Download District Health Action Plan - STATE HEALTH SOCIETY BIHAR

District Health Action Plan
2011-2012
District Health Society, Samastipur
Contents
Preface
Foreword
About the Profile
CHAPTER 1- INTRODUCTION
1.1
1.2
1.3
1.3.1
1.3.2
Genesis
Objectives of the process
Process of Plan Development
Preliminary Phase
Main Phase - Horizontal Integration of Vertical Programmes
Preparation of DHAP
1.3.3
CHAPTER 2- DISTRICT PROFILE
2.1
Samastipur at a Glance
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.8.1
2.8.2
2.8.3
History
Geographic Location
Govt. administrative setup
Administrative units and towns.
District Health Administrative setup
Socio economic Profile
Health Profile
Health Status and Burden of diseases
Public Health Care delivery system
DLHS 3 data
CHAPTER 3- SITUATION ANALYSIS
3.1
3.1.1
3.1.2
3.1.3
3.2
3.3
3.4
Gaps in infrastructure
HSC Infrastructure
Services of HSC
HSC Human Resource
APHC
PHC
District Hospital
CHAPTER 4- Setting Objectives and suggested Plan of Action
4.1
Introduction
4.2
Targeted objectives and suggested Strategies
4.3
Maternal Health
4.4
Child Health
4.5
Family Planning
4.6
Kala-azar program
4.7
Blindness Control Program
4.8
Leprosy Eradication Program
4.9
Tuberculosis control Program
4.10
Filaria Control Program
4.11
Institution Strengthening
4.12
HIV/AIDS
4.13
Program wise Budget
CHAPTER-5-Annexure
Preface
Achieving mission amidst a number of constraints is, of course an acid test of an administrator because there he/she needs excellence in
managing even the unmanageable things.
Samastipur is a district with non optimal resources, poor supporting infrastructural facilities and inadequate public utility facilities in relation
to the increasing demographic pressure. This is obvious albeit in the health sector, where The National Rural Health Mission has
considerably been successful in bridging the gap between the demand and supply of health services. Basic services which were almost
non-existent till a few years ago are now being provided in centers which were once considered defunct, whether it be at the PHC, APHC
or Sub Centre level. Besides, a number of advanced services are also being delivered in the PHC and upwards. This in turn has increased
the level of expectations of users. In order to cope with the ever growing demands in terms of increase in services specially to cater to a
larger populace, a comprehensive District Health Action Plan is imperative. Only a systematic and organized approach will be able to
resolve the issues that need due attention and I am confident that this action plan will provide a road map.
The action Plan has been prepared keeping in mind the myriad of challenges to be tackled ahead specially with the limited human
and material resources. The action plan if practiced in letter and spirit will ensure the people of this district a number of benefits from the in
the days and years to come. I'm sure that, with a little more effort, we will be able to achieve the goal of the Mission to ensure quality
health care services especially to the disadvantaged segments of the district who mainly on account of poor affordability have suffered a
lot. Let’s hope that succeed in injecting team spirit and nurturing team culture considered essential for service culture and service
fragrance without which our tasks remain unfulfilled and the efforts become unproductive.
Pankaj Kumar, IAS
District Magistrate
Samastipur
Forward
Under the National Rural Health Mission this District Health Action Plan of Samastipur district has been prepared. From this, situational
analysis the study proceeds to make recommendations towards a policy on workforce management, with emphasis on organizational,
motivational and capacity building aspects. It recommends on how existing human and material resources optimally utilized and critical
gaps can be minutely identified and bridged. It looks at how the facilities at different levels optimally structured and organized.
The information related to data and others used in this action plan is authentic and correct according to my knowledge as this has been
provided by the concerned medical officers of every block. I am grateful to the state level consultants (NHSRC/PHRN), ACMO, MOICs,
Block Health Managers and ANMs and AWWs for their enormous cooperation in preparing this District Health Action Plan of Samastipur
District.
I firmly believe that this District Health Action Plan would fulfill the intended purpose.
Dr. Anil Kumar Choudhary
Civil Surgeon
Samastipur
About the Profile
With the targets of recognizing the importance of Health in the process of economic and social development and improving the quality of
life of our citizens, the Government of India has resolved to launch the National Rural Health Mission to carry out necessary architectural
correction in the basic health care delivery system.
This District Health Action Plan (DHAP) is one of the key instruments to achieve NRHM goals. This plan is based on the changing
healthcare requirements of the population of Samastipur district.
This document has been prepared on the basis of a situation analysis. The teams engaged have made an anatomy of the coverage of
poor women and children. The barriers and constraints in the service process have been identified. The focus has also been given on
current availability of health care infrastructure in public/NGO/private sector, availability of wide range of providers. This DHAP has been
evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained
their specific health needs in villages, problems in accessing health services, especially poor women and children at local level.
The goals of the Mission are to improve the availability of and access to quality health care by people, especially for the segments residing
in rural areas e.g. the poor, women and children.
The department of Health and Family Welfare and State Health Society of Bihar deserve appreciation for their dynamic leadership in
managing health care sector reform programme.Which virtually may provide to us backup materials for replicating strategies. I also
appreciate their decision to invite consultants (NHSRC/ PHRN) to facilitate our DHS regarding preparation the DHAP. I am thankful
specially to our team members ACMO Dr.R.P.Swetanki, DIO Dr.A.K.Singh, DAM Mr. A. K. Sinha, M&EO Mr. Alok Kumar,DPC Mr.Aditya
Nath Jha, Epidemiologist Mr. Arif Ali Siddiqui and Data Operator Mr.Sanjeev Kumar & Mr.Hari Shanker Roy.I also thankful to Mr. Ajeet of
NHSRC for the personally attention to preparation of District Health Action Plan 2011- 12. The proposed location of
HSCs,APHCs,PHCs,SDHs,Referral and Sadar Hospital and its service area reorganized with the consent of ANM, AWW, Male Health
Worker and participation of community has finalized in the block level meeting.
I am sure that this excellent report will galvanize the leaders and administrators of the primary health care system in the district, and would
enable them to go into the details of implementation based on lessons drawn from this study.
Manish Kumar
District Program Manager
District Health Society
Samastipur
Chapter-1
Introduction
1.1 Genesis
Establishment of small affluent islands around the vast sea of backwardness can not the motive of a development sensitive welfare state. India can not
prosper when rural India suffer and rural India can not prosper unless the disadvantaged segment of society living in villages are found neglected. The
process of Economic transformation remains incomplete if the process of social transformation is delayed. It was against this backdrop that Government
of India launched NRHM with prime motto providing effective healthcare devices to the rural population. It is not a program indeed a mission. The
multi-faceted objectives to achieve the mission are-:
 Reduction in child and maternal mortality
 Universal access to services for food and nutrition, sanitation and hygiene, safe drinking water
 Emphasis on services addressing women and child health; and universal immunization
 Prevention and control of communicable and non-communicable diseases, including locally endemic diseases
 Access to integrated comprehensive primary health care
 Revitalization local health traditions and mainstreaming of AYUSH
 Population stabilization
 Community participation PUBLIC HEALTH FAMILY WELFARE AND RURAL SANITATION COMMITTEE popularly known as VILLAGE
HEALTH SANITATION COMMITTEE (VHSC).
One of the main approaches of NRHM is to communities, which will entail transfer of funds, functions and functionaries to Panchayati Raj Institutions
(PRIs) and also greater engagement of Rogi Kalyan Samiti (RKS). Improved management through capacity development is also suggested. Innovations
in human resource management are one of the major challenges in making health services effectively available to the rural/tribal population.Thus,
NRHM proposes ensured availability of locally resident health workers, multi-skilling of health workers and doctors and integration with private sector
so as to optimally use human resources. Besides, the mission aims for making untied funds available at different levels of health care delivery system.
Core strategies of mission include decentralized public health management. This is supposed to be realized by implementation of District Health Action
Plans (DHAPs) formulated through a participatory and bottom up planning process. DHAP enable village, block, district and state level to identify the
gaps and constraints to improve services in regard to access, demand and quality of health care. In view with attainment of the objectives of NRHM,
DHAP has been envisioned to be the principal instrument for planning, implementation and monitoring, formulated through a participatory and bottom
up planning process. NRHM-DHAP is anticipated as the cornerstone of all strategies and activities in the district.
For effective programme implementation NRHM adopts a synergistic approach as a key strategy for community based planning by relating health and
diseases to other determinants of good health such as safe drinking water, hygiene and sanitation. Implicit in this approach is the need for situation
analysis, stakeholder involvement in action planning, community mobilization, inter-sectoral convergence, partnership with Non Government
Organizations (NGOs) and private sector, and increased local monitoring. The planning process demands stocktaking, followed by planning of actions
by involving program functionaries and community representatives at district level.
Stakeholders in Process






Members of State and District Health Missions
District and Block level programme managers, Medical Officer.
State Programme Management Unit, District Programme Management Unit and Block
Program Management Unit Staff
Members of NGOs and civil society groups
Support Organisation – PHRN and NHSRC
Members of Political Parties
Besides above referred groups, this document will also be found useful for health managers, academicians, faculty from training institutes and people
engaged in programme implementation, monitoring and evaluation.
1.2 Objectives of the Process
The aim of this whole process is to prepare NRHM – DHAP based on the framework provided by NRHM-Ministry of Health and Family Welfare
(MoHFW). Specific objectives of the process are:
 To focus on critical health issues and concerns specifically among the most disadvantaged and under-served groups and attain a consensus on
feasible solutions
 To focus on more involvement of PRI members in Community participation with respect to health through
PUBLIC HEALTH FAMILY
WELFARE AND RURAL SANITATION COMMITTEE popularly known as VILLAGE HEALTH SANITATION COMMITTEE (VHSC).
 To identify performance gaps in existing health infrastructure and find out mechanism to fight the challenges
 Lay emphasis on concept of inter-sectoral convergence by actively engaging a wide range of stakeholders from the community as well as different
public and private sectors in the planning process
 To identify priorities at the grassroots and curve out roles and responsibilities at block level in designing of DHAPs for need based implementation
of NRHM
1.3 Process of Plan Development
1.3.1 Preliminary Phase
The preliminary stage of the planning comprised of reviewing the available literature and reports. Following this the research strategies, techniques and
design of assessment tools were finalized. As a preparatory exercise for the formulation of DHAP, the secondary Health data were complied to perform a
situational analysis.
1.3.2 Main Phase – Horizontal Integration of Vertical Programmes
The Government of the State of Bihar is engaged in the process of re – assessing the public healthcare system to arrive at policy options for developing
and harnessing the available human resources to make impact on the health status of the people. As a part of this effort the present study attempts to
answer the following three questions:
1. How adequate are the existing human and material resources at various levels of care (namely from sub – center level to district hospital level) in
the state; and how optimally have they been deployed?
2. What factors contribute to or hinder the performance of the personnel in position at various levels of care?
3. What structural features of the evolving health care system affect its utilization and the effectiveness?
With this in view, the study proceeds to make recommendations towards workforce management with emphasis on organizational, motivational and
capacity building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps can be
identified and bridged. It also recommends that how the facilities at different levels can be structured and organized.
The study used a number of primary data components which includes collecting data from field through situation analysis format of facilities that was
applied on all HSCs APHC and PHCs of Samastipur district. In addition, a number of field visits and focal group discussions, interviews with senior
officials, Facility Survey were also conducted. All the draft recommendations on workforce management and rationalization of services were then
discussed with employees and their associations, the officers of the state, district and block level, the medical professional and professional bodies and
civil society. Based on these discussions, the study group clarified and revised its recommendations and the final report was finalized.
Government of India has launched National Rural Health Mission, which aims to integrate all the rural health services and to develop a sector based
approach with effective intersectoral as well as intrasectoral coordination. To translate this into reality, concrete planning in terms of improving the
service situation is envisaged as well as developing adequate capacities to provide those services. This includes health infrastructure, facilities,
equipments and adequately skilled and placed manpower. District has been identified as the basic coordination unit for planning and administration,
where it has been conceived that an effective coordination is envisaged to be possible.
This Integrated Health Action Plan document of Samastipur district has been prepared on the said context.
1.3.3 Preparation of DHAP
The Plan has been prepared as a joint effort under the chairmanship of District Magistrate of the district, Civil Surgeon, ACMO (Nodal officer for DHAP
formulation), all program officers and NHSRC/PHRN as well as the MOICs, Block Health Managers, ANMs, as a result of participatory processes as
detailed below. After completion the DHAP, a meeting is organized by Civil Surgeon with all MOIC of the block and all programme officer. Then
discussed and displayed prepared DHAP. If any comment has came from participants it has added then finalized. The field staffs of the department too
have played a significant role. District officials have provided technical assistance in estimation and drafting of various components of this plan.
After a thorough situational analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural
poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions,
barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability
of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory
and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in
accessing health services, especially poor women and children at local level.
District Health Action Plan Planning Process
- Fast track training on DHAP at state level.
- Collection of Data through various sources
- Understanding Situation
- Assessing Gap
- Orientation of Key Medical staff, Health Managers
on DHAP at district level
-Block level Meetings
-Block level meetings organized at each level
by key medical staff and BMO
- District level meetings
- District level meeting to compile information
- Facilitating planning process for DHAP
District Profile
2.1
District: At a Glance
Samastipur is a district in Bihar which is spread over an area of 2904 sq. kms. Samastipur is bounded on the north by the Bagmati River which separates it from
Darbhanga district. On the west it is bordered by Vaishali and some part of Muzaffarpur district, on the south by the Ganges it has separated to Patna, while on its east
it has Begusarai and some part of Khagaria district. The district headquarters is located at Samastipur.
The people of Samastipur mainly speak Hindi. According to the 2001 census, Population Density in the District was 1169 per sq.km. And the total population was 3.40
million.
The District is lacking in educational infrastructure and the Literacy rate is only 45.13 % (male 57.59, female 31.67). The medical facilities are also not adequate but
there are efforts to improve the condition.
The district comprises of 4 sub-divisions, and 20 Community Development Blocks. It has 5 towns and 1248 villages. Infrastructure wise Samastipur is very strong. It
is the Divisional Headquarters of the North Eastern railway. The district has direct train links with Patna, Kolkata, Delhi, Dhanbad, Jamshedpur and other places of
importance. National Highway No. 28 passes through the district.
Agriculture is the main economic occupation of the district and about 83 per cent of the total working population depends on it. Samastipur is noted for its fertile
alluvial soil and its rabi crops. It has been the center of the indigo industry. Wheat, pulses and edible oil seeds are also grown here. Samastipur is lucky to be traversed
by rivers like Burhi Gandak, Baya, Kosi, Kamla, Kareh and Jhamwari and Balan, which are both the offshoots of Burhi Gandak. The Ganges also skirts the district on
the south.
2.2
HISTORY
According to Gazetteers, Darbhanga, the modern subdivision of Samastipur (originally Shamsuddinpur) was founded by Hazi Shamsuddin Ilyas of West Bengal.
2.3
Administrative Unit & Location
Samastipur District : Sub-divisions/ Blocks/ Panchayat Villages
Subdivisions / Blocks
Sl. No Subdivision Name (4)
1
Dalsinghsarai
2 Patori
3 Rosera
4
Samastipur Sadar
Block Name (20)
Dalsinghsarai, Ujiyarpur, Vidyapatinagar
Patori, Mohanpur, Mohiuddinnagar
Rosera, Hasanpur, Bithan, Sighia, Bibhutipur, Shivajinagar
Samastipur, Kalyanpur, Warisnagar, Khanpur, Pusa, Tajpur, Morwa, Sarairanjan
O
The District is located at 25° to 30° North latitude and 84° to 85° east longitude. The District is surrounded by river Ganga in south, Gandak in west, District
Darbhanga in north ,Vaishali in west, in the south Patna and in the east Begusarai & Khagaria Districts. The District is in semi tropical Gangetic lane.
The state capital Patna is linked with famous Mahatma Gandhi Setu. The District is spread over 2904 sq km area.
2.6
District Health Administrative Setup
Samastipur
District Health Society
District Magistrate
cum Chairman
Civil Surgeon cum
Member Secretary
DPMU
ACMO
DTO
DMO
DLO
DFO
DPM
Block Management/ RKS
DS cum Secretary
&
MOI/c cum Chairman
MOs,
DAM
M&EO
DS cum Secretary
&
MOI/c cum Chairman
APHC-MO
HSC-ANM
VHSC
ASHA
COMPARATIVE POPULATION DATA ( 2001 Census)
Basic Data
Population
Density
Socio- Economic
Sex- Ratio
Literacy % Total
Male
Female
India
1027015247
324
LITERACY RATE
TOTAL
:50.49%
MALES
:63.23%
933
65.38
75.85
54.16
Bihar
82878796
880
921
47.53
60.32
33.57
Samastipur
3413413
1335
920
50.49
63.23
36.58
FEMALES :36.58%
VILLAGES
TOTAL
:1239
INHABITED :1102
PANCHAYATS
:381
SUB-DIVISION
:04
BLOCKS
:20
REVENUE CIRCLES:- 18
HALKAS
:132
POLICE STATIONS:22
POLICE OUTPOSTS:06
TOWNS
:04
NAGAR PARISHAD (SAMASTIPURPUR):- 01
NAGAR PANCHAYAT : - 04 ( Samastipur, Rosera, Mohiddinagar and Dalsingsarai).
M.P CONSTITUENCY:- 2 (Ujiyarpur & Samastipur)
M.L.A. CONSTITUENCY:- 10
2.7
SOCIO-ECONOMIC PROFILE
Social

Samastipur district has a strong hold of tradition with a high value placed on joint family, kinship, caste and community.

The villages of Samastipur have old social hierarchies and caste equations still shape the local development. The society is feudal and caste
ridden.

20.7% of the population belongs to SC and 0.02% to ST. There are at least 13% percent villages where the SC population is more than 40%.
Some of the most backward communities are Mushahar, Turha, Mallah and Dome.

The main occupation of the people in Samastipur is Agriculture, Fisheries and Daily wage labour.

Almost 20% of the youth population migrates in search of jobs to the metropolitan cities like Kolkata, Mumbai, Pune etc.

The main crops are Wheat, Paddy, Pulses, Oilseeds, Mango.

Tobacco are the major cash crops of the community residing at the bank of holy river Ganges.
Demographic scenario of Samastipur district
According to Census of India 2001:
 The size of population of Samastipur district is above 3413623, comprising 3.27% population of Bihar state in 2.2% proportion of state’s area.
 Very high density of population (1335) which is still rising
 Decadal population growth rate of 26.39% as against 28.43% of the state as a whole. Thus the decadal growth rate of the district is slightly less
than that of the state.
 Sex ratio of the population is 927 females per thousand males which is almost same as the sex ratio of the state. It is difficult to interpret the
deficit of 80 females per thousand males in the district despite outward migration, predominantly of males in the working ages. A plausible
explanation seems to be that over the years male population has benefited more from the epidemiological transition than the female population.
 Only 6.9% of the population resides in the urban area, and the rest lives in the rural areas.
Based on these statistics one can say that Samastipur district lacks urbanization and industrialization. As elsewhere in Bihar, Samastipur suffers from
lack of infrastructure facilities, lack of connectivity, and lack of social development and most people depend on small size agricultural land. Agricultural
productivity is further affected adversely by recurrent floods and droughts (World Bank, 2005).
Flood effected area of the district
The district receives medium to heavy rainfall (average rainfall 1161 mm), and faces condition of severe flood. In the year 2007 the flood condition was
so bad that almost 145 gram panchayats and 583 villages got marooned.Bithan, Hasanpur, Singhia, Kalyanpur, Sivajinagar, Rosera, Khanpur, and
Warishnagar blocks were the worst affected blocks. According to the estimates of National Disaster Management Department, in the year 2007,
16,00,000 people were directly affected by the floods. Crops were damaged, and there was irreparable damage to property and huge loss of lives. The
economic loss due to floods this year amounts to Rs. 100 crore of crop loss, Rs. 25 crore of housing loss and Rs. 27 crore of public property loss. The
district has poor drainage system and nearly 4% of the area is water logged. The district is spread over 2,036 sq km area, with no forest cover. 67% of the
land is agricultural and nearly 67% of the area under cultivation is irrigated. Samastipur district is also affected by droughts. Cycles of floods and
droughts severally affect the food production and food distribution system, and lead to distressful situation for most people.
2.8
HEALTH PROFILE
General Status of health in Samastipur district
In a study of 513 districts of the country (“Jansankhya Sthirata Kosh", www.jsk.gov.in) in terms of overall rank in health it was found that Samastipur
district ranks 552 though on the basis of under-five mortality it ranked 313. Filaria, Malaria, Kala-azar, skin diseases, and Tuberculosis are some of the
most common diseases in district. Hepatitis, Diarrhea, Typhoid, Blindness and Leprosy are other high prevalence diseases. Kala-azar is an endemic
problem in Bihar. As per DLHS 2002-2004 the prevalence percentage of kala-azar is 11.4% and TB is 4.3%. The overall prevalence of tuberculosis in
India is 544 per 100,000 populations while in Samastipur it is reported to be close to 618 per 100,000 (RCH, Round 2).
HEALTH
DISTRICT HOSPITAL
SUB-DIVISIONAL HOSPITAL
REFERRAL HOSPITAL
PRIMARY HEALTH CENTRE
ADDITIONAL PRIMARY HEALTH CENTRE
HEALTH SUB CENTRE
GRAMIN AUSADHALAY
BLOOD BANK
BLOOD STORAGE UNIT
AIDS CONTROL SOCIETY
::::::::::-
01
03
01
20
45
354
03
01
02
01
2.8.1 HEALTH STATUS AND BURDEN OF DISEASES
S.No.
Table: CASE FATALITY RATE
2010 (Up to Nov.10)
2009
2008
Disease
Case
Death
Case
Death
1
Gastroenteritis
166
0
17328
0
2
Diarrhea/Dysentery
882
2
26544
0
3
4
5
6
7
8
Cholera
Meningitis
Pneumonia
Malaria
Measles
A.R.I.
0
0
0
0
0
0
0
0
0
0
NA
NA
0
3
4008
0
228
6067
0
0
0
0
0
0
Table : MORBIDITY DUE TO MAJOR DISEASE
S.No.
