MEETING STATE HEALTH MISSION NRHM 04-09-2009

NATIONAL RURAL HEALTH MISSION (2005-2012) NRHM launched by Hon’ble Prime Minister on 12/4/2005. 100% by GoI for 2005-06 and 2006-07 and 85:15 from 2007-08 to 2011-12. 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. 2

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

NRHM 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 . Emphasis on potable drinking water, hygiene, sanitation and nutrition. 4 4

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 IN BRIEF Reduction in IMR and MMR through institutional deliveries - Recruitment of Gyne, Paed, Anaesth, Medical Officers (Female), Staff Nurse, ANM, ASHAs, Various Incentives, Upgradation of PHC, CHC for 24 hrs. delivery. Decentralization – Transfer of funds where needed. Untied funds and Maintenance Grant for SC, PHC, CHC; Funds for Rogi Kalyan Samiti, VHSC. Involvement of Community – State Health Society, District Health Society, Planning and Monitoring Committees at Block, District and State Level, Village Health and Sanitation Committees. Convergence – No separate funds but Department of Health expected to work in close coordination with other Departments like – Women and Child (ICDS), Water Supply and Sanitation, Education and Department of Rural Development. Besides AYUSH to be integrated with Allopathic Health Institutions.

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 Medical Units Intra & inter sectoral convergence 24-Hour- delivery services Emergency Obstetric Services Specialist Services – On call/contract Immunization strengthening IMNCI Adolescent health Family welfare services Accessibility, Approachability and Quality

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 8

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. State Level Planning and Monitoring Committee headed by Hon’ble Health Minister

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

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

HEALTH INDICATORS 3 SN CATEGORY INDIA PUNJAB BETTER STATES 1 Crude Birth Rate (SRS 2007) 23.1 17.6 Kerala (14.7), Himachal Pradesh (17.4), Tamil Nadu (15.8) 2 Total Fertility Rate NFHS-III 2.7 2.0 Tamil Nadu (1.6), Kerala (1.7), AP (1.9), HP (1.9), W.B.(1.9) 3 Death Rate 7.4 7.0 J &K (5.8), W. Bengal (6.3), Haryana (6.6), Maharashtra (6.6), Kerala (6.8), Rajasthan (6.8) 4 Sex Ratio at Birth 901 837 AP (915), Assam (939), Bihar (909), Chatisgarh (969), Himachal (931), Jharkhand (927), Karnataka (926), Kerala (958), Madhya Pradesh (913), Orissa (933), TN (944), W. Bengal (936) 5 Sex Ratio (0 to 4 years) 914 838 AP (942), Assam (950, Bihar (940), Chatisgarh (954), Himachal (945), Jharkhand (926), Karnataka (925), Kerala (962), Madhya Pradesh (935), Orissa (952), TN (950), W. Bengal (964) TOP

HEALTH INDICATORS : MATERNAL HEALTH SN Category India Punjab Better States 6 Maternal Mortality Ratio (SRS 2001-03) (SRS 2004-06) 301 254 178 192 Gujarat (172), Haryana (162), Kerala (110), Tamil Nadu (134), Maharashtra (149) 7. Infant Mortality Rate (SRS 2007) NFHS-III 55 57 43 42 Kerala (15), Tamil Nadu (31), Maharashtra (38), Himachal Pradesh (36) TOP

HEALTH INDICATORS : ANTE NATAL CHECK UP SN Category India Punjab Better States 8. Ante Natal Care (3 or more visits) NFHS-III DLHS – III 50.7 75.3 72.5 65.1 Kerala (93.5), Tamil Nadu (96.5), Maharashtra (75.3) 9. Institutional deliveries NFHS – III 41 47 53 63.3 Andhra Pradesh (71.8), Goa (96.3), Karnataka (65.1), Kerala (99.4), Maharashtra (63.6), T. Nadu ( 94.1) 10. Pregnant women who are anemic (%age) DLHS-III 57.9 41.6 Goa (36.9), HP (37.0), Kerala (33.1), Manipur (36.4) TOP

HEALTH INDICATORS : CHILD HEALTH SN Category India Punjab Better States 11 Breast Feeding (%age) Children under 3 years breast fed within one hour of birth NFHS-III DLSH-III 23.4 40.2 10.3 44.6 Assam (65.7), Goa (61.5), Kerala (65.3), Meghalya (75), Mizoram (78.4), Orissa (63.7), Sikkam (64.7), Tamil Nadu (77.5) 12 %age of children fully immunized NFHS-III 44.0 54.1 60.0 79.9 Goa (93.4), Himachal Pardesh (82.3), Tamil Nadu (83.2) TOP

Health Indicators – India and World Sr. No. Item India Best Countries Neighboring countries 1. Infant Mortality Rate 56 Iceland (2) Norway, Sweden & Japan (3) Sri Lanka (12) China (23) Bangladesh (54) Nepal (56) Pakistan (79) 2. Maternal Mortality Ratio 450 Ireland (1) Sweden & Italy (3) China (45) Sri Lanka (58) Pakistan (320) Bangladesh (570) Nepal (830) 3. Life Expectancy at Birth 63.7 Japan (82.3) Hong Kong (81.9) China (72.5) Sri Lanka (71.6) Pakistan (64.6) Bangladesh (63.1) Nepal (62.6) Source Human Development Report 2007-08

TARGETS FOR PUNJAB UNDER NRHM Indicators At the start of RCH SRS 1998-1999 Present Status 2008-2009 Target by 2009-2010 Total Fertility Rate 2.5 2.1 1.8 Infant Mortality Rate (per 1000 live births) 49 43 <30 Maternal Mortality Ratio (per 100000 live births) 199 178 192 <100 Institutional Deliveries 37.5% (NFHS II) 52.5 80% ANC Check-up with 03 contacts 58.4% 72.5 100% TOP

HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR MEDICAL COLLEGES 3 5 DISTRICT HOPITALS 20 983 SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78) 36 COMMUNITY HEALTH CENTRES 129 (114 PHSC, 15 DHS) BLOCK PHCs 118 - BLOCK PHCs AND SDH - BLOCK PHCs AND CHCs 72 - ONLY (EXCLUSIVE) BLOCK PHCs 41 TOP

HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR TOTAL PHCs – EXCLUSIVE 394 - PHCs (MINI PHCs) – EXCLUSIVE 353 - PHCs BLOCK – EXCLUSIVE 41 TOTAL PHCs – EXCLUSIVE + AT CHC/SDH 394 + 77 = 471 SUBSIDIARY HEALTH CENTERS 1187 SUB-CENTRES AT VILLAGE LEVEL 2950 CLINICS /DISPENSARIES 3046 TOP

FINANCIAL REPORT FOR THE YEAR 2005-10 Rs. in lakhs Year Ope-ning Bal-ance Approved Plan Releases Expenditure Incurred % of Utilization Unspent Balance (Bank Balance SHS) GOI State Share 15% from 2007-08 Total Funds released by GOI Funds released by State Total Funds Available 1 2 3 4 5 6 7 8 (2+6+7) 9 10 11 (8-9) 2005-06 283.2 9820.8 Not Required 8103.3 8386.45 5971.37 61% 2415.08 2006-07 2415.1 16272 14194 16609.1 8326.24 46% 8282.9 2007-08 16197 2841 19038 11516.2 20504.2 10469.28 53% 9329.89 2008-09 17324 2600 19924 17821 2884 30034.98 17524.71 58% 12510.57 2009-10 (July 09) 21805 3271 25245 5410 17920.57 4911.33 21.52 13009.24 TOP

FINANCIAL REPORT FOR THE YEAR 2005-10 Opening Balance 2009-10 - Rs. 12510.57 Lakhs District Health Societies - Rs. 5686.07 Lakhs State Health Society - Rs. 6824.50 Lakhs Closing Balance 2009-10 (July 2009) - Rs. 13009.24 Lakhs District Health Societies - Rs. 10673.15 Lakhs State Health Society - Rs. 2336.09 Lakhs TOP

Status of State Contribution FINANCIAL REPORT FOR THE YEAR 2005-10 Status of State Contribution 2008-09 GOI share as per PIP - 173.23 crore State share - 26.00 crore Total - 199.23 crore Release by GOI - 178.03 crore Matching State share - 31.35 crore Released by State - 21.79 crore Balance yet to be received - 9.56 crore 2009-10 GOI share as per PIP - 218.05 Crore State share - 32.71 Crore Unspent Balance - 1.69 Crore Total - 252.45 Crore Release by GOI - 54.10 Crore Matching State share - 9.55 Crore yet to be received - 9.55 Crore TOP

ANNUAL PLAN 2009-10 Part Component Approved Allocation A Rs. In lakhs Part Component Approved Allocation A RCH - Flexipool 6412   Maternal Health, Child Health, Family Planning, ARSH, Infrastructure, Training & BCC. B NRHM- Additionalities 11276 Mandatory Funds- Untied Funds, Annual Maintenance Grant & Corpus Grant to RKS Upgradation of Institutions- Civil Works, Drugs, Equipment, Mobile Medical Units, Emergency Response Services & Programme Management C Immunization 280 D National Disease Control Programme 1365 - RNTCP, NLEP, IDSP, NVBDCP, NIDDCP & NPCB E Inter sectoral Convergence AYUSH, Convergence with PRIs, ICDS & PHED Family Welfare Direction & Administration -2211 5912 Total 25245 TOP

Important Items of Expenditure – Rs. 252 Cr. PARTICULARS AMOUNT (in Crores) Salaries under NRHM 100.86 Mandatory Provisions for Untied Funds & Annual Maintenance Grant 28.12 Upgradation of health institutions 14.20 National Disease Control Programmes 13.65 Immunization 2.80 Maternal Health 6.10 Family Planning 11.17 Training 6.54 Behaviour Change Communication 3.67 TOP

