NATIONAL RURAL HEALTH MISSION

1
NATIONAL RURAL HEALTH MISSION FOR HONBLE HEALTH
MINISTER 13TH DECEMBER 2008
PRESENTATION
2
NATIONAL RURAL HEALTH MISSION (2005-2012)

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

3
HISTORICAL PROSPECTIVE

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

4
NRHM OBJECTIVES

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

5
Community PartnershipVillage level planning
ASHAVillage Health Nutrition DaysVillage
Health Sanitation CommitteesIncreased
involvement of PRIs
KEY COMPONENTS OF NRHM
Improved services

• System strengthening
• Infrastructure development
• Monitoring through computerisation
• Improved financial management
• Human Resource
• Public Private Partnership
• Telemedicine
• Mobile Medical Units
• Intra inter sectoral convergence

• 24-Hour- delivery services
• Emergency Obstetric Services
• Specialist Services On call/contract
• Immunization strengthening
• IMNCI
• Adolescent health
• Family welfare services

Accessibility, Approachability and Quality
6
NRHM STRATEGIES

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

7
NRHM ILLUSTRATIVE STRUCTURE
Health Manager
BLOCK LEVEL HEALTH OFFICE ---------------
Accountant
Store Keeper
100,000 Population 100 Villages
Accredit private providers for public health goals
BLOCK LEVEL HOSPITAL
Strengthen Ambulance/ transport Services Increase
availability of Nurses Provide Telephones Encourag
e fixed day clinics
Ambulance Telephone Obstetric/Surgical
Medical Emergencies 24 X 7 Round the Clock
Services
30-40 Villages
CLUSTER OF GPs PHC LEVEL
3 Staff Nurses 1 LHV for 4-5 SHCs Ambulance/hire
d vehicle Fixed Day MCH/Immunization Clinics
Telephone MO i/c Ayush Doctor Emergencies that
can be handled by Nurses 24 X 7 Round the
Clock Services Drugs TB / Malaria etc. tests
5-6 Villages
GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1
male MPW FOR 5-6 Villages Telephone Link
MCH/Immunization Days Drugs MCH Clinic
VILLAGE LEVEL ASHA, AWW, VH SC
ASHAs, AWWs in every village Village Health
Nutrition Day Drug Kit, Referral chains
8
NRHM FIVE COMPONENTS
(PART- A) RCH AND RELATED ACTIVITIES (RCH FLEXI
POOL)
(PART- B) INITIATIVES UNDER NRHM OTHER THAN
RCH (MISSION FLEXI POOL)
(PART- C) IMMUNIZATION STRENGTHENING PROGRAMME
(PART- D) NATIONAL DISEASE CONTROL PROGRAMMES
(PART- E) INTER SECTORAL CONVERGENCE SCHEMES
9
INSTITUTIONAL ARRANGEMETS UNDER NRHM

• STATE LEVEL
• State Health Mission chaired by Honble Chief
  Minister.
• State Health Society chaired by Chief Secretary.
• Merger of all vertical societies into State
  Health Society.
• Signing of MoU with GoI.
• State Level Planning and Monitoring Committee
  headed by Honble Health Minister