Disease
2007
1
Kala-azar
12603
2
T.B. (NSP)
997
3
Leprosy
1.15
2008
5312
575
1.30
Case
13259
(Including
Diarrhea)
13998
(Only
Dysentery)
N/R
0
779
1
72
62735
2009
1172
1586
0.91
Death
0
0
N/R
0
0
0
0
0
2010 (Up to Nov.10)
1158
1605
N/A
(PR/10000)
Table : BASIC HEALTH STATUS INDICATORS OF SAMASTIPUR DISTRICT
Indicators
Samastipur
Bihar
Couple Protection Rate (CPR)
33%
Crude Death Rate (CDR)
8.1
8.1
Crude Birth Rate
31.9
30.4
Infant Mortality Rate
56
56
Maternal Mortality Rate
371
371
Total Fertility Rate (TFR)
4.6
4
Under 5 Mortality Rate
85
85
Still Birth Rate
2%
NA
Abortion rate
NA
NA
Table: DENOTING PRIORITY AREAS IN EACH OF THE BLOCK
Block
Hard to Reach area
Bithan
Whole Bithan block (72 villages)
Hasanpur
2 Panchayat
Sighia
5 Panchayat
Kalyanpur
2 Panchayat
Warishnagar
2 Panchayat
Khanpur
1 Panchayat
Mohanpur
2 Panchayat
Note: During raining season i.e. From mid June to September almost 80 percent of the villages become hard to reach area.
2.2.2 PUBLIC HEALTH CARE DELIVERY SYSTEM: ORGANISATIONAL STRUCTURE AND INFRASTRUCTURE Table. HEALTH CARE
INSTITUTIONS IN THE DISTRICT
S.No.
1
Type of Institutions
District Hospital
Number
1
No. of Beds*
120
2
Sub-divisional Hospital
03
90
3
Referral Hospital
1
30
4
Block PHCs
15+5
180
5
APHCs
45
0
6
Sub-centres
354
0
7
Ayurvedic Dispensaries
03
0
8
Anganwadi Centres
3233/3433
-
9
Others (Pvt. Facility accredited)
Nil
2.8.3 Map showing BLOCK AND PHC locations
Map showing WPV 1 and WPV 3 affected BLOCK AND PHC locations
Map showing Kala azar affected BLOCK locations
Nil
2.8.4 DLHS 3 Data
As per the DLHS3 ( 2007-08)reports the percentage of full immunization(BCG, 3 doses each of DPT and Polio and measles) coverage(12-23 months) in
the district is 51.1%. And BCG coverage of the district is 83.6%. 3 doses of polio vaccine is 60%, 3 doses of DPT vaccine is 62.6% and Measles Vaccine
is 57.5%. The coverage of Vit A supplementation for the children 9 months to 35 months is 97% percent.
ANC in Rural Areas
Comparision of Child Immunisation Coverage
Child Breastfeeding Practices (Under 3 Yrs) according DLHS 3
Chapter 3
Situation Analysis
In the present situational analysis of the blocks of district Samastipur the vital statistics or the indicators that measure aspects of health/ life such as
number of births, deaths, fertility etc. have been referred from census 2001, report of DHS office, Samastipur and various websites as well as other
sources. These indicators help in pointing to the health scenario in Samastipur from a quantitative point of view, while they cannot by themselves
provide a complete picture of the status of health in the district. However, it is useful to have outcome data to map the effectiveness of public investment
in health. Further, when data pertaining to vital rates are analyzed in conjunction with demographic measures, such as sex ratio and mean age of
marriage, they throw valuable light on gender dimension. Table below indicates the Health indicators of Samastipur district with respect to Bihar and
India as a whole.
Table: Health Indicators
Indicator
CBR
CDR
IMR
MMR
TFR
CPR
Complete Immunization
Samastipur
34.8
8.1
61
371
4.6
33
51.1
Bihar
29.2
8.1
61
371
4
34.1
32.8
India
23.8
6
58
301
2.68
56.3
44
Sources: DLHS3, NFHS3, SRS2007
3.1.1.
GAPS IN INFRASTRUCTURE:
BPHC
Population
80000-120000
APHC
HSC
VHSC
Population
20000-30000
Population
5000
Population
1000
First contact point with community
3.1.1 HSC Infrastructure
Health Sub Centre is very important part of entire Health System. It is first available Health facility nearby for the people in rural areas.
We are trying to analyze the situations at present in accordance with Indian Public Health Standards.
IPHS Norms:
i. Location of the centre: The location of the centre should be chosen that:
a. It is not too close to an existing sub centre/ PHC
b. As far as possible no person has to travel more than 3 Km to reach the Sub centre
c. The Sub Centre Village has some communication network (Road communication/Public Transport/Post Office/Telephone)
d. Accommodation for the ANM/Male Health Worker will be available on rent in the village if necessary.
For selection of village under the Sub Centre, approval of Panchayats as may be considered appropriate is to be obtained.
ii. The
minimum
covered
area
of
a
Sub
Centre
along
with
residential
Quarter
for
ANM will vary from 73.50 to 100.20 sq. mts. depending on climatic conditions (hot and dry climate, hot and humid climate, warm and humid
climate), land availability and with or without a labor room. A typical layout plan for Sub-Centre with ANM residence as per the RCH
Phase-II National Programme implementation Plan with area/Space Specifications is given below
Health Sub Centers: Total population of the district as per 2001 census is 3413413. After considering two percent growth rate of the total population it
comes around 4100000 (Decadal Growth Rate 2.3). After considering projected population in 2008, the district needs altogether 683(354 existing
HSC AND 329 Proposed HSC) HSCs to cater not its whole population but cover 83% population, so, we need 820 HSCs our present population
requirement. As per the IPHS norms (5000 population in plain area) the district still requires 466 new HSCs to be formed. Again, out of 354
established HSCs, only 121 have their own buildings and rest 242 run in rented houses or in Panchyat Bhavan. Out of 121 HSCs 67 HSCs need
renovation work. All the above mentioned HSCs need equipments, drugs, furniture and stationeries.
Health Sub Centers:
Sub Heads
Gaps
A. Out of 354 HSCs
only 130 are having
own building
B. In existing 130
Buildings 56 is
running in
Infrastructure
comparatively in good
condition.
Issues
Inadequate facility in
constructed building and
lack of community
ownership
Strategy
Enhance visibility of
HSC through
hardware activity by
the help of
community
participation
.
Activities
A. Strengthening of HSCs
having own buildings
B.1.White washing of HSC
buildings.
B.2.Organize adolescent girls
for wall painting and
plantation./hire local painter
for colorful painting of HSC
walls.
List out all services which
are provided at HSC level on
the wall.
B.3.Gardening in HSC
premises by school children.
C. Not even one
building is having
running water and
electric supply.
C. Mobilize running water
facility from nearby house if
they have bore well and
water storage facility and it
could be on monthly rental.
Availability fund for
224 HSC
Hire rented building of
224HSC or construct
the HSC building
Hire rented building of
newly sanctioned 331
HSC or construct the
HSC building
Non availability of fund
Proper flow of fund
3B. Strengthening of HSCs
running in rented
buildings.
B2. Streamlining the
payment of rent through
untied fund from the month
of April 2011.
B3.Purchase of
Furniture
as per need
B4 Prioritizing the
equipment list according to
service delivery
B5 Purchase of equipments
as per need
B6 Printing of formats and
purchase of stationeries
1. The district still
needs 325 more HSCs
to be formed.
1. Land Availability for
new construction
Non participation of
Community in
monitoring
construction work
Monitoring
Ensuring community
Monitoring
3C. Construction of new
HSCs
C1. Preparation of PHC wise
priority list of HSCs
according to IPHS
population and location
norms of HSCs
C2. Community mobilization
for promoting land donations
at accessible locations.
C3. Construction of New
HSC buildings
C4. Meeting with local PRI
/CO/BDO/Police Inspector
for smooth transfer of
constructed HSC buildings.
1. Biannual facility survey of
HSCs through local NGOs as
per IPHS format
2. Regular monitoring of
HSC facilities through PHC
level supervisors in IPHS
format.
3. Monitoring of
renovation/construction
works through VHSC
members/ Mothers
committees/VECs/others as
implemented in Bihar
Education Project.
4. Training of
VHSC/Mothers
committees/VECs/Others on
technical monitoring aspects
of construction work.
5. Monthly Meeting of one
representative of
VHSC/Mothers committees
on construction work
1. Lack of community
ownership in the
construction of Health
infrastructures.
1.Community
ownership
Strengthening of
VHSCs, PRIs
1.Formation and
strengthening of VHSCs,
Mothers committees,
2.“Swasthya Kendra Chalo
Abhiyan” to strengthen
community ownership
3.Nukkad Nataks on
Citizen’s charter of HSCs as
per IPHS
4.Monthly meetings of
VHSCs, Mothers committees
Sub Heads
Gaps
No ANC at HSC level
Issues
Improvement in quality
of services like ANC,
NC and PNC,
Immunization
Strategy
Strengthening one
HSC per PHC for
institutional delivery
in first quarter
Only 14.2% PW
registered in first
trimester PW with
three ANCs is15.1%,
TT1 coverage is
35.4%,
Family Planning
Status Any method43.6%
Any modern method39.8%
No sterilization at
HSC level IUD
insertion -0.5%
Pills-1.5%
Condom-1.9%
Improvement in quality
of services like ANC,
NC and PNC,
Immunization and
family planning
1. Phase wise
strengthening of 39
HSCs for
Institutional delivery
and fix a day for
ANC as per IPHS
norms.
2. Community
focused family
planning services
Activities
1. Identification of the best
HSC on service delivery
2.Listing of required
equipments and medicines as
per IPHS norms
3. Purchasing/ indenting
according to the list prepared
4.Honouring first delivered
baby and ANM
1 Gap identification of 39
HSCs through facility survey
2. Eligible Couple Survey
3. Ensuring supply of
contraceptives with three
month’s buffer stock at
HSCs.
4. training of AWW/ASHA
on family planning methods
and RTI/STI/HIV/AIDS
5. Training of ANMs on IUD
insertion
Total unmet need is
32.7%, for spacing14.9,
Lack of counseling
services
Training
Training
HSC unable to
implement disease
control programs
Integration of disease
control programs at HSC
level.
Implementation of
disease control
programs through
HSC level
80% of the HSC staffs
do not reside at place
of posting
Problem of mobility
during rainy season
Absence of staffs
Community
monitoring
Communication and
safety
1. Training to ANMs on
ANC, NC and PNC,
Immunization and other
services.
1 Review of all disease
control programs HSC wise
in existing Tuesday weekly
meetings at PHC with form
6.
( four to five HSC per week)
2.Strengthening ANMs for
community based planning of
all national disease control
program
3. Reporting of disease
control activities through
ANMs
4. Submission of reports of
national programs by the
supervisors duly signed by
the respective ANMs
1. Submission of absentees
through PRI
1.Purchasing Life saving
jackets for all field staffs
2. Providing incentives to the
ANMs during rainy season so
that they can use local boats.
Lack of convergence
at HSC level
Convergence
Convergence
Lack of proper
reporting from field
Reporting
Strengthening of
reporting system
Lack of appropriate
HMIS formats.
1. Fixed Saturday for meeting
day of ANM, AWW, ASHA,
LRG with VHSCs rotation
wise at all villages of the
respective HSC.
2. Monthly Video shows in
all schools of the concerned
HSC area schools on health,
nutrition and sanitation
issues.
1.Training to the field staffs
in filling up form 6, Form 2,
Immunization report format,
MCH registers, Muskan
achievement reports etc
2.Printing of adequate
number of reporting formats
and registers
3. Hiring consultants to
develop software for
reporting.
Sub Heads
Gaps
Issues
Strategy
Human Resource
Out of 478 sanction
post of regular
ANM 20 post are
vacant, and out of
486 post of
contractual ANM
only 174 seats are
vacant. Out of 30
sanctioned post of
LHVs only 11 are
placed, Seat of 28
male workers are
vacant
All Contractual
ANMs need training
on different services.
Filling up the staff
shortage
Staff recruitment
Untrained staffs
Capacity building
1.Training need Assessment
of HSC level staffs2.Training
of staffs on various services
The ANM training
Training
Strengthening of
1.Analyzing gaps with
Activities
1.Selection and recruitment of
312 ANMs
2.Selection and recruitment of
28 male workers
3.2 Human Resource
Source: DHS Samastipur Report.
school situated at
Sadar Hospital
campus, lacks
adequate number of
trainers, staffs and
facilities
Drug kit
availability
1.No drug kit as
such for the HSCs as
per IPHS
norms.(Drugs for
delivery, drug for
national disease
control program
(DDT, DECs)
2.No Drug kit for
AWCs(@one kit per
annum,) 3.No
ASHA kit
Only need based
emergency supply
Irregular supply of
drugs
ANM training
school
Indenting
( ABC & VED Basis)
Strengthening of
reporting process
and indenting
through form 6
Logistics
Operationalization
Couriers for vaccine
and other drugs
supply
Phase wise
training school
2.Deployment of required
staffs/trainers
3.Hiring of trainers as per
need
4. Preparation of annual
training calendar issue wise as
per guideline of Govt of India.
5.Allocation of fund and
operationalization of allocated
fund
1.Weekly meeting of HSC
staffs at PHC for promoting
HSC staffs for regular and
timely submission of indents
of drugs/ vaccines according
to services and reports
1.Ensuring supply of Kit A
and Kit B biannually through
Developing PHC wise
logistics route map
2. Hiring vehicles for supply
of drug kits through untied
fund.
3.Developing three coloured
indenting format for the HSC
to PHC(First reminder-Green,
Second reminder-Yellow,
Third reminder-Red)
1 Hiring of couriers as per
need
2 Payment of courier through
ANMs account
1.Purchasing of cold chain
strengthening of
APHCs for vaccine /
drugs storage
equipments as per IPHS
norms
2. training of concerned staffs
on cold chain maintenance
and drug storage
3.2Additional PHCs: --There are 45 APHCs functioning out of 45 APHC in the district and 59 more are proposed to be established.
Additional PHC:
Sub Heads
Infrastructure
Gaps
1.The district
altogether need 104
APHCs but there are
45 APHCs
functioning in the
district and 59 more
are proposed to be
established.
2.Out of 45APHCs
only 27 are having
own building
3.Existing 22
buildings are not
properly maintained
Lack of equipments,
Lack of appropriate
furniture
Non availability of
HMIS
formats/registers and
stationeries
Issues
Lack of facilities/ basic
amenities in the
constructed buildings
Strategy
Strengthening of
VHSCs, PRI and
formation of RKS
Non payment of rent
Land Availability for
new construction
Constraint in transfer of
constructed building.
Lack of community
ownership
Strengthening of
Infrastructure and
operationalization of
construction works
in Three phase
Activities
1.“Swasthya Kendra Chalo
Abhiyan” to strengthen
community ownership
2.IEC & BCC on Citizen’s
charter of APHCs as per IPHS
3. Registration of RKS
4.Monthly meetings of
VHSCs, Mothers committees
and RKS
A. Strengthening of APHCs
having own buildings
A.1Rennovation of APHCs
buildings
A.2 Purchase of
Furniture
A.3 Prioritizing the equipment
list according to service
delivery
A.4 Purchase of equipments
A.5 Printing of formats and
purchase of stationeries
B. Strengthening of APHCs
running in rented buildings.
B1. Estimation of backlog rent
and facilitate the backlog
payment within two months
B2. Streamlining the payment
of rent through untied fund/
RKS from the month of
April 09.
B3.Purchase of
Furniture
as per need
B4 Prioritizing the equipment
Monitoring
list according to service
delivery
B5 Purchase of equipments as
per need
B6 Printing of formats and
purchase of stationeries
3C. Construction of new
APHC buildings as standard
layout of IPHS norms.
C1. Preparation of PHC wise
priority list of APHCs
according to IPHS population
and location norms of APHCs
C2. Community mobilization
for promoting land donations
at accessible locations.
C3. Construction of New
APHC buildings
C4. Meeting with local PRI
/CO/BDO/Police Inspector in
smooth transfer of constructed
APHC buildings.
4 Biannual facility survey of
APHCs through local NGOs
as per IPHS format
4.1 Regular monitoring of
APHCs facilities through PHC
level supervisors in IPHS
format.
4.2 Monitoring of
renovation/construction works
through VHSC members/
Mothers
committees/VECs/others as
implemented in Bihar
Education Project.
4.3 Training of
VHSC/Mothers
committees/VECs/Others on
technical monitoring aspects
of construction work.
4.4 Monthly Meeting of one
representative of
VHSC/Mothers committees
on construction work.
Human Resource
Lack of doctors,
Lack of A Grade
nurses,
Filling up the staff
shortage
Untrained staffs
Staff recruitment
Lack of Pharmacists.
Untrained ANMs
and male workers
The ANM training
school situated at
Sadar Hospital
campus, lacks
adequate number of
trainers, staffs and
facilities
Out of 30 sanctioned
post of LHVs only
11 are placed
Most of the APHC
staffs are deputed to
respective PHC
hence APHC are
defunct
Capacity building
1.Selection and recruitment of
51 Grade A nurse/ANMs
2.Selection and recruitment of
28 male workers
3. Sending back the staffs to
their own APHCs.
1.Training need Assessment
of APHC level staffs
2.Training of staffs on various
services
3.EmoC Training to at least
one doctor of each APHC
1.Analyzing gaps with
training school
2.Deployment of required
staffs/trainers
Strengthening of
ANM training school
3.Hiring of trainers as per
need
4. Preparation of annual
training calendar issue wise as
per guideline of Govt of India.
5.Allocation of fund and
operationalization of allocated
fund
Drug kit
availability
No drug kit as such
for the APHCs as
per IPHS
norms.(Drugs for
delivery, drug for
national disease
control program
Only need based
emergency supply
Irregular supply of
drugs
Indenting
Logistics
Strengthening of
reporting process and
indenting through
form 2 and 6
Operationalization
Couriers for vaccine
and other drugs
supply
Phase wise
strengthening of
APHCs for vaccine /
drugs storage
Service
performance
RKS has not been
formed at any of the
APHC.
No institutional
delivery at APHC
level
No inpatient facility
available
No lab facility
No Ayush
practitioner posted
No rehabilitation
Formation of RKS
Operationalization of
Untied fund.
Improvement in quality
of services like ANC,
NC and PNC,
Immunization and other
services as identified as
gaps.
Capacity building of
account holder of
untied fund
Phase wise
strengthening of 16
APHCs for
Institutional delivery
and fix a day for
1.Weekly meeting of APHC
staffs at PHC for promoting
APHC staffs for regular and
timely submission of indents
of drugs/ vaccines according
to services and reports
2.Ensuring supply of Kit A
and Kit B biannually through
Developing PHC wise
logistics route map
2.1 Hiring vehicles for supply
of drug kits through untied
fund.
2.3 Developing three colored
indenting format for the
APHC to PHC(First reminderGreen, Second reminderYellow, Third reminder-Red)
3.1 Hiring of couriers as per
need
3.2 Payment of courier
through APHC account
4.1 Purchasing of cold chain
equipments as per IPHS
norms
4.2 training of concerned
staffs on cold chain
maintenance and drug storage
1.Training of signatories on
operating Untied fund /RKS
account, book keeping etc
2. Assigning PHC RKS
accountant for supporting
operationalization of APHC
level accounts
2. Timely disbursement of
untied fund/ seed money for
APHCs RKS.
3. 1 Gap identification of 16
APHCs through facility
services
No safe MTP
service
No OT/ dressing and
Cataract operation
services.
Approx 80% of
APHC staffs not
reside at place of
posting
Lack of counseling
services
Problem of mobility
during rainy season
Lack of convergence
at APHC level
Operational gaps:
There is no link
between HSCs and
APHCs and the
same way there is no
link between APHC
and PHC
Integration of disease
control programs at
APHC level.
Family Planning
services
Convergence
Operational issues
ANC as per IPHS
norms.
Implementation of
disease control
programs through
APHC level where
APHC will work as a
resource center for
HSCs. At present the
same is being done
by PHC only.
Community focused
Family Planning
services
PPP
Convergence
survey
2.strengtheing one APHC per
PHC for institutional delivery
in first quarter
3.Honouring first delivered
baby and ANM
1 Review of all disease control
programs APHC wise in
existing Tuesday weekly
meetings at PHC with form 6
2.Strengthening ANMs for
community based planning of
all national disease control
program
3. Reporting of disease control
activities through ANMs
4. Submission of reports of
national programs by the
supervisors duly signed by the
respective ANMs.
5.Weekly meeting of the staffs
of concerned HSCs ( as
assigned to the APHC)
1.Eligible Couple Survey
2. Ensuring supply of
contraceptives with three
month’s buffer stock at HSCs.
3.Training of AWW/ASHA
on family planning methods
and RTI/STI/HIV/AIDS
4. Training of ANMs on IUD
insertion
1. Outsourcing services for
Generator, fooding,
cleanliness and ambulance.
1. Fixed Saturday for meeting
day of ANM, AWW, ASHA,
LRG with VHSCs rotation
wise at all villages of the
respective HSC.
Primary Health centers: The district has 20 PHCs, 3 Sub-div. 1 Referral hospitals and a District hospital.
Primary Health Centers:
Indicators
Gaps
All PHCs are running
Infrastructure
with 10- 15 Bed
facility.
At present 15 PHCs
are working with
average 15 delivery
per day, 10 FP
operation/emergency
operation and 250
OPD per day in each
PHC. This huge
workload is not being
addressed with only
six beds inadequate
facility.
The comparative
analysis of facility
survey (08-09) and
DLHS3 facility
survey(06-07) , the
service availability
tremendously
increased but the
quality of services is
still the area of
improvement.
Lack of equipments as
per IPHS norms and
also under utilized
equipments.
Lack of appropriate
furniture
Operation of RKS:
Lack in uniform
process of RKS
Issues
Available facilities are
not compatible with the
services supposed to be
delivered at PHCs.
Strategy
Up gradation of
PHCs into 30
bedded facilities.
Quality of services
Community
participation.
ISO certification of
selected PHCs in the
district.
Strengthening of
BMU
Ensuring
community
participation.
Activities
1.Need based ( Service
Delivery) Estimation of cost
for up gradation of PHCs
2. Preparation of priority list
of interventions to deliver
services.
1. Selection of any two PHCs
for ISO certification in first
phase.
2. Sending the
recommendation for the
certification with existing
services and facility detail.
1. Ensuring regular monthly
meeting of RKS.
2. Training to the RKS
signatories for account
operation.
1.Meeting with community
representatives on erecting
boundary, beautification etc,
2. Meeting with local public
representatives/ Social
workers and mobilizing them
for donations to RKS.
Strengthening of PHCs
1.Rennovation of PHCs
2.Purchase of
Furniture
3. Prioritizing the equipment
list according to service
delivery and IPHS norms.
4. Purchase of equipments
5. Printing of formats and
operation.
Lack of community
participation in the
functioning of RKS.
Lack of facilities/
basic amenities in the
PHC buildings
Human Resource
As per IPHS norms
human resource
management not
follow up and also
local arrangement of
human resource is tuff
to arrange.
Doctors and para
medical staff are not
posted
As per IPHS norms in
each PHC
Only 16 BHMs and 15
accountants are placed
at present. BPMU not
working in Proper
manner due lake of
manpower in BHMU
Strengthening of
Infrastructure and
operationalization of
construction works
Monitoring
Staff shortage
Untrained staffs
Staff recruitment
Capacity building
purchase of stationeries
1. Biannual facility survey of
PHCs through local NGOs as
per IPHS format
2. Regular monitoring of
PHC facilities through PHC
level supervisors in IPHS
format.