Important Items of Expenditure …contd. PARTICULARS AMOUNT (in Crores) Construction & Repair of SCs 8.65 Drugs for PHCs/CHCs/SDHs/DHs 7.18 Equipment for PHCs/CHCs/SDHs/DHs 3.97 Recurring Cost of MMUs 3.60 ASHA Training 4.49 Emergency Response Services 25.61 School Health Programme 2.00 Total 252.45 TOP

ACHIEVEMENTS 2008-09 & 2009-10 (July 09) TOP

RECRUITMENTS-SUMMARY SN Category Total Sanctioned Filled up during 2005-06 to 2007-08 Filled up during 2008-09 Filled up during 2009-10 Total Filled up Vacant 1 SPMU 48 32 16 2 41 7 DPMU 140 71 72 20 3 BPMU 394 228 118 53 4 FRU Gynae 60 13 9 21 39 Paed. 14 11 6 24 36 Nurses 560 180 120 65 347 213 5 PHC 24x7 MO (F) 196 54 86 110 588 174 129 155 403 185 DHs 15 - 10 MMU 168 134 17 154 MO - PHCs 95 59 43 52 8 MPHW(F) – Urban Slums 230 330 116 ANMs – Sub Centres 1468 1338 130 Total 4126 1062 2180 373 3231 791 TOP

PART A- RCH FLEXI POOL SN Sub Components Allocation Expenditure Rs. In lakhs SN Sub Components Allocation Expenditure 2008-092008-09 2009-10 (up to July 09) 1 Maternal Health ( Referral Transport, VHND etc.) 235.00 444.26 120.00 160.00 Janani Suraksha Yojna ( JSY, Incentive to ASHA) 186.00 417.18 490.00 150.35 2 ASHA 334.50  71.18 3 Child Health & IMNCI 86.15 7.37 25.30 4 Family Planning (Compensation) 920.60 835.82 1116.50 267.08 5 ARSH 27.07 15.75 38.23 6.78 6 Urban RCH ( Salary of MPHW (F)) 135.60 155.42 165.60 77.97 7 PNDT Sex Ratio (Awards to Panchayat, Decoy patients, Informers, sting operations) 64.84 26.91 62.80 2.29 Innovations / PPP/NGO 442.50 77.53 295.00 51.00

PART A- RCH FLEXI POOL (Contd..) Rs. In lakhs SN Sub Components Allocation Expenditure 2008-09 2009-10 ( up to July 09) 8 Infrastructure & Human Development (Specialist Doctors,, Female Medical Officers, SNs) 1558.50 664.12 2547.39 314.27 Logistic Management 323.34 170.23 61.76 53.93 Quality Assurance and Infection Control Programme HMIS Monitoring and Evaluation 9 Training 461.88 151.00 654.09 28.13 10 Behaviour Change Communications 291.76 254.03 367.82 47.97 11 Procurement 122.50 437.71 53.55 34.64 13 Programme management Units SPMU and DPMUs 347.26 278.13 414.22 97.78 12 Flexi pool 157.50 112.96   Total A (RCH II) 5695.00 4119.60 6412.26 1292.19

ACHIEVMENTS - PART A Reproductive & Child Health Programme Reproductive and Child Health Programme focus on reducing MMR and IMR. Presently MMR of the State is 192 and IMR is 43. Target is to reduce MMR less than 100 and IMR to less than 30 by 2010. This can be reduced only by improving ANC coverage and promoting institutional deliveries. State focuses on Up gradation of institutions and community mobilisation. TOP

ACHIEVMENTS - PART A MATERNAL HEALTH Up-gradation of 196 PHCs to 24x7 PHCs 75 PHCs upgraded to 24x7 PHCs in 2007-08, 26 PHCs in 2008-09 and 95 PHCs in 2009-10 for providing 24 hours delivery services. Total upgraded 196. In each 24x7 PHC, 1 Medical Officer (Female) and 3 Staff Nurses on contract basis are being provided. Out of 196 Medical Officer (F), 86 posts have been filled up leaving 110 posts vacant. 403 Staff Nurses are in position (Target - 588). Generator set provided at 75 PHCs and for remaining 26 the process is on. Labour room etc. constructed. TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) (2) Up-gradation of 114 CHCs to FRUs 50 CHCs in 2007-08, 10 in 2008-09 and 52 in 2009-10 upgraded to First Referral Units (FRUs). Facility for a complicated delivery including blood transfusion. 1 Gynecologist, 1 Pediatrician and 5 Staff Nurses to be appointed. So far 21 Gynecologist, 24 Pediatricians have been appointed. Anesthetists on call in all the FRUs. 347 Nurses are in position (Target – 560). TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) (3) Signages for these 101 and 60 institutions developed. Order given. On line monitoring of performance of these institutions through PEC, work given. Biometric based on-line attendance system for these institutions. TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) Recruitment of ANMs : 486 ANMs recruited in December 2008 to fill up all the vacant post of ANMs in the Sub-Centers (2858) under Central Government Scheme 2211. 1161 ANMs recruited in December 2008 as 2nd ANM for the Sub-Centers having population of 6000 or more. All these ANMs have been recruited district wise and there is no provision for their transfer. They can never be transferred outside the district. TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) (5) Village Health and Nutrition Day : PIP 2008-09 : Rs. 1.10 crore The amount has been released and a sum of Rs.7.71 lac has been utilized. Work started late in 2008-09 and would be systematized in 2009-10. (6) Abolition of user fee for delivery related work in Govt. Hospitals (Rs. 300/900) TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) Promotion of Breast feeding : Rs. 25 lakh initiative through Breast Feeding Promotion Network of India (BPNI) in two districts – GDS and FZR for promotion of Breast Feeding. Project includes Training of Middle Level Trainers and the front line workers on breast feeding, complementary feeding and HIV counseling through Breast Feeding Promotion Network of India (BPNI). 16,000 (ASHAs & ANMs) to be trained as Front Line Workers. TOP

ACHIEVMENTS - PART A ASHA One ASHA to cover 1000 population. No pay but incentives based on performance. Important incentives – Rs. 50/- to 200/- for delivery, Immunization, family planning, RNTCP, Blindness Control, Toilet Promotion, Registration of Births and Deaths, Intimation regarding death of mother and infant etc. 17279 ASHA selected in the State, 163 yet to be selected. ASHA training for Module-1 completed In the FY 08/09, Rs. 301 lakh was disbursed to ASHAs for various incentives In the FY 09/10 upto June 2009 – Rs.197.46 lakh. have been spent for ASHA. In the FY 09/10 upto June 2009 – Rs. 105.83 lakh was distributed to ASHA for various incentives. TOP

ACHIEVMENTS - PART A ASHA Provision of Rs. 4.49 crore for training of ASHAs in the PIP 2009-10. In the FY 2008-09 Training at the State level for district trainers of ASHA completed in July 2008. Training at the District level for Block level trainers completed in August, 2008. Master Trainers of ASHA include members of different departments like Education, Social Security, Women and Child Development, Rural Development. Mother NGOs are also trained as Master trainers of ASHA at State and District level. Training at the Block level for ASHAs has been conducted and 15203 ASHAs trained. ASHA Module has been translated in Regional Punjabi language. Training of ASHAs at Block level planned through credible and capable health NGOs in 4 districts. ASHA Drug Kit has been procured and distributed to ASHAs after the training of ASHAs at Block level. TOP

Name of the Institution ACHIEVMENTS – PART A MATERNAL HEALTH (Contd…) (8) Posting Position of Gynecologists/ Female Medical Officer SN Name of the Institution Regular NRHM No Gynae/FMO Inst. Upgraded upto 2008-09 Inst. Upgraded upto 2009-10 1 DH – Gynae 36 10 2 SDH – Gynae 33 - 6 3 CHC – Gynae 69 12 9 4 24 x 7 PHC – FMO 50 108 5 Non Sanctioned Posts 11 Gynae administrative post 27 TOTAL TOP

ACHIEVMENTS - PART A MATERNAL HEALTH (Contd..) (9) Institutional Deliveries in Govt. Institutions: 2008-09 SN Institute/ Category Institutional Deliveries 2008-09 Institutional Deliveries 2007-08 Difference In No. of Deliveries %age Increase over 2007-08 1 DH 22209 19991 2218 11.09 2 SDH 14270 13100 1170 8.93  3 (a) CHCs(PHSC) 13535 8248 5287 64.1 (b) CHCs(DHS) 874 281 593 211.03 4 CHCs as FRUs 8928 4693 4235 90.24 5 24x7 PHCs 6752 1090 5662 519.45 6 STATE TOTAL 66451 44451 22000 49.49 TOP

Institutional Deliveries 2009-10 Institutional Deliveries 2008-09 INSTITUTIONAL DELIVERIES IN GOVT. APRIL – JULY 09: SN Institute/ Category Institutional Deliveries 2009-10 Institutional Deliveries 2008-09 %age Increase over 2008-09 1 DH 7301 5996 21.76 2 SDH 4945 3756 31.6 Sub total (Urban) 12246 9752 25.57  3 (a) CHCs(PHSC) 6229 3275 90.2 (b) CHCs(DHS) 383 225 70.22 4 CHCs as FRUs 3999 2213 80.70 5 PHCs 3358 1798 66.76 (a) 24x7 PHCs 3532 1638 115.63 6 Satellite Hosp+RH+Others 213 169 36.03 Sub total (Rural) 17714 9318 90.10 7 Medical Colleges+ ESI Hosp+ other allied Inst 1931 1731 11.55 8 STATE TOTAL 31891 20801 53.31

DELIVERIES – RURAL/URBAN   2007-08 2008-09 2009-10 (Upto July) Rural Area Institutions 10065 23511 10371 % age increase 133.59 Urban Area Institutions 34420 43019 14177 24.98 TOTAL 44485 66530 24548 49.56 43.53

TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTES (2007-08 , 2008-09 & 2009-10) TOP