10
INSTITUTIONAL ARRANGEMETS UNDER NRHM

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

11
..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM

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

12
HEALTH INDICATORS
India Punjab Best State Best State
Birth Rate (SRS 2007) 23.1 17.6 14.6 14.7 Manipur Kerala
Death Rate (SRS 2007) 7.4 7.0 4.4 4.8 Manipur Delhi
Life Expectancy at birth 62.15 68.25 73.5 Kerala
Sex Ratio (Census 2001) 933 876 1001 1058 Pondicherry Kerala
IMR (SRS 2007) 55 43 12 13 Manipur Kerala
TFR (SRS 2005) 2.9 2.1 1.7 Kerala
Maternal Mortality Ratio (SRS 2005) 301 178 110 Kerala
Ante Natal Care (at least 3 checkup) () (NFHS III) 50.7 72.5 96.5 T.Nadu
Institution Delivery () (NFHS III) 41 53 100 Kerala
Contraceptive Use () (NFHS III) 56 63.3 73 HP
Vaccine coverage () (NFHS III) 44 60 81 T.Nadu
13
TARGETS FOR PUNJAB UNDER NRHM
Indicators At the start of RCH SRS 1998-1999 Present Status 2007-2008 Target by 2009-2010
Total Fertility Rate 2.5 2.1 1.8
Infant Mortality Rate (per 1000 live births) 49 44 lt30
Maternal Mortality Ratio (per 100000 live births) 199 178 lt100
Institutional Deliveries 37.5 (NFHS II) 52.5 80
ANC Check-up with 03 contacts 58.4 (NFHS II) 72.5 100
14
HEALTH INSTITUTIONS
INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR
MEDICAL COLLEGES 3 5
DISTRICT HOPITALS 20 983
SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78) 38 983
COMMUNITY HEALTH CENTRES 127 (112 PHSC, 15 DHS) 983
BLOCK PHCs 118
BLOCK PHCs AND SDH 6
BLOCK PHCs AND CHCs 70
ONLY (EXCLUSIVE) BLOCK PHCs 42
15
HEALTH INSTITUTIONS
INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR
PHCs (MINI PHCs) EXCLUSIVE 352
PHCs BLOCK EXCLUSIVE 42
TOTAL PHCs EXCLUSIVE 394
TOTAL PHCs EXCLUSIVE AT CHC/SDH 394 76 470
SUBSIDIARY HEALTH CENTERS 1187
SUB-CENTRES AT VILLAGE LEVEL 2858
CLINICS /DISPENSARIES 3046
16
NRHM BUDGET OVER THE YEARS
17
PROGRAMME IMPLEMENTATION PLAN

• NRHM is a centrally sponsored scheme. For Year
  2005-06 and 2006-07, GoI contribution was 100,
  from Year 2007-08, GoI contribution is 85 and
  state contribution is 15.
• Every year State Health allocation to increase at
  least 10 of the previous year.
• State Govt. is required to prepare a Programme
  Implementation Plan (SPIP). It is discussed with
  Ministry of Health, GoI and then approved by it.
• After approval of SPIP the funds are released by
  GoI and the Sate Govt.
• Minor changes in PIP can be made and major
  changes are allowed only with the approval of GoI.

18
FINANCIAL REPORT FOR THE YEAR 2005-09
Rs. in lakhs
Year Op Balance Approved Plan Approved Plan Approved Plan Releases Releases Releases   Expenditure Incurred   of Utilization   Unspent Balance
Year Op Balance GOI State Share 15 from 2007-08 Total Funds released by GOI Funds released by State Total Funds Available   Expenditure Incurred   of Utilization   Unspent Balance
1 2 3 4 5 6 7 8 (267) 9 10 11 (8-9)
2005-06 283.20 9820.78 Not Required 9820.78 8103.25 0.00 8386.45 5971.37 61 2415.08
2006-07 2415.08 16271.85 Not Required 16271.85 14194.06 0.00 16609.14 8326.24 46 8282.90
2007-08 8282.90 16196.72 2841.00 19037.72 11516.27 705.00 20504.17 16657.93 84 3846.24
2008-09 (Up to Oct 08) 3846.24 19923.00 3000.00 22923.00 5292.51 0.00 9138.75 7132.84 79 2005.91
19
FINANCIAL STATUS UPTO OCTOBER 2008 (DISTRICT
LEVEL)
Rs. in lakhs
SN Component Releases Expenditure
1 RCH II 1968.24 1133.70
2 NRHM Additionalities 1790.21 1183.95
3 Immunization PP 164.05 91.63
4 NDCP 366.61 366.61
5 Inter Sectoral Convergence 0.00 0.00
6 CSS Family Welfare Head 2211 2540.13 2540.13
   TOTAL 6829.20 5316.02
20
STATE OBLIGATIONS UNDER NRHM

• State signed MoU with Govt. of India in December
  2005 for implementation of NRHM