1.Selection and recruitment
of Doctors
2.Selection and recruitment
of ANMs/ male workers
3.Selection and recruitment
of paramedical/ support staffs
4. Appointment of Block
Health Managers,
Accountants in all
institutions.(16 PHCs, 3
Referrals and Sadar hospital.)
1.Training need Assessment
of PHC level staffs
2.Training of staffs on
various services
3. Trainings of BHM and
accountants on their
responsibilities.
4. Trainings of BHM on
implementation of services/
various National programs.
Drug kit
availability
Irregular supply of
drugs because of lack
of fund disbursement
on time.
Only 70 % essential
drugs are rate
contracted at state
level.
Indenting
Logistics
Operationalization
Lack of fund for the
transportation of drugs
from district to blocks.
There is no clarity on
the guideline for need
based drug
procurement and
transportation.
Service
performance
1. Excessive load on
PHC in delivering all
services i.e. 15
deliveries per day, 10
FP operation /
emergency operations
and 250 OPD per day
in each PHC.
2. Total 59 seats of
Regular and 51 seats
of contractual doctors
in the district is
vacant.
3. All posted doctors
are not regularly
present during the
OPD time so the no of
OPDs done is very less
(only average 23
patients per Doctor per
OPD days during
April 10-Nov 10,
however the IPHS
norms says that the
Strengthening of
reporting process
and indenting
through form 7
Strengthening of
drug logistic system
Optimum Utilization of
Human Resources
Quality
improvement in
residential facility of
doctors/ staffs.
1.Training of store keepers on
invoicing of drugs
2.Implementing computerized
invoice system in all PHCs
3.Fixing the responsibility on
proper and timely indenting
of medicines( keeping three
months buffer stock)
4. Enlisting of equipments for
safe storage of drugs.
5. Purchase of enlisted
equipments.
6. Ensuring the availability of
FIFO list of drugs with store
keeper.
7. Orientation meetings on
guidelines of RKS for
operation.
1. Hiring of rented houses
from RKS fund for the
residence of doctors and key
staffs.
2. Incentivizing doctors on
their performances especially
on OPD, IPD, FP operations,
Kala-azar patient's treatment.
3. Revising Duty rosters in
such a way that all posted
doctors are having at least 8
hrs assignments per day
1.Selection and appointment
of contractual doctors and
staffs
Recruitment
Epidemic outbreaks and
Proper and timely
1. Mapping of the areas
having history of outbreaks
disease wise.
2.Developing micro plans to
address epidemic outbreaks
2.Assigning areas to the MOs
and staffs
OPD should be 40 per
Doctor.)
4. 5 PHCs out of 20
are lacking 24 hrs new
born care services.
5. Only five PHCs
provide 24 hrs BEmoC
services.
6. None of the PHC
provides 24 hour
blood transfusion
services, however
PHC has been
provided the
equipments for blood
storage unit.
7 PHC does not have
laboratory facilities.
8 Lab services
provided by PPP
services have fled
away.
9. Only one PHC
provides adolescent
sexual and
reproductive health
services.
10. Referral
a. No pick up facility
for PW or patients.
b.BPL patients are not
exempted in paying
fee of ambulance.
c. Lack of
maintenance of
ambulances
d. Shortage of
ambulances
11. Quality of food,
cleanliness (toilets,
Labour room, OT,
wards etc) electricity
Need based intervention
in epidemic areas.
information of
outbreaks
Service Load centered at
PHC
Strengthening of
equipments and
services and
increase in the
number of
ambulances.
Availability of AYUSH
patchy.
Strengthening of
AYUSH services at
PHC level in the
first level.
Insecurity ( Staff and
Properties)
Confidence building
measures
Govts existing services
like lab, x-ray,
generator, fooding and
cleanliness services.
Strengthening of the
Govts. existing
services like lab, xray, generator,
fooding and
3.Motivating ASHA on
immediate information of
outbreaks
4. Purchasing folding tents,
beds and equipments and
medicines to organize camps
in epidemic areas.
1. Repairing of all defunct
Ambulances
2. Repairing of PHCs gensets
and initiating their use.
3. Hiring of ambulances as
per need.
1. Appointment of one
AYUSH practitioner and
Yoga teacher in every PHC
1.Insurance of all properties
and staffs of PHC
2.Placing one TOP in every
PHC
1. Assigning mothers
committees of local BRC for
food supply to the patients in
Govt’s approved rate.
2.Recruitment of lab
technicians as required
3. Purchase of equipments/
instruments for strengthening
lab.
4. Hiring of menial workers
for cleanliness works.
1. Assigning LHV for
counseling work
2. Wall writing on every
section of the building
denoting the facilities
3. Name plates of doctor
4. Displaying Roster of
facilities are not
satisfactory in any of
the PHC.
12. In serving
emergency cases, there
are maximum chances
of misbehave from the
part of attendants, so
staffs are reluctant to
handle emergency
cases.
13. Several cases of
theft of instruments,
computers, and
submersible pumps etc
at PHCs.
14. No guidance to the
patients on the
services available at
PHCs.
15. Non friendly
attitude of staffs
towards the poor
patients in general and
women are
disadvantaged group
in particular.
16.Lack of counseling
services
17.Problem of
mobility during rainy
season
18.Lack of
convergence
cleanliness services.
Creating friendly
environment
HMIS and
strengthening of
reporting process
doctors with their details.
5. Gardening
6. Sitting arrangement for
patients
7. Installation of LCD TV
with cable connection
8.Installation of safe drinking
water equipments/water
cooler,
9.Installation of solar heater
system and light with the help
of BDO/Panchayat
9. Apron with name plates
with every doctors
10. Presence of staffs with
uniform and name plates.
1.Orientation of the staffs on
indicators of reporting
formats
2.Purchase of Laptops for
DPMs and BHMs
SITUATIONAL ANALYSIS OF SUB DIVISION HOSPITAL
DIAGNOSTIC CENTRE MAIN HOSPITAL
•
NEW BORN CARE UNIT -1
IMMUNIZATION CENTER-1
•
LABOUR ROOM -1
OPERATION THEATRE-1
•
DOCTOR’S DUTY ROOM-1
ANM DUTY ROOM -1
•
KALA ZAR WARD-1
SMALL OT-1
•
GENERAL WARD-30 bedded
PATHOLOGY LAB-1
•
X-RAY & ULTRASOUND -1
•
BLOOD STORAGE UNIT (NON FUNCTIONAL) -1
•
ADMINISTRATIVE CHAMBER - 2 Rooms
DATA OPERATOR ROOM-1
•
STAFF TOILET M-1, F-1
LABOUR ROOM’s TOILET - 1
•
TOILET – M-2
TOILET –F-2
•
RUNNING WATER 24 Hrs
ELECTRIC FACILITY 24 Hrs
Gaps in Infrastructure
•
At present Sub divisional hospital is working with average 25 deliveries per day, 20 FP operation/emergency operations and 300 OPD per day.
This huge workload is not being addressed with only 30 beds inadequate facility.
•
Lack of equipments as per IPHS norms and also underutilized equipments.
•
Lack of appropriate furniture
•
Operation of RKS is not on time
•
Empower RKS and community participation
•
Lack of facilities/ basic amenities in the SDH buildings
•
Huge workload in central registration unit
•
No sitting arrangement for patients.
•
No safe drinking water facility.
•
Half of the hospital area remains dark at night.
•
Delivery room lacks beds, labour table, stretchers, and equipments.
•
No proper gate and boundary wall.
•
Water logging during rainy season
•
No enquiry counters as such for the patients.
•
No residential facilities for doctors and staffs.
•
No canteen facility for out patients and attendant
Activities for Infrastructure strengthening:
•
Purchase of fowler deluxe beds -100.
•
Listing of required equipments as per IPHS norms and their purchase.
•
Listing of required furniture and their purchase.
•
Simplifying process of RKS operation.
•
Computerization of registration system for the OPD/IPD patients.
•
Construction of shed for waiting patients
•
Installation of 3 Water cooler freezes as per requirement.
•
Installation of seven vapour lights as per requirements.
•
Renovation of boundary wall and gate.
•
Renovation of drainage system and levelling of internal area up to the level of outer area.
•
Construction of enquiry counters at the gate.
•
Construction of new residential buildings.
•
Hiring of rented houses from RKS fund for the residence of doctors, BMU and key staffs.
•
Proper sitting arrangement for patients
•
Installation of LCD TV with cable connection
GAPs in HR and Drugs
•
3 MBBS and 1 eye specialist running SDH
•
Post dresser, OT assistant and ophthalmic assistant are vacant,2 A-Grade nurse and 2 ANM
•
Irregular supply of drugs
•
Only 70% essential drugs are rate contracted at state level.
•
There is no clarity on the guideline for need based drug procurement and transportation.
•
Lack of proper space, furniture and equipments for drug storage
Human Resource
•
•
Appointment of Gynaecologist, Paediatrician, Anaesthetist, surgeon and pathologist on contract basis.
Appointment of dresser, OT assistant, ophthalmic assistant, blood bank assistant, blood
contract basis.
•
Motivational training to all medical or non medical staffs
•
Deputation of required staffs from field.
DRUG AND SUPPLY
•
Training of store keepers on invoicing of drugs
•
Implementing computerized invoice system
•
Enlisting of equipments for safe storage of drugs.
•
Purchase of enlisted equipments.
•
Ensuring the availability of FIFO list of drugs with store keeper.
Service performance Gap
•
Excessive load in OPD on SDH
bank technician and other office assistant on
•
Blood storage unit is present but not functional .
•
24hrs Lab facility and x Ray services are not available
•
Health facility with AYUSH services is not being provided
•
No pick up facility for PW or patients.
•
Lack of maintenance of ambulances
•
No guidance to the patients on the services available at SDH.
•
Non friendly attitude of staffs towards the poor patients in general and women are disadvantaged
SERVICE PERFORMANCE
•
Operationalising APHC and strengthening adjoining PHC .
•
One doctor nurse and paramedical staff designate for blood storage unit and ensure 24 hours electric supply and organise blood donation camps.
•
Incentivizing doctors/ staffs on their performances and achievement especially on OPD, IPD, FP operations, Kala-azar patient’s treatment.
•
Organise blood donation camps
•
Revising Duty rosters in such a way that all posted doctors are having at least 8 hrs assignments per day
•
Strengthening VHSC for providing free ambulance services to all PW women.
•
Appointment of one AYUSH practitioner
•
Purchase of semi auto analyser for pathological lab.
•
Displaying Roster of doctors with their details.
•
Gardening and lightening in SDH
•
Apron with name plates with every doctors, and organise organisational behaviour training of all staff.
•
Presence of staffs with uniform and name plates.
•
Out source canteen to local NGOs/ SHG
District Hospital:
District Hospital Samastipur:
Indicators
Gaps
1.There are 120 beds in the Sadar
Infrastructure
hospital which is not adequate as
per the requirement.
Ward
No of beds
Male medical ward: 20
Male surgical ward: 20
Female ward
: 20
Child ward
: 20
Delivery ward
: 10
TB ward
: 10
Infectious disease : 10
Prisoners ward
: 10
Total
: 120
2. At present District hospital is
working with average 45
deliveries per day, 20 FP
operation / emergency operations
and 800 OPD per day. This huge
workload is not being addressed
with only 120 beds inadequate
facility.
3. Lack of equipments as per
IPHS norms and also under
utilized equipments.
4.Lack of appropriate furniture
5.Operation of RKS:
Delayed process of operation.
Delay in disbursement of fund
6.Lack of facilities/ basic
amenities in the PHC buildings
7.Huge workload in central
registration unit
8. No sitting arrangement for
patients.
10. No safe drinking water
facility.
11. Half of the hospital area
remains dark at night.
12. Delivery room lacks beds,
Issues
Lacks in
infrastructure
Strategy
Strengthening of
infrastructure
Activities
1. Purchase of fowler
deluxe beds 100.
2. Repairing of beds.
3. Listing of required
equipments as per IPHS
norms and their
purchase.
4. Listing of required
furniture and their
purchase.
5. Simplifying process
of RKS operation.
6. Computerization of
registration system for
the OPD/IPD patients.
7.Construction of shed
for waiting patients
8. Installation of 3
Water cooler freezes as
per requirement.
9. Installation of seven
vapor lights as per
requirements.
10. Renovation of
boundary wall and gate.
11. Construction of new
Post mortem room with
all facilities.
12. Renovation of
drainage system and
leveling of internal area
up to the level of outer
area.
13. Construction of
enquiry counters at the
gate.
14. Hiring of
ambulances.
Human
Resource
labor table, stretchers, and
equipments.
13. No proper gate and boundary
wall.
14.No proper post mortem room
and equipments.
15. Heavy water logging during
rainy season.
16. Buildings for ICU, Causality
ward are ready but due to lack of
equipments, facilities are not
functional.
17. No use of paying wards.
18.No enquiry counter as such for
the patients.
20.No residential facilities for
doctors and staffs.
21. No canteen facility
1. Post of gynecologist may be
increased and pathologist is
vacant.
2. Post of one dresser, one OT
assistant and one ophthalmic
assistant are vacant.
15. Construction of new
residential buildings.
16.Hiring of rented
houses from RKS fund
for the residence of
doctors, BMU and key
staffs.
16.Tender for canteen
facility.
17. Sitting arrangement
for patients
18. Installation of LCD
TV with cable
connection
Lack in Staff position
Recruitment
Redployment
Drug kit
availability
1. Irregular supply of drugs
because of lack of fund
disbursement on time.
2. Only 70% essential drugs are
rate contracted at state level.
3. There is no clarity on the
guideline for need based drug
procurement and transportation.
Improper Supply and
logistics
Capacity building
and strengthening
of reporting process
and indenting
through form 7
1. Appointment of
gynecologist and
pathologist on contract
basis.
2.Mapping of specialist
Doctors in Block as
well as District
3. Appointment of one
dresser, one OT
assistant and one
ophthalmic assistant on
contract basis.
1. Deputation of
required staffs from
field.
1.Training of store
keepers on invoicing of
drugs
2.Implementing
computerized invoice
system
4. Enlisting of
equipments for safe
storage of drugs.
4. Lack of proper space, furniture
and equipments for drug storage
Lack in storage
facility
Service
performance
1.Exessive load in delivering all
services
2. Blood storage unit is present
but not utilized
3.No 24hrs Lab facility
4. Referral
a. No pick up facility for PW or
patients.
b. BPL patients are not
exempted in paying fee of
ambulance.
c. Lack of maintenance of
ambulances
d. Shortage of ambulances
5. No guidance to the patients
on the services available at
DH.
6. Non friendly attitude of
staffs towards the poor
patients in general and women
are disadvantaged group in
particular.
Workload
Motivation building
Lack in infrastructure
Strengthening of
infrastructure
5. Purchase of enlisted
equipments.
6. Ensuring the
availability of FIFO list
of drugs with store
keeper.
1. Incentivizing doctors/
staffs on their
performances especially
on OPD, IPD, FP
operations, Kala-azar
patient's treatment.
2. Purchase of
equipments for Blood
storage unit,
3. IEC on blood storage
unit.
4. Revising Duty rosters
in such a way that all
posted doctors are
having at least 8 hrs
assignments per day
5. Repairing of all
defunct Ambulances
6. Hiring of ambulances
as per need.
7. Appointment of one
AYUSH practitioner
and Yoga teacher
8. Purchase of
equipments/ instruments
for strengthening lab.
9. Wall writing on every
section of the building
denoting the facilities
10. Name plates of
doctor
11. Displaying Roster of
doctors with their
details..
Chapter 4
Setting Objectives and Suggested Action Plan
4.1 INTRODUCTION
District health action plan has been entrusted as a principal instrument for planning, implementation and monitoring of fully accountable and accessible
health care mechanism. It has been envisioned through effective integration of health concerns via decentralized management incorporating determinants
of health like sanitation and hygiene, safe drinking water, women and child health and other social concerns. DHAP envisages accomplishing requisite
amendments in the health systems by crafting time bound goals. In the course of discussions with various stakeholder groups it has been anticipated that
unmet demand for liable service provision can be achieved by adopting Intersectoral convergent approach through partnership among public as well as
private sectors.
4.2 Targeted Objectives and Suggested Strategies
During consultation at district level involving a range of stakeholders from different levels, an attempt has been made to carve out certain
strategies to achieve the specific objectives that are represented by different indicators. The following segment of the chapter corresponds to the
identified district plan objectives demonstrating current status of the indicators along with the expected target sets that are projected for period
of next three years (2009-12).
4.3 MATERNAL HEALTH
Logical Framework
Sl. Goal
Sl.
Impact indicators
1
1.1
Reduction in MMR
To improve
maternal
health
Sl. Objectives
Sl.
Outcome
indicators
Sl.
Strategy
Sl.
Output indicators
1
To increase
institutional
safe
delivery by
28.2%
( DLHS3)
to 100% by
year 2010
1.1
% of
institutional
delivery
reported
1.1.1 To make
functional PHC
(24hr x7days)
for institutional
deliveries
1.1.1.1
% of PHC having
functional OT and
Labour room with
equipment
1.1.1.2
% of PHC having
Obestetric First Aid
medicine 24hrx 7
days
% of Grade A nurse
available 24hrx7days
1.1.1.3
1.1.1.4
1.1.2 To make
functional FRU
for institutional
deliveries
1.1.2.1
1.1.2.2
1.1.2.3
1.1.2.4
% of PHC having
functional Neo-natal
care units
No of FRUs having
functional blood
storage units linkage
with blood banks and
24hr ready referral
transport
No of FRUs having
EmOc and CEmOc
facilities
No of FRUs having
specialist doctors/
multiskilled Medical
Officers
No of FRU having
functional Neo-natal
care units
2
3
To increase
safe
delivery by
trained SBA
9.6% (
DLHS3) to
100% by
year 2010
To increase
ANC
coverage
with quality
16%
(DLHS3) to
50% by year
2010
1.1.3 To provide
Referral
transport
services at FRU
/PHC
1.1.4 To strengthen
Janani Suraksha
Yojana / JSY
1.1.3.1
No of pregnant
women availed the
referral facilities
(pick up and drop)
1.1.4.1
% of pregnant
women received
JBSY payments
immediately after
delivery
% of home deliveries
attended by SBA
2.1
Proportion
of birth
attendant by
skilled
health
personnel
2.1.1 To ensure
support of SBA
at home
deliveries
2.1.1.1
3.1
% ANC
reported
through
HMIS
formats /
Form -7
3.1.1 To strengthen
HSC for
providing
outreach
maternal care
3.1.1.1
3.1.2 To organize
integrated RCH
camps
specially for
hard to reach
areas, isolated
population and
Maha Dalit
Tolas
3.1.2.1
3.1.1.2
% of HSCs having
ANMs
% of HSCs
conducted fixed ANC
and clinics
(
planned & held)
% of RCH camps
planned and held
4
To provide
safe
abortion
services at
all facilities
4.1
5
To increase
community
participation
in maternal
care
5.1
Sl.
A1
Strategy
To make
functional
PHC (24hr
x7days) for
institutional
deliveries
Sl
1.1
% MTP
cases
reported
through
HMIS
formats /
Form -7
% of
Mahila
mandal
meetings
conducted.
3.1.3 To improve
adolescent
reproductive
and sexual
health
3.1.4 To accelerate
APHC for OPD
and Fixed AN
clinics
4.1.1 To provide
MTP services at
health facilities
3.1.3.1
No of pregnant
adolescent counseled
by ANM/
AWW/ASHA
3.1.4.1
% of OPD clinics
organized at APHC
level.
4.1.1.1
No of facilities
having MTP services
(public and private )
5.1.1 To strengthen
Monthly
Village Health
and Nutrition
Days
5.1.1.1
% of monthly Village
Health & Nutrition
Days planned and
held
MATERNAL HEALTH
Gaps
Sl
Infrastructure
All PHCs are with only
six bedded facility.5060% of facilities are not
adequate as per IPHS
norms.(List attached,
Annexure..)
1.1.1
Activities
Need based ( Service delivery)Estimation of
cost for upgradation of PHCs
Selection of any two PHCs for ISO
certification in first phase
1.2
1.4
1.5
1.6
1.11
To make
functional
PHC (24hr
x7days) for
institutional
deliveries
1.12
1.12
.1
At present 15 PHC are
working with average
15 deliveries per day,
10 FP operation /
emergency operations
and 250 OPD per day
in each PHC. This huge
workload is not being
addressed with only six
beds inadequate
facility.
The comparative
analysis of facility
survey (08-09) and
DLHS3 facility
survey(06-07) , the
service availability
tremendously increased
but the quality of
services is still the area
of improvement.
Lack of equipments as
per IPHS norms and
also under utilized
equipments.
Lack of appropriate
furniture
1.2.1
Preparation of priority list of interventions to
deliver services.
1.4.1
Sending the recommendation for the
certification with existing services and facility
detail.
1.5.1
Prioritizing the equipment list according to
service delivery and IPHS norms.
1.5.2
Purchase of equipments
1.6.1
Purchase of
Furniture
Lack of facilities/ basic 1.11.1 Renovation of PHCs
amenities in the PHC
buildings
As per IPHS norms each PHC requires the following clinical staffs:(List
attached)
The actual position is
not sufficient as per
IPHS norms List of
Human resource is
Selection and recruitment of Doctors on contractual
basis and give priority in selection those who are living
in same PHC.
attached in Annexure.
1.12.1
0.1
Salary of Contractual Grade A nurses
1.12.
10
Selection and recruitment of grade A nurses for
conducting delivery
73 Grade A Nurse
3 Grade A nurse for each PHC
Selection and recruitment of dresser
19 Dresser, one for each PHC
Selection and recruitment of Pharmacist.
19 x2 Pharmacist for each PHC
Three month induction training of Grade A
nurse under supervision of District level
resource team.
100/-per day x 90 days for 51 grade A
nurse
1.13
1.13.1
Training need Assessment of PHC level staffs
Honorarium of Block Accountants
20 Accountant @ 8800/
Rent of Data Center
20 Data Center @ 8000/
Honorarium of BHM
20 BHM @ 13200/Mobility support to BHMs
Rs 2000 per month per BHM
1.14
1.14.1
Appointment of Block Health Managers,
Accountants in all institutions.(15 PHCs, 2
Referrals and Sadar hospital.)
Process of all recruitments
6 types of recruitment @ 10000
Trainings of BHMs on Health statistics
20 BHMs
Training on Program, Finance management
and HMIS
20 BHMs, 20 Block Accountants and 20
Data Center operators
Drug Supply
1.16
1.17
Irregular supply of
drugs because of lack
of fund disbursement
on time.
Only 38 essential drugs
are rate contracted at
state level .