JANANI SURAKSHA YOJANA Estimated Number of Cases : Estimated number of deliveries in a year in the State of Punjab = 5,00,000 Estimated number of deliveries of BPL/SC/ST @ 35% = 1,75,000 Estimated number of Beneficiaries upto 2 living Children @ 50% = 87,500 Financial Assistance : Home Delivery - Rs. 500 Institutional Delivery - Rs. 600/ 700 for Urban and Rural women TOP

ACHIEVMENTS - PART A JANANI SURAKSHA YOJANA (Contd..) Yearly Progress JSY : Year Number of Beneficiaries Expenditure (Rs. In Lakhs) For Home/ Non Institutional Delivery For Institutional Delivery Total 2005-06 (Full) 7489 4106 11595 70.99 2006-07 (Full) 9466 6613 16079 88.69 2007-08 (Full) 16453 12823 29256 170.90 2008-09 40350 27561 67911 383.92 2009-10 Upto July 15109 8886 23995 TOP

ACHIEVMENTS - PART A PNDT & SEX RATIO Sex Ratio in the age group 0-6 was 798 as per 2001 census. As per latest SRS data it has increased from 796 in 2001 to 838 (0-4 age group) in 2006. A campaign has been launched to strictly enforce the provisions of PNDT Act-1994. There are 1356 Ultrasound Centres in the State. Action taken so far : The licenses of 305 Centres were suspended or cancelled. 99 Court Cases/FIRs launched in the State for violation of the act. 10 persons have been convicted for violation of PNDT Act and have been awarded fine/imprisonment varying from 3 months to 3 years. 11 Panchayats awarded Rs. 3 lac each during year 2006-07. Incentives in force: Awards to Panchayats having > 1000 population. Awards to decoy patients (Rs. 10,000/-). Awards to Informers (Rs. 25,000/-) Awards for sting operations (Rs. 50,000/-) Fresh Sex Survey : Contract for survey of sex ratio for 25% population awarded in October 2008 to an agency, report expected by first week of March 2009. TOP

ACHIEVMENTS - PART A PNDT & SEX RATIO (Contd..) Other Schemes for female child : Balri Rakshak Yojna (Health Department) Kanya Jagriti Jyoti Scheme (Woman and Child) Mahila Jagriti Yojna and Swayamsidha Kishori Shakti Yojana (Woman and Child) Dhan Lakshmi (GoI) Nanhi Chhan TOP

ACHIEVMENTS - PART A INNOVATIONS – SURAKHIT JANEPA YOJANA (PPP) Rs. 2 crore provided in PIP 2008-09 for private health institutions for deliveries in BPL/ SC families. Rs. 4100 per delivery provided in the original guidelines. We have now vide letter dated 11/2/2009 revised the rates to Rs. 1700 per delivery and authorized the District Health Societies to empanel private health institutions. The scheme would be implemented till 30/10/2009. TOP

ACHIEVMENTS - PART A NGOs A sum of Rs. 2.42 crore has been provided for NGOs in the PIP of 2008-09. MNGO/ FNGO scheme was launched in 6 districts – Ropar, SAS Nagar, Patiala, Nawanshehar, Fatehgarh Sahib and Ferozepur during 2007-08 and their second installment of Rs. 15 lac per district has been released to 3 MNGOs in 6 districts. MNGO/ FNGO scheme has been extended to 8 more districts in the current year 2008-09. Applications were invited and 8 MNGOs have been selected. These MNGOs has been given grant-in-aid of Rs. 15.00 lakh per district. For the remaining 6 districts applications have been invited and field appraisals conducted at district level. The 5 MNGOs has been recommended by State NGO Committee for final approval of GOI. Service NGOs : The 2 Service NGOs for Ludhiana and Amritsar have been given Rs. 15 lac each. SNGOs for 2 districts Bathinda and Gurdaspur State NGO Committee has recommended for approval of GOI. TOP

ACHIEVMENTS - PART A TRAINING 2008-09 2009-10 Planned Conducted Achievement Expenditure 20 Types Employees (7574) 100% (5540) 60-100% (73.14%) 1.30 cr Employees All Started 70-95% 22.8 lacs Strengthening of Training Centres – State of the art equipments supplied to all Training Centres Strengthening of Training Centres – 1.80 Crores earmarked for repair/ renovation and upgradation – Work being done by PHSC, Mohali

ACHIEVMENTS - PART A HMIS – MONITORING AND EVALUATION NHSRC – HMIS: Data from April 2008 onward is being uploaded on the HMIS portal as desired by GoI. Data Block wise from November 2008 uploaded at district level. SAs from Blocks come to the district headquarter to upload the data. TOP

ACHIEVMENTS - PART A CIVIL REGISTRATION SYSTEM Birth and death registration – As per the latest data the registration in the State is nearly 95%. There is a provision of Rs. 0.40 crore in the PIP 2008-09 and of Rs.0.79 Crore in the PIP 2009-10 for computerization of Civil Registration System (CRS). EoIs for digitization and computerization of CRS were invited in January 2009 and WIPRO is taking up two districts under e-governance project. State may allot the work of CRS to WIPRO for remaining districts on successful completion model of two districts. TOP

ACHIEVMENTS - PART A BCC UNDER THE BCC/IEC COMPONENT OF NRHM PUNJAB, THE FOLLOWING ACTIVITIES HAVE BEEN EXECUTED Funds at a glance -2008-09 Total budget : Rs. 291.76 Lacs Total expenditure till 31-3-2009 Rs. 254. Lacs Utilization of Funds 100% Funds at a glance -2009-10 Total budget : Rs. 367.82 Lacs Total expenditure till 30.07-2009 Rs. 47.97 Lacs TOP

TRANSLATION AND PRINTING NRHM material was translated and prepared. Detailed guidelines were circulated to Sarpanches, ASHA, ANM, SMOs, Gynecologists and others involved. TOP

PART B- NRHM ADDITIONALITIES Rs. In lakhs SN Sub Components 2008-09 2009-10 B NRHM Additionalties Allocation Expenditure upto July 2009 a Village Health & Sanitation Committees 1230.00 1824.44 1273.80 197.16 b ASHA - proposed under RCH II   449.00 213.55 c SC Untied Fund & Maintenance 286.20 301.94 285.80 4.29 d PHC Untied Fund & Maintenance 121.00 108.78 99.00 4.02 e CHC Untied Fund & Maintenance 64.00 54.01 63.00 31.58 f Annual Maintenance Grant 162.00 199.25 454.00 22.61 g Mobile Medical/ Health Units 397.40 859.75 360.00 65.25 h Upgradation of CHC 1091.80 625.53 811.40 793.41 I Upgradation of PHC 821.43 850.00 658.62 33.92 j Upgradation of SC 725.38 145.79 1551.88 275.84

Expenditure (Upto July 2009) PART B- NRHM ADDITIONALITIES (Contd..) Rs. in lacs SN Sub Components 2008-09 2009-10 B NRHM Additionalties Allocation Expenditure Expenditure (Upto July 2009) k Upgradation of SHC 600.00 96.00 0.00 21.45 l Upgradation on SDH/ FRUs 100.00 488.00 m Upgradation of DH 370.00 143.88 689.50 52.71 n School Health 500.00 174.53 200.00 77.36 o Strengthening of Programme Management 476.56 150.79 254.88 57.36 p Strenthning of Logistics Management 50.00 q Rogi Kalyan Samitiis 12.33 648.15 r Emergency Response Services 937.50 2561.00 s Mobile Phones for ANMs 134.00 24.70 t District Action Plan 42.08 Major Civil Works for FRUs Other Activities 226.47 u SHC under Rural Development Board 638.60 v Health Mela 2.86 3.31 w Panchayati Raj Initiative 10.60   Total B 8079.60 6218.23 11299.20 1864.42

ACHIEVMENTS - PART B VILLAGE HEALTH AND SANITATION COMMITTEES (VHSC) 12592 VHSCs constituted upto 30/6/09. Almost Complete. Untied Grant of Rs. 10,000 each for 2007-08, 2008-09 and 2009-10 released and deposited in the bank account. So far, a sum of Rs. 19.16 crore has been spent out Rs. 38 Crore. TOP

ACHIEVMENTS - PART B MOBILE MEDICAL UNIT (MMUs) 24 MMUs deployed in districts. 4 districts Faridkot, Bathinda, Mansa and Barnala have one additional MMU. Cost of each MMU Rs. 36.00 lacs. Full Bus chassis used for MMUs. Has the facility of ECG, X-Ray and Lab. 1 MO(F), 1 MO(M), 1 Radiographer, 1 Lab Technician, 1 Staff Nurse, 1 Pharmacist (Regular) and 1 Driver and 1 Helper provided. 13 MO(F) and 21 MO(M) recruited. Instruction issued for free treatment and medicine (Rs. 7500 per month) issued. The works of MMUs is monitored through GPS Tracking System. TOP

ACHIEVMENTS - PART B UNTIED FUNDS AND MAINTENACNE GRANT Component Amount/Scope 2007-08 2008-09 2009-10 Remarks Untied Funds Rs. 10,000 2858 SCs 2947 SCs Funds Released Rs. 25,000 484 PHCs 396 PHCs Rs. 50,000 Nil 128 CHCs 126 CHCs Annual Maintenance Grant 100 PHCs Rs. 1 Lac 112 CHCs Rogi Kalyan Samitis Rs.5 Lac 20 DHs 1 Lac 36 SDHs  110 CHCs  114 CHCs  TOP

ACHIEVMENTS - PART B UPGRADATION OF HEALTH INSTITUTIONS Sub-Centres : Rs. 7.25 crore PIP 2008-09 and Rs.15.51 Crore PIP 2009-10. 954 Second ANMs for the Sub-Centres having more than 6000 population. Pay of these second ANMs is booked here. Sub-Centres New Construction Renovation FY 08/09 50 77 FY 09/10 60 150 TOP