SN INITIATIVES STATE LEVEL DISTRICT LEVEL BLOCK LEVEL / VILLAGE LEVEL REMARKS
1 Setting up of the Health Missions On 26th October 2005 constituted. On 17th August 2005 constituted. Not applicable Completed
2 Incorporation of Health Societies Incorporated on 26th February 2007 Incorporated from 26th August 2005 to January 2006 Block Health Committees notified on 11/12/2007 Completed
2 Incorporation of Health Societies Incorporated on 26th February 2007 Incorporated from 26th August 2005 to January 2006 Village Health Sanitation Committees constituted on 21/10/2007. Completed
3 Integration of all vertical programmes of Health Family Welfare Department. Already Integrated Already Integrated Already Integrated Completed
4 Merger of different societies with State Health Society. Done on 21/12/2007 Being Done Not required Yet to be completed
5 Constitution of Rogi Kalyan Samities in all Health Institutions upto PHCs Not required Already notified and are operational At Block Level Community Health Centres already notified and are operational. Completed upto CHC but yet to be done in 484 PHCs
21
contd. STATE OBLIGATIONS UNDER NRHM
SN INITIATIVES STATE LEVEL DISTRICT LEVEL BLOCK LEVEL / VILLAGE LEVEL REMARKS
6 Recruitment of staff for Programme Management Units. Recruitment completed Recruitment completed Recruitment under process at block level. Being discussed separately
7 State and District Health Plans 2007-08 PIP submitted on 10th July 07 PIP approved on 25/9/07 Outlay-Rs.16196 lacs 2008-09 PIP submitted on 27th Feb 08 Approval of PIP received Outlay- Rs. 22923 lacs Facility Survey completed. Integrated District Health Action Plan ready for 20 districts. Facility survey upto Sub centre level completed. District Action Plans completed in all 20 districts
The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed.. The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed.. The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed.. The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed.. The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed.. The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is being signed..
22
WORK DONE - FUNDS
Component Amount/Scope 2007-08 2008-09 Remarks
Untied Funds Rs. 10,000 2858 SCs 2858 SCs Funds Released
Untied Funds Rs. 25,000 484 PHCs 484 PHCs Funds Released
Untied Funds Rs. 50,000 Nil 128 CHCs Funds Released
IPHS Rs. 20 Lacs 20 DHs Nil Funds Released
IPHS Rs. 20 Lacs 116 CHCs Nil Funds Released
Annual Maintenance Grant Rs. 50,000 484 PHCs 100 PHCs Funds Released
Annual Maintenance Grant Rs. 1 Lac Nil 112 CHCs Funds Released
Rogi Kalyan Samitis Rs.5 Lac 20 DHs Nil One Time Grant
Rogi Kalyan Samitis 1 Lac 36 SDHs  Nil One Time Grant
Rogi Kalyan Samitis 1 Lac 110 CHCs  Nil One Time Grant
Mobile Phones for ANMs 134 Lacs   4000 In Process
Application Solution for on line data transfer from ANMs to State Application Solution for on line data transfer from ANMs to State     In Process
23
WORK DONE MCH 24x7 PHCs

• 75 PHCs upgraded to 24x7 PHCs in 2007-08 and 26
  PHCs in 2008-09 for 24 hrs. delivery.
• 24x7 PHC 1 MO (F) and 3 Staff Nurses on
  contract basis.
• Out of 101 MO(F), 60 posts filled up leaving 41
  posts vacant.
• 34 Staff Nurses yet to be appointed.
• Posts advertised. Last date 20/12/2008
• Generator set provided at 75 and for remaining 26
  in process.
• Labour room etc. constructed

24
WORK DONE MCH - FRUs

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

25
WORK DONE 24 x7 PHCs and FRUs

• Signages for these 101 and 60 institutions being
  developed. Tender floated
• On line monitoring of performance of these
  institutions through PEC, work given.
• Biometric based on-line attendance system. Tender
  already received.

