NATIONAL RURAL HEALTH MISSION (NRHM) 30TH OCTOBER 2008 PRESENTATION ON

NATIONAL RURAL HEALTH MISSION NRHM launched by Hon’ble Prime Minister on 12/4/2005. Aimed to ensure affordable, quality health care to the poorest house holds in remotest areas. Special focus on 18 low performing States which have weak public health indicators and weak infrastructure. Punjab is among the nine high performing States- Punjab, Haryana, Gujarat, Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, West Bengal. 4/15/2017

NRHM OBJECTIVES Universalized access to quality health care especially to rural poor with focus on women and children. Reduced infant mortality rate and Maternal Mortality Rate. Ensuring population stabilization & gender equity. Prevention and control of communicable and non-communicable diseases. Access to integrated comprehensive primary health care. Mainstream AYUSH- Integration of AYUSH with mainstream health institutions . Promotion of Healthy life style. Emphasis on potable drinking water, hygiene, sanitation and nutrition. 4/15/2017

Accessibility, Approachability and Quality KEY COMPONENTS OF NRHM Community Partnership Village level planning ASHA Village Health & Nutrition Days Village Health & Sanitation Committees Increased involvement of PRIs Improved services System strengthening Infrastructure development Monitoring through computerisation Improved financial management & Human Resource Public Private Partnership Telemedicine Mobile units for un reached Intra & inter sectoral convergence 24-Hour- delivery services Emergency Obstetric Services Specialist Services – On call/contract Immunization strengthening IMNCI Adolescent health Family welfare services Accessibility, Approachability and Quality

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

NRHM – ILLUSTRATIVE STRUCTURE Health Manager BLOCK LEVEL HEALTH OFFICE –--------------- Accountant Store Keeper Accredit private providers for public health goals 100,000 Population 100 Villages BLOCK LEVEL HOSPITAL Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; 30-40 Villages CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests 5-6 Villages GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic VILLAGE LEVEL – ASHA, AWW, VH & SC ASHAs, AWWs in every village; Village Health & Nutrition Day Drug Kit, Referral chains

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

INSTITUTIONAL ARRANGEMETS UNDER NRHM STATE LEVEL State Health Mission chaired by Hon’ble Chief Minister. State Health Society chaired by Chief Secretary. Merger of all vertical societies into State Health Society. Signing of MoU with GoI. DISTRICT LEVEL District Health Mission chaired by Chairman Zila Parishad. District Health Society chaired by Deputy Commissioner. Rogi Kalyan Samities in District/Sub Divisional Hospitals. Merger of all vertical societies into District Health Society.

..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM BLOCK LEVEL Block Health Committees at Block PHC. PHC Management Committee at PHC level. Rogi Kalyan Samities. VILLAGE LEVEL Village Health & Sanitation Committees in each village. Accredited Social Health Activist (ASHA) for every 1000 population.

HEALTH INDICATORS India Punjab Best State Birth Rate Death Rate (SRS 2006) 23.5 17.8 13.4 14.9 Manipur Kerala Death Rate 7.5 6.8 4.5 4.7 Delhi Life Expectancy at birth 62.15 68.25 73.5 Sex Ratio (Census 2001) 933 876 1001 1058 Pondicherry IMR 57 44 11 15 TFR (SRS 2005) 2.9 2.1 1.7 Maternal Mortality Ratio (SRS 2005) 301 178 110 Ante Natal Care (at least 3 checkup) (%) (NFHS III) 50.7 72.5 96.5 T.Nadu Institution Delivery (%) (NFHS III) 41 53 100 Contraceptive Use (%) (NFHS III) 56 63.3 73 HP Vaccine coverage (%) 60 81

TARGETS FOR PUNJAB Indicators Total Fertility Rate At the start of RCH SRS 1998-1999 Present Status 2007-2008 Target by 2009-2010 Total Fertility Rate 2.5 2.1 1.8 Infant Mortality Rate (per 1000 live births) 49 44 <30 Maternal Mortality Ratio (per 100000 live births) 199 178 <100 Institutional Deliveries 37.5% (NFHS II) 52.5 80% ANC Check-up with 03 contacts 58.4% 72.5 100%

HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR MEDICAL COLLEGES 3 5 DISTRICT HOPITALS 20 983 SUB DIVSIONAL HOSPITALS 42 COMMUNITY HEALTH CENTRES 128 PRIMARY LEVEL HEALTH INSTITUTIONS (PRIMARY HEALTH CENTRES/ CLINICS/ POLY-CLINICS/ DISPENSARIES) 1823 3046 SUB CENTRES AT VILLAGE LEVEL 2858 -- TOTAL = 4858 4034

NRHM OVER THE YEARS A sum of Rs. 336.25 crore has been received from GoI from 2005-06 to 2007-08 against which a sum of Rs. 309.29 crore has been spent. The plan for the current year 2008-09 is for Rs. 210.70 crore (Rs. 180.00 crore GoI + Rs. 30 crore GoP).