ACHIEVMENTS - PART B UPGRADATION OF HEALTH INSTITUTIONS (Contd..) (2) Up-gradation of CHCs : 128 CHCs at a cost of Rs. 20 lakh per CHC during 2005-06 to 2008-09. Work almost completed. Upgradation of SDH: Proposed 25 SDHs @ Rs. 10 lakh per SDH during 2009-10. TOP

ACHIEVMENTS - PART B UPGRADATION OF HEALTH INSTITUTIONS (Contd…) (4) Upgradation of other Institutions: - Category Amount required Provided in 2008-09 Provided in 2009-10 New PHC -Adampur and Ghuda 2.70 Cr. New CHC – Zirakpur 3.00 Cr. 1.00 Cr. 2.00 Cr. New RH – Morinda Upgradation of SDH - Batala, Patti and Pathankot. 7.15 Cr. 1.00 + 5.50 Cr. DH- Mohali, Patiala, Gurdaspur, Ludhiana and Bathinda 17.00 Cr. 3.70 Cr. 1.40 + 5.00 Cr. (ACA, FTGH) DH- Faridkot and Sangrur TOP

ACHIEVMENTS - PART B DRUGS AND EQUIPMENTS Drugs (Rs. in lacs) PIP provision : 2007-08 2008-09 2009-10 PHC 1662 484 97 CHC 90 360 290 SDH - - 108 DH - - 200 Procured for Rs. 17.68 crore from the CPSUs for PHCs and Sub-Centres. For CHCs – funds being transferred to PHSC for purchase of medicines. Tenders received and under process. TOP

ACHIEVMENTS - PART B DRUGS AND EQUIPMENTS (Contd..) (2) Equipments (Rs. in lacs) PIP provision : 2008-09 2009-10 PHC 130.46 97 CHC 621.32 200 DH - 100 The requirement has been finalized by PHSC and tenders were floated and received by PHSC. Orders are being placed. TOP

ACHIEVMENTS - PART B SCHOOL HEALTH Out of 22706 schools which were to be covered in 2008-09, 20001 schools (89%) have been covered by Government Doctors. 32,64,926 of students are in Primary and Secondary level schools, 2697739 examined in 2008-09 and 266064 examined till 30/6/09 School Health Cards have been got printed by Education Department (upto class 8th ) and NRHM for Secondary/ Senior Secondary Schools. IFA and Albendazole Tablets, Scabies Lotion distributed to School Children. TOP

ACHIEVMENTS - PART B SCHOOL HEALTH (Contd..) Free Treatment for CHD and Cancer Decision taken on 4/11/2008 for free treatment of students (up-to +2 level) studying in Govt. & Govt. aided schools suffering from Congenital Heart Disease (CHD) and Rheumatic Heart Disease (RHD) in PGI Chandigarh. Their treatment would cost about Rs. 50,000 to 1,25,000. So far 72 students have been treated at PGI. 7 Students suffering from Cancer referred to PGI for treatment. Referral treatment of students in Govt. Hospitals made free w.e.f. July 2009. TOP

ACHIEVMENTS - PART B EMERGENCY MEDICAL RESPONSE SYSTEM PIP Provision – Rs. 9.37 crore in 2008-09 Tenders invited and work awarded to EMRI Hyderabad on 30/12/2008 for 90 ambulances and the control facility. The matter was kept on hold due to SATYAM Episode. Rs. 25.61 Crore in 2009-10. GOI has now allowed Capital Cost from NRHM Recurring Cost - GOI State 1st year 60% 40% 2nd year 40% 60% 3rd year 20% 80% 4th year 0% 100% TOP

ERS contd Punjab Phase No of Ambulance Capital Cost Recurring Cost Phase I 90 990 Lakh 1782 Lakh Phase II 150 1650 Lakh 2970 Lakh Total 240 2640 Lakh 4752 Lakh

ACHIEVMENTS - PART B MOBILE PHONES FOR ANMs PIP Provision - Rs. 1.34 crore in 2008-09 and Rs. 0.23 crore in 2009-10. Bids have been received and the work is being allotted. NSHRC has designed mobile based application for monitoring the performance of ANMs. It would be operationalized. TOP

ACHIEVMENTS - PART C IMMUNIZATION Activity Monthly Target Achievement Gain/ Loss % 2007-08 2008-09 2009-10 Upto 30/06/09 Fully immunized 39358 38751 38625 379983 362312 97884 -3 BCG 423539 386171 -14.6 DPT 410939 330907 115789 16.6 OPV-3 440939 346783 115954 12.9 Measles 106768 2.3 Hep. B 36383 271634 108223 38.2 TT-2 (PW) 45335 44588 44450 388211 364220 114375 3.2 TOP

ACHIEVMENTS - PART C IMMUNIZATION Contd.. Expenditure in 2008-09 was Rs. 4.23 Cr. against the allocation of Rs. 12.34 Cr. Allocation during 2009-10 is Rs. 10.09 Cr. As per NFHS-III (2006), the immunization coverage was 60% whereas as per DLHS-III (2008), it was 80%. TOP

NATIONAL DISEASE CONTROL PROGRAMME PART D- NATIONAL DISEASE CONTROL PROGRAMME Rs. In lakhs SN Sub Components Allocation Expenditure Up to July 09 2008-09 2009-10 a RNTCP (T.B.) 522.16 439.04 616.30 77.83 b Leprosy 0.76 105.17 130.30 9.44 c IDSP 79.91 95.91 142.45 d National Iodine Deficiency Disorder Control Programme. - NIDDCP 20.00 0.00 e Malaria & Vector Borne 212.36* 32.25 107.35 3.06 f Blindness Control 637.50 81.46 350.00 10.87   Total D 1366.40 101.20 * Includes in-kind grant of Rs. 148.00 lakh. TOP 73

ACHIEVMENTS - PART D RNTCP (Contd..) Year wise RNTCP Performance of Punjab Year Suspects examined per Lac per quarter (150/lac/qtr) Total TB cases put on DOTs Annualized total case detection rate (180-257) Annualized new smear positive case detection rate 67- 95(70%) 3 month conversion rate of NSP patients (>90%) Cure rate of NSP patients (>85%) Success rate of NSP patients (85%) 2005 140 30764 118 46 (48%) 81% 84% 2006 149 34538 133 52 (55%) 87% 86% 2007 (National) (Punjab) 143 146 1475587 35875 130 136 52(55%) 53 (56%) 89% 88% 83% 85% 2008 154 38456 58 (61%) 80% 2009 165 69 90% 73%

National Leprosy Eradication Program Punjab is a low endemic state. During 2008-09, new leprosy cases detected and brought under treatment were 933. Out of 933, the 180 patients are Punjabi cases. Total No. of Cases detected during the year 2007-08 were 964. Out of 964, the 196 patients are Punjabi cases. Prevalence Rate comes to 0.32 per 10000 population. State achieved the goal elimination set by Govt. of India i.e. less than 1 case/10000.

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS Prevalence of Blindness in the State is 9.5 per 1000 Population as compared to 11.2 of all India . Estimated No. of cases (incidence) of blindness per year in Punjab= 49072 Estimated No. of cases (incidence) of blindness per year in India = 2132048. The cataract surgical coverage is 105% in the year 2007-08 and 94.8% in the year 2008-09.  To encourage eye donations ,camps are organized from 25 August to 08-September .

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS Contd.. ACHIEVEMENTS Cataract Operations Year Cataract Operation IOL Implantation Target Performance % Cataract % IOL 2007-08 1,60,000 1,67,256 105.0 1,52,353 95 2008-09 1,80,000 1,70,572 94.8 1,62,000 1,60,878 99.3 2009-10 (Upto July) 60,000 (Prop) 38,360 63.0 54,000 35,175 65.1

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS Contd.. ACHIEVEMENTS Contd.. School Eye Screening Programme, Eye Donation and Teacher Trained:- Particulars Target for the year 2008-09 Performance Target for the year 2009-10 2008-09 % Age 2008-09 2009-10 % Age 2009-10 School Children Screened by DBCS 2,38,095 4,69,055 197.0 116667 152170 130.00 School Children Detected with Refractive errors 16,667 35,876 215.3 7000 8810 136.00 No. of Free Spectacles given to Children 5,000 5924 118.5 2100 2427 Eye Donation 600 247 41.2 267 89 Teacher Trained 4,000 2580 65 1333 2805 210.00 78

1. Infrastructure Development ACHIEVMENTS - PART D INTEGRATED DISEASE SURVEILLANCE PROJECT (IDSP) 1. Infrastructure Development Launched in the State in Phase-3 on 12th June, 2007. State Surveillance Officer, District Surveillance Officers in all districts nominated. State Surveillance Unit and District Surveillance Units established. IT networking through broadband, EDUSAT system at SSU , 3 Govt. Medical Colleges and all districts. MoU signed with five Private Medical Colleges and private practitioners in the districts. 2. Lab. Upgradation Up gradation of State Public Health Lab. at CH Mohali, District Labs in all the Civil Hosp. and provision of heavy metal testing in drinking water under Water Quality component, supplied equipment and reagents.( Approx 24 lacs) 20 CHCs (1 in each Distt.) selected for up gradation. ( Approx 4 lacs) TOP

ACHIEVMENTS - PART D NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME.) In Punjab, Dengue and Malaria are of main public concern. Although three random cases of Japanese Encephalitis have been reported in the State in 2008. No case of Chikungunya, Kala Azar and Filaria have been reported in the State. In the year 2009-10 only 4 cases of PF Malaria has been detected. Year Disease Confirmed cases Death April 2008 to March 2009 Upto June 2009 Dengue 4349 Nil 21 April 2008 to March 2009 Malaria 2494 637 TOP

Six Apheresis machines have been procured. ACHIEVMENTS - PART D NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (Contd..) Six Apheresis machines have been procured. 7 districts of the Punjab State have Blood Cell Separator units. 10 Blood Cell Separator Units procured. Apart from above, effective steps shall be undertaken to further strengthen the surveillance to lower the number of Malaria cases. A strict watch shall be kept on Japanese Encephalitis during the year 2009-2010. TOP

INTERSECTORAL CONVERGENCE PART E- INTERSECTORAL CONVERGENCE Rs. In lakhs SN Sub Components Allocation Expenditure (upto July 09) 2008-09 2009-100020002009-10 a Convergence with AYUSH (Pay of AMOs) 424.80 77.90 715.00 155.17 b Co ordination & Orientation with PRIs 75.15 40.00 c Special innovation for Minorities 33.45 0.00   Total E 533.40 117.90 TOP

PART-II OF NRHM (CSS-2211) The salary of ANMs deputated in 2950 Sub- Centres is paid by GoI under 100% GoI Scheme. A sum of Rs. 59.32 Cr. was utilized against the allocation of Rs. 59.34 Cr. in 2008-09. Allocation in 2009-10 is Rs. 59.12 Cr.