26
WORK DONE - MMUs

• 20 MMUs deployed in districts. 4 districts
  Amritsar, Jalandhar, Ludhiana and Mohali not
  provided with MMUs. 4 districts Faridkot,
  Bathinda, Mansa and Barnala have one additional
  MMUs.
• Cost of each MMU Rs. 36.00 lacks. Full Bus
  chassis used for MMUs. Has the facility of ECG,
  X-Ray and Lab.
• 1 MO(F), 1 MO(M), 1 Radiographer, 1 Lab
  Technician, 1 Staff Nurse, 1 Pharmacist (Regular)
  and 1 Driver and 1 Helper provided.
• 12 posts of MO(F) and 10 MO(M) vacant.
  Advertisement given.
• Instruction issued for free treatment and
  medicine (Rs. 7500 per month) issued.
• Tenders for GPS enabled tracking system invited
  and last date 15/12/2008.
• Decision regarding MMUs for the remaining 4
  districts yet to be taken.

27
WORK DONE - VHSCs

• NRHM implementation planned within the frame work
  of PRIs at different levels.
• Village Health Sanitation Committees formed in
  coordination with PRIs at each village level.The
  committee consists of ideally 11 member under
  the chair of Sarpanch/Panchayat Member and ANM or
  AWW as Member Secretary with 50 representation
  of women and due representation from weaker
  sections.
• 11418 VHSCs formed and remaining 1161 yet to be
  formed.
• Committee provided with annual grant of Rs
  10,000/- to be used as untied grant to meet
  village level public health activities. Funds
  already released to VHSCs (Total Rs. 11.31 Cr.
  In 2007-08)
• Headed by Panch / Sarpanch.

28

• WORK DONE - ASHA

• 15400 ASHAs selected in the State, 2356 yet to be
  selected
• ASHA - a female health activist in the community
  to create awareness on health and mobilize the
  community for utilization of the existing health
  services.
• One ASHA to cover 1000 population.
• ASHA to be a woman resident of the
  village-Married/Widow/Divorced preferably in the
  age group of 25 to 45 years with the formal
  education up to eighth class.
• Selection of ASHA to be made by the District
  Health Society under the supervision of Deputy
  Commissioner, and Civil Surgeon to be as District
  Nodal Officer.
• SMO at block level to be the Block Nodal Officer.
  
• Performance based incentive money of Rs. 3.96
  crore has already been released to District
  Health Societies for ASHAs for the year 2008-09
  Rs. 1.3 crore in 2007-08.