Up-gradation of Institutions District Hospitals – 5 District Hospitals are being upgraded at a cost of Rs 13.00 crore by adding 230 beds in the current year. The Hospitals are – Gurdaspur (100-150 beds), Ludhiana (100-130 beds), Mohali (70-130 beds), Patiala (MKS) (154-250 beds) & Bathinda. Construction of Mother and Child Hospital at Fatehgarh Sahib which was lying suspended for 2 years would be resumed at a cost of Rs. 7 crores. Sub Divisional Hospitals – 4 Sub Divisional Hospitals are being upgraded at a cost of Rs.6.50 crores in the current year. The Hospitals are Batala (50-80 beds), Pathankot (100-130 beds), Nabha ( 100-130 beds) & Patti (50-80 beds) at a cost of Rs. 2.50 crore. PHCs at Adampur & Rural Hospial Morinda are being upgraded at a cost of Rs. 1 crore. CHCs – Community Health Centre at Dhakoli (Zirakpur) will be constructed at a cost of Rs. 2.50 crore. 75 PHCs for 24 hour delivery upgraded during 2007-08 and 26 being upgraded 2008-09. 50 CHCs for Emergency Obstetric care upgraded during 2007-08 and 10 being upgraded 2008-09. A sum of Rs. 10.00 crore has been earmarked from ACA of 2008-09 for setting up of Urban Healthcare Centres in Municipal Corporation town, Bathinda.

Equipment and Furniture Equipment and Furniture worth Rs. 6.5 crore to be provided to CHCs as per IPHS Norms Drugs Drugs and consumable Rs. 3.60 crore provide to CHCs, Rs. 4.84 crore provided to PHCs and Rs. 6.00 crore provided to SHCs. - Total Rs. 14.44 crore Rogi Kalyan Samities In the year 07/08 Corpus Grant of Rs. 5 lac for 20 district hospitals, 1 lac each for 42 Sub Divisional Hospitals and Rs. 1 lac each for 100 CHCs was provided.

Untied Fund & Maintenance Grant Rs. 10,000 as Untied Funds to 12300VHSCs–Rs. 12.30 crore has been provided each year. Rs. 10,000 as Untied Funds to 2858 Sub Centre–Rs. 2.85 crore has been provided each year. Rs. 25,000 as Untied Funds for 484 PHCs – Total Rs. 1.21 crore has been provided each year. Rs. 50,000 as Untied Funds to 128 CHCs - Total Rs. 64.00 Lac has been provided in 2008-09. Rs. 50,000 as Annual Maintenance Grant to 484 PHCs – Total Rs. 2.42 Crore in 2007-08 and to 100 PHCs – Total Rs. 50.00 Lac in 2008-09. Rs. 1.00 Lac as Annual Maintenance Grant to 112 CHCs – Total Rs. 1.12 crore

School Health Programme Under School Health Campaign health checkup of 32,64,826 students of Primary and Secondary level will be done and minor ailments will be treated and referral will be provided wherever necessary. Report from PGI regarding treatments of Congenital Health Disease and Rheumatic Heart Disease among children has been received and proposal is being finalized. A total outlay of Rs. 5.00 crore has been provided for the programme. Emergency Response Services 224 Ambulance (56 advance life saving and 168 with basis life saving equipments) equipped with medical facilities and Medical Technicians are to be deployed in the State with Public-Private Partnership total initial cost will be Rs. 41.00 crore. Recurring cost will be Rs. 25.00 crore per annum.

Mobile Medical Unit Mobile Medical Unit (Rs. 36.00 Lac each) equipped with one Male Medical Officer, One Female Medical Officer, Lab Technician, Radiographer and Staff Nurse has been deployed to provide medical services in the rural and remote areas. Total outlay of Rs. 7.00 crore. Village Health and Sanitation Committees 11319 Village Health and Sanitation Committees constituted and provided Rs. 10,000 each per year. ASHA 13201 ASHA workers selected in the State. They are not paid given any fixed salary but instead are given cash ncentives on the basis of their performance in child health, family planning and institutional deliveries.

Consolidated Salary PM RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Director Finance On Deputation 2 State Programme Manager From State Govt. 3 Maternal Health Specialist 40,000 Services have been terminated 4 Family Welfare Specialist 5 Procurement Manager 25,000 Candidate resigned 6 Manager (HRD) 20,000 7 Manager (F&A) 8 Manager (M&E) 9 State NGO Coordinator 30,000 10 Programme Coordinator (ARSH & Gender)

Consolidated Salary PM …contd… SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 11 Programme Coordinator (BCC) 1 20,000 12 Consultant (Admn) 13 Consultant (M&E) 14 System Analyst 15,000 15 Accounts Officer 2 16 Statistical Assistant 4 10,000 17 Hardware Supervisor 18 Accountant/ Accounts Clerk Not to recruit 19 Accountant-cum-Cashier