PART E CONVERGENCE WITH AYUSH Against 121 AMOs, 108 MOs have been appointed in November 2008. Against 112 HMOs, 94 HMOs have been appointed in January 2009. In 2009-10 in 121 Dispensers are to be appointed. TOP

PART E COORDINATION WITH PRIs (Rural Development Department) In the FY 08/09 Rs. 40 lac for coordination and orientation with PRIs. Guidelines being got printed in Punjabi and circulated to all Gram Panchayats. State Institute of Rural Development has organised training and orientation of Gram Panchayats. Approximately 15,000 representatives of VHSCs, Block/PHCs Monitoring and Planning Committee given training for NRHM. TOP

PART E CONVERGENCE – WATER SUPPLY AND SANITATION Joint BCC campaigns by health and PHED department on sanitation and toilet use. ASHA, AWW and ANM oriented to communicate with the community on sanitation and toilet use. Incentive of Rs. 50/- per toilet given to ASHA. Improve sanitation and toilet facilities in all schools and promote use of toilet and clean water in all schools through a joint campaign. Coordination meeting between WSS and health department through the District and State Health Missions. The head of the WSS in both district and state headquarters to be invited to participate in the meetings of the NRHM.

PART E DRINKING WATER SUPPLY Out of 11623 villages, a total of 5724 habitations (2241 NC and 3483 PC) are yet to be covered. These will be covered by 2012. For Rural Areas, there are various schemes – Accelerated Rural Water Supply Scheme (Rs. 120 crore), NABARD (Rs. 120 crore), World Bank (Rs. 150 crore), Rajiv Gandhi National Drinking Water Mission (Rs. 28 crore), RO Process (Rs. 19.61 crore) for clean drinking water. Out of 327 villages RO system commissioned in 107 villages, and will be commissioned in 140 villages as soon as electricity connection is installed and remaining in process TOP

PART E SANITATION Sewerage works will be executed in urban areas under JNNURM and JBIC Projects. Rs. 100 Cr. provided for rural toilets during 2009-10. Under Total Sanitation Programme of GoI, a sum of Rs. 70 has been sanctioned for providing toilets in schools, Aanganwadi Centers, Community toilets and individual toilets. Under World Bank Project, there is a provision for laying underground sewer in 100 villages and cleaning of village ponds in 1000 villages. TOP

PART E SANITATION Nirmal Gram Puruskar Under TSC Nirmal Gram Puruskar is awarded by the GOI to the Villages where people are not going for toilet in open places. 22 Villages awarded with Nirmal Gram Puruskar in 2008-09. Target to cover 251 more villages in 2009-10. TOP

PART E CONVERGENCE WITH EDUCATION DEPARTMENT School Health programme to provide health check up to all school going children. Special campaign for treatment of Rheumatic Heart Disease and Congenital Heart Disease among School going children. Orient secondary school teachers on the Adolescent issues and availability of health services in the public health facilities. Undertake a joint campaign with the Education Department on the ill-effects of habit forming practices. Encourage Education Department to promote co-production of health by students through practices such as Yoga and physical exercises. Use the opportunity of NSS camps in colleges to involve youth on health issues. Orientation of youth done during the camps and they could be encouraged to undertake campaign on behalf of the health department. IEC campaign through school children i.e. awareness generation rallies, poster competitions, wall painting by children. TOP

PART E SCHOOL – WATER & TOILETS A campaign was launched to provide toilets and drinking water to all schools during 2008-09. As of now 195 schools are without toilets and 18 schools without drinking water. These would be covered in three months. The number of toilets are inadequate as per the student strength in some of the schools. A total of 5089 schools do not have adequate number of toilets. These would be covered in the current year. Funds to the extent Rs. 20000.00 per school for Girls toilet and Rs 20000.00 for Boys toilets provided from Total Sanitation Campaign (TSC) TOP

ACHIEVMENTS - PART E Convergence with DWCD Observe VHND strengthen fixed health and nutrition day at village level. ASHA to mobilize women and children for the fixed health and nutrition day. AWW to be a part of the Village Health and Sanitation Committees and inform the VHSC about the activities of the ICDS. AWW to facilitate referral of women to appropriate health facilities for institutional deliveries, RTI/STI, MTP, violence and any other gynaecological and other morbidity AWW and ASHA to counsel the adolescent girls on the provision of adolescent health in various health facilities. AWW and ASHA to be informed of the provision. A joint strategy meeting on BCC is done at the state and district level to evolve common communication strategy between the two departments and ensure convergence. AWW along with ASHA to participate in routine immunization and in special campaigns like pulse polio and mobile community.

ACHIEVMENTS - PART E NUTRITION Under ICDS Programme (50:50) the State Government will be spending Rs. 100 crore in 2009-10. Under Kishori Shakti YoMarcha (Nutrition for adolescent girls) will spent Rs. 5.00 crore through Woman and Child Development.57921 beneficiaries Under these ICDS programmes a total of 13.86 lakh children and mothers were provided nutrition. TOP

SYSTEMATIC CHANGES 2008-09 District wise recruitment of ANMs and Nurses – There was a practice in the state to depute these employees at the places other than the places from which they were drawing their pay. This practice has been completely stopped and now these employees have been recruited in the NRHM district wise. There is no provision what so ever for transfer of these employees from one district to the other district. The deputation of existing employees have been cancelled and the ANMs have been sent to their proper places of posting. Increase in the pay of Gynecologists and Medical Officer (F) recruited under NRHM – The existing pay of these employees under NRHM was increased by Rs. 5000/- to as under in 2008-09: Gynecologists : Rs. 30000+Incentives Pediatricians : Rs. 30000+Incentives MO (F) : Rs. 25000+Incentives TOP

SYSTEMATIC CHANGES 2008-09 Contd… (3) Special Incentive for Remote Areas - A special incentive of Rs. 5000/10000/- and Rs. 10000/15000/- provided in the annual plan of 2009-10 for MO(F) and Gyne. working in remote and extreme remote PHC and CHCs. These are being identified. TOP

SYSTEMATIC CHANGES 2008-09 Contd… (4) Medical Officers under NRHM in PHCs – Large number of PHCs were without any medical doctor and this problem was more acute in the southern of the state. The state government accordingly in the month of December gave an advertisement for filling up 97 posts of MOs in PHCs which were without any doctor in the 10 southern districts. We have been able to fill up 59 posts for these PHCs. (5) Rationalization of postings and transfers – There was an acute shortage of doctors in PHCs and CHCs. Part of this shortage was on account of irrational deployment of the doctors specially the specialists who were deputed in excess of the resistance at CHCs/PHCs/DH/SDH. The Department in July 2008 carried out a comprehensive exercise to remove the excess staff to vacant places. As on date only 40 CHCs are without Gynecologists. TOP

SYSTEMATIC CHANGES 2008-09 Contd… (6) Recruitment on regular basis – (a) Medical Officers – The State Government has appointed 100 MOs through PPSC. - The Government has approved recruitment of another 212 MOs through PPSC. (b) Specialists – 2 rounds of recruitment were carried out to appoint 165 MO (specialists) i.e. MD/MS in the department. 53 specialists doctors have already been issued appointment letters in March 2009. Remaining posts are being filled up. TOP

SYSTEMATIC CHANGES 2008-09 Contd… (c ) Regular recruitments - The State Government has also decided that recruitment of doctors would be carried out every year to fill up the vacancies arising from retirement, selection in medical colleges and resignations. (7) Tele-medicine- Government Medical Colleges and all the 20 District Hospitals have been linked to PGIMER to receive specialized services through tele-medicine. Necessary equipment and connectivity have been provided. TOP

SYSTEMATIC CHANGES 2008-09 Contd… (8) Super-Specialty Cancer Hospitals- The incidence of Cancer in Punjab has increased in recent years. The State Government got a study conducted from the Department of Community Medicine, PGI, Chandigarh and they reported that the increased incidence was due to increased use of pesticides especially in the cotton growing districts. The State Government decided to set up two Super-Specialty Cancer Hospitals in Public- Private- Partnership – -Super-Specialty Cancer and Cardiac Hospital, Bathinda -Super-Specialty Cancer and Trauma Hospital, Mohali Land has been earmarked in the existing hospitals for the private parties. Bids have been invited and work has been allotted to Max Healthcare Institute Limited against upfront fee of Rs. 1.58 crore of Bathinda and Rs. 4.73 crore for Mohali and 5% revenue share at both the places. The party would commission the hospitals within 2 years i.e. by 31/3/2011. TOP

SYSTEMATIC CHANGES 2008-09 Contd… (9) New Hospitals- (i) Satellite Hospital- State Government secured an Additional Central Assistance of Rs. 10 crore for construction of 4 satellite hospitals in slum basties of Bathinda. The amount was received in February, 2009 and the work has been started. Mother and Child Hospital at Fatehgarh Sahib- The State Government secured Rs. 5 crore from the Government of India as Additional Central Assistance for completing the Mother and Child Hospital at Fatehgarh Sahib. These two hospitals are now being given to PIDB for PP project. TOP