29
WORK DONE - TRAINING OF ASHAs

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

30
WORK DONE RECRUITMENT

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

31
WORK DONE RECRUITMENT

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

32
RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Director Finance 1 1 0 On Deputation
2 State Programme Manager 1 1 0 From State Govt.
3 Maternal Health Specialist 1 0 1 40,000 Rs 30,000/- from Dec Services have been terminated
4 Family Welfare Specialist 1 1 0 40,000 Rs 30,000/- from Dec
5 Procurement Manager 1 0 1 25,000 Advertisement for recruitment issued on 1/12/2008
6 Manager (HRD) 1 0 1 20,000 Officer Resigned Advertisement for recruitment issued on 1/12/2008
7 Manager (FA) 1 1 0 25,000
8 Manager (ME) 1 1 0 20,000
9 State NGO Coordinator 1 1 0 30,000
10 Programme Coordinator (ARSH Gender) 1 1 0 20,000
33
contd
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
11 Programme Coordinator (BCC) 1 1 0 20,000
12 Consultant (Admn) 1 0 1 20,000 Candidate resigned
13 Consultant (ME) 1 1 0 20,000
14 System Analyst 1 0 1 15,000 Officer Resigned Advertisement for recruitment issued on 1/12/2008
15 Accounts Officer 2 2 0 15,000
16 Statistical Assistant 4 4 0 10,000
17 Hardware Supervisor 1 1 0 10,000
19 Accountant-cum-Cashier 2 2 0 10,000
34
contd
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
20 Computer Assistant 4 4 0 8,000 Selection has been done for the vacant position candidate is yet to join
21 Office Assistant 9 9 0 7,000
23 Graphic Designer 1 1 0 10,000
24 Procurement Assistant 2 1 1 8,000 Candidates have been adjusted at State HQ from the districts
25 Drivers 2 0 2 5,000 Action is being initiated
26 Class-IV 3 2 1 3,000 Action is being initiated
Total Total 44 35 9
35
RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 District Programme Manager 20 18 2 20,000 Selection has been Done.
2 District Accounts Officer 20 17 3 15,000 Advertisement for recruitment issued on 1/12/2008
3 District Monitoring Evaluation Officer 20 20 0 15,000
4 Procurement Officer 20 4 16 15,000
5 Maintenance Engineer 20 17 3 12,000
6 Statistical Assistant 20 18 2 8,000 Advertisement for recruitment issued on 1/12/2008
7 Procurement Assistant 20 0 20 8,000 No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification
8 Accountant-cum-Cashier 20 17 3 8,000 Advertisement for recruitment issued on 1/12/2008
9 BCC Facilitator 20 20 0 8,000
Total 180
36
RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Block Statistical Assistant 118 98 20 8,000 Advertisement for recruitment issued on 1/12/2008
2 Block Accountant cum Cashier 118 93 25 8,000 Advertisement for recruitment issued on 1/12/2008
3. Computer Operator 173 155 18 5,000 Advertisement for recruitment issued on 1/12/2008
Total 409 346 63
37
RECRUITMENT - FRUs
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Obstetricians 60 2121 39 Rs. 25000/- Rs. 3000/- HRA Rs. 1000/ EmOC Rs. 500/- per delivery conducted Rs. 200/ MTP 28 Recruited, 7 resigned. Advertisement issued for 39 posts on 1/12/2008
2 Paediatricians 60 223 35 Rs. 25000/- Rs. 200/- per Emergency Case during off duty hours Rs. 3000/- HRA 31 Recruited, 9 resigned. Advertisement issued for 35 posts on 1/12/2008
3 Anaesthesia 60 60 Rs. 1500/- on call per case TA Rs. 6/KM upto 50 KM Empanelment for CHCs at District level
4 Staff Nurses 300 287 13 Rs. 8500/- Rs. 1500/- (if accommodation is not provided) Advertisement for recruitment issued on 1/12/2008
5 OT Assistant 60 10 50 Rs. 4000/- 300/- evey Major OT Case Rs. 1500/- HRA Not required to recruit
38
RECRUITMENT - PHCs 24x7
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Female Medical Officer 101 50 51 Rs. 20000 PM Rs. 500 per Delivery Rs. 200/ MTP Rs. 3000/- HRA Advertisement for recruitment issued on 1/12/2008
2 Staff Nurses 303 269 34 Rs. 5000/- Rs. 500/- per delivery conducted Rs. 100/- per delivery assisted and Rs. 1500/- HRA (if accommodation is not provided) Advertisement for recruitment issued on 1/12/2008
39
RECRUITMENT - Mobile Medical Unit (MMU)
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Medical Officer (Male) 20 10 10 22,000 20 recruited 10 resigned/ not joined Advertisement issued for 10 posts on 1/12/2008
2 Medical Officer (Female) 20 8 12 22,000 20 recruited 12 resigned/ not joined Advertisement issued for 12 posts on 1/12/2008
3 Nurses 20 17 3 8,000 Advertisement for recruitment issued on 1/12/2008
4 Radiographer 20 12 8 8,000 Advertisement for recruitment issued on 1/12/2008
5 Lab Technician 20 17 3 8,000 Advertisement for recruitment issued on 1/12/2008
6 Driver 20 20 0 7,000 Placement agency hired
7 Helper 20 20 0 4,000 Placement agency hired
40
RECRUITMENT MO (Mini PHC) ANM for Urban Slum
Area Sub-Centres
SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks
1 Medical Officer for Mini PHC 95 61 34 20,000 Advertisement issued for the recruitment on 1/12/2008
1 MPHW (Female) for urban slums 230 230 0 6,000
2 ANM for vacant sub-centres (2211) 514 1265 203 6,000 Mainly reserved posts Advertisement for recruitment issued on 1/12/2008
3 2nd ANM for 954 sub-centres 954 1265 203 6,000 Mainly reserved posts Advertisement for recruitment issued on 1/12/2008
41
WORK DONE - SCHOOL HEALTH

