 11.4 87.2 32.8

Lohardaga 63.6 20.9 96.5 34.1 Pakur 47.1 10.8 65.2 15.6

Palamu 41.5 18 66.5 39.9 Ranchi 67.1 27.4 90.1 39.8

Sahebganj 46 6 63.1 28 Saraikela 70.5 24.4 91.5 37.4 Simdega 67 10.1 83.5 23.4

West Singh Bhumi 65.2 21.9 78.5 27.9 source DLHS-III