HEALTH DEPARTMENT 23rd DECEMBER 2008 PRESENTATION 1

STAFF The Health Department is one of the biggest Departments in the State with the following break up SN Group Sanctioned Posts Filled Posts Vacancies 1 A 5251 4055 1196 2 B 971 925 46 3 C 20853 16336 4517 4 D 13255 11025 2230 TOTAL 40330 32341 7989

BUDGET- DHS Non Plan provision - Rs.528 cr. State Plan provision - Rs.48 cr. GoI provision - Rs.198 cr. Total Budget – Rs. 774 cr.

BUDGET- OTHER SOURCES PHSC Rs.20.00 crore AIDS Rs.13.41 crore ESI AYUSH (Ayurveda+Homeopathy) Rs.41.15 + Rs.8.45 crore = Rs.49.60 crore Total Rs. 129.53 crore

BUDGET Total budget provision in Punjab on health is Rs. 904.02 crore (excluding Medical Education), which is 0.65% of GSDP (1.40 lac crore).   As per norms the Health Budget should be 3% of GSDP, thus we have to substantially increase the budget on health (i.e. approx. Rs. 3296 crore more). Per capita expenditure on Health by Govt. – Rs. 367.40 per person per year.

ORGANIZATIONAL STRUCTURE

SECRETARIAT Health & Family Welfare Minister Professor Laxmi Kanta Chawla, Minister of Health & Family Welfare, Punjab (since 7/3/2007) Principal Secretary, Health Sh. A.R. Talwar, Principal Secretary, Health & Family Welfare, Punjab (since 1/12/2008)

SECRETARIAT Secretaries/ Additional Secretaries Sh. M.S. Sandhu, Managing Director, Punjab Health Systems Corporation (since 16/9/2008) Sh. Satish Chandra, Secretary, Health & Family Welfare-cum-Mission Director, NRHM, Punjab (since 15/4/2008) Sh. K.B.S. Sidhu, Secretary Health & Family Welfare-cum-Commissioner AYUSH (since 21/11/2007) Sh. C.S. Talwar, Additional Secretary (since 12/09/2008) Sh. R.P. Pruthi, Deputy Secretary (since 02/04/2008)

DIRECTORATES State Head Quarter Director Health Services (DHS) – Dr. S.P.S. Sohal DHS is supported by different Programme Officers, which include Additional Director, Joint Directors, Deputy Directors and Assistant Directors in implementation of National & State Level Health Programmes. DHS is also Ex-officio Chief Registrar of Births & Deaths and Local Health Authority for implementation of Registration of Births & Deaths and Prevention of Food Adulteration Act.

DIRECTORATES Director Family Welfare (DFW) - Dr. S.P.S. Sohal DFW is supported by different Programme Officers, which include Deputy Director, Assistant Directors, Administrative Officer, and State Mass Media Officer in enforcement of PC& PNDT Act as State Appropriate Authority and implementation of MTP Act. DFW also Implements and coordinates at district level different schemes in the State under National Family Welfare Programme.

DIRECTORATES Directorate of Employee State Insurance (ESI): Dr. YC Markan The Department headed by Director (Social Insurance) and divided into four zones i.e. Amritsar, Jalandhar, Ludhiana and Chandigarh headed by Medical Superintendent / Senior Medical Officers I/c of ESI Hospitals 7 Hospitals and 70 ESI Dispensaries are providing medical facilities of all kinds to the workers registered under ESI Act. 589639 registered ESI workers and their families are being provided medical facilities. All expenditure is done in the ratio of 1:7 between State and ESI Corporation.

DIRECTORATES Director of Ayurveda – Dr. R.K. Sharma The Directorate of Ayurveda is headed by Director Ayurveda (DAY) who is assisted by two officers of District Ayurvedic & Unani Officer (D.A.U.O.) rank for providing Specialized Medical Services through Ayurveda, Yoga and Unani System of Medicines. 5 Hospitals, 17 Swastha Kendras, 472 Ayurvedic and 35 Unanai Dispensaries functioning in the State. To encourage cultivation of quality raw drugs, their conservation and optimum utilization by drug industries and to encourage the farming community to adopt diversification of crops, the State Medicinal Plant Board constituted in the state.