1.16.1
Ensuring the availability of FIFO list of drugs
with store keeper.
1.17.1
2.Implementing computerized invoice system
in all PHCs
Purchase of Drug invoice software
Rs 10000 per PHC
Lack of fund for the
transportation of drugs
from district to blocks.
1.18
1.17.2
3.Fixing the responsibility on proper and
timely indenting of medicines ( keeping three
months buffer stock)
1.18
4. Payment from Rogi Kalyan samiti account.
Rs 2000 per month per PHC
1.19
1.2
There is no clarity on
the guideline for need
based drug
procurement and
transportation.
Drugs are not properly
stored
1.19.1
5. Orientation meetings/ training on guidelines
of RKS for operation.
Rs 2000 per PHC
1.20.1
6. Enlisting of equipments for safe storage of
drugs.
1.20.2
7. Purchase of enlisted equipments.
Rs 15000 per PHC
1.20.3
8.training of store keepers on invoicing of
drugs Rs 2000 per PHC
1.21
.1
1.21
.2
1.22
To make
functional
PHC (24hr
x7days) for
institutional
deliveries
1.24
1.27
Performance
Excessive load on PHC
in delivering all
services i.e. 10
deliveries per day, 10
FP operation /
emergency operation
and 250 OPD per day
in each PHC.
Total 59 seats of
Regular and 51 seats of
contractual doctors in
the district is vacant.
All posted doctors are
not regularly present
during the OPD time so
the no of OPDs done is
very less (only average
23 patients per Doctor
per OPD days during
April 10-Nov 10,
however the IPHS
norms says that the
OPD should be 40 per
Doctor.)
All PHCs are lacking
24 hrs new born care
services.
Only five PHCs
provide 24 hrs BEmoC
services.
1.21.1
Recruitment of Doctors on contractual basis
1.22.1
Hiring of rented houses from RKS fund for the
residence of doctors and key staffs.
Rs 5000 per PHC per month
1.22.2
Incentivizing doctors on their performances
especially on OPD, IPD, FP operations, Kalaazar patient's treatment.
Rs 5000 per PHC per month
1.22.3
Revising Duty rosters in such a way that all
posted doctors are having at least 8 hrs
assignments per day
1.24.1
Ensure 24 hrs new born care services in 20
PHC.
Budget in Child health care activity
1.27.1
Ensure 24 hrs BEmoC services at 10 PHC
Training of one Doctor from each PHC on
BEmoC. Rs 2000/-Per Docter
Equipments for BEmoC
50000 per facility
1.29
15 PHC does not have
laboratory facilities on
PPP based services. But
09 PHCs have T.B lab
Technician. In addition
to this the regular lab
technician has been
deputed for this
purpose.
1.3
1.29.1
Deputation of 17 regular Lab tech at PHC level
for providing free of cost lab services to all
pregnant women and BPL families.
1.30.1
Recruitment of 5 lab technicians as required
for regular support of lab activity
6000/-per head
Training of TB lab technician on other
pathological tests.
1000/-per training
Purchase reagent (recurring) for strengthening
lab.
5000 per unit per month
Purchase of equipments/ instruments if needed.
Fund could be rooted through RKS and if it is
not utilized it could be diverted to other women
and child friendly activities
1.33
Referral Services
1.33
.1
No pick up
facility for
PW or BPL
patients.
1.33.
1.1
Provision for pick up & drop pregnant mothers and BPL
families free of cost using existing Ambulance services at
PHC level.
60000/-each PHC per month
Provide EDD list of pregnant women to Ambulance driver
and Number of ambulance deriver and 102 /PHC tel. No
to all Pregnant women.
1.33
.3
Lack of
maintenance
of
ambulances
1.33.
3.1
Repairing of all defunct Ambulances
15 Ambulances @ rs 50000 per Ambulance
Prepare list of Vehicle those are utilized in Monitoring
work in PHC that can be use in pick up and dropping
facility for PW.
1.34
Quality of
food,
cleanliness
(toilets,
Labour room,
OT, wards
etc)
electricity
facilities are
not
satisfactory
in any of the
PHC.
1.34.
1
Assigning mothers committees of local BRC for food
supply to the patients in govt’s approved rate.
Rs 50 per patients into 40 patients per day per PHC
Review of Cleanliness activity in all PHC by Quality
assurance committee and payment of agency should be
link with it.
1.34.
2
Hiring of workers for cleanliness of OT and Labour room
in PHC
Two workers per PHC for maximum 30 days @ Rs
100 per day by concerned RKS
Purchase equipments and uniform for cleanliness in all
PHC
50000/each PHC
Training of Workers on using machine/equipments and
importance of cleanliness.
2500/-per PHC twice in a year.
Develop mechanism for monitoring of cleanliness work
1.35
1.8
1.9
05 PHCs
have their
own
generator sets
Operation of
RKS:
1.35.
1
Repairing of PHCs gensets and initiating their use.
1.8.1
Ensuring regular monthly meeting of RKS.
Lack in
uniform
process of
1.9.1
Rs 5000 per PHC
Confectionary costs @ Rs 500 per month per PHC
Training to the RKS signatories for account operation.
Rs 1000 per participant, Two participants from each
PHC
RKS
operation.
1.9.2
Trainings of BHM and accountants on their
responsibilities.
Rs 1000 per participant, Two participants from each
PHC
1.1
1.36
To make
functional
PHC (24hr
x7days) for
institutional
deliveries
1.37
1.38
Lack of
community
participation
in the
functioning
of RKS.
1.10.
1
Meeting with community (School children or
other)representatives on erecting boundary, beautification
etc,
1.10.
2
Meeting with local public representatives/ Social workers
and mobilizing them for donations to RKS.
In serving
emergency
cases, there
are maximum
chances of
misbehave
from the part
of attendants,
so staffs
reluctant to
handle
emergency
cases.
1.36.
1
Meeting in RKS with Local Police Station in charge to
handle emergency situation.
Several cases
of theft of
instruments,
computers,
and
submersible
pumps etc at
PHCs.
No guidance
to the
patients on
the services
available at
1.37.
1
Insurance of all properties and staffs of PHC
1.38.
1
Pictorial wall painting on every section of the building
denoting the facilities and attached trained volunteers to
guide patients.
5000/-per PHC
Training local NCC/NYK/Scout & Guide/NSS etc.
volunteers on identification of emergency situation. And
deployment of volunteers at PHC.
5000/-per PHC
Rs 10000 per PHC
Rs 2000 per PHC
PHCs.
1.39
1.41
Non friendly
attitude of
staffs
towards the
poor patients
in general
and women
are
disadvantage
d group in
particular.
Lack of
counseling
services
1.39.
1
1.41.
1
Name plates of
Doctors
Displaying Name
Photograph and
DOB of all staff of
PHC and put
cleanliness staff
name on top of the
list.
Rs 2000 per PHC
There are 22 LHV in the district we can utilize their
experience in counseling work of women and adolescent
girls after training.
1000 per person
1.42
1.43
1.44
There is no
hot water
facility for
PW and there
is no
adequate
lighting
facility at
adjoining
area of PHC
Lack of
convergence
1.42.
1
Installation of solar heater system and light with the help
of BDO/Panchayat at PHC or purchase equipments from
market.
1.43.
1
Convergence meeting by RKS & DHS
Lack of
timely
reporting and
delay in data
collection
1.44.
1
Orientation of the staffs on indicators of reporting formats
50000/-per PHC
1.45
Lack of space
for waiting,
environmenta
l cleanliness
around PHC,
provision for
hospitality
etc
1.45.
1
Gardening
1.45.
2
Sitting arrangement for patients
Rs 5000 per PHC
Rs 5000 per PHC
Construction of patients waiting shade
Rs 75000/-Per PHC
1.45.
3
Installation of LCD projector for manage wait over time
of OPD patients.
Rs 100000/- per PHC
1.45.
4
Installation of safe drinking water equipments/water
cooler,
Rs 10000 per PHC
2
To make
FRU
functional
and up
gradation of
PHC to
CHC for
institutional
deliveries
2.1
C-Section
deliveries are
not
conducted in
institution.
1.45.
5
Apron with name plates with every doctors
1.45.
6
Presence of staffs with uniform and name plates.
2.1.1
Develop Rosera, Dalsingsarai , Pusa SDH & Refferal
Tajpur for C-section facility
2.1.2
Training of MOs of three PHCs in multi skilling.
Rs 250 per Doctor for total 185 doctors
3 Doctors from each PHC @ 2000/-per person
2.1.5
Specialist should be posted at Sadar Hospital & above
mentioned Hospitals.
2.1.6
Incentive for C-section to PHC those who conducted 10 15 = 10000,15-20=20000, 25-30= 50000/,C-section in a
month the incentive money should be distributed among
all staff of the PHC after the decision of RKS.
Rs 25000 per PHC per month
2.1.8
Need based Equipments and drugs in O.T and Labour
room.
List of Equipments attached (100000 per PHC)
None of the
PHC
provides 24
hour blood
transfusion
services,
however two
SDH has
been
provided the
equipments
for blood
storage unit.
Establishing blood storage units at
Dalsingsarai, Rosera & Pusa 85000/- Per Hospital
Training of lab technicians on management of blood
storage
3 lab technicians
Infection
control
protocols is
not at all
maintained at
all facilities
2.2.2
Licensing blood storage / blood bank
2.2.3
Meeting infrastructure requirements as per norms for
Blood storage
10000 Per PHC
2.2.4
Training of MO and lab tech/ staff nurse blood storage on
grouping /cross matching and management of transfusion
reactions
stabilized linkages with mother blood bank.
Rs 1000 per participant, Two participants from each
PHC
2.2.5
Provide free of cost Blood for pregnant women who need
blood transfusion for severe anemia/ PPH on prescribed
through RKS Fund
20000/-for each PHC per month
2.2.1
1
Organize Blood donation camps at all institution and
mobilize community for voluntary blood donation
Rs 10000 per camp per PHC for organizing two camp
annually
2.3
2.4
Welcome
PW at
Institution
and PHC and
FRU
Reporting of
maternal
death
Maternal
death
reporting is
usually not
reported by
worker
2.3.1
Provision of food for the delivered mothers and mothers
under gone in tubectomy in all the health facilities.
2.3.2
Mobilize community Resources for providing Free food
for PW at Institution.
2.3.3
Quality indicators (clean environment, wards with clean
linen, clean toilets , clean labour rooms, running waters
supply, hot water and safe water for inpatients, new born
corners, treatment protocols, aseptic precautions,
immediate disbursement of JBSY funds
2.4.1
Training of ASHA & ANM on reporting of Maternal
deaths and conduct Verbal Autopsy
Rs 5000 per PHC
2.4.2
Incentives for maternal death reporting by ASHA @ Rs
50/-per maternal death
Rs 50/-per maternal death for approx 300 maternal
deaths
2.4.3
Reporting line should be in five columns – name of
mother, place of death, date of death, cause of death and
no. of birth.
2.4.4
Institution and urban center also to report Maternal death
to the district CS/ACMO.
2.4.5
Maternal Death should be reported by ASHA, AWW,
ANM Staff Nurse & Doctors to the district data center
2.4.6
Investigation of maternal death by district team. and third
party review(District magistrate)
2.4.7
Training of ASHA and investigation team objective and
process of investigation and review of maternal death Rs
3000 per PHC
2.5
4 To
strengthen
Janani
Suraksha
Yojana /
JSY
4.1
4.2
Biomedical
waste
management
is not
properly
taken care off
at all
institution
Tracking of
pregnant
women from
first
Trimester is
not done
form the
register.
Too much
documentatio
n process.
Photo
required for
mother and
baby. It cost
Rs.30/- to
Rs.60/- .
2.5.1
Procurement of equipment
Rs 50000 per PHC
2.5.2
As per example Introduce color coded buckets for
facilities as per IMEP
4.1.1
Review of early registration with 3 ANC checkup, two
TT.100/200 IFA Tab. In ASHA Diwas.
4.2.1
Ensure 100 % Pregnancy Test Kit is to ASHA and regular
supply.
Rs 50 for 99000 pregnancies
4.2.2
Direct transfer of funds from district to PHC through
core banking / directly from DHS
4.2.3
Finger print technology for JSY beneficiaries at facility
level where computer with internet facility is available.
This will help in financial monitoring.
4.2.4
The photo system should be replaced by some other
alternatives like- bank account opening of pregnant
women in first trimister and directaly transfer the money
to their account after delivery.
Incentive to ASHA for rs 50 per PW for opening of
bank account of PW for 99000 pregnancies
5 To ensure
support of
SBA at
home
deliveries
5.1
Home
Delivery is
still
prevailing
through
untrained
traditional
Dai’s
5.1.1
5.1.2
5.1.3
6
To
strengthen
HSC for
providing
outreach
maternal
care
Reporting of
home
delivery is
not done so
the PNC is
not provided
Infrastructure
6.1 Out of 354
HSCs only
130 are
having own
building
6.2 In existing
130 buildings
are running
comparativel
y in good
condition, 8
Delivery kit (equipment, medicine)for ANM should be
supplied
Rs 10000 per PHC
5.1.4
5.2
Home Delivery should be conducted by SBA trained Staff
Nurse or ANM.
Provision of Dai Delivery kit(DDK) to TBA where
institution access is poor. And it should be supervised by
ANM for home deliveries.
5.2.1
Supply of delivery Kits as per number of deliveries
conducted in home.
Incentive based system for reporting of home delivery by
ASHA and it should be linked with ANM
6.1.1
Strengthening of HSCs having own buildings
6.2.1
White washing of HSC buildings.
Rs 2000 per PHC
6.2.2
Organize adolescent girls for wall painting and
plantation./hire local painter for colourful painting of
HSC walls.
6.3
To
strengthen
HSC for
providing
outreach
maternal
care
6.4
are in under
construction,
one is very
poor
condition and
one is
constructed
but not
handed over
to health
department.
No one
building is
having
running
water and
electric
supply.
Lack of
appropriate
equipments
and ANM are
reluctant to
keep all
equipments
in HSC.
6.2.3
List out all services which is provided at HSC level. On
the wall.
6.2.4
Gardening in HSC premises by school children.
6.3.1
No one HSC are running Water supply but they have
hand pump.
Arrangement of water supply up to HSC ( Wiring ) from
water source
Rs 50000 per HSC
6.4.1
Purchase of Furniture Prioritizing the equipment list
according to service delivery(for ANC /Family planning
/Immunization/)
Rs 20000 per HSC having own buildings
6.4.2
6.4.3
Purchase of equipments according to services
Purchase one almirah for keep all equipment safely and it
could be kept in AWW / ASHA house.
Rs 10000 per HSC
6.5
Non payment
of rent of 300
HSCs for
more than
three years
6.5.1
Strengthening of HSCs running in rented buildings.
6.5.2
Estimation of backlog rent and facilitate the backlog
payment within two months
Rs 300 per HSC per month for 36 months(State fund)
6.5.3
Streamlining the payment of rent from the month of April
09.
Rs 300 per HSC per month for 12months( from State
fund)
6.5.4
Purchase of Furniture as per need where building is on
rent
From untied fund
6.5.5
Prioritizing the equipment list according to service
delivery
6.5.6
Purchase of equipments as per need
From untied fund
6.6
To
strengthen
HSC for
providing
outreach
maternal
care
6.7
The district
still needs
325 more
HSCs to be
formed.
Non
participation
of
Community
in monitoring
construction
work
6.6.1
Required Construction of new HSCs.
From State Govt fund
6.6.2
Preparation of PHC wise priority list of HSCs according
to IPHS population and location norms of HSCs
6.6.3
Community mobilization for promoting land donations at
accessible locations.
6.6.5
Meeting with local PRI /CO/BDO/Police Inspector in
smooth transfer of constructed HSC buildings.
6.7.1
Biannual facility survey of HSCs through local NGOs as
per IPHS format
Rs 200 per HSC biannually
6.7.2
Regular monitoring of HSCs facilities through PHC level
supervisors in IPHS format.
6.7.3
Monitoring of renovation/construction works through
VHSC members/ Mothers committees/VECs/others as
implemented in Bihar Education Project.
6.7.4
Training of VHSC/Mothers committees/VECs/Others on
technical monitoring aspects of construction work.
Rs 20000 per PHC
6.7.5
Quarterly Meeting of one representative of
VHSC/Mothers committees on construction work and
other issues
Rs 50 for TA to VHSC members for attending
monthly meeting at PHC
6.8
Lack of
community
ownership in
the
monitoring of
construction
work.
6.8.1
Formation and strengthening of VHSCs, Mothers
committees,
6.8.2
“Swasthya Kendra chalo abhiyan” to strengthen
community ownership
One week Training of Nukkad Natak team on IPHS
Rs 300 per participant per day for 85 persons for 7
days
6.8.3
Nukkad Nataks on Citizen’s charter of HSCs as per IPHS
Three days performance at 354 HSCs
7
To
strengthen
ANM
Training
Human Resource
7.1 1.Out of 30
sanctioned
post of LHVs
only 11 are
placed,
2.All 312
posted ANM
® are not
trained
enough to
deliver
services.
3. 174 seats
of contractual
ANM and 27
seats of
Regular
ANMs are
vacant.
7.2 The ANM
training
school
situated at
6.8.4
Monthly meetings of VHSCs, Mothers committees
7.1.1
Selection and recruitment of 174 ANMs
Honorarium of 174ANMs @ Rs 6000 per month for
12 months
Honorarium of existing 312 ANMs
Honorarium of existing 312 ANMs @ rs 6000 per
month for 12 months
7.1.2
Selection and recruitment of 28 male workers
Honorarium of 28 male workers @ Rs 5000 per
month for 12 months
7.1.3
Training need Assessment of HSC level staffs by BHM in
weekly meeting
7.1.4
Training of staffs on various services in the PHC,
Rs 1000 per participant (Total no of participants 174
new ANMs, 312 existing ANMs and 28 new male
workers)
7.2.1
Analyzing gaps with training school
7.2.2
Deployment of required staffs/trainers
7.2.3
Hiring of trainers as per need
School for
providing
regular
training of
ANMs.
8
To
strengthen
HSC for
providing
outreach
maternal
care
Sadar
Hospital
7.2.4
campus,
lacks
adequate
number of
trainers,
staffs and
facilities
Drug Kit Availability
8.1 No drug kit
8.1.1
as such for
the HSCs as
per IPHS
norms.(KitA,
Kit B, drugs
for delivery,
drug for
national
disease
control
program
(DDT, MDT,
DOTs,
DECs)and
contraceptive
No Drug kit
for AWCs
(@one kit per
annum,) . No
ASHA kit,
only need
based
emergency
but that too
Preparation of annual training calendar issue wise as per
guideline of Govt of India.
Weekly meeting of HSC staffs at PHC for promoting
HSC staffs for regular and timely submission of indents of
drugs/ vaccines according to services and reports
8.1.2
Ensuring supply of Kit A and Kit B biannually through
Developing PHC wise logistics route map
8.1.3
Hiring vehicles for supply of drug kits through untied
fund. Rs 200 per HSC per month
8.1.4
Developing three coloured indenting format for the HSC
to PHC(First reminder-Green, Second reminder-Yellow,
Third reminder-Red)
Rs 2000 per PHC
being
irregular in
supply
8.1.5
Hiring of couriers as per need
Rs 50 per courier for 200 couriers for 8 days per
month
8.1.6
Payment of courier through ANMs account
Fund for the payment of Couriers should be
transferred to ANMs account.
9
To
strengthen
HSC for
providing
outreach
maternal
care
Performance
9.1 Unutilized
untied fund at
HSC level
9.1.1
Training of signatories on operating Untied fund account,
book keeping etc
Rs 100 per person for two persons for 354 HSCs
9.1.2
Timely disbursement of untied fund for HSCs
Rs 10000 per HSC per year for 354 HSCs
9.2
9.3
No ANC at
HSC level
Only 14.2%
PW
registered in
first trimester
PW with
three ANCs
is 15.1%,
TT1
coverage is
35.4%,
Family
Planning
Status:-Any
method43.6%,Any
modern
method-
9.1.3
Assigning a person at PHC level for managing accounts
9.2.1
Identification of the best HSC on service delivery
9.2.2
Listing of required equipments and medicines as per IPHS
norms in facility survey
9.2.4
Honoring those ANMs who devolve women friendly HSC
in given criteria.
5 ANM in a year per PHC social honoring with one
shawl.
9.3.1
Gap identification of 354 HSCs through facility survey
9.3.2
9.3.3
Eligible Couple Survey
Ensuring supply of contraceptives with three month’s
buffer stock at HSCs.
State Fund
9.4
To
strengthen
HSC for
providing
outreach
maternal
care
39.8%,No
sterilization
at HSC level
,IUD
insertion 0.5%,Pills1.5%,Condo
m-1.9%,Total
unmet need is
32.7%, for
spacing14.9,Lack of
counseling
Skill.
HSC unable
to implement
disease
control
programs
9.3.4
Rs5000 per PHC
9.3.5
9.6
80% of the
HSC staffs
do not reside
at place of
posting
Problem of
mobility
during rainy
season
Training of ANMs on IUD insertion
Rs 10000 per PHC
9.4.1
Review of all disease control programs HSC wise in
existing Tuesday weekly meetings at PHC with form 6.(
four to five HSC per week)
9.4.2
Strengthening ANMs for community based planning of all
national disease control program
Reporting of disease control activities through ANMs
Submission of reports of national programs by the
supervisors duly signed by the respective ANMs.
9.4.3
9.4.4
9.5
One day training of AWW/ASHA on family planning
methods and RTI/STI/HIV/AIDS
9.5.1
Submission of absentees through PRI
9.6.1
Purchasing Life saving jackets for all field staffs
3 units per PHC at the rate of Rs 3000 per unit
9.6.2
Providing incentives to the ANMs during rainy season so
that they can use local boats.
From untied fund
9.7
Lack of
convergence
at HSC level
9.7.1
Fixed Saturday for meeting day of ANM, AWW,
ASHA,LRG with VHSCs rotation wise at all villages of
the respective HSC.
from untied fund
9.7.1
Monthly Video shows in all schools of the concerned HSC
area schools on health, nutrition and sanitation issues.
From untied fund
9.8
10
To organize
integrated
RCH camps
specially for
hard to
reach areas,
isolated
population
and Maha
Dalit Tolas
10.1
Lack of
knowledge
and skill of
field level
staffs in data
compilation
in HMIS
formats
Out reach
camps are not
organized in
plan manner.
It is totally
based on
demand of
organization
and
eventually it
is not
reported to
respective
HSCs and
PHCs.
9.8.1
9.8.2
Training to the field staffs in filling up form 6, Form 2,
Immunization report format, MCH registers, Muskan
achievement reports etc
Printing of adequate number of reporting formats and
registers
Discussed earlier
10.1.
1
Identifying Socially Backward, Slums & Maha Dalit
Tolas.
10.1.