NEW ACTIVITIES 2009-10 UNDER MATERNAL HEALTH PROGRAMME INSTITUTIONAL DELIVERIES – 51 % IN THE STATE, STATE AT NO. 10 IN THE COUNTRY. NO. OF DELIVERIES IN GOVERNMENT HOSPITALS IN 2008-09 (March) IS 53530 AGAINST 37916 IN 2007-08, AN INCREASE OF 15614 (41.81 %). STILL GOVERNMENT HOSPITLAS ACCOUNT FOR ONLY 13 % OF TOTAL BIRTHS IN THE STATE. PLAN TO INCREASE THIS NUMBER. UNDER NRHM REFERRAL TRANSPORT @ RS. 200/- FOR BPL/SC/ST . A TOTAL Rs. 90 LAKH PROPOSED DURING 09/10 96 MORE PHCs TO BE STRENGTHENED AS 24 x 7 CENTRES. 101 PHCs ALREADY TAKEN UPTO 2008-09 DURING 09/10 52 MORE CHCs TO BE STRENGTHENED AS FRUs. 60 CHCs ALREADY TAKEN UPTO 2008-09 PREGNANCY TRACKING AND WORK DONE BY ANMs – WILL PROPOSE A NEW SCHEME FOR RS. 70 LACS + 140 x 12000 = 87 LACS. PILOT PROJECT – WILL PROPOSE FOR ON LINE REGISTRATION OF PREGNANCIES. TOP

NEW ACTIVITIES 2009-10 UNDER ARSH PROGRAMME - STATE GOVERNMENT INITIATIVES – NEW PLAN SCHEME – ASSISTANCE FOR INSTITUTIONAL DELIVERIES TO BPL/ SC FAMILIES (RS. 10 CRORE) – RS. 1500 PER BIRTH UPTO TWO CHILDREN. MONITORING OF WORKS DONE BY GYNAECOLOGISTS – MONTHLY MONITORING AND ISSUANCE OF LETTERS. - REGULAR GYNE : 11, 7, 10 ABOVE AVERAGE, AVERAGE, BELOW AVERAGE - NRHM GYNE : 6, 3, 5 30, 20, < 20 - SMC : 47, 25, 85 15, 10, <10 PER MONTH UNDER CHILD HEALTH PROGRAMME PROMOTION OF EXCLUSIVE BREAST FEEDING THROUGH TRAINING, IEC AND FOCUSED GROUP DISCUSSIONS. RS. 50.00 LAKH PRPOSED DURING THE FY 09/10 UNDER ARSH PROGRAMME - SEVEN MORE DISTRICTS TO BE COVERED IN THE YEAR 09/10 (BARNALA, HOSHIARPUR, MANSA, MOGA, NAWANSHAHAR, ROPAR AND TARN TARAN). TOP

NEW ACTIVITIES 2009-10 (Contd..) Multi purpose youth friendly centers in 4 districts – Rs. 2 lakh per district proposed. Provision of sanitary napkins through social marketing to adolescent girls TO ENFORCE PC PNDT Award money for sting operation @ rs. 50,000/- per operation UNDER PPP MODEL To outsource 20 PHCs for 24x7 services @ rs. 70,000/- per PHC. TRAINING 5 more districts added for sba IMNCI training of LHVs, ANMs, AWWs, school teachers to continue and completed during this year IUD insertion training using alternative methodology – 4 selected districts - initially TOP

NEW INITIATIVES -ADDITIONALITIES MEDICAL OFFICER FOR 50 PHCs WITHOUT DOCTORS @ Rs. 25,000 PER MONTH PER MEDICAL OFFICER INCENTIVES TO DOCTORS WORKING IN EXTREMELY REMOTE AREAS ENGAGEMENT OF 5 HOSPITAL ADMINISTRATOR ONE GYNAECOLOGIST FOR 15 DHs TOP

Thank You

PIP 2009-10

MATERNAL HEALTH Rs. 120.00 LAKH HAS BEEN APPROVED FOR THE FY 09/10 FOR ACTIVITIES UNDER MATERNAL HEALTH Early registration of pregnancies and ensuring institutional delivery REFERRAL TRANSPORT @ RS. 200/- FOR BPL/SC/ST FAMILIES 24 HR DELIVERY SERVICES IN IDENTIFIED PHCs During 09/10 96 more PHCs to be strengthened 101 PHCs already taken upto 2008-09 20 PHCs to be outsourced for providing 24X7 services Human resource and infrastructure strengthening Contd… 107

MATERNAL HEALTH 24 HR CEmONC SERVICES IN SELECTED CHCs During 09/10 52 more CHCs to be strengthened 60 CHCs already taken upto 2008-09 Provision of Obstetrician, Paediatrician and 5 S/Ns New born care corners in the identified CHCs. Blood storage units in the identified CHCs. Contd… 108

MATERNAL HEALTH JANANI SURAKSHA YOJNA RS. 490.00 LAKH HAS BEEN APPROVED FOR THE FY 09/10 Implementation to be as per GOI guidelines Payments to be through bearer cheques Incentive of Rs. 200.00 to ASHA ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA) RS. 462.70 LAKH HAS BEEN PROPOSED DURING THE FY 09/10 Total 17285 ASHAs selected . Trainings and supply of drug kits. ASHA resource centre as a part of the state resource centre to be established funds to be utilized from the PIP 08/09 approvals. 109

CHILD HEALTH Rs. 25.30 LAKH HAVE BEEN APPROVED FOR THE FY 09/10 New programme of integrated management of neonatal and childhood illnesses (IMNCI) in 4 districts (Amritsar, Tarn Taran, Ludhiana and Patiala)- already launched Strengthening IMNCI cell at state & 4 districts by providing data recording & analysis support and training facilities. IMNCI training for 22 tots, 360 MOs, 76 SNs, 335 LHVs and 967 ANMs, 780 AWW (identified districts) & DIOs of all 20 districts Strengthening of immunisation services (details under immunization) 110

CHILD HEALTH 25 new born care centres established, 35 are in process at CHC level, total 112 centres are to be established upto 09/10. Distribution with training of manual mucus suckers to SBAs Promotion of exclusive breast feeding through training, IEC and focused group discussions Promotion of deliveries by SBAs by providing trainings and sensitization through IEC activities 111

BREAST FEEDING SCHEME Rs. 25.00 LAKH APPROVED FOR THE FY 09/10 State-wide behaviour change effort to promote breastfeeding by involving all grassroot workers (ANMs/ AWWs/ ASHAs). At PHC level Medical Officer, staff nurse to be sensitized. ANMs/Male Health Workers to counsel mothers for breast-feeding. Booklets to mothers on exclusive breast-feeding. Train ASHAs, TBAs, AWWs, ANMs, LHVs, Male Workers to improve their counselling skills for breast-feeding Adequately qualified ASHAs to be trained as breast-feeding counsellor at CHC level Supplementary diet in kind to BPL/ SC/ ST mothers for promoting breast-feeding. 112

FAMILY PLANNING Rs. 1116.50 LAKH APPROVED FOR THE FY 09/10 Dissemination of revised manuals on sterilization standards and quality assurance of sterilization services Organizing female sterilization & IUD insertion camps in districts -one camp per month per block- Organizing NSV camps – 40 camps per month in the state Printing of sterilization files, printing of cards, insurance manuals and purchase of computers- continues process Compensation package for sterilization / IUD as per GOI guidelines 113

ARSH Rs. 38.23 LAKH APPROVED FOR THE FY 09/10 13 districts covered upto 08/09. Seven more districts to be covered in the year 09/10 (Barnala, Hoshiarpur, Mansa, Moga, Nawanshahar, Ropar and Tarn Taran). Adolescent Friendly health services through 1057 special clinics (PHCs, CHCs, civil hospitals and selected sub centres) to be provided i.e. management and treatment of anemia, menstrual disorders, tt immunization, nutrition counselling, management & treatment of RTIs/STIs and reducing the incidence of HIV/AIDs Printing of ARSH IEC material for dissemination to health care providers & stakeholders Printing of guidelines, handouts, facilitator guides for MOs ANMs, LHVs Under IEC activities advocacy workshop at state 7 districts & all blocks in the selected districts Multi purpose youth friendly centers. Provision of sanitary napkins through social marketing to adolescent girls 114

URBAN RCH Rs.165.60 LAKH APPROVED FOR THE FY 09/10 Contractual appointment of 230 MPHWs in slum areas of the state to continue 115

PNDT & SEX RATIO Rs. 62.80 LAKH APPROVED FOR THE FY 09/10 : Orientation programme for programme managers and service providers on PC PNDT Organization of seminars, workshops of prominent personalities on the declining sex ratio Manpower & operational support for PNDT cell at the state HQ by induction of a lawyer, social scientist, Annual analysis of sex – ratio in the state on the basis of institutional deliveries and civil registration data. Monitoring of sex ratio at birth through ASHA. Award money for sting operation @ Rs. 50,000/- per operation Award money for informers @ Rs. 20,000/- & provision for decoy patients- @ Rs. 10,000/- . Award to panchayats – Rs. 1.5 lac, 2 best performing panchayats in each district. 116

INNOVATIONS / PPP / NGO Rs. 295.00 LAKH APPROVED FOR THE FY 09/10 MNGO & NGO (SNGO) Preparatory phase to newly selected MNGOs for proposal development. 1st instalment of grant in aid for 12 months to 5 MNGOs Service NGO scheme Preparatory phase to newly selected SNGOs for proposal development (04 SNGOs) 1st instalment of grant in aid for 18 months to existing SNGOs Promotional activity for seminar/ workshop/ review meeting/ study tours as per need assessment To outsource 20 PHCs for 24x7 services @ Rs. 70,000/- per PHC. 117

INSTITUTIONAL STRENGTHENING LOGISTICS Rs. 13.20 LAKH APPROVED FOR THE FY 09/10 Development of inventory management system and software development is in process POL for transportation of supplies from state up to sub centre level Strengthening of warehouse facilities. 118

HMIS Rs. 74.76 lakh APPROVED FOR the FY 09/10 Strengthening of HMIS system at state level by providing computers & peripherals 173 Computer Operators on contract recruited- 2 Programmers 2 Hardware Supervisors, 1 System Analyst on contract to be recruited – 1 Hardware Supervisor already recruited Operationalization of new MIES formats Internet connectivity upto block level Need assessment study on strengthening HMIS. Mid term and endline evaluation study through external agencies. Establishing CRS, preservation and digitalization of CRS reports Printing of new formats, compilation sheets and publication and dissemination of state level reports on various health indicators. Training and monitoring by the M & E team.