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

School No. of Students No. of Students No. of Students
Primary 7,09,747 6,29,510 13,39,257
Middle-Secondary 10,39,509 8,86,160 19,25,679
Total 17,49,256 15,15,670 32,64,926
42
WORK DONE - SCHOOL HEALTH

• Free Treatment of School Students for CHD RHD
• Decision taken on 4/11/2008 for free treatment of
  students (upto 2 level) studying in Govt.
  Govt. aided schools suffering from Congenital
  Heart Disease (CHD) and Rheumatic Heart Disease
  (RHD) in PGI Chandigarh. So far 16 students
  referred to PGI and Rs. 10.00 lacks deposited.
• Directions given to heads of PHCs, CHCs and
  dispensaries to diagnose school students
  suffering from RHD and CHD and refer to PGI.
• Work of examination of School Children not so
  systematic. Students cards are under print and
  would be supplied to the Schools.
• Civil Surgeons have been directed to fix the
  target and show achievement alongwith
  certificates from the School Headmaster that the
  health team has visited the school and examined
  the children.

43
WORK DONE - COMMUNITY MONITORING PLANNING
COMMITTEES

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

44
WORK DONE SEX RATIO

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

45
STATE PROGRAMME IMPLEMENTATION PLAN 2008-09
46
PIP 2008-2009
COMPONENTS DESCRIPTION OUTLAY (Rs. In crores)
PART A RCH 56.95
PART B NRHM ADDITIONALITIES 80.80
PART C IMMUNIZATION PPI 12.34
PART D NATIONAL DISEASE ONTROL PROGRAMME 14.73
PART E INTERSECTORAL CONVERGENCE 5.33
TOTAL NRHM 170.15
CENTRALLY SPONSORED SCHEMES (Already under Implementation but now merged with NRHM) 59.34
GRAND TOTAL GRAND TOTAL 229.49
47
PIP 2008-2009

• GoI contribution Rs. 180 Cr., GoP contribution
  Rs. 30 Cr.
• Previous funds available GoI- Rs. 31.41 Cr.
  GoP Rs. 7.05 Cr. TOTAL Rs. 38.43Cr.
• TOTAL FUNDS AVAILABLE FOR 2008-09 Rs. 210 Cr.
  Rs. 38 Cr. Rs. 248 Cr.

48
PART A- RCH FLEXI POOL
Rs. In lakhs
Allocation Releases/ Expenditure
SN Sub Components 2008-092008-09 2008-092008-09
1 Maternal Health 235.00 52.50
1 Janani Suraksha Yojna 186.00 171.50
2 ASHA 334.50 440.00
3 Child Health IMNCI 86.15 .67
4 Family Planning 920.60 937.71
5 ARSH 27.07 10.02
6 Urban RCH 135.60 32.90
7 PNDT Sex Ratio 64.84 21.57
7 Innovations / PPP/NGO 442.50 0
8 Infrastructure Human Development 1558.50 221.87
8 Logistic Management 323.34 95.35
8 Quality Assurance and Infection Control Programme 323.34 95.35
8 HMIS Monitoring and Evaluation 323.34 95.35
9 Training 461.88 276.70
10 Behaviour Change Communications 291.76 40.75
11 Procurement 122.50 125.91
13 Programme management Units SPMU and DPMUs 347.26 264.35
12 Flexi pool 157.50 11.70
  Total A (RCH II) 5695.00 2703.50
49
..contd.. PART A