2
Hiring trained alternate vaccinator/ retired ANMs and
Medical officer .hiring vehicle for fixed day out reach
camps with drugs.
Rs 10000 per PHC per month
10.1.
3
Fixed day OPD clinics at APHC level and adjoining HSC
of respective APHCs. With dedicated MO and support
staff.
10.1.
4
To make calendar for camps with date and identified
areas. and link NGOs those who are willing to organize
Camps .
10.1.
5
Community based reporting system through SMS. involve
PRI members and training on reporting and Camp
approach
11
To improve
adolescent
reproductive
and sexual
health
11.1
11.2
11.3
11.4
11.6
To improve
adolescent
reproductive
and sexual
health
No training
programme
for
adolescent
particularly
health and
sex.
Preventions
of anemia in
adolescence
girls
11.1.
1
Multipurpose counselor can be used for adolescent care.
For this services of LHV can be used. and calendar of
activity could be developed.
11.2.
1
Linkage with adolescent anemia control programme in
Schools with Unicef. And training to one teacher from the
school
Marriage
before legal
age.
Preventions
of teen age
pregnancy
and abortion.
11.3.
1
Sensitization of PRI members particularly women
11.4.
1
Adolescent pregnancy should be addressed with priority
care (eclampsia, 3 ANC, anemia, 100 IFA, 100%
institution delivery, low birth Wight baby, Brest
feeding.PNC with in 48 hours.
Limited
interventions
for
empowering
adolescent
girls
11.6.
1
Family counseling for adolescent pregnancy tracking on
above mentioned through ASHA and AWW.
11.6.
2
State to develop and issue guidelines for implementation
of Kishori Mandals Formation of Kishori Mandals by
registration of all girls(11-18 yrs)
11.6.
3
Prepare a monthly plan of activities for one day per week
11.6.
4
Counseling nutrition, health and social issues every week
at AWCs by AWW
11.6.
5
Weekly distribution of IFA Tablets to out-of-school girls
at AWCs
Rs 5000 per PHC
Rs 5000/-Per PHC
From State
11.6.
6
Deworming adolescent every 6 months
Purchase of 12lac tablets
11.6.
8
Initiate family schools for learning child care , safe
motherhood life skills and Family life education
Rs 10000 per Schools each in each PHC
12
To provide
MTP
services at
health
facilities
12.1
MTP services
are not
available in
Public
sectors
12.1.
1
Selection of facilities for provision of safe abortion
services
12.1.
2
12.1.
3
Location of facility availability of trained service provider,
space, equipments.
To Provide appropriate equipments at all facilities and
MVA syringes.
50000/-per PHC
12.1.
4
Putting the trained doctors at appropriate facilities to
commence the services
12.1.
5
Training of Medical officers and Para medical staffs on
Safe abortion services training including awareness about
legal aspects of MVA/ EVA and Medical abortion by
IPAS.
One doctor and one ANM from each PHC @ Rs
2000
To provide
MTP
services at
health
facilities
12.1.
6
Formation of district level committee (DLC) to accredit
private sites as per GOI guide line.
12.1.
7
Develop reporting system of MTP services in private and
public sector.
12.1.
8
Through training program make the govt doctors skilled to
perform MTP in the approved sites.
12.1.
9
To Involve community to aware about location of services
, process and legal aspects of MTP services through AWW, ASHA & ANM, LRG and mass media.(IEC)
Rs 5000/-Per PHC
12.1.
10
The services of Pregnancy testing should be strengthened
and it should be linked with MTP services.
13
To
strengthen
Monthly
Village
Health and
Nutrition
Days
13.1
Nutrition and
Counseling
Component
is not visible
in VHND
and there is
no
monitoring of
VHND
activity by
Community.
12.1.
11
NGO’s and local Practitioner should be involved for
counseling and information of facility
12.1.
12
12.1.
13
Assurance of privacy and link with family welfare
services counseling at all facility.
Linkage with MTP services with NGOs (PPP) those who
are working in Safe abortion services. and create one
modal center at district and PHC level.
12.1.
14
13.1.
1
Training of ASHA on medical abortion.
13.1.
2
Develop an activity plan calendar for VHND as
seasonality.
13.1.
3
Counseling of mothers on ANC, preparation for Child
care ,STI/RTI, and AYUSH, adolescent Health
13.1.
4
Organize VHND in Four Table concept regularly where
One place is for registration, one is for weighing, one is
for immunization and fourth is for counseling
Incorporated in ASHA training
AWC should be developed as a Hub of activities (VHND)
Booklet on four table concept @Rs 5 for 10000
booklets
13.1.
4
Meeting of VHSC and preparation for area specific
epidemiological planning and community based
monitoring.
13.1.
5
Skill development training is required to ANM , ASHA &
AWW and Dular (LRG)
Rs 5000 per PHC
13.1.
6
Develop monitoring plan map of each village and
displaced at AWC with identification of priority houses
with PW, lactating women ,Malnourished children , New
born, DOTs and other services
From untied fund
13.1.
7
SMS reporting system of conducting VHND and ANM
collect Data from field level and compile it in
weekly/Monthly formats.
B
APHC
To form
/strengthen
APHC in
Phase
manner
1.3
1.4
1.5
1.6
1.7
2
2.1
2.2
3
3.1
Infrastructure
Out of
45APHCs
only 27 are
having own
building
Existing 27
buildings are
not properly
maintained
Non payment
of rent of 18
APHCs for
more than
three years
Lack of
equipments,
1.3.1
Registration of RKS
1.4.1
Renovation of APHCs buildings from RKS Fund
Rs 150000 per APHC
1.5.1
From state fund
1.6.1
Lack of
1.7.1
appropriate
furniture
Human Resource
in the district 2.1.1
no any
APHC
functioning
as per IPHS
norms
2.2.1
Drug Supply
No drug kit
as such for
the APHCs
as per IPHS
norms,
Payment Of Rent of APHC building
3.1.1
Purchase of equipment as per service need from RKS
fund
From state fund
Purchase of Furniture from RKS fund
From state fund
Operationalising one APHC in each PHC by conducting
daily OPD by Doctor and support staff.
Notification from district for operationaling APHC
Purchasing 23 listed OPD Drugs of PHC for APHC
Rs 200000/- Per PHC for OPD drugs for one year.
5
RTI/STI
services at
health
facilities
5.1
No regular
clinic at all
PHCs &
APHCs.
5.1.1
Trained service provider on syndrome management of
RTI/STI (As per GOI guide line) up to APHC level.
Rs 1000/- for Two person from each PHC
5.1.2
Logistics of setting of clinics and free drugs availability
5.1.3
Integrated Counseling services in four public sector
facilities by trained personnel.
5.1.4
IEC/BCC for awareness available RTI/STI services at all
health facilities.
Rs20000 for Per PHC
Sl.
1
Sl.
1
2
Goal
To improve
Child health &
achieve child
survival
Objectives
To increase
ORS
distribution
from
51%(DLHS3)
to 80%
To increase
treatment of
diarrohoea
from 77.1% to
90% within two
weeks
Sl.
1.1
1.2
4.4 Chid Health
Logical Framework
Impact indicators
Reduction in IMR
Child performance in the school - enrolment, attendance and dropout
Sl.
Outcome indicators
Sl.
1.1
% increase of ORS
distribution.
1.1.1
Strategy
% increase of
treatment of
diarrohoea within
two weeks
IMNCI,Home Based
Newborn Care/HBNC
Sl.
Output
indicators
% of PHC
initiated
IMNCI and
HBNC
training.
3
4
5
6
7
8
To increase
treatment of
ARI/Fever in
the last two
weeks from
82.2%(DLHS3)
to 95%
To increase of
infant care with
in 24hr of
delivery from
29.7%(DLHS3)
to 50%
% increase of
treatment of
ARI/Fever in the last
two weeks
To increase %
of
breastfeeding
from 33.8% to
70% within 1
hr of birth
To increase
initiation of
complimentary
feeding among
6 month of
children from
88.3% to 90%
To increase
exclusive
breastfeeding
among 0-6
month of
children from
36.4% to 80%
To increase
immunization
coverage from
53.3% to 70%
% increase of breast
feeding within 1 hr
of birth.
% increase of infant
care with in 24hr of
delivery.
% increase of
complimentary
feeding among
6month of children.
% increase of
exclusive
breastfeeding
among 0-6 month of
children.
% increase of full
immunization
coverage.
Strengthening of Facility
Based Newborn
Care/FBNC and trained
workers on using
equipments.
1.1.2
Infant and Young Child
Feeding/IYCF
No of PHC
initiated
FBNC with
trained
MAMTA on
facility
based new
born care..
No of
training
organized
in PHC on
IYCF
9
To increase vit
A coverage of
received at
least one dose
(9 month to 35
months ) from
67.3% to 80%
and include up
to 5 years.
To increase Vit A
reported adequate
coverage among
(9m to 5ys )
1.1.3
Management of diarrhea,
ARI and Micronutrient
Malnutrition through
Child survival months
Two round
of Child
survival
Month
organized
in one
financial
year.
10
To decrease
Malnutrition
form
58%(NFHS III
state ) to 30%
of the age
group of (0 to
5 yrs)
% of decrease
Malnutrition age
group of (0 to 5 yrs)
1.1.4
Care of Sick Children
and Severe Malnutrition
and strengthen VHND at
all AWCs
No of
VHND
organized
vs
Planned.
2.1.1
School Health
Programme
No Of
school
health
programme
organized
in the PHC
Sl.
Strategy
IMNCI, Home
Based
Newborn
Care/HBNC
2.1
Gaps
Training
Gaps(AWW-2328
/2476, ASHA0,ANM377/401,MPW11/83,MO47/146,CDPO05/16,ICDS Super05,Health
supervisors27,NGOs-06)
No ASHA is
trained on IMNCI
Activities
Assessment of Training load and prepare
calendar of training
Incorporate ASHA in IMNCI training team
ASHA kit regular supply and incorporate use of
ASHA Kit in training curriculum.
Inadequate
monitoring of this
activity at field level
Division of area among all trained supervisors
for revision of IMNCI activity in their area.
BHM will be responsible for review of health
supervisors and LS(ICDS)on given format.
Unicef staff will support in developing review
mechanism in PHC.
Incorporate IMNCI reports in HIMS format
Encouraging mother regarding child care. in
VHND
Frequent checkups of babies by Pediatrician.
Distribute telephone number to AWW and
ANM of respective doctors those who are
supervising them in the field.
Wednesday could be fixed a day for IMNCI
related work at HSC level
Community based Monitoring support system
develop with SHG in one PHCTraining of
Group membersseed money to SHG for
referral services and other need based
services.
Rs 100000 for one PHC
Facility Based
Newborn
Care/FBNC
only eight
institutions have
baby warmer
machines but
maintenance of
machine is not up
to the mark and
district having
referral six bedded
SNCU
All PHCs should be equipped with baby
warmer machines.
Mobilizing nine units from UNICEF
ANMs and Doctors
are not trained to
operate these
machines
There is no
provision of stay of
mothers of
neonates at PHC.
Neonatal Care Unit
not up to mark.
Training of Doctors and ANMs to operate baby
warmer machine.
Rs 5000/- for demonstration at District level
Organize training program for newborn care for
the nurses in the district hospitals
One Nurse from each PHC Cost will be 5000/-
District level Supporting supervisory team
should be developed with the responsibility of
non functioning of neonatal care unit.
Training of team on monitoring of NCU
Rs.5000/-for one time training
Colostrums feeding and breast feeding
inclusively for six months. Through IMNCI
Training.
Non awareness of
breast feeding and
proper diet of
young children.
Baby friendly hospital
Training of one doctor from each Nursing
hospital at District Level
Rs.20000 for training program
Two days training of one staff nurse from each
private hospital on counseling skill.
Rs 20000/- for training program
Infant and
Young Child
Feeding/IYCF
Accreditation of nursing home and facility
according to norms of baby friendly hospital
initiatives
Poor knowledge
regarding new
born care and
child feeding
practices
Development and Printing of BCC
materials
Rs 5 per unit for 10000 units
Preparing adolescent and pregnant
mother on IYCF by IPC through AWW,
LRP and ASHA
Linking JBSY with colostrums feeding
Myths and
misconceptions
about early
initiation of
breast feeding,
exclusive breast
feeding and
complementary
feeding
Counseling and orientation of local priests,
opinion leaders, fathers, mother in laws by
ICDS/ Health functionaries in mothers
meetings and VHSCs meetings
Folk performance to promote exclusive
breast feeding
Included in maternal health
Uniform message on radio from state
head quarter
State budget
Organize social events through VHSCs
Strengthening of Mahila Mandal meetingsfortnightly with involvement of adolescent
girl
Lack of
awareness on
importance of
appropriate and
timely IYCF
Organize healthy baby shows, healthy
mother / pregnant woman.
Rs 2000 per month per PHC
Appreciation and reorganization of positive
practices in community. For this purpose
hiring a documentation specialist.
Rs 100000 for the whole district on community wise
sample basis
Demonstration of recipes.
Rs 250 per month per AWC( Under MUSKAN
program)
Exposure visits to existing NRCs to
observe different models in the country
Rs 50000 for the district
Care of Sick
Children and
Severe
Malnutrition
There is not a single
unit in the district
where severely
malnourished
children could be
treated.
Establish rehabilitation center in district
hospital, FRU and one PHC and promote
locally available food formula for nutritional
Therapy as Hyderabad Mix
Rs 1000000 per unit
Procurement of ,ORS , Vitamin A
supplementation(9m to 5 years children) with
De-worming pediatric IFA syrup.
Management
of diarrhea,
ARI and
Micronutrient
Malnutrition
There is high
prevalence of PEM
and anemia among
children because of
Child nutrition is
least priority among
service providers.
No Pre School
Health checkup &
complete
Immunization card.
School Health
Program
No training of
school teacher for
basic health care
and personnel
hygiene.
No regular health
checkup camp at
school.
100000 ORS packets at the rate of Rs 5 per
packet.(If ORS is not provided in Kit A)IFA syrup for
800000 children at rate of Rs 4 per children
Include coverage of Vitamin A and IFA, children in
New HIMS format.
Insure two rounds of Vitamin A and de worming for
the age group of (9m to 5 yrs) & (2 yrs to 5 yers)
respectively in the month of April And Oct as per
GOI guide line.
Rs 1500000 per round into two rounds( If Vit A is
not provided in Kit A)
Involvement of ICDS, school teachers and PRI
for monitoring and evolution
Half yearly health checkup camp for children in
schools should be organized.
Rs 2000 per PHC
Training of school teacher by the medical
personnel with support of administrative
person.
Budget incorporated in adolescent health
Quarterly meetings of VEC representatives by
attending existing meetings of VECs
representatives at block level by the concerned
MOI/Cs and BHMs.
No Training &
Screening of
school’s teacher
for eye sight test.
Linking existing 7 ophthalmic paramedics with
this program and developing school wise
calendar.
No other specific
program has been
formulated in the
district.
School health anemia control program should
be strengthened with biannually de worming.
Mobility support of Rs 10000 per PHC for moving
other blocks and hard to reach areas.
Budget incorporated in adolescent health
Organizing competitions/Debates/Painting
competitions/Essay/demonstration and model
preparation of nutritional food and health.
Rs 20000 per PHC
Half yearly Health checkups and health card of
all school going children.
Printing of Health Card at the rate of Re 1 per card
for the children of class 6 to 10
Films shows on health, sanitation and nutrition
issues
Use LCD projector in this activity.
Social science Lab activities.
Included in adolescent health
Rally and Prabhat Phery in epidemic areas.
(Kala-azar & Malaria)
Local contribution/ Untied Fund/VHSC
Referral system for the school children for
higher medical care.
From RKS fund
4.5 Family Planning
S
l.
Goal
Sl.
Logical Framework
Impact indicators
1
Population
stabilization
1.1
To decrease TFR up to replacement level
To increase sex ratio
S
l.
2
Objectives
Sl.
To increase
female
sterilization
from present
35%(DLHS3) to
50%
2.1
Outcome
indicators
% increase
in female
sterilization
Sl.
2.1.1
2.1.2
2.1.3
2.1.4
2.1.5
2.1.6
3
4
5
To increase
male
sterilization
from 0.6%(
DLHS 3) to 2%
3.1
% increase
in male
sterilization
4.1
To increase
use of pills from
present
1.5%(DLHS3)
among current
married women
5.1
% increase
in the use
of condoms
3.1.2
4.1.1
4.1.2
% increase
in the use
of pills
Terminal/Limiting
Methods
Dissemination of
manuals on
sterilization standards
& quality assurance
of sterilization
services
Female Sterilization
camps
Compensation for
female sterilization
IUD camps
Accreditation of
private providers for
IUD insertion
services
3.1.1
3.1.3
To increase
use of
condoms from
1.9% (DLHS3)
to 5%
Strategy
5.1.1
Sl.
2.1.1.1
2.1.2.2
2.1.3.3
2.1.4.4
2.1.5.5
2.1.6.6
3.1.1.1
NSV camps
Compensation for
male sterilization
Accreditation of
private providers for
sterilization services
Promotion to Social
Marketing of
condoms
Contraceptive Update
seminars
Promotion to Social
Marketing of pills
3.1.2.2
3.1.3.3
Output indicators
% of terminal/limiting
methods use
No of facilities providing
quality manuals on
sterilization standards of
sterilization services.
No of camps organized for
female sterilization .
% of Female received
compensation
No of IUD used in Camps
No of Private providers
accredited for IUD Insertion
services.
No of NSV Camps
organized.
% of Male received
compensation
No of Private providers
accredited for Sterilization
services.
4.1.1.1
No of Condoms distributed
through Social Marketing.
4.1.1.2
No of Seminars Organized
on Contraceptive Update.
No of Pills distributed
through Social Marketing.
5.1.1.1
age 15-49 yrs
to 5%
Sl
Strategy
Gaps
Terminal/Limiti
ng Methods
Lack of
knowledge
of small
family
norms.
Activities
Ensure one MO trained on mini lap and NSV up to PHC
Training of nurses and ANMs on IUD and other spacing
methods at PHC level.
Ensure availability of contraceptives (indenting , logistic Rs
500000 per PHC
Female
Sterilization
camps
Laparoscop
y surgery
not done.
NSV camps
Trained
doctors are
not
available.
Compensation
for female
sterilization
Compensation
for male
sterilization
Trained doctors on laparoscopy.
Procure Laparoscopy equipments for trained doctors Rs
100000 per PHC
Training of doctors needed.
Procurement of equipment.
Immediate disbursement of incentive after sterilization
camps.
Fund for
Compensat
ion for
sterilization
is not
available
on time at
facility.
Rs1000 each for 25000 male and 5000 female operations
Logistic planning is needed before organizing camps.
Block Health manager can hire one support staff for logistic
support.
Immediate disbursement of incentive after sterilization
camps.
Logistic planning is needed before organizing camps.
Block Health manager could be hire one support staff for
disbursement for logistic support.
Accreditation of private nursing home. As per GOB
Camps not
held
Training of ANM & staff nurse for IUD insertion.
IUD camps
Procurement of IUD. Rs 30 into 52800 units
Accreditation of
private
providers for
IUD insertion
services
No
accreditatio
n of private
providers
for IUD
insertion
services
Social marketing of need based OC & IUD.
Social
Marketing of
contraceptives
Monitoring
of Social
Marketing
is not
monitored
by PHC.
Contraceptive
Update
seminars
Not being
held.
Equipments for IUD insertion
Accreditation of private providers for IUD insertion services.
As per GOI guide lines.
Increasing access to contraceptive through communities
based distribution system free of cost.
Seminars for MO and other through Professional bodies
(FOGSI. BMA, Nursing association etc. on
Copper-T 380-A should be popularized.
Awareness for emergency contraceptive.
4.6 Kala-azar
Gaps
Issues
Strategy
Activities
Poor
coverage
of DDT
spray
Vector
control
through
insecticid
e spray in
the attack
area
1
To
increase the
coverage of
DDT spray in
the endemic
zone , there
should be
proper
monitoring by
the supervisors,
capacity
building of the
sprayer,
supervisors and
other
healthcare
professionals
Monitoring of
the spraying
squad by
MOIC
1. Ensure planning for timely spray of DDT in Feb-March and
May-June for 40 days in each block
2. Identification of Houses with Kala-azar patients by ANM &
ASHA @ 50/ per village Rs 50 for 751 villages twice in a year
3. Two round of spraying scheduled in Feb-March and May-June
should be strictly observed
4. DDT spray should be at the rate
of 1gm/sq. meter upto the height of
6 feet.
Less time
spent on
spraying
DDT
Training and
capacity
building for
proper spraying
Regular capacity building training on prescribed module for the
sprayer to ensure that every corner of the house is properly spray
up to heights of six feet from ground level.
Rs 5000 per PHC
Poor
condition
of
Sprayer,
pump
and
nozzles
etc
Inadequa
te stock
of DDT,
DDT
available
-41mt,
DDT
required33mt
Faulty
payment
plan
Poor rate
of case
detection
of
Kalazar
Early
diagnosis
and
treatment
through
PHC
system
Regular
checking of the
spraying pumps
for better
functioning and
timely
replacement of
the faulty
pieces.
Making
available DDT
during spraying
round
Fund allocation and timely release for maintenance of old sprayer
pumps, Purchase of new pumps and other articles needed- buckets,
mugs etc.
Rs 150000 for the district
Appropriate
fund allocation
for the payment
of the spraying
of DDT
Case detection
rate should be
increased with
appropriate
diagnostic test
Fund would be allocated for regular payment of wages
Early diagnosis
and treatment
through PHC
system
1. Ensuring availability of Amphotericin at all level
Purchase of 10000 vails of Amphotericin B @ Rs 65 per unit
Ensure adequate Stock of DDT through proper & timely indenting
to improve the quality of spray
DDT Carriage
Increase efficiency of case detection through training of
Community workers on signs and symptoms of Kala-azar:
1) three weeks persistent fever not responding to antibiotics,
malaria being excluded, with palpable spleen.
2) Ensure availability of aldehyde test at PHC level
3) Purchase of RK 39 kit for detection of Kalazar
Purchase of 50000 units of RK39 @ Rs 25 per unit
2
Reductio
n of
kala-azar
mortality
and
morbidit
y
Loss of wages for KZ patients(case detection in year 2007-3275)
Rs 50 for 22 days for 3200 patients
2. Replacing of medicines on priority based
3. Training of ANMs and ASHA for IM injection
Rs 5000 per PHC
Lack of
monitorin
g and
supervisio
3
n
mechanis
m,
Preparation of Monthly visit plan for supervision :- Checking
spraying schedule- For supervision & treatment follow up
Monitoring
and
supervision
mechanism
Mobility support for CS, ACMO and DMO
Mobility for MOIC 20x 40days x Rs 100
Mobility for supervisor 33x 40 days x Rs100
Office expenses 25000 for the district
Lack of
appropriat
e BCC &
Communi
ty
Mobilizat
ion.