DIRECTORATES Director of Homeopathy – Sh. K.B.S Sidhu, IAS   The State Govt. established a separate Homeopathic Department in the year 1980 (May 1980). Secretary Health-cum Commissioner AYUSH working as Head of Homeopathic Department, Punjab and assisted by Assistant Director Homeopathy at state Head Quarter . There are 14 In-charge district level dispensaries which coordinate the working of the department at district level. 107 Homeopathy dispensaries are functioning in the state for providing Homeopathy treatment in the rural and urban areas.

OTHER BODIES Punjab Health Systems Corporation (PHSC) – Sh. M.S. Sandhu, IAS (MD) The Punjab Health Systems Corporation was incorporated in the year 1995 for establishing, expanding, improving and administering medical care in the State of Punjab. Since 1995-96, the corporation was implementing a World Bank supported "Second State Health System Development Project" under which 157 secondary level healthcare institutions, which include District Hospitals, Sub Divisional Hospitals and Community Health Centres have been upgraded. The PHSC consist of the chairman, a Board of Directors and the Managing Director who is an executive officer of the corporation to implement the decision of the Board of Directors

OTHER BODIES National Rural Health Mission (NRHM) – Sh. Satish Chandra, IAS (MD)   NRHM launched in April 2005 to ensure quality health services to the masses especially rural poor, women and children is headed by Mission Director, NRHM in the State. Program Management Support Units have been set up at State, District and Block Levels for additional support for implementing various program/ projects. The State unit also provides the required technical and management support to the Directorate.

OTHER BODIES Punjab AIDS Control Society – Sh. Satish Chandra, IAS (PD) The Punjab State AIDS Control Society (PSACS) registered in 1998 under Societies Registration Act as per government of India and National AIDS Control Organization (NACO) guidelines. The 1st phase of the National AIDS Control Programme implemented from 1993-1999 in the State by establishing State AIDS Cell. The 2nd phase of the programme was implemented in the State through Punjab State AIDS Control Society from 1999 till 31st March 2007. The 3rd phase of National AIDS Control Programme (NACP) started w.e.f 1st July, 2007 throughout the country. This is 100 % centrally sponsored scheme of Govt. of India. Principal Secretary, Health, is the Chairman and Secretary, Health, is the Project Director of the Society. They are assisted by Additional Project Director, other Officers and supporting staff. Total 57 posts have been sanctioned for Punjab State AIDS Control Society (PSACS), out of which 45 posts are filled and 12 posts are vacant, which are in process of being filled up.

DISTRICTS District Head Quarter:   Civil Surgeon (CS) at District Level take care of implementation of various National and State Level Health Programmes, Implementation of Registration of Births & Death Act and Prevention of Food Adulteration Act. District Health Officer, District Family Planning officer, Assistant Civil Surgeon and other programme officer assists the Civil Surgeon in the implementation of the Programmes. Under NRHM, District Programme Management Unit is established with the staff of District Programme Coordinator, District Procurement Officer, District Account Officer, Monitoring & Evaluation Officer, Maintenance Engineer, District Accountant/Cashier, District Statistical Assistant, District Procurement Assistant

DISTRICTS Block Level:   Senior Medical Officer I/c of PHCs/CHCs assisted by Medical Officers implements various National and State Health Programmes at grassroots level through Multi purpose Health Worker (Male & Female) working at Sub Centre Level. Under NRHM, Block Programme Management Unit has been established with the staff of Block Statistical Assistants and Block Accountant cum Cashier.

HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR MEDICAL COLLEGES 3 5 DISTRICT HOPITALS 20 983 SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78) 38 COMMUNITY HEALTH CENTRES 127 (112 PHSC, 15 DHS) BLOCK PHCs 118 BLOCK PHCs AND SDH 6 BLOCK PHCs AND CHCs 70 ONLY (EXCLUSIVE) BLOCK PHCs 42

HEALTH INSTITUTIONS INSTITUTIONS PUBLIC SECTOR PRIVATE SECTOR PHCs (MINI PHCs) – EXCLUSIVE 352 PHCs BLOCK – EXCLUSIVE 42 TOTAL PHCs – EXCLUSIVE 394 TOTAL PHCs – EXCLUSIVE + AT CHC/SDH 394 + 76 = 470 SUBSIDIARY HEALTH CENTERS 1187 SUB-CENTRES AT VILLAGE LEVEL 2858 CLINICS /DISPENSARIES 3046

ACHIEVEMENTS

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 2002 to 821 (0-4 age group) in 2006.   A campaign has been launched to strictly enforce the provisions of PNDT Act of 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