Consolidated Salary PM …contd… SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 20 Computer Assistant 4 8,000 Selection has been done for the vacant position candidate is yet to join 21 Office Assistant 9 7,000 Appointment orders to 4 OAs are being given 22 Graphic Designer 1 10,000 Selection has been done for the vacant position 23 Procurement Assistant 2 Candidates have been adjusted at State HQ from the districts 24 Drivers 5,000 Action is being initiated 25 Class-IV 3 3,000 Total 45 38 7

Consolidated Salary PM RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 District Programme Manager 20 17 3 20,000 Selection has been Done. 2 District Accounts Officer 15,000 District Monitoring & Evaluation Officer 18 4 Procurement Officer 16 No further recruitment to be made 5 Maintenance Engineer 12,000 6 Statistical Assistant 8,000 7 Procurement Assistant No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification 8 Accountant-cum-Cashier 13 9 BCC Facilitator 11 Total 180 117 63 36 vacancies are not to be filled

Consolidated Salary PM RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Block Statistical Assistant 118 93 25* 8,000 *Recruitment in final stage at district level 2 Block Accountant cum Cashier 102 16* 3. Computer Operator 173 97 76* 5,000 Total 409 292 117

Consolidated Salary PM RECRUITMENT - EmOCs SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Obstetricians 60 29 31* Rs. 20000/- + Rs. 3000/- HRA+ Rs. 1000/ EmOC + Rs. 500/- per delivery conducted + Rs. 200/ MTP *Appointment letter to 11 Obst. Are being Issued on 30.10.2008 2 Paediatricians 21 39* Rs. 200/- per Emergency Case during off duty hours + Rs. 3000/- HRA *Appointment letter to 12 Paed are being issued on 30.10.2008 3 Anaesthesia 38 22 Rs. 1500/- on call per case + TA Rs. 6/KM upto 50 KM *Empanelment for 12 CHCs under process 4 Staff Nurses 300 251 59 Rs. 8500/- + Rs. 1500/- (if accommodation is not provided) *Recruitment Final stage at district level 5 OT Assistant 50 10 40 Rs. 4000/- + 300/- evey Major OT Case + Rs. 1500/- HRA Not required to recruit

Consolidated Salary PM RECRUITMENT - PHCs 24x7 & Mini PHCs SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Female Medical Officer 75 24 51* Rs. 15000 PM + Rs. 500 per Delivery+ Rs. 200/ MTP + Rs. 3000/- HRA *Appointment letter to 13 FMOs are being issued on 30.10.2008 2 Staff Nurses 225 168 57* Rs. 5000/- + Rs. 500/- per delivery conducted + Rs. 100/- per delivery assisted and Rs. 1500/- HRA (if accommodation is not provided) *Recruitment under process at district level 3. Medical Officer Mini PHCs 95 Rs. 16,000/- PM Appointment letter to 61 MOs are being issued on 30.10.2008

Consolidated Salary PM RECRUITMENT - Mobile Medical Unit (MMU) SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 Medical Officer (Male) 20 22,000 Appointed in August 2008 2 Medical Officer (Female) 4 Selection at final stage 3 Nurses 18 2* 8,000 *Recruitment under process at district level Radiographer * 5 Lab Technician *Recruitment under process at district level from July 2008 and reports being received 6 Driver 7,000 *Placement agency hired 7 Helper 4,000

Consolidated Salary PM RECRUITMENT - ANM for Urban Slum Area & Sub-Centres SN Name of the Post Sanctioned Post Filled Vacant Consolidated Salary PM Remarks 1 MPHW (Female) for urban slums 230 114 *116 6,000 *Recruitment under process at district level from July 2008 and reports being received 2 ANM for vacant sub-centres (2211) 514 Advertisement given on 23.08.2008 recruitment in final stage 3 2nd ANM for 954 sub-centres 954

Essential Services to be provided at EmOCs (FRUs) 24-hour delivery services including normal and assisted deliveries Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other medical interventions New-born Care(*) Emergency Care of sick children Full range of family planning services including Laproscopic Services Safe Abortion Services Treatment of STI / RTI Blood Storage Facility (*) Essential Laboratory Services Referral (transport) Services Janani Suraksha Yojna (*): Critical determinants of functionality

Essential service package to be provided at 24x7 PHC 24-hour delivery services, both normal and assisted (*) Essential newborn care (*) Referral for emergencies (*) Ante-natal care and routine immunisation services for children and pregnant women (besides fixed day services). Post-natal care Early and safe abortion services (including MVA) Family planning services Prevention and management of RTIs/STIs Essential laboratory services Janani Suraksha Yojna (*): Critical determinants of functionality

Services at Mini PHCs Routine OPD Management of National Health Programmes RCH Service Immunization Programmed National TB Control Programme National Leprosy Eradication Programme National Vector Borne Disease Control Programme Integrated Disease Surveillance Programme School Health Programme Supervision of services at Sub-Centre Level

THANK YOU