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

50
PART B- NRHM ADDITIONALITIES
Rs. In lakhs
Allocation Releases/ Expenditure
SN Sub Components 2008-09 2008-09
B NRHM Additionalties  
a Village Health Sanitation Committees 1230.00 0.00
b ASHA - proposed under RCH II  
c SC Untied Fund Maintenance 286.20 285.80
d PHC Untied Fund Maintenance 121.00 121.00
e CHC Untied Fund Maintenance 64.00 64.00
f Annual Maintenance Grant 162.00 655.80
g Mobile Medical/ Health Units 397.40 111.20
h Upgradation of CHC 1091.80 0.00
I Upgradation of PHC 821.43 0.00
j Upgradation of SC 725.38 0.00
k Upgradation of SHC 600.00 0.00
l Upgradation on SDH/ FRUs 100.00 100.00
m Upgradation of DH 370.00 0.00
n School Health 500.00 12.45
o Strengthening of Programme Management 476.56 0.00
p Strenthning of Logistics Management 50.00 0.00
q Rogi Kalyan Samitiis 12.33 0.00
r Emergency Response Services 937.50 0.00
s Mobile Phones for ANMs 134.00 0.00
  Total B 8079.60 1350.30
51
..contd.. PART B

• Extension of New Institutions
• 40 New Sub Centre's is to be constructed at a
  cost of Rs. 2.5 crore.
• One new CHC to be constructed at Zirakpur at a
  cost of Rs. 2.5 crore
• Up-gradation of Institutions
• 77 Sub Centres to be renovated at a cost of Rs.
  1.00 Lakh each
• 10 PHCs to be repaired / renovated at cost of rs.
  60.00 Lakh.
• PHC at Adampur and Rural Hospital Morinda to be
  completely renovated.
• Following Sub Divisional Hospitals to be upgraded
  with an outlay of Rs.6.00 Crore
• Batala (50 to 80 beds) ... Rs. 1.5 crore
• Patti (50 to 80 beds) ... Rs. 1.5 crore
• Nabha (100 to 130 beds) Rs. 1.5 crore
• Pathankot (100 to 130 beds) Rs. 1.5 crore

52
..contd.. PART B

• Following District Hospitals to be upgraded
• Mohali (70 to 120 beds) Rs. 3.00 Crore
• Mata Kaushalya Hospital Patiala Rs.2.00 Crore
• (154 to 250 beds)
• Gurdaspur (100 to 150 beds) Rs.2.50 Crore
• Ludhiana (addition of 30 beds burnh Unit) Rs.
  1.00 Crore
• Bathinda (Renovation) ... Rs.0.50 Crore

• Equipment and furniture worth Rs.6.50 Crore to be
  provided in CHCs as per IPHS Norms
• Equipment and furniture worth Rs.1.83 Crore to be
  provided in the PHCs as per IPHS norms
• Drugs and consumables as per following details to
  be given
• - CHCs Rs. 3.60 Crore
• - PHCs Rs.4.84 Crore
• - SHCs Rs.6.00 Crore

53
PART C- IMMUNIZATION
Rs. In lakhs
Allocation Releases/ Expenditure
SN Sub Components 2008-09 2008-09
a Alternative vaccine Delivery 103.34
b Mobilization of Children by AWW/TBA/ASHA 68.59
c Strengthening of Monitoring and Supervision 9.18
d Computer Assistant to DIO, Provision for Additional Support, Slums and underserved area 79.58
  Total C 260.69 91.63
54
PART D- NATIONAL DISEASE CONTROL PROGRAMME
Rs. In lakhs
Allocation Releases/ Expenditure
SN Sub Components 2008-09 2008-09
a RNTCP 522.16 201.52
b Leprosy 0.76 26.35
c IDSP 79.91 43.86
d National Iodine Deficiency Disorder Control Programme. - NIDDCP 20 0.00
e Malaria Vector Borne 212.36 19.88
f Blindness Control 637.5 75.00
  Total D 1472.69 366.61
55
PART E- INTERSECTORAL CONVERGENCE
Rs. In lakhs
Allocation Releases/ Expenditure
SN Sub Components 2008-09 2008-09
a Convergence with AYUSH 424.80 0.00
b Co ordination Orientation with PRIs 75.15 0.00
c Special innovation for Minorities 33.45 0.00
  Total E 533.40 0.00
Part II CSS Family Welfare Head 2211 5934.00 2540.13

• Appointment of one Ayurveda MO one Homeopathy
  MO in 121 PHCs 112 CHCs respectively.
• 99 Ayurveda MOs already recruited. 22 MOs of
  reserved categories (9 SC, 1 FF, 2 Sports, 3
  Handicapped, 6 Exn, 1 General)
• Written test Counseling for appointment of 112
  Homeopathy MOs done. Appointment letters being
  issued