Increasi
ng
awarene
ss for
preventi
on of
Kalaazar
4
Community
participation
in reducing
mortality and
morbidity due
to Kala-azar
1. Fund allocation for training activities
2. Identification of NGO/Private partner as trainer
3. Knowledge sharing with the community on signs and symptoms
of Kala-azar through VHSC
4. Training of VHSC/PRI and community health worker on sign &
symptom of Kala-azar
5. Regular monitoring of IEC activities
6. IEC activities through nukkad natak, kalajatha mass media like
radio etc Rs 10000 per PHC
7.Activity for surveillance like polio surveillance
8. Wall painting of Treatment protocol and provisions for patients
in PHC in Hindi.
IEC van for each PHC
Gaps
4.7 Blindness
issues
Strategy
Activities
Lack of adequate eye surgeon and
staffs in the district. Only 2 eye
surgeons are posted in the district
Staff
shortage
Recruitme
nt
Only 6 Ophthalmic Assistants are
posted in the district, however the
requirement is 25.
Most of the doctors and staffs are
not trained enough on new IOL
techniques
Untrained Capacity
staffs
building
Recruitment of Eye Specialists and surgeons
on contractual basis.
Already discussed in maternal health
Recruitment of Ophthalmic Assistants on
contractual basis.
Only 4 in the current year @ Rs 8000 per
month
Training of Doctors on IOL technique
Rs 10000 per person for 5 person
Training of Ophthalmic Assistant
Rs 5000 for 4 Ophthalmic assistants
In the Year2008-09 only 66 Cataract
operations have been done by the
Govt facilities and 1763 by the
private facilities(till Nov 08).In the
year 2007-07,altogether 1945
surgeries were performed out of
3000 and in the year 2007-08 2966
surgeries have been performed.
Low
achievem
ent
Increasing Organizing Operations at District level
no
of Rs750 per operation for 3000 operations
camps
PPP
Accreditation of Nursing Homes capable of
doing Cataract surgeries
Purchase of equipments and medicines
Lack of awareness among
community regarding cataract
blindness and its treatability.
Fear of eye operation.
Lack of Education among the
masses about the existing
facilities: Need of wide publicity.
Lack of
awarenes
s
Awarenes
s building
Assigning LHV/Supervisor counseling work
Organizing eye screening camps in villages/
schools
IEC on cataract and its facilities
Rs 100000 at district level
Poor coordination between the
health functionaries and the
voluntary organizations resulting in
less cataract surgeries.
Lack of adequate referral
services to take care of
complications.
Lack of monitoring and follow
up
Involving
NGOs
Lack of
adequate
referral
services
Monitori
ng and
follow up
Meeting with Local NGOs on this issue
Strengthen Arrangement of carrying patients to the
Operation Centers and then taking them back
ing
homes Rs 10000 per PHC
referral
system
Monitoring
and follow
up
Mobility support for Visiting homes of the
patients to manage any post treatment
complication. Rs 10000 per PHC
Developing records of cataract cases from
OPD registers at PHC level
Gaps
4.8 Leprosy
Issues
Strategy
Activities
Existing PR of the district is 1.1 and
the target is only 1, so the existing
program performance is good.
Lack of
Awarenes
s
 Lack of awareness is still a problem
with the Leprosy Program as most of
the cases are detected accidentally.
 Inadequate staff, Only 6 supervisors Lack of
and 14 Non Medical Assistants are Human
working while the requirement of Resource
Supervisor is 20 and that of ANM is
40 (One ANM in each APHC)
 There is no active involvement of
the Medical officers at sector and
Block levels.
Awareness
generation
IEC on Leprosy
Rs 5000
per PHC
in a year
Staff
Recruitment of 14 supervisors
Recruitment Rs 7000 per supervisor per month
in contract
basis
Strengthen
Health Care
Orientation of MOs and staffs on Leprosy
 Lack of PHC staff involvement. No
manpower support,
Services
Case validation, to have check on wrong
diagnosis and re registration
Prompt and early detection of the cases to
avoid deformity and disability,
Ulcer care foot ware reorientation training
of medical & para medical staff.
Rs2000 per PHC
No lab testing facility in the district
Infrastruc
ture Gap
Establishing Establishing Lab at district level
Lab
Recurring expenditure like reagents
Rs 1000 per month
Lack of monitoring at all level
Monitorin
g Gap
Increasing
mobility
Updation of master register
Mobility support for DLO
RS 3000 per month
Office expenses
Rs 2000 per month
4.9 T.B.
Indicators
1
2
Infrastructure
HR
Gaps
Lack of well
equipped/Designed
Microscopy Centre
Activities
Development and Renovation of DMCs with proper water supply and
Electricity connection Rs 5000 per PHC
Microscopes of many
Designated
Microscopy
Centers(DMC) are
not functioning
Poor Maintenance of
Microscopes
Supply of New binocular Microscopes
Rs 50000 per PHC
Many DMCs are
closed due to lack of
Microscopes / Lab
Technician
Recruitment Process should be followed.
Special Training to Lab Technician/Microscopes for maintenance of
Microscopes
Honorarium for 35 TB technicians
Rs8000 per month for 17 technicians for 12 months
3
4
Drugs and
Chemicals
Service
Performance
Constraint in
selection Process of
new Staffs by the
District Health
Society
Remuneration of Pvt
DOT Providers has
not been paid
Obstacle in recruitment Process will be rectified.
Irregular supply of
Drugs specially of
Pediatric Drug Boxes
(PC-13, PC-14)
Supply of short
expiry drugs which
causes difficulties in
drug management
To ensure regular and adequate supply of drugs and other Laboratory
materials
Poor Retrieval of
Drug Boxes of
Defaulted patient
Irregular supply of
slides and other
Chemicals and other
logistics
Delay in purchasing
of chemicals and
other logistics at
District level
Poor quality of DOTS
Retrieval of Drugs may be ensured by STS.
ANMs providing
DOTS at the HSCs
do not visit the
Center on DOTS day
resulting irregular
intake of drugs by the
patient causing poor
Cure- rate.
Problems in payment of remuneration will be solved
Rs 50 per DOTS provider for 500 units
Proper care should be taken regarding short expiry drugs. Short expiry
drugs may be used where there is large number of patients having
DOTS.
Proper supply of Slides and other Chemicals should be ensured
Constraints in purchasing of Chemicals and other logistics will be
removed. Official Process will be simplified.
Proper and Regular supervision and monitoring of program will be
ensured.
Motivation and Sensitization of Staffs by Refreshment training on
friendly behavior with patient
Due to irregularities
in DOTS cases of
MDR TB may be
increased
Not friendly behavior
of Lab Technician
and other staffs with
patient who comes
for sputum
examination or for
DOTS
Poor Case Detection
i.e., <70%
Poor Cure Rate i.e.,
<85%
Proper counseling of patient should be done regarding importance of
DOTS and importance of Follow-up Sputum examination
Appointment of a Counselor at all PHC
Organizing Community meetings
Medical Officers should take care of referring all chest symptomatic
patients for sputum examination
Proper Follow-up Schedule should be maintained
Proper care for side effects of drugs.
4.10 Filaria
Gaps
It affects mainly
the economically
weaker sections
of communities
Issues
Strategy
1. Single dose
DEC mass
therapy once a
year in
identified
blocks and
selected DEC
treatment in
filariasis
endemic
areas.
Activities
Line listing of the cases
Purchase of equipments for the management of Filaria cases
like towel, Bucket, soap, mug etc
Rs 500 per HSC for 354 old and 154 new HSCs
DEC distribution through AWCs and paying hon to AWWs for
this. Rs 100 for all 2672 AWC
Purchase of DEC
Training to AWWs/ASHA on DEC distribution and filaria case
management Rs 2000 per PHC
Result in low
priority being
accorded by
governments for
the control of
lymphatic
filariasis.
Low effectiveness
of the tools used
by the control
programme
The chronic
nature of the
disease
2. Continuous
use of vector
control
measures.
Meeting with VHSC members
Detection and treatment of micro-Filaria carriers,
treatment of acute and chronic filariasis.
Wall paintings
4.IEC for
ensuring
community
awareness and
participation
in vector
control as
well as
personal
protection
measures.
4.11 INSTITUTIONAL STRENGTHENING
Logical Framework
Sl.
Goal
1 To improve
institutional
setup as per
IPHS norms
Sl.
Impact indicators
1.1 Improved service delivery for women and children friendly with quality
2 To bring
required
architectural
correction in
the
Institutional
System
Sl. Objectives
1
To
strengthen
NGOs
Partnership/
PPP for
communitiza
tion of
Health
services.
Sl.
Outcome
Sl.
indicators
1.1 No and Type 1.1.1
of MOU
signed
between
NGO and
DHS/RKS
1.1.2
for
strengthenin
g of
communitiza
tion of health
services and
NGO
partnership/
PPP in place
Strategy
Sl.
To enforce PNDT 1.1.1.1
Act and to
increase sex ratio
of female child
To make Public
Private
Partnerships for
referral transport,
IPD care canteen
facility, STD
booth and other
routine facility
where it is not
functional.
1.1.2.1
Output indicators
% decrease in sex
selective abortions. %
increase in birth of
female babies (
delivery registers)
No of cases supported
by referral transport
system under PPP.
1.1.2.2
No of canteen facility
functional at
institutional facility
level.
1.1.2.3
No of STD booth and
other routine facility
carried out under PPP.
1.1.2.4
No of cases supported
and payments made by
RKS/ DHS to BPL
families in availing
these services
1.1.2 To develop
partnership with
NGO
Programmes in
the districts
3
4
To develop
IEC and
BCC and
Training
support
system .
To
strengthen
ASHA
support
1.1.2.1
Strengthen
1.1.2.2
Logistics
management
system for regular
supply of Drugs
and equipments
Develop a strong 1.1.2.3
Monitoring &
Evaluation /
HMIS System in
all PHC
3.1.1 Establishing BCC 3.1.1.1
and training cell
at District &
BPHC level
3.1 No of IEC
materials
developed
and BCC
event carried
out
No of
Net working with 3.1.1.2
training
folk media team
support
system
developed
4.1 No of ASHA 4.1.1 Develop ASHA
4.1.1.1
capacities
support System in
all PHC(One
person per 20
No of partnership with
NGO for programme
implementation for
MCHN, Micronutrient
supplementation,
national program
implementation
specially Kalazar
elimination
No and % of drug &
equipments available
and supplied ( stock
ledger)
Regular monitoring
and evaluation reports
Functional BCC cell at
DHS/ RKS level
No of folk media team
engaged in BCC
activity. Type and No.
of BCC event
organized
Establishment of
ASHA support system
at DHS and RKS level
System
ASHA)
4.2 No of
activities
carried out
by RKS
Sl.
Strategy
To enforce
PNDT Act
and to
increase sex
ratio of
female child
To make
Public
Private
Partnerships
for referral
transport,
IPD care
canteen
facility, STD
booth and
other routine
facility
where it is
not
functional.
Gaps
No
registration
of ultra
sound clinic.
Out
sourcing of
services is
not as per
the need of
local Need
and BPL
families are
not
exempted
from Fee of
out source
services
4.1.2 Strengthening
RKS
4.1.1.2
4.1.1.3
No of RKS having
monthly meetings.
% of untied fund, JSY
fund, referral transport
etc utilized
Activities
Registration and monitoring of ultra sound clinic.
MTP clinic should be watched for termination of
pregnancy following USG.
IEC on PNDT act
Rs 5000 per PHC
District /PHC level managers should be aware about the
TOR of PPP which is finalized at State level.
Build the capacity of manager to manage contracts of
PPP
Develop
partnership
with NGO
Programmes
in the
districts
There is an
acute
shortage of
para medics
like
radiographer
, lab
technician,
ECG
technician
etc. in the
state.
Non
involvement
of NGO in
F.P
programme,
Institutional
delivery,
Blindness
control
programme.
Accreditation of institutions and to set standards, an
institute of paramedical sciences may be started in the
state. This would create more employment opportunities
in addition availability of para medical personnel for
absorption into the government health system.
There is no
MOU with
NGO/VO/in
dividuals for
Donation
and
voluntary
support in
PHC
Process of MOU should be decentralization and it should
operationlise through RKS.
Listing of NGOs those who are working in F.P , MTP
program, Institutional delivery, Blindness control
programme.
Accreditation of these facilities from state Health Socity.
Strengthenin
g of DMU
NGOs
Management
aspects is
one of the
area of
improvement
ASHA Program manager facilitate the NGO
management process in the district and ASHA
Facilitators will be managed at the PHC level
Honorarium to DPM, DPM(ASHA), DAM and DA
Rs 37000 pm for DPM, Rs 20000 pm for DPM(ASHA),
Rs 32000 pm for DAM and Rs 30000 pm for DA
Capacity building training programme for NGOs office
bearer with the help of professionals on linkage with
health system strengthening component.
Rs 5000 per PHC
Mentoring Group at district level.
There is
some
problem to
form VHSC
in the
district.
Capacity
building of
Managers
and Doctors.
Reporting mechanism should be developed of NGOs
work in the district.
Co-ordination with community based organization at
SHG, LRG, VEC,
, PRI for VHSC formation.
Meeting expenses money should be provided
Exposure visit of DPM/BHM /ASHA DPM/ DAM/ DA
/selected ASHA to other state where facility is
comparatively working better.
Rs 100000 for the district
To start DNB (Family Physician) 3 year course in the
district hospitals.
Rs 100000 for the district
ASHA/ AWW career advancement programme may be
planned to retain them in the system. Seats in the ANM
course, staff nurses and other paramedical courses may
be reserved for the qualified ASHAs
Preparation
of
decentralized
District
Health
Action Plan
First time
five
members of
the districts
were trained
on DHAP
preparation
Trainings of DPMU,BPMU members on implementation of
services/ various National program and district Health action
Plan through distance education
1 DPM, 20 Doctors ( One from each PHC) , 20 BHMs
and district planning team
Start preparation of plan from the month of October with
situational analysis, Facility survey, line reporting system
and qualitative finding from Community and users of
facility.
Rs 50000 for the district
Develop a
strong
Monitoring
& Evaluation
/ HMIS
System in all
PHC
Monitoring
of a program
is one of the
weakest
links of all
programs.
Lack of
Supervisors
in all PHC
Lack of skill
of use of
data
Community
is not aware
about
monitoring
aspects of
Distribution of role and responsibility among MO and
Managers of programme implementation.
Use Process indicator as monitoring of respective
program.
Develop Program review calendar for review of
HSC/PHC performance as per form 6 & 7
Gradation of Health Sub centers in three categories.
Information exchange visits among ANM according to
Grade.
Social recognition of Grade one ANM.
Develop four potential VHSCs in all PHC on
Community based Monitoring of Health and Nutrition
program. Rs 2000 in each PHC
Strengthen
Logistics
management
system for
regular
supply of
Drugs and
equipments
Health
Programme.
Organize "JAN ADALAT" in with PRI & VHSC and
invite nearby VHSC to observe the process of "JAN
ADALAT"
Develop Health and Nutrition Report Card by using
growth monitoring charts of Village and present in "JAN
ADALAT" By VHSC Rs 2000 in each PHC
There is no
system of
logistic
management
of Drugs and
other supply
at any level.
Weekly meeting of HSC staffs at PHC for promoting
HSC staffs for regular and timely submission of indents
of drugs/ vaccines according to services and reports
Only vaccine
supply
management
is
comparativel
y stronger
than other
logistic
work.
Establishing
BCC and
training cell
at District &
BPHC level
There is not
as such
designated
post for BCC
and Training
at the district
and PHC
level
Hiring vehicles for supply of drug kits
Rs 2000 per PHC per month
Hiring of couriers as per need
Discussed in maternal health
Developing three colored indenting format for the HSC
to PHC(First reminder-Green, Second reminder-Yellow,
Third reminder-Red)
Discussed in maternal health
Training of all ANM and Stock keepers on Indenting and
Logistic Management.
Rs 5000 per PHC
Develop TMC model for Logistic Management in the
state.
ASHA Programme manager facilitate the process of
training and BCC in the district and ASHA Facilitator
will be managed at the PHC level
Develop resource team at District Level.
MOU with Local NGOs for logistic management of
training and Develop issue wise Master trainers in
district
Develop ASHA support system on one person/20 ASHA
for on the job training of AHSA and AWW
Net working
with folk
media team
There is no
BCC
management
unit at
District
Level
Identify Health Communication organization for
identification of BCC issues as per need of District.
MOU with organization for formative research.
Develop IEC/BCC material based on Findings of
formative research
Printing of IEC and BCC material
Training of Folk Media group on IEC/BCC material
Planning of performance route chart of Folk media
Group
Strengthenin
g RKS
Strengthenin
g community
process
through
supportive
supervision
of ASHA
program
RKS are not
uniformly
functioning
in the district
Poor
monitoring
mechanism
of ASHA
program
Monitoring of performance through SMS of PRI
members
Impact analysis of Performance by Organization
Ensure registration of RKS of all functional APHC
Training of RKS signatory and BHM on financial
Management of RKS
Presentation of case study of functional RKS in district
level Meeting.
Appointment of PHC level ASHA facilitator
Provide training cum supervisory support @ one
supervisor for 20 ASHA
Rs 250 per supervisor for 160 supervisors for maximum
15 days in a month
Training of DPM (ASHA), Facilitator and supervisors at
block level.
Rs 250 per participant for three days for 180 participants.
Media
Sensitization
Wrong and
provocative
Reporting
Having
baseless
News.
Media Sensitization work shop
Rs 5000 per Quarter at district level.
Structured approaches for State/ District/ Block PIP planning
National Rural Health Mission
Strategy & Activity Plan with budget
Name of the District:- Samastipur
Activity Plan
Q3
Budget Planned (including spill over
amount) {(AP x A) ± E} = BP
Tentative Unit Cost (2010-11)
under or over-utilised Budget
{(B~D} =E
Budget utilised {Y x (A)} = D
Budget received B or C
(< or > than planned)
Budget Planned
{X x (A)} = B
Budgetary Source (other than NRHM
source)
Q2
2011-2012 FY
Remarks
NRHM
Q1
A
2010-2011 FY
Tentative Unit Cost (A)
Special efforts to overcome constraints
(Process to be adopted)
Activity planned including previous yrs
gap {Z+(X~Y)} =AP
Reasons for Variance
2011-2012 FY
Variance (X~Y)
Activity Executed (Y)
Activity planned (X)
Output 2012
Component Code (only at state level)
Activities
2010-2011FY
time line of activities
STRATEGIES
Budget Plan
1 new FRUs
Proposed in
FY 2011-12
Q4
RCH
A.1
1.
Maternal Health
0
A.1.1.1
A.1.1.1.1
1.1Operationalise
facilities
(dissemination,
monitoring & quality)
(details of
infrastructure &
human resources,
training, IEC / BCC,
equipment, drug and
supplies in relevant
sections)
0
1.1.1 Operationalise
Block PHCs/
CHCs/
SDHs/DHs as FRUs
1.1.1 Operationalise
FRUs (Diesel,
Service Maintenance
Charge, Misc. &
Other costs) 1.1.1.1
Operationalise Blood
Storage units in FRU
0
3
1
0
Functional at Sadar
Hospital,Samastipur
A.1.1
3
1
1
1
3420
00
1026000
244000
782000
408000
2006000
15
RTI/STI srvices at
health facilities
A.1.1.5
Operationalise Subcentres
A.1.3.
1.3. Integrated
outreach RCH
services
A.1.3.2.
A.1.4
A.1.4.1
1.3.1. RCH Outreach
Camps in un-served/
under-served areas
130
1
0
0
3
130
156
1.3.2. Monthly Village
Health and Nutrition
Days at AWW
Centres
5
1
40
Y
5
5
0
0
0
0
50000
100000
0
0
0
0
0
25000
500000
0
0
40
Y
1
40
Y
1
36
Y
0
743
40
1.4. Janani Evam
Bal Suraksha
Yojana/JBSY
1.4.1 Home deliveries
(500/-)
427
A.1.4.2
5
0
MTP services at
health facilities
1
A.1.3.1
20
1
1.4.2 Institutional
Deliveries
0
427
0
1200
300
300
300
300
500
0
0
0
0
0
0
0
0
0
0
0
407400
407400
523308
40
Training+
200
Micropla
n+15000
Review
795960
0
0
0
0
213500
0
0
0
1260000
743
388560
213500
420000
407400
388560
213500
0
New
activities
planned for
FY 2011-12
A Medical
officer (Skin
Specialist)
shall be
appointed
on
contractual
basis
@Rs.35,000
/- per month
0
0
0
0
NRHM
0
1
NRHM
15
2
Workshop at all PHCs has been
planned during FY 2011-12
0
Orientation
of Mos ,
ANM &
Other Staff
posted in
FRU for
Operationali
sation of
FRU
NRHM
A.1.1.4
0
To open an OPD at SDH
for providing RTI/STI
Services
A.1.1.3
1.1.2 Operationalise
24x7 PHCs (Organise
workshops on
various aspects of
operationalisation of
24x7 services at the
facilities @ Rs.
25,000 / year /
district)
0
No budgetary provision was
planned for FY 10-11
A.1.1.2
Orientation 2 times
in a year for FRU
Operationalisation
03 Months
Achievement
Remaining
A.1.1.1A
0
500
600000
0
50 Home
delivery
incentive
Planned for
each Block
PHC
A.1.4.3
A.1.5.1
1.4.2.3 Caesarean
Deliveries (Facility
Gynec, Anesth &
paramedic) 10.3.1
Incentive for Csection(@1500/(facility Gynec.
Anesth. &
paramedic)
04 Months
achievements
remaining
A.1.4.2.3
1.4.2.2 Urban (B)
Institutional
deliveries (Urban) @
Rs.1200/- per
delivery for 2.00 lakh
deliveries
1E+05
29678
2967
8
03 Months
Achievement
Remaining
A.1.4.2.2
1.4.2.1 Rural (A)
Institutional
deliveries (Rural) @
Rs.2000/- per
delivery for 10.00
lakh deliveries
1200
250
250
250
250
1200
1000000
1000000
0
1000000
1200
1440000
03 Months Achievement
Remaining
A.1.4.2.1
425
105
105
105
110
1500
600000
600000
0
600000
1500
1237500
2160000
2160000
0
2160000
2000
2160000
0
0
0
0
50000
50000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
85000
59788
25212
1000
0
1000
400
105
295
1.4.3 Other
Activities(JSY)
1.4.3. Monitor quality
and utilisation of
services and Mobile
Data Centre at HSC
and APHC Level and
State Supervisory
Committee for Blood
Storage Unit
Institutional based
Death Review/
Community based
MDR (Workshop at
District Level)
29678
29678
2000
1080
0
0
0
1
y
0
163600000
1636000
00
75024562
88575438
2000
325999438
Total (JSY)
A.1.5
A.1.5.1
A.2
1.5 Other
strategies/activities
1.5.1 Maternal Death
Audit 1.1.3 Survey on
maternal and
perinatal deaths by
verbal autopsy
method (in two
districts) @ 850 per
death
2. Child Health
Committed
Expenditure
is also
included Rs
88575438/-
N
R
H
M
A.2.2
A.2.3.