Rs 2 crore- 202 beneficiaries registered under State specific scheme – Balri Rakshak Yojna. Rs 500 pm for 1 girl child, Rs 700 per month for 2 girl child. Terminal method of FP and not on IT assessee. Contract for survey of sex ratio for 25% population awarded to an agency, report expected by first week of March 2009

Other measures by Woman and Child Development Department   Kanya Jagriti Joti Scheme: Rs. 2 crore- Girl Child – Rs.5000 with LIC. She will get Rs.100- 200 pm scholarship wef 6th year (Class I). BPL families – two children norm Balika Samridhi Yojna: Scholarship Rs.300 – 1,000 per annum for checking school dropout rate (Rs. 40 lac). Dhanlakshmi: District Fatehgarh – Experimental basis – cash transfer at various stages: Birth – Rs. 5000 Immunization- Rs.1250 Enrolment –Rs.7250 Unmarried at the age of 18 years- Rs.1 lac 0.72 lacs Lohri Celebrations for girl child at Anganwadi Centres

PREVENTION OF FOOD ADULTERATION ACT The Health Department launched a campaign to check adulteration in the food items. During 2007, 2377 food samples taken, out of which 413 samples found failed. During 2008 (upto November) 254 samples out of 3232 samples found adulterated. A special campaign launched during the festival season 2007 and 138 samples out of 471 samples found to be sub-standard.   900 quintals of Gur seized in Patiala and destroyed. Large quantity of Khoa was also seized from various districts and action taken against the concerned persons. 300 tins of honey, 650 quintals of Achar and Morabba, 300 quintals of Garam Masala also seized and destroyed.

PREVENTION OF FOOD ADULTERATION ACT As many as 35 cases of production and sale of synthetic milk were discovered and action taken against them. Some of the important cases relate to Patiala where 25,000 and 8,000 litres of synthetic milk was seized. Similarly action was taken for sale of spurious desi ghee.   The State Government is strengthening the Department. The food laboratory at Chandigarh has been strengthened by providing latest equipments. There are filled 9 posts of Analysts and 21 more are being filled up. Out of 23 posts of Food Inspectors, 12 posts are filled and 11 posts are being filled up.

DRUG MENACE The Chemical Laboratory earlier situated at Patiala has now been shifted to Kharar in a new building. It is being strengthened in terms of equipments and manpower. A new machine for testing the drugs/poisons has been purchased at a cost of Rs. 22 lac.   During a campaign launched to check the menace of drug abuse, drugs worth Rs. 3,10,19,212 seized (from January 08 to November 08) and action taken against the defaulters. Licenses of 33 shops were cancelled and licenses of 245 chemists were suspended. Prosecution launched against 47 chemists. 17 cases have been decided by the various courts and ordered conviction in 7 cases. Total 4448 licensed and unlicensed chemists shops were inspected. During inspection 1878 samples of drugs have been taken and 833 samples tested, out of which 2 samples declared spurious, 67 samples declared not of standard quality and 16 samples declared as misbranded.

DRUG MENACE Monthly targets of inspections and sampling of medicines fixed for Drug Inspector in the State since August 2008 in which every Drug Inspector has to inspect 30 chemist shop every month and to take 10 samples of medicines for test and analysis from small districts (Kapurthala, Hoshiarpur, Nawanshahar, Taran Taran, Moga, Muktsar, Mohali, Mansa, Ropar, Faridkot, Fatehgarh Sahib, Sangrur, Barnala), 12 samples in medium districts (Ferozepur, Gurdaspur, Bathinda) and 15 samples in big districts (Amritsar, Jaandhar, Ludhiana & Patiala).   The State Government is setting up Drug De-adiction Treatment Centres (DDTCs) in all the district hospitals where 10 to 20 beds will be earmarked for the addicts. A sum of Rs. 1.65 crore has been earmarked for this purpose. Besides a State Level Centre at Amritsar will be set up at an estimated cost of Rs. 2 crore. There is a proposal to set up 20 bedded Centre at Talwandi Saboo as part of Guruta Gadi Celebration Project at an estimated cost of Rs. 2.00

RASHTRIYA SWASTHYA BIMA YOJANA   The Ministry of Labour has started a scheme to provide health insurance cover upto Rs. 30000/- to around 4.44 lakh BPL families. Under Phase- I, five districts i.e. Ferozepur, Patiala, Gurdaspur, Amritsar and Sangrur has been covered and three more district i.e. Jalandhar, Hoshiarpur and Muktsar will be covered very soon. Approximately