56
DRINKING WATER SUPPLY

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

57
SANITATION

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

58
SCHOOLS WATER TOILETS

• Schools not having Water Toilet facilities have
  been identified by a survey.
• 480 Schools are without drinking water facilities
  Water Sanitation Department would provide these
  facilities from their regular schemes like ARWSP.
• 4447 schools are without Toilet facilities Water
  Sanitation Department has been asked to prepare
  estimates.
• Funds to the extent Rs. 40000.00 per school will
  be provided from Total Sanitation Campaign (TSC)
  above Rs. 40000.00 from 12th Finance Commission
  of Rural Development Department.

59
NUTRITION

• Under ICDS Programme (5050) the State Government
  will be spending Rs. 55 crore in 2008-09.
• Under Kishori Shakti Yojana (Nutrition for
  adolescent girls) will spent Rs. 2.50 crore
  through Woman and Child Development.
• Under these 2 programmes a total of 13.52 lakh
  children and mothers were provided nutrition.

60
VILLAGE HEALTH COMMITTES

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

61
COORDINATION WITH OTHER DEPARTMENTS

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

62
OTHER INITIATIVES
63
NATIONAL URBAN HEALTH MISSION

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

64
EMERGENCY RESPONSE SERVICE IN THE STATE

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

65
OTHER INITIATIVES

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

66
MONITORING AND STATUS (31/10/2008)

• Institutional Deliveries
• Annual pregnancies 4,80,000
• Deliveries in health department institutions in
  2007-08 25269
• Total institutional deliveries About 52
• Performance upto October 2008 (Health Department
  Institutions)
• 2007-08 2008-09
• 25269 31357
• Increase of 24.10
• 4 Excel Sheets

67
INSTITUTIONAL DELIVERIES
1992-93
1997-98
2005-06
INSTITUTIONAL DELIVERIES
Year 2007-08 2008-09 (Up to October 08)
68
Trend of Institutional Deliveries Month
wise (Health Department Institutions)
24
69
District wise Institutional Deliveries- 2007-08
2008-09 (till Oct 08)
70
Institutional Deliveries- District Hospitals
2007-08 2008-09 (till Oct 08)
71
Institutional Deliveries- Sub Divisional
Hospitals 2007-08 2008-09 (till Oct 08)
72
Institutional Deliveries- FRUs 2007-08 2008-09
(till Oct 08)
73
Institutional Deliveries- 24x7 PHCs 2007-08
2008-09 (till Oct 08)
74
Institutional Deliveries- CHCs other than FRUs
2007-08 2008-09 (till Oct 08)
75
JANANI SURAKSHA YOJNA
Cash assistance scheme for BPL and SCs/STs
mothers (age 19 and above upto 2 living children)
on birth in Public or Private accredited health
units. Rural area Rs.700/- Urban area Rs.
600/- Non Institutional delivery Rs.500/- Rs.150
0/- to be provided for hiring the services of
specialists to carry out the caesarean in a Govt.
Institution

• 2007-08 29256 beneficiaries covered against
  the target of 90,000 per annum.
• 2008-09 Till October 19,949 beneficiaries
  covered constituting 22.17 of the annual target.
  It should have been 60 at the end of October

76
JSY Performance District wise Beneficiaries
covered (till Oct 08)
77
UTILIZATION OF FUNDS

• As per GOI condition funds upto 2006-07 to be
  utilized and UC sent for further release of GOI
  funds during 2008-09.
• Similarly funds upto 2007-08 to be utilized for
  release of funds during 2009-10.
• UCs to be sent for 2006-07.
• Utilization during 2008-09 Rs. 68.29 cr. was
  given to districts and various agencies.

78
District wise utilization of funds (till Oct 08)
79
Ranking of the districts
To achieve more and to strengthen the NRHM
programme the districts have been ranked on
performance basis on different health parameters
Ranking of the districts-
80

• THANK YOU