QUALITY ASSURANCE Quality assurance committees at State, District and Block Level Patient Satisfaction Survey is being conducted through private agency Training for management of waste Training of staff for segregation & treatment of medical waste 120

TRAININGS SIHFW/ HFWTC Strengthening & Upgradation of Training Institutes – As per GOI Guidelines SIHFW, Mohali; HFWTC, Amritsar MPHW (M) Training Centres – Kharar, Nabha ANM Training Centres – Hoshiarpur, Nangal, Sangrur, Gurdaspur, Moga, Bathinda Strengthening of District Training Centres SIHFW/ HFWTC BCC Skill Building Training for Medical Officers BCC Skill Building Training for Paramedicals Integrated NRHM Training for Rural Medical Officers TOT for IUCD Insertion using Alternative Methodology Computer Training for MOs Computer Training for Clerical staff TOT for RTI/ stI TOT for ARSH Integrated NRHM Training of ANMs (Contractual under NRHM) 121

TRAININGS Districts – Apart from most of the trainings conducted during 2008-09 New Trainings added 5 more districts added for SBA IMNCI Training of LHVs, ANMs, AWWs, School Teachers to continue and completed during this year IUD Insertion Training using Alternative Methodology – 4 selected districts - initially 122

BEHAVIOUR CHANGE COMMUNICATION Rs. 367.82 LAKH APPROVED FOR THE FY 09/10 Strategies for Intra Communication designed Printing of booklets for adolescents on ARSH issues. Implementation of BCC strategy as per GOI guidelines Focus group discussions, wall paintings, hoardings, folders, posters, radio/TV coverage, newspapers adds & folk media for components of maternal health, child health, family planning, JSY, ARSH, water and sanitation, gender and sex ratio Advocacy workshop at state, district & block level on issues of early registration of pregnancy, ANC and institutional delivery Flip book for neonatal care and NSV etc. Strengthening of BCC/IEC bureau (state & district level) School based activities on sanitation purchase of exhibition stand and digital camera. Educational material for life style diseases 123

PART-B NRHM ADDITIONALTIES 124

NRHM-ADDITIONALITIES (RS IN LAKHS) SN ACTIVITY BUDGET APPROVED (Rs. In Lakhs) 1 VILLAGE HEALTH & SANITATION COMMITTEES 1273.80 2 ASHA 449.00 3 SC UNTIED FUND 285.80 4 PHC UNTIED FUND 99.00 5 CHC UNTIED FUND 63.00 6 ANNUAL MAINTENANCE GRANT(1443 SC, 396 PHC & 112 CHCs 454.00 7 MOBILE MEDICAL/ HEALTH UNITS 360.00 8 UP-GRADATION OF CHC 811.40 9 UP-GRADATION OF PHC 658.62 10 UP-GRADATION OF SC 1551.00 Contd… 125

NRHM-ADDITIONALITIES (RS IN LAKHS) SN ACTIVITY BUDGET APPROVED (Rs. In Lakhs) 11 UP-GRADATION OF SHC 0.00 12 UP-GRADATION ON SDH/ FRUS 488.00 13 UP-GRADATION OF DH 689.50 14 SCHOOL HEALTH 200.00 15 ROGI KALYAN SAMITIES 648.15 16 STRENGTHENING OF PROG. MANAGEMENT 371.31 17 ADDITIONAL ACTIVITIES(EMRI,CELL PHONE, ZINC SULPHATE) 2617.04 18 CRS 78.70 19 MAJOR CIVIL WORKS TOTAL B 11298.32 126

NRHM Additionalities Mandatory Provisions Untied Funds and Annual Maintenance Grant Funds to 12673 VHSCs @ Rs. 10,000.00 – Provided Untied Funds Sub Centre 2858 @ Rs. 10,000.00 – Provided PHCs 396 @ Rs. 25,000.00 – Provided CHCs 126 @ Rs. 50,000.00 – Provided Annual Maintenance Grant Sub Centre 1443 @ Rs. 10,000.00 – Provided PHCs 396 @ Rs. 50,000.00 – Provided CHCs 112 @ Rs. 1,00,000.00 – Provided 127

NRHM Additionalities Rogi Kalyan Samiti Rs. 5.00 lakh per district hospital – Provided Rs. 1.00 lakh per sub-divisional hospital/ CHC– Provided ASHA Funds @ Rs. 200/- per ASHA per month claimed in NRHM Part-B and Rs. 2300/- per ASHA claimed for training in Part-A. 128

NRHM Additionalities Mobile Medical Unit Approval was sought for deploying 4 additional MMUs in the State out of the funds already available in the PIP 08/09, in the southern districts of the State where health facilities are lacking due non availability of manpower. In these 4 districts two MMUs have already been provided. In 4 districts where presently no MMUs in place, MMUs needs to be provided. Medical Officers in Mini PHCs – demand for additional 100 MOs not justified, State should bear this expenditure Additional posts deleted. 59 Medical Officers in Mini PHCs in place so salary may kindly be allowed for only one year 2009-10. 129

NEW INITIATIVES -ADDITIONALITIES Medical Officer for 60 PHCs without doctors @ Rs. 25,000 per month per Medical Officer Incentives to doctors working in extremely remote areas Engagement of 5 Hospital Administrator One Gynaecologist for 15 DH Part-C 130

UNTIED FUNDS Funds to 12673 VHSCs @ Rs. 10,000.00 – Provided VILLAGE HEALTH & SANITATION COMMITTEES Funds to 12673 VHSCs @ Rs. 10,000.00 – Provided UNTIED FUNDS Sub Centre 2858 @ Rs. 10,000.00 – Provided PHCs 396 @ Rs. 25,000.00 – Provided CHCs 126 @ Rs. 50,000.00 – Provided ANNUAL MAINTENANCE GRANT Sub Centre 1443 @ Rs. 10,000.00 – Provided PHCs 396 @ Rs. 50,000.00 – Provided CHCs 112 @ Rs. 1,00,000.00 – Provided 131

MOBILE MEDICAL UNITS (MMUs) Recurrent cost for 24 MMUs @ Rs. 15 lakh P.A. Rs. 360.00 lac proposed for FY 09/10 Recurrent cost for salaries, medicines etc for 24 MMUs 132

UPGRADATION OF INSTITUTIONS UPGRADATION OF CHCs TO IPHS Rs. 811.40 LAKH APPROVED FOR THE FY 09/10 Construction of 6 new CHCs @ Rs.200 lakh. Work to be initiated in 09/10 4 CHCs on priority and continue to 10/11. Rs. 300 lakh proposed Drugs @ Rs. 2.3 lakh per CHC per annum - Rs. 289.80 lakh proposed. Equipment/furniture for CHCs based on facility survey Rs. 221.60 lakh proposed UPGRADATION OF SDH/FRUs Rs. 488.00 LAKH APPROVED FOR THE FY 09/10 Major repair and renovation of 4 SDHs Rs. 130 lakh Approved Repair renovation and alteration of existing 25 SDH @ Rs. 10.00 lakh. Drugs @ Rs. 3.00 lakh for 36 SDH 133

UPGRADATION OF INSTITUTIONS UPGRADATION OF PHCs FOR 24 HRS SERVICES RS. 658.62 LAKH APPROVED FOR THE FY 09/10 Upgradation of 97 PHCs for 24x7 services Rs. 200 lakh Equipment & furniture for 97 PHCs Drugs @ Rs. 1.00 lakh per 24X7 PHC P.A. Medical Officer for 60 PHCs without doctors @ Rs. 25,000 per month per Medical Officer Incentives to doctors working in extremely remote areas UPGRADATION OF SUB CENTRES RS. 1551.88 LAKH APPROVED FOR THE FY 09/10 Construction of 353 existing SCs located in rented buildings in phases out of which 100 to be taken up in 09/10. Rs. 640.00 Lacs 823 existing SCs need restoration, out of which 150 will be taken up in 09/10 @ Rs. 1.5 lakh per SC Salary of 2nd ANM in 954 SCs. 134

UPGRADATION OF INSTITUTIONS UPGRADATION OF DISTRICT HOSPITALS Rs. 689.50 LAKH APPROVED FOR THE FY 09/10 Drugs @ Rs. 10 lakh per DH PA Equipment/furniture based on Facility Survey Rs. 100 lakh proposed Upgradation of District Hospitals Sangrur, Faridkot Rs. 200 lakh proposed Engagement of 5 Hospital Administrator One Gynaecologist for 15 DH ROGI KALYAN SAMITIS Grant in Aid to Rogi Kalyan Samities at PHC/CHC/SDH @ Rs. 1.00 Lakh DH Level @ Rs.5.00 Lakh 135

SCHOOL HEALTH Provision for screening of all the School Children for which Rs. 200 lakh have been Approved. Special focus on RHD and CHD treatment at PGI 136

OTHER ACTIVITIES Funds Approved Rs. 2617.04 lakh Capital cost of 90 Ambulances and infrastructure for ERS (proposed in additional over planning activities) Cell phone to State Officers/Civil Surgeons, DPMs, Block SMOs, LHVs and ANMs Procurement of Calcium & Zinc Sulphate tab. 137