A.2.4
2.1. Integrated
Management of
Neonatal &
Childhood
Illness/IMNCI
(Monitor progress
against plan; follow
up with training,
procurement, review
meetings etc)
2.2 Facility Based
Newborm Care/FBNC
in districts (Monitor
progress against
plan; follow up with
training,
procurement, view
meeting etc.)
1
0
1
173
0
173
2.3 Home Based New
born care/HBNC
Expected in Feb. - Mar. 10
A.2.1
2
173
50
43
135000
872
152000
152000
0
0
0
135000
135000
270000
152000
1000
173000
0
0
2.4 School Health
Programme (Details
annexed)
4039
919
5919
14874000
5275122
0
0
3E+0
6
3093600
3093600
0
3093600
3402000
3402000
3270
00
654000
327000
0
654000
327000
981000
0
0
0
0
0
0
0
0
0
0
22000
22000
0
0
A.2.5.
2.5 Infant and Young
Child Feeding/IYCF
A.2.6.
2.6 Care of sick
children & severe
malnutrition
1
0
1
1
2.7 Management of
Diarrhoea, ARI and
Micro nutrient
2
1
1
3
A.3.1.
3.1.Terminal/Limiting
Methods
A.3.1.1.
3.1.1. Dissemination
of manuals on
sterilisation
standards & quality
assurance of
sterilisation services
A.3.1.2
3.1.2 Female
Sterilisation camps
A.3.1.3
3.1.3 NSV camps
(Organise NSV
camps in districts
@Rs.10,000 x 500
camps)
3.1.4 Compensation
for female
sterilisation
1
0
1
03 Months
Achievement
Remaining
3.Family Planning
1500
1500
1500
1419
3000
0
1
1
0
1
2200
0
1
0
36
0
36
####
5626
14374
Maximum
03 Months
Cases done in Achievement
Dec. - Mar.
Remaining
A.3
A.3.1.4
40
135000
0
4958
A.2.7.
40
1350
00
148290
14725710
3000
0
0
22000
32482710
0
25000
0
47000
0
40
5
5
15
15
1000
0
360000
360000
0
360000
10000
400000
34374
3000
3000
9000
19374
1000
20000000
1961775
0
2027858
17972142
1000
34374000
12000000Rs
Commited
expenditure
for FY 201011(Payment
Due for
4000
Camps)
3.1.6 Accreditation of
private providers for
sterilisation services
3.1.3.1
Compensation for
sterilization done in
Pvt.Accredited
Hospitals (1.50 lakh
cases)
A.3.2
3.2. Spacing
Methods
A.3.2.1
3.2.1. IUD Camps
A.3.2.2
A.3.2.3
3.2.2 IUD services at
health facilites/
compensation
3
1029
6895
0
6895
1032
100
100
400
432
1500
1548000
1546875
0
1548000
1500
1548000
10000
1000
1000
2000
2895
1500
15000000
8962500
0
15000000
1500
21647000
0
0
0
Social Marketing of
contraceptives
A.3.2.5
3.2.5 Contraceptive
Update Seminars
(Organise
Contraceptive
Update seminars for
health providers (one
at state level & 38 at
district level)
(Anticipated
Participants-50-70)
3.3 POL for Family
Planning for 500
below sub-district
facilities
0
0
360
0
360
360
90
90
90
90
1500
540000
540000
0
540000
1500
540000
11258
788
10470
11558
3000
3000
3000
2558
50
562900
562852
0
562900
50
577900
0
0
0
0
0
0
0
0
7135
142700
142600
0
142700
7135
285400
1620
0
324000
340200
0
324000
16200
648000
Accreditation of
private providers for
IUD insertion
services
A.3.2.4
A.3.3
1032
Accreditation is Under Process
A.3.1.6
3.1.3.1
3.1.5 Compensation
for male slerilisation
3.1.2.4.Compensatio
n for NSV
Acceptance @50000
cases x1500
0
20
0
20
20
0
20
40
Maximum FP
done in Dec. Mar.
A.3.1.5
3.1.2.4
40
5
5
15
15
Expenditure
Expected for
Last quarter
of FY 10-11
A.3.4
A.3.5
A.4
A.4.1
A.4.2
3.4 Repair of
Laproscopes (Rs.
5000 x 40 nos.)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
25000
25000
0
0
0
0
0
0
0
0
0
0
1080000
1080000
1080000
3.5 Other strategies/
activities
4. Adolescent
Reproductive and
Sexual Health
(ARSH)
(Details of training,
IEC/BCC in relevant
sections)
Adolescent services
at health facilites.
4.1.1. Disseminate
ARSH guidelines.
4.1.2. Establishing
ARSH Cells in
Facilities 4.1.2.1.
Developing a Model
ARSH Cell for the
facilities
1
0
4.2 Other
strategies/activities
A.5
5. Urban RCH
A.5.1
5.1. Urban RCH
Services
2
1
1
1
1
1
0
0
0
0
0
0
1
0
2500
0
5400
00
0
25000
25000
540000
25000
1080000
A.6
6 Tribal Health
0
0
0
0
0
A.6.1
Tribal RCH services
0
0
0
0
0
A.6.2
Other
strategies/activities
0
0
0
0
0
7. Vulnerable Groups
0
0
0
0
0
A.7.1
7.1 Services for
Vulnerable groups
0
0
0
0
0
A.7.1
7.1 Services for
Vulnerable groups
0
0
0
0
0
A.7.2
7.2 Other strategies/
activities
0
0
0
0
0
8. Innovations /PPP
/NGO
0
0
0
0
0
A.7
A.8
Commited
expenditure
of FY 201011
A.8.1
8.1.PNDT and Sex
Ratio
8.1.1. Orientation
programme of PNDT
activities, Workshop
at State, District and
Block Level
(1+38+533) (amount
Rs.50 Lakhs) 8.1.2
Monitoring at District
level and Meetings of
District level
Committee (100
Lakhs)
A.8.2.
Public Private
Partnerships
A.8.3
A.8.4
A.9
A.9.1
A.9.1.1
A.9.1.2
8
0
8
18
4
4
4
6
5591
0
447280
447280
0
447280
25000
897280
0
0
0
0
0
NGO Programme
0
0
0
0
0
Other innovations (if
any)
0
0
0
0
0
INFRASTRUCTURE
& HR
0
0
0
0
0
Contracutal Staff &
Services
0
0
0
0
0
9.1.1 ANMs 10.1.1.2.
Hiring of 1000
Retired ANMs or
ANMs from other
states for out reach
services @ Rs. 5000 /
month / ANM
0
0
0
100
25
25
25
25
5000
0
0
0
0
6000
600000
9.1.2 Laboratory
Technicians
6
0
6
12
y
y
y
y
7800
0
468000
526500
0
468000
90000
612000
146
88
58
146
y
y
y
y
1440
00
21024000
1699200
0
2865700
18158300
144000
39182300
9.1.4 Doctors and
Specialists
(Anaesthetists,
Paediatricians,
Ob/Gyn, Surgeons,
Physicians) Hiring
Specialists
1
0
1
2
y
y
y
y
1E+0
6
1260000
1260000
0
1260000
1260000
1260000
Honorarium of
Voluntary Workers @
of 1200/- PA x 3106
No.
52
0
52
104
y
y
y
y
1200
62400
63157
0
63157
1200
187957
A.9.1.3
Staff Nurses
A.9.1.4
A.9.1.5.3
Committed
Expenditure
of FY 201011
Commited
Expenditure
of FY 200910-11.
A.9.1.6
Incentive/Awards
etc. 8.2.1 Incentive
for ASHA per AWW
center (80000x200
per month) and
Incentive toANMs
per Aganwari Centre
under Muskan
Programme (@80000
x Rs.150 Per Month
1
1
0
1
y
y
y
y
2E+0
7
16095000
1486100
0
6548037
9546963
1.6E+07
25641963
A.9.2
9.2. Major civil works
(new
construction/extensi
on/addition) for DH
0
0
0
1
y
0
0
0
0
0
1.4E+08
138500000
Construction
of 100
beded
District
Hospital
(Maternity
Ward)
9.2.1 Major Civil
works for
operationalisation of
FRUS
0
0
0
1
y
0
0
0
0
0
2000000
2000000
Operationali
sation of
FRUs in
SDH PUSA.
9.2.2 Major Civil
works for
operationalisation of
24 hour services at
PHCs
1
0
1
1
y
0
0
0
0
0
2000000
2000000
Operationali
sation of
24x7 in PHC
Morwa.
0
0
A.9.2.1
A.9.2.2
A.9.3
9.3 Minor Civil Works
0
0
0
A.9.3.1
A.9.3.2
A.9.4
9.3.1 Minor civil
works for
operationalisation of
FRUs 10.4.1 Facility
improvement for
establishing New
Born Centres at 76
FRUs across the
state - @ Rs. 50,000 /
per FRU
0
0
0
2
1
1
0
0
0
0
0
0
0
100000
200000
9.3.2 Minor civil
works for
operationalisation of
24 hour services at
PHCs
20
0
20
20
y
y
y
y
1000
00
2000000
2000000
0
2000000
100000
4000000
9.4 Operationalise
IMEPat health
facilites
0
0
0
0
0
A.9.5
9.5 Other Activities
0
0
0
0
0
A.10
10. Institutional
Strengthening
0
0
0
0
0
A.10.1
10.1 Human
Resource
Development
0
0
0
0
0
A.10.2
A.10.3
10.2 Logistics
management/
improvement
10.3 Monitoring
Evaluation/HMIS
Monitoring &
evaluation Mobility
Support to M&E
Officer through
monitoring cell
0
0
0
0
0
1
1
0
1
y
y
y
y
8343
29
10.4 Sub-centre rent
and contingencies @
Rs.500/-
71
10
61
224
y
y
y
y
6000
426000
426000
56500
369500
6000
1713500
APHC rent and
contingencies @
Rs.2000/-
0
0
0
32
y
y
y
y
0
0
0
0
0
24000
768000
0
0
0
0
0
11 Training
0
0
0
0
0
A.11.1
11.1 Strengthening
of Training
Institutions
0
0
0
0
0
A.11.2
11.2 Development of
training packages
0
0
0
0
0
A.11.3
11.3 Maternal Health
Training
0
0
0
0
0
A.11.3.1
11.3.1 Skilled Birth
Attendance /SBA
12.1.2 Skilled
Attendance at Birth /
SBA--Two days
Reorientation of the
existing trainers in
Batches 12.1.3
Strengthening of
existing SBA
Training Centres
12.1.4 Setting up of
additional SBA
Training Centre- one
per district 12.1.5
Training of Staff
Nurses in SBA
(batches of four)
12.1.6 Training of
ANMs / LHVs in SBA
(Batch size of four)
20 batches x 38
districts x
Rs.59,000/-
3083850
3083850
A.10.4
A.10.4A
A.10.5.
10.5. Other
strategies/activities
TA & DA for the 30
days contact
programme
834329
834329
0
834329
978329
1812658
35
6
29
03 Months achievements remaining
A.11
30
6
6
6
7
8811
0
195192
2888658
88110
2643300
Expenditure
expected in
last Quarter
of FY 201011
EmOC Training
12.1.3 EmOc Training
of (Medical Officers
in EmOC (batchsize
is 8 )
0
0
0
0
0
A.11.3.3
11.3.3 Life Saving
Anaesthesia Skills
training 12.1.5
Training of Medical
Officers in Life
Saving Anaesthesia
Skills (LSAS)
0
0
0
0
0
A.11.3.4
11.3.4 MTP Training
12.1.6.1 Training of
nurses/ANMs in safe
abortion 12.1.8
Training of Medical
Officers in safe
abortion
1
0
1
2
0
1
0
1
2500
0
25000
25000
0
25000
25000
75000
A.11.3.5
11.3.5 RTI/STI
Training
0
0
0
2
0
1
0
1
0
0
0
0
0
96900
193800
A.11.3.6
Dai Training
0
0
0
0
0
A.11.3.7
Other MH Training
0
0
0
0
0
A.11.4
IMEP Training
0
0
0
0
0
A.11.5
11.5 Child Health
Training
0
0
0
0
0
A.11.5.1
11.5.1 IMNCI 12.2.1.1.
TOT on IMNCI for
Health and ICDS
worker 12.2.1.2.
IMNCI Training for
Medical Officers
(Physician)
12.2.1.3. IMNCI
Training for all health
workers
2.2.1.4. IMNCI
Training for ANMs /
LHVs/AWWs 12.2.1.6
Followup training
(HEs,LHVs)
48
20
28
A.11.5.2
11.5.2 Facility Based
Newborn Care
12.2.2.1 SNCU
Training
12.2.2.2.NSU (TOT)
4
3
1
03 Months achievements remaining
A.11.3.2
68
15
15
15
23
1347
60
6468480
6413220
2015365
4453115
143760
9935680
4
1
1
1
1
1996
00
798400
611000
199600
598800
199600
798400
A.11.5.3
11.5.3 Home Based
Newborn Care
0
0
0
0
0
A.11.5.4
11.5.4 Care of Sick
Children and severe
malnutrition
0
0
0
0
0
A.11.5.5
11.5.5 Other CH
Training (Pl. Specify)
0
0
0
0
0
A.11.6
11.6 Family Planning
Training
0
0
0
0
0
A.11.6.1
12.6.1 Laproscopic
Sterilisation Training
0
0
0
0
0
A.11.6.2
11.6.2 Minilap
Training
1
0
1
2
0
1
1
0
7024
0
70240
70240
0
70240
28000
126240
A.11.6.3
11.6.3 NSV Training
1
0
1
1
0
1
0
0
3390
0
33900
33900
0
33900
33900
33900
A.11.6.4
11.6.4 IUD
InsertionTraining
2
0
2
2
0
1
1
0
8472
5
169450
169450
0
169450
84725
338900
A.11.6.5
Contraceptive
Update Training
0
0
0
0
0
A.11.6.6
Other FP Training
0
0
0
0
0
A.11.7
11.7 ARSH Training
12.4.1 ARSH training
for medical officers
12.4.3 One Day
ARSH Orientation by
the MOs of 25%
ANMs 12.4.4 One
Day ARSH
Orientation of PRI by
the MOs of 50%
ANMs
0
0
A.11.8
11.8 Programme
Management
Training
0
0
0
0
0
0
20
y
y
y
y
0
0
0
0
8350
167000
0
A.11.8.2
A.11.9
A.11.9.1
A.12
A.12.1
A.12.2
A.12.3
11.8.2 DPMU
Training 12.5.1
Training of DPMU
staff
1
0
1
1
0
1
0
0
1100
00
110000
110000
0
110000
110000
110000
Other Training
0
0
0
0
0
11.9.1 Continuing
Medical & Nursing
Education
0
0
0
0
0
0
0
0
0
0
12. BCC/IEC (for
NRHM Part A, B & C)
12.1 Strengthening
of BCC/IEC Bureaus
(State and District
Levels)
12.2 Development of
State BCC/IEC
strategy
1
0
1
1
y
y
y
y
0
0
0
0
0
0
0
0
12.3 Implementation
of BCC/IEC stretegy
0
0
426500
426500
0
426500
0
0
0
0
0
0
853000
0
0
426500/Expenditure
Expected in
Last Quarter
of FY 2010 11
0
0
A.12.3.1
12.3.1 BCC/IEC
activities for MH
0
0
0
1
y
y
y
y
0
0
0
0
0
25000
25000
A.12.3.2
BCC/IEC activities
for CH
0
0
0
1
y
y
y
y
0
0
0
0
0
25000
25000
A.12.3.3
12.3.3 BCC/IEC
activities for FP
0
0
0
1
y
y
y
y
0
0
0
0
0
25000
25000
A.12.3.4
12.3.4 BCC/IEC
activities for ARSH
0
0
0
1
y
y
y
y
0
0
0
0
0
25000
25000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
55800
55800
0
0
0
0
A.12.4
12.4 Other activities
Sub-total IEC/BCC
A.13
Procurement
A.13.1
13.1 Procurement of
Equipment
A.13.1.1
13.1.1 Procurement
of equipment
A.13.1.2
A.13.1.3
3
0
13.1.2 Procurement
of equipment : CH
13.1.3 Procurement
of equipment : FP
3
4
1
1
1
1
1860
0
0
0
0
0
8
y
y
0
0
0
0
55800
18600
0
0
0
130200
0
25000
200000
A.13.1.4
13.1.4 Procurement
of equipment : IMEP
0
0
0
0
0
A.13.2
13.2 Procurement of
Drugs & supplies
0
0
0
0
0
A.13.2.1
13.2.1 Drugs &
Supplies for MH
95
0
95
95
1500
142500
141360
0
142500
1500
285000
Expenditure
Expected in
Last Quarter
of FY 201011
A.13.2.1.
2
A.13.2.1.
3
A.13.2.1.
5
13.2.1 Drugs &
Supplies for MH
(Delivery Kits at
HSC/ANM/ASHA)
13.2.1 Drugs &
Supplies for MH
(SBA Drug Kits)
7651
0
7651
7651
500
0
500
500
125
125
125
125
1
0
1
1
y
y
y
y
100
0
100
100
y
y
y
y
y
y
y
13.2.2 Drugs &
Supplies for CH
A.13.2.3.
1
13.2.3 Drugs
Supplies for FP
(Minilap Sets)
A.13.2.3.
2
13.2.3 Drugs
Supplies for FP
(Procurement of NSV
Kits)
5
0
5
10
y
13.2.3 Drugs
Supplies for FP
(Procurement of IUD
Kits)
1
0
1
2
y
A.13.2.4
191280
0
191275
25
382550
245
122500
122480
0
122500
245
245000
2943537
2943537
0
2943537
3000
300000
300000
0
300000
3000
300000
1100
5500
5500
0
5500
1100
11000
1500
0
15000
15000
0
15000
15000
30000
0
0
16881059
1688105
9
7780816
13.2.4 Supplies for
IMEP
0
A.13.2.5
191275
13.2.1 Drugs &
Supplies for MH (IFA
Tablets for
Adolescents girls)
A.13.2.2
A.13.2.3.
3
25
General drugs &
supplies for health
facilities
A.13.2.5
A
General drugs &
supplies for health
facilities (AYUSH)
A.14
14. Prog.
Management
0
0
0
16881059
20000000
10000000
0
0
0
0
0
Expenditure
Expected in
Last Quarter
of FY 201011
Expenditure
Expected in
Last Quarter
of FY 201011
Pregnant &
Lactating
Mothers2315719 For
Children 0-5
Yr. 3859532
Adolescent
Girls1605565
14.2 Strengthening
of District
Society/DPMU
16.2.1. Contractual
Staff for DPMSU
recruited and in
position
A.14.2
DPM@3542
0x1x12M=4
25040/DAM@2772
0x1x12M=3
32640/DNM&EO@
23100x1x12
M=277200/12
12
0
12
3
3
3
3
1961120
1961120
764041
1197079
238480
2861760
DEO@8500
x3x12M=30
6000/Peon@4000
x2x12=9600
0/Office
Assistant@1
0000x2x12=
240000/-
A.14.3
14.3 Strengtheningof
Financial
Management
Systems
Total Prog. Mgt.
12
12
0
12
3
3
3
3
2000
0
240000
0
0
0
304569780
Grand Total RCH II
240000
2817625
21
51626
90140771
188374
20000
240000
0
0
21442900
9
712370420
Structured approaches for State/ District/ Block PIP planning
National Rural Health Mission
Strategy & Activity Plan with budget
Name of the District : Samastipur
Budget Plan
Tentative Unit Cost (F)
Budget Planned (including spill
over amount) {(AP x A)  E} = BP
1051311
0
1051311
116812
1752180
12000
1920000
1920000
0
1920000
12000
3600000
0
0
0
0
0
0
0
y
998
7654660
7268476
0
7654660
998
15309320
y
725
2820375
2820375
0
2820375
725
2820375
Q2
Q3
Q4
3
Budgetary Source (other than
NRHM source)
under or over-utilised Budget
{(B~D} =E
1051311
Q1
Budget utilised {Y x (A)} = D
116812
Tentative Unit Cost (A)
Budget received B or C
(< or > than planned)
2011-2012 FY
Budget Planned
{X x (A)} = B
2010-2011FY
time line of activities
Special efforts to overcome
constraints (Process to be
adopted)
Activity planned including
previous yrs gap {Z+(X~Y)} =AP
Reasons for Variance
2011-2012 FY
Variance (X~Y)
Activity Executed (Y)
Activity planned (X)
2010-2011 FY
Output 2012
Activities
Component Code (only at state level)
Activity Plan
Decentrlisation
B.1.11
ASHA Support
system at State
level
B.1.12
ASHA Support
System at District
Level
B.1.13
B.1.14
B.1.15
B.1.16
ASHA Support
System at Block
Level
ASHA Support
System at Village
Level
9
0
9
12
3
3
3
160
0
160
240
60
60
60
0
0
0
0
7670
0
7670
7670
y
y
y
11505
825
10680
22185
y
y
y
#
0
ASHA Drug Kit &
Replenishment
Motivation of
ASHA
Remarks
B.1.17
Emergency
Services of ASHA
B.1.18
ASHA Divas
B.1.19
Capacity
Building/Academic
Support
programme
B.1.2
B.1.22
B.1.23
Untied Fund for
Health Sub
Center,Additional
Primary Health
Center and Primary
Health Center
Village Health and
Sanitation
Committee
0
0
0
1412
y
y
y
y
0
0
0
0
0
100
141200
3835
1582
2253
6088
y
y
Y
Y
1032
3957720
3957720
767400
3190320
1032
9473136
0
0
0
20
y
y
0
0
0
0
0
4000
80000
486 +
73+
20
354 +
45+20
1122
1122
0
1122
40
40
0
41
0
y
y
0
0
y
y
y
0
0
10000
10000
HSC &
25000
APHC
5581000
5581000
2105895
3475105
11220000
11220000
2260000
8960000
4700000
4700000
2873661
1826339
5000000
0
0
0
0
10000
10660105
20180000
Rogi Kalyan Samiti
Infrastrure
Strengthening
B.2.1
Construction of
HSCs ( 315 No.)