PART-C IMMUNIZATION 138

PART C- IMMUNIZATION: BUDGET S.N. ACTIVITY BUDGET APPROVED (Rs. In Lakhs) 1 Mobility Support for Supervision 10.83 2 Cold Chain Maintenance 4.72 3 Mobilization of Children Through ASHA/ Mobilizers 130.00 4 Alternative Vaccine Delivery: For RI Session in Other Areas 34.30 5 Support For Computer Asst. For RI Reporting 12.72 6 Printing & Dissemination of Cards Etc. 27.50 7 Review Meetings 15.15 8 Trainings 14.91 9 Microplanning 4.43 10 POL For Vaccine Delivery From State To District & From District To PHC/CHCs 20.00 11 Consumable for Computer E.G. Internet etc. 0.08 12 Injection Safety 1.05 13 Enhansed Immunisation coverage in Urban & Peri Urban colonies 4.58 TOTAL 280.27 139

IMMUNIZATION BUDGED APPROVED FOR Rs. 280.27 LAKH FOR THE YEAR 09/10 Alternate Vaccine Delivery, Mobilization of Children, Slums and under served areas, strengthening and monitoring, computerization as per GOI guidelines. State specific strategies Social mobilization to increase awareness to serve uncovered and leftover children Enhanced immunization coverage and urban and peri urban colonies Waste disposal plan at PHCs level Totally micro-plan based at the sub-centre level Pulse-polio drive strategy used in uncovered urban areas Monitoring and supervision at state, district and PHC level Identification & coverage of slums areas State wide immunization in partially covered/ uncovered areas on Saturdays Training /orientation of DIO/DFPO and other functionaries 140

NATIONAL DISEASE CONTROL PROGRAMME PART-D NATIONAL DISEASE CONTROL PROGRAMME 141

PART D- NDCP : BUDGET SN ACTIVITY TOTAL 1394.72 BUDGET APPROVED (Rs. In Lakhs) 1 National Vector Borne Disease Control Programme (NVBDCP) 135.00 2 Integrated Disease Surveillance Programme (IDSP) 142.42 3 National TB Control Programme (RNTCP) - Approved 616.30 4 National Leprosy Eradication Programme (NLEP ) - approved 131.00 5 National Blindness Control Programme (NBCP) 350.00 6 National Iodine Deficiency Disorder Control Programme (NIDDCP) - Approved 20.00 TOTAL 1394.72 142

PART D- NVBDCP : BUDGET S. NO ACTIVITY 1 Incentive to ASHA 0.00 2 BUDGET APPROVED (Rs. In Lakhs) 1 Incentive to ASHA 0.00 2 Supplies, Consumables and Medicines 2.00 3 Indoor Residual Spray (IRS) 4 Anti Larval Measure in Urban And Peri-urban Areas 40.00 5 Entomological Monitoring 6 IEC 20.00 7 Training 10.00 8 MIS (NAMMIS) 5.00 MALARIA TOTAL 77.00 Dengue and Chikungunya 58.00 Japanese Encephalitis IEC GRAND TOTAL 135.00 143

Incremental staff/ personnel PART D- IDSP : BUDGET S.N. Activity Amount approved 1 Incremental staff/ personnel + Operational cost 132.95 2. Training cost 3. IEC 5.00 4. Lab. equipment etc. 4.50 Total 142.42 144

PART D- RNTCP and NLEP : Formal approval received for an outlay of Rs. 616.30 for RNTCP from the Concerned Division and budget revised accordingly in the PIP Formal approval received for an outlay of Rs. 131.00 for NLEP from the Concerned Division and budget revised accordingly in the PIP 145

PART D- NBCP : BUDGET Sr. No Particulars Approved Amt 1 Grant-in Aid to NGOs for free Catract Operations (Annual target for free catops 1,80,000 & for IOL 1,62,000 for which the achievement of the State is 107% in the year 2007- 08 & 88% upto Jan. 2008-09 198.40 2 GIA for School Eye Screening. Provision for supply of spectacles, medicines and other supplied for school eye care programme. 3 Grant for Medical Colleges (there are 3 Medical Colleges in the State. Grtant-in-Aid for Govt. Medical College Faridkot & Medical College Patiala @ 20.00 lakh each 40.00 4 Distt. Hospitals 1) 2 Phaco Machines @ 12,00,000 2) 5 Yag Laser @ 10,00,000 3) Maintenance of ophthalmic equipments 16,00,000 5 Establishing & Strengthening and supply to New Vision Centres at CHCs and Sub-Distt. Hospitals at 25 centres @ 50,000 in the border and remote areas of the State. 5.00 146

PART D- NBCP : BUDGET Sr. No Particulars Approved Amt 6 Recurring GIA to Eye Banks (there are 4 eye banks in the State). Which has got collection of more than 100 eye balls 7 Non-recurring GIA to Eye Donation Centre @ Rs. 1 lakh for 10 eye donation centres 1.00 8 Recurring GIA to Eye Donation Centres 9 Training for PMOAs and MPHWs 10 IEC activities World Sight days and Fortnight at 20 districts @ 50,000 and 100 eye donation awareness camps in remote and border areas at PHCs and CHCs level @ 15,000 for each camp. 147

PART D- NBCP : BUDGET Sr. No Particulars Approved Amt 11 SBCS Remuneration other activities & Contingency 12 Financial assistance for other diseases Glucoma, Diabetic Retinopathy, Laser Tech., corneal transplantation, childhood blindness, squint surgery etc. 13 Maintenance of Tele Ophthalic Van and the staff 14 Ophthalmic Surgeon 30.00 15 Ophthalmic Assistant 9.60 16 Eye Donation Consellor 6.00 17 GIA for strengthening of RIO 60.00 Total 350.00

PART D- IDDCP : BUDGET Activity / Item 2009-10 Salary (Rs. In Lakhs) Salary   Salary for Punjab State IDD Cell 6.00 Salaries for lab technician, Lab astts. And other staff of IDD monitoring laboratories 3.50 Monitoring and IEC Cost for IDD surveys/ monitoring 2.50 IEC Activities for the programme 8.00 Total 20.00 149

INTER SECTORAL CONVERGENCE PART-E INTER SECTORAL CONVERGENCE 150

PART E- INTERSECTORAL CONVERGENCE - AYUSH – To meet the health needs and harness the potential of indigenous health knowledge convergence with AYUSH Contractual appointment of one AYUSH doctor and dispensor (in phased manner) Contractual appointment of one AYUSH doctors (Homeopathy) and dispensor (in phased manner) 151

SPECIAL PROGRAMME FOR MINORITIES- CARRY OVER ACTIVITIES Outreach camps to be held 20 in every month @ Rs 10000 per camp for providing family welfare services and dissemination of information on RCH components and also counselling on various issues like FP, adolescent health and early registrations of pregnancies Audience specific communication material in Urdu, Punjabi pertaining to themes like age at marriage, immunization, sterilization, CC use, IUD, OCP, male involvement, child health issues (pamphlets, hoardings, wall paintings) Meetings/workshops with stakeholders and opinion leaders Peer educator 152

SPECIAL PROGRAMME FOR MINORITIES Special Innovative Programme for Minorities Activity / Item 2009-10 Camps to be held 20 in every month @ Rs. 10000 per camp for providing Family Welfare services and dissemination of information on RCH components and also counselling on various issues like FP, Adolescent health and early registrations of pregnancies (Rs 3000/- for arrangements, mobility, and referral , Rs 6000/- for Drugs and supplies, Rs 1000/- for miscellaneous ) 24.00 Peer Educator 20 @ Rs. 1000/-p.m 2.40 Audience specific communication material in Urdu, Punjabi pertaining to themes like age at marriage, immunization, sterilization, CC use, IUD, OCP, Male involvement, Child Health Issues (Pamphlets, Hoardings, wall paintings) 6.00 Meetings/Workshops with Stakeholders and opinion leaders 1.05 Total 33.45 153

CONVERGENCE WITH PRIs Activity / Item BUDGET PROPOSED (Rs. In Lakhs) BUDGET MODIFIED Preparation of guideline on role of PRIs printed and disseminated in local language to all PRI members and other key stakeholders in NRHM. 3 lakh copies @ Rs. 5 per copy 15.00 Preparation of module to orient PRIs on their role in NRHM 0.15 Discussion with Panchayati Raj Department on orientation of PRI representatives 40.00 0.00 Organise advocacy meetings with PRIs on key issues such as maternal health, JSY, PNDT and GBV. SHSRC and Centre for Communication to jointly provide support in preparing advocacy materials. Advocacy to be organised in each district by the District Health Mission. A provision of Rs 1 lakhs per district made, detailed budget to be prepared by each district 20.00 Total Budget 75.15 35.15

POSITION WITH REGARD TO CONCURRENT AUDIT AND HMIS Concurrent Audit – The work for 2008-09 was allotted to M/s. N. C. Mittal & Association, New Delhi vide this office letter dated 28.01.2009 for Rs. 5.40 lacs after inviting bids through newspapers. For 2009-10 we are again inviting bids through newspapers and work has been allotted to M/s A Agarwal & Associates of Chandigarh. HMIS – Monitoring and Evaluation NHRC – HMIS : Data from April 2008 to October 2008 uploaded on the HMIS portal. Data Block wise from November 2008 uploaded at district level. SAs from Blocks come to the district headquarter to upload the data. Other initiatives of the State Mission – Website : Website of Punjab NRHM www.pbnrhm.org launched in June 2008. Service particulars : Service particulars of doctors with complete bio-data prepared and uploaded. GIS – Administrative maps upto village level have been digitized by Punjab Remote Sensing Agency, Ludhiana. The work of health functionaries would be monitored through this GIS enabled system. TOP

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