B.2.2B
Construction of
residential quarters
of old APHCs for
staff nurse
y
y
Y
Y
0
9
0
9
20
Y
y
y
y
950000
0
0
0
0
1557000
38740000
0
0
0
17
y
y
y
y
3E+06
0
0
0
0
3000000
51000000
B.2.2A
Construction of
building of APHCs
where land is
available
(5315000/APHCs)
1
1
0
10
y
y
y
y
5E+06
0
0
0
0
7599000
81305000
B.2.3
2.3 Up gradation of
CHCs as per IPHS
standards
8
0
8
8
y
y
y
y
4E+06
0
0
0
0
4000000
32000000
B.2.3A
2.3 Up gradation of
CHCs as per IPHS
standards
0
0
0
8
Y
y
y
y
0
0
0
0
0
9000000
72000000
B.2.4
Infrastructure and
service
improvement as
per IPHS in (DH &
SDH) hospitals
0
0
0
1
y
y
y
y
0
0
0
0
0
4000000
4000000
Rs 7600000/Commited
expenditure of
FY 2009-10
Rs 5315000/Commited
expenditure of
FY 2009-10
01 SDH to be
Upgrade as per
IPHS Norms.
B.2.5
Annual
Maintenance Grant
25
B2.6
ISO 9000
certification of
Health Facilities
B.2.7
Upgradation of
ANM Training
Schools
2
1
25
0
1
TOTAL
INFRASTRUCTURE
strengthening
B.3
Contractual
Manpower
B.3.1 A
Incentive for PHC
doctors & staffs
B.3.1 B
Salaries for
contractual Staff
Nurses
B.3.1.C
Contract Salaries
for ANMs
B.3.1.
D
Mobile facility for
all health
functionaries
0
2
0
25
2
1
y
y
y
y
y
y
y
y
y
y
y
y
164000
1E+06
3E+06
4100000
0
3917000
0
0
0
0
3017000
0
0
164000
1000000
3800000
7117000
500000 for DH,
500000 SDH,
100000PHCs
2000000
02 PHCs to be
upgraded for
ISO 9000
Certification.
5750000
1950000/commited
expenditure of
FY 10-11
1050000
1050000
0
0
0
0
0
0
0
0
0
0
BHM@18480
BA@12320
BM&E@10000
B.3.2.
Block Programme
Management Unit
40
B.3.4.
31
40
y
y
y
y
497340
19893600
9946800
2768626
17124974
849600
16859026
1425000
225000/ Commited
Expenditure of
F.Y. 2010-11
Addl. Manpower
for NRHM
3
0
PPP Initiativs
B.4.1
9
Mobility@20000
Exp.@10000
Contigency for
TA/DA
etc@10000
3
4
y
y
y
y
300000
0
900000
450000
0
0
0
0
0
450000
300000
0
0
102-Ambulance
service(state806400) @537600 X
6 Distrrict
0
0
0
0
0
0
0
0
0
B.4.2
1911- Doctor on
Call & Samadhan
B.4.3
Advance life
Saving Ambulance
(108)
0
B.4.4
12
B.4.6
B.4.7
B.4.8
5
SHRC
10
0
16
0
y
y
y
y
130000
B.4.9
B.9
Outsourcing of
Pathology and
Radiology Services
from PHCs to DHs
B.10
Operationalising
MMU
B. 11
Monitoring and
Evaluation (State ,
District & Block
Data Centre)
Strengthening of
Cold Chain
10
25
y
y
y
y
156000
0
1560000
0
0
0
0
0
0
130000
0
3060000
980000/Commited
Expenditure for
FY 2010- 11
4225000
325000/commited
expenditure of
FY 2010 -11
2340000
1755000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2879625
2879625
0
Services of
Hospital Waste
Treatment and
Disposal in all
Government Health
facilities up to PHC
in Bihar (IMEP)
Dialysis unit in
various
Government
Hospitals of Bihar
Setting Up of UltraModern Diagnostic
Centers in
Regional
Diagnostic Centers
(RDCs) and all
Government
Medical College
Hospitals of Bihar
Providing
Telemedicine
Services in
Government Health
Facilities
B. 14
2
0
Referral Transport
in district
15
B.4.5
0
0
###
0
###
0
8870
25
20000
y
y
y
y
y
y
y
194537
y
175
164750
2175250
156000
0
0
2078571
0
801054
0
200000
175
5000000
4301054
12
1
11
12
y
y
y
y
468000
5616000
6401000
0
6401000
468000
12017000
26
20
6
26
y
y
y
y
90000
2340000
2340000
0
2340000
180000
7020000
1
0
1
1
y
y
800000
800000
848300
0
848300
800000
1648300
0
0
6401000/Commited
Expenditure of
FY 2010 -11
2340000/commited
expenditure of
FY 2010 -11
B. 15
B.15A
Mainstreaming
Ayush under
NRHM
69
58
11
73
y
y
y
y
105000
Ayush Training
7245000
7245000
0
7245000
6474600
6474600
0
6474600
240000
24765000
6474600
B.15B
5400000
01 Pharmasist
in each APHC6000/-, 01 MPW
in each APHC4000/-
1680000
01 Specialist
AYUSH in DH &
SDH- 35000/Construction of
new Drug
warehouse in
district.
Ayush Manpower
45
y
y
y
y
0
0
0
0
0
7245000/commited
expenditure of
FY 2010-11
120000
B.15C
Specialist AYUSH
Doctors
0
0
0
4
y
y
y
y
0
0
0
0
0
420000
B.16.3
District Drug
Warehouse
0
0
0
1
0
0
0
100
y
0
0
0
0
0
9000000
9000000
0
0
0
0
0
10000
1000000
B.17.1
Provision of
Quality Bed
y
0
0
0
B.18.2
4218146
Commited
Expenditure of
FY 2010-11 for
Equipments
Payment.
1300000
25000/- per
month salary
for DPC,
200000/- for
District
Planning &
40000/- for per
PHC
2700000
ICU
construction is
completed,
equipments is
needed.
Procurement of
SCNU Equipments
15
B.19
0
15
15
4218146
4218146
0
4218146
De - Centralized
Planning
21
21
0
21
Y
y
y
y
780000
780000
31567
748433
Equipment for ICU
0
B.13.4
Equipments for the
Labour Room
B.21
ANM- R
238
0
238
0
0
1
486
y
y
y
y
0
y
0
y
0
0
0
0
0
0
0
0
0
0
96000
22848000
22848000
6965086
15882914
2700000
4950000
96000
62538914
Commited
Expenditure of
FY 2009- 10 for
Purchased &
installed
Labour room
equipments.
15882914/commited
expenditure of
FY 2009-10-11
for increased
salary & FY
2009-10 Dues
Payment.
B. 22
Intersectoral
Convergence
(Incentive for AWW
under Muskan
Project)
3438
Grand Total NRHMB
3438
y
y
y
y
1200
4125600
4126000
0
4126000
1200
8251600
549009776
Commited
expenditure of
FY 2010-11 for
Muskan
Incentive
Payment to
AWW
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH SOCIETY,SAMASTIPUR
DISTRICT HEALTH ACTION PLAN 2011-12
PART - C ( Pulse Polio & Routine
Immunization)
SI.NO
C
C.1
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
STRATEGY/ACTIVITIES
Unit
Budget
Unit cost
TOTAL
IMMUNISATION
99060000.00
Pulse Polio Operating Costs
Per Diem to Vaccinators @ Rs. 75 per
day per Vaccinators for actual working
day
Per Diem to Supervisors @ Rs. 75 per
day per Supervisors for actual working
day
Per Diem to Cold chain Handler per subdepot 1. @ Rs. 75 per day for actual
working day
3 vehicle per district HQ and 1 vehicle
per sub-depot for 5 days @ Rs. 650 per
vehicle per day (hiring with POL)
4 Ice packs Per Vaccination
Team/Supervisor & 20 Ice Packs per
sub-depot/depot per day @ Rs. 3 per Ice
Pack for 5 days & Rs. 3000/ for HQ
Mobility Support to Supervisors @ Rs.
100 per day per supervisor for actual
working day
Supplies & logistics @ Rs. 25 per team &
per Supervisor for the whole activity
period
IEC & Social Mobilization @ Rs 350/- per
40 H- T-H Teams for 1 days
10965 HTH,
700 Transit,
1000 Mobile
Transit, 1300
Mobile,
(15000 Total
Team)
850
75 Rs Per
day per
Vaccinator
67500000.00
75 Rs Per
day Per
supervisor
3825000.00
165
742500.00
168
6552000.00
36700 Per
Day
6642000.00
850
850
Rs 100 Per
Day for
Mobility
5100000.00
255000.00
231000.00
Remarks
C.3
C.3
Contigency for Xerox, Stationary etc. for
Dist HQ Rs 3000/- & for each PHC @ Rs.
1750/- per areas for the Whole Activities
period
Per Diem to Vaccin Cold Chain Handler
at Dist HQ 5 person & at PHC 3 person
(including 1 depotholder) @ Rs. 50 per
person
Support to WIC for maintainance
Vaccine transport from PHI Patna &
PAYMENT OF PER DIEM TO @ VACCINE
HANDLER @ RS. Per day for 7 days
Support to districts @ Rs. 2000 per dist
& @ Rs 1000 per PHC for lifting vaccine
From WIC/ Districts
Total A Team Activity
C.3
Total B Team Activity
C.3
C.3
C.3
C.2
01 DQ, 20
PHCs
292500.00
0.00
264000.00
91860000.00
7200000.00
7767897.00
ROUTINE IMMUNISATION
C.1
Mobility Support
1
C.2
Cold chain maintenance
21
C.3.1
3.2
C.4.1
C.4.2
C.5
456000.00
Alternative vaccine delivery in NE
States, Hilly terrains & geograhically
from vaccine delivery point, river
crossing etc.hard to reach areas in per
month @ Rs. 100 per session for 12
months
Alternative Vaccine Deliery in other
areas @ Rs. 50 per session sites for
Approx 14000 Session sites in a month
& AVD for Urban Areas
Focus on slum & underserved areas in
urban areas:
Alternate vaccinators honorarium for
urban @ Rs 1400 per month for 12
months for under served areas
Social Mobilization of Children through
ASHA/ Link workers & paid mobilizers
for Under served areas & Hard to Reach
area @ Rs 200/- per month for
mobilization (for 12 months)
10000 Per
Month
120000.00
792000.00
As per
Previous
Year
448800.00
As per
Previous
Year
2176400.00
As per
Previous
Year
115200.00
0.00
As per
Previous
Year
1795200.00
C.6.2
C.8.2
Computer Assistants support for District
level @ Rs.10000 per person per month
for one computer assistant in each 38
districts
Quarterly review meetings exclusive for
RI at district level with one Block Mos,
CDPO, and other stake holders @ Rs.
100 per participants for 5 participants
per PHCs 533
C.8.3
Quarterly review meetings exclusive for
RI at block level @ Rs. 50/- PP as
honorarium for ASHAs and Rs. 25 per
persons for meeting expenses for 73629
ASHAs
C.9.1
District level orientation for 2 days for
ANMs MPHW, LHV Health Assistants
Nurse, Mid wife Bees and other
One day cold chain handlers training for
block level cold chain hadlers for 542 +
38 Sadar Hosp. cold chain handlers
C.9.4
C.9.5
One day training of block level data
handlers for 533 person.
C.10.1
To develop microplan at sub-centre level
@ Rs 100/- per sub - centre
C.10.2
For consolidation of microplans at block
level @ Rs. 1000 per block/ PHC(533)
and at district level @ Rs. 2000 per
district for38 districts.
POL for vaccine delivery from State to
district and from district to PHC/CHCs
(@ Rs. 20000/- per WIC/WIF point & Rs.
20000/- per Districts + Rs. 5500/- for each
PHC per year),
Consumables for computer including
provision for internet access for RIMs
Rs. 400 per month per district for
38districts.
1- Red & 1-Black plastic bags etc. @.90
paise per session for 12 months
C.11
C.12
C.13
1
As per
Previous
Year
120000.00
20
Rs. 150 per
participants
for 5
participants
per PHCs
60000.00
3835
RS @ 50/PP as
honorarium
for ASHAs
and Rs. 25
per person
for Meeting
As per
previous
Year
As per
Pervious
year
1150500.00
20 + 01 DH
As Per
Previous
Year
As Per
Previous
Year
20 + 01
district
20 + 01
district
1
54000
sessions
501900.00
26810.00
25% Hike
25587.00
25% Hike
67900.00
22000.00
30000 for
District, &
12000 Per
PHC Per
Year
1000 Per
Month
270000.00
90 Paise
each
Session
48600.00
12000.00
C.16
For major AEFI cases investigation for
every district in a year. @Rs 1000/- for
mobility in the field and @ 5000/- for
specimen shipment to lab including
travel cost, lodging & fooding etc.
PART - C (Pulse Polio )
PART - C (Immunization)
As Per
Previous
Year
15000.00
99060000.00
7767897.00
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH SOCIETY,SAMASTIPUR
DISTRICT HEALTH ACTION PLAN 2011-12
SI.NO
STRATEGY/ACTIVITYS
Unit
Budget
Unit cost
TOTAL
F. National Vector Borne Disease Control
Programme (NVBDCP)
D.1
DDT Spray (Kala-azar) Programme
Wages For SFW @ 175 per SFW for 60 Days
110
Rs - 175
1155000.00
Wages For FW @ 145 per FW for 60 Days
520
RS . 145
4524000.00
Office Expenses @ 250 per Squad ( 55 Squad / 10 Lakh
Population)
110
Rs . 250
27500.00
Contigency @ 250 per Squad ( 55 Squad / 10 Lakh
Population)
110
Rs. 250
27500.00
Transportation of DDT ( District to PHC @ 2200 per affected
PHC)
20
Rs . 2200
44000.00
Transportation of DDT (PHCto Village @ 1650 per affected
PHC)
20
Rs. 1650
33000.00
Repair of Spray Equipments including Nozal Tips @ 150 per
Squads
110
Rs. 150
16500.00
Purchase of Spray Equipments including Nozal Tips @ 1000
per Squads
110
Rs. 1000
110000.00
District Mobility for CS Vehicle @ 10000 per Month for 2
Months
1
Rs. 10000
20000.00
District Mobility for ACMO Vehicle @ 10000 per Month for 2
Months
1
Rs . 10000
20000.00
District Mobility for DMO Vehicle @ 20000 per Month for 2
Months
1
Rs 20000
40000.00
Mobility for PHC Mos @ Rs. 800 per Day for 2 Months
20
Rs. 800
960000.00
DA For Supervision @ 2200 per affected PHC
21
Rs. 2200
46200.00
IEC Activity @ Rs 2200 Per PHC & District HQ
21
Rs. 2200
46200.00
Remarks
Incentive ASHA @ 100 for per Projected case for complete
Treatment
1500
Rs. 100
150000.00
Loss of Wages Rs. 50 for Maximum 30 Days for Per Projected
case during Treatment period.
1500
Rs. 50
2250000.00
Moblity for Qurative Measures of DMO & ACMO @ 10000 per
Month
1
Rs . 10000
1
Rs. 750
Drug Storage in District Level @ 750 per Month for 12 Months
9000.00
1500
Rs. 5
15000.00
20
Rs. 50
4000.00
Hiring of Warehouse at District Level for Storage of DDT @
6000 per Month for 12 Months
1
Rs. 6000
72000.00
KalaZar Search Programme for all PHC @ 750 for 12 Months
(2 days in a Month)
20
Rs. 750
360000.00
IEC for visiblity @ Rs 10000 for PHC
20
Rs. 10000
200000.00
Treatment Card @ Rs 5 per treatment card for 2 disfferent
types of each card for Projected case
Regular for line Listing / Loss of wages /ASHA Record /Drug
Record @ 50 for 4 Register per affected PHC
10249900.00
Sub Total :
D.2
120000.00
Malaria
Revised NAMMIS Activity
CD / DVD Writer
1
Rs. 2000
2000.00
2 GB RAM
1
Rs. 2500
2500.00
160 GB HDD
1
Rs 3000
3000.00
AMC (With Parts)
1
Rs. 5000
5000.00
Broad Band Installation Charge
1
Rs. 4500
4500.00
Broad Band Connectivity Rental Charge
1
Rs. 800
9600.00
For District HQ - System Maintenance , UPS, Battery,
Stationary, Pen Drive, CD/ DVD, Cartridge, Paper etc.
1
12000.00
38600.00
Sub Total :
1
IEC Activity
Sub Total :
Rs. 18000
18000.00
56600.00
PART - D(Kala-azar )
PART - D(Malaria )
10249900.00
G. Total :
56600.00
10306500.00
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH SOCIETY,SAMASTIPUR
DISTRICT HEALTH ACTION PLAN 2011-12
SI.NO
STRATEGY/ACTIVITYS
Unit
Budget
Unit cost
TOTAL
F. National Vector Borne Disease
Control Programme (NVBDCP)
F.1
MDA (Mass Drug Administration) Fileria Con.
Programme
25000.00
Training of MOs Trainer @ Rs 300 & Each Trainee @
200 Each.
Training for Paramedical Staff & PHC Level @ Rs 2500
per PHC & District HQ
21
Rs. 2500
52500.00
Coordination Meeting ( 2 Round) District Level Rs 5000
per Meeting
2
Rs -5000
10000.00
IEC Activity @ Rs 2500 Per PHC & District HQ
21
Rs. 2500
52500.00
Line Listing @ 3000 per PHC + District HQ
21
Rs 3000
63000.00
Night Blood survey @ 3500 Per PHC & District HQ
POL for Activity survey @ 1000 Each PHC & District
HQ
21
Rs 3500
73500.00
21
RS 500
21000.00
21
11000.00
Hononarium of Drug distributor in District @ Rs 125
each distributor
9500
Rs 1000 For
District + 500 For
PHC
Rs 118
Hononarium of Supervisor in District @ Rs 150 each
Supervisor
950
Rs . 150
Office Expenditure @ 1000 District HQ & 500 for each
PHC
Sub Total :
1121000.00
135000.00
1564500.00
Remarks
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH SOCIETY,SAMASTIPUR
DISTRICT HEALTH ACTION PLAN 2011-12
SI.NO
STRATEGY/ACTIVITYS
Unit
Budget
Unit cost
TOTAL
Iodine Dificiency Disorder (IDD)
Control Programme
Training
20
Rs. 1500 per PHC
30000.00
Awareness Programme
20
Rs. 750 per PHC
15000.00
School Program
20
Rs. 1500 per PHC
30000.00
IEC Activity
20
Rs. 500 per PHC
10000.00
Activity conducting in Community & AWC
20
Rs. 2000 per PHC
40000.00
Sub Total
125000.00
Remarks
Annexure-B
Blindness
Grant in Aid other components-
1
2
3
4
5
6
7
8
9
10
Recurring GIA for Eye Donation
Vision Centre 3 @ 50 K
Eye Bank
Eye donation Centre
Non-Recurring Grant to NGO for strengthening/expansion of eye care unit on
1:1 sharing basis 2 @ 30 lakh
Training of Ophthalmic & support Man Power
IEC - Annex. 1
GIA for free Cataract Operation for DHS-Blindness Division GIA for School Eye Screening for DHS- Blindness Division @ 2 lakh per
district
For Eye Ward and eye OTs@Rs 75 Lakhs for district
Nill
150000
Nill
Nill
Nill
Nill
Annexure 1
1500000
200000
Nill
Support towards salaries of Ophthalmic Manpower to States A. Demand for
Manpower
11
12
13
14
15
16
17
18
1. Ophthalmic surgeon in districts for dist. @ 35000/- per month
2. Ophthalmic Assistant in district Hospital/PHC @ 15000/- per month
3. Office / Accounts Assistant @ 8000/- per month
Strengthening / setting up of Regional Institutes of Ophthalmology
(Non Recurring Assistance for pediatrics ophthalmology)
Strengthening of Medical College @ 40 Lakh for--- Medical Colleges
Strengthening of District Hospitals @ 20 Lakhs for dist.
Grant-in-aid to District Health Societies (Recurring Assistant) @ 5 Lakhs
Back log dues in dist. (Approx.) NGOs payment
Non-recurring GIA for maintenance of Ophthalmic equipment @ 5 lakhs per
unit
Procurement of Opthlamic equipments
(a) Opereting microscope
(b) A Scan Biometer
(c) Auto refractor with Keretometer
(d) Slit lamps
696000
Nill
Nill
2000000
500000
800000
Nill
577800
558750
476000
879100
TOTAL
8337650
District Health Society Samastipur
IDSP Division
Budget 2011 - 12
Subactivity
1. Staff
Salary
Tasks
Unit Cost
No. of
Units
1.1
Epidemiologists
45000
1
1.7
District Data Manager
24000
1
1.8
Data Entry Operator
10000
1
1.9
Accountant
6000
1
Sub Total
2. Training
Remarks
45000 X 12 =
540000
24000 X 12 =
288000
10000X 12 = 120000 New Post
Accounting work for
IDSP & rest of time
6000 X 12 = 72000
they do additional
work in DHS.
1020000
2.1
Training of Hospital
Doctors
15000
25 (Per
Batch)
Reporting Unit 25
15000 X 2 = 30000 (Each institution 2
Doctors)
2.2
Training of Hospital
Pharmasist / Nurses
15000
25 (Per
Batch)
Each Instiution 1
15000 X 2 = 30000 Pharmasist and 1
Nurse
2.4
Workshop for Support to
DSU in Surveillance of
Health Manager / Data
Operator
25000
01
Bartch
Sub Total
3.
Operational
Cost
2010-11 (Amount)
3.1
Mobility Support for IDSP
& RRT
3.2
Office Expenses
3.3
ASHA incentives for
Outbreak reporting
25000
85000
20000
1
20000X 12 = 240000
5000
1
5000 X 12 = 60000
100
10
Vachicale for IDSP
Office & RRT
Expected 10
100 X 10 X 12 = Outbreaks reported
12000 to District in a
Month.
3.4
3.5
3.6
Consumables for District
Labs
Collection & transportation
of samples
IDSP reports including
alerts
200000
1
200000 X 1 =200000
50000
1
50000 X 1 = 50000
20
15
20 X 15 X 52 =15600
2080
3.7
Printing of Reporting
Forms
20
3.8
Phone & Broadband
Expenses
1000
1
3.9
Mobile Expences
500
2
Sub Total
4. New
Innovations
Private Reporting
Unit 15
For 25 Govt.
Institution & 15
20x2080= 41600
Private Reporting
Unint in a week.
1000 X 12 = 12000
Mobile Expences
500 X 2 X 12 =
for Epidemiologist &
12000
Data Manager
627600
Expected to be
1000*20*12=240000 operational at PHC
level
4.1
Social Mobilization and
Intersectoral co-ordination
1000
20
4.3
Community based
surveillance
1000
354
4.4
Case based study reports
1000
1
1000*1*12=12000 Per Case 1000
4.5
Integration of Private
Sector for Disease
Surveliance.
1000
1
1000*1*12=12000
4.6
Furniture for IDSP VC
cum Training Hall
Sub Total
TOTAL
100000
1
1000*354*12=424800
Expected to be
operational at HSC
level
Establishedment of
100000 X 1 = VC cum Training
100000 Hall with Long
Table & 30 Chairs
788800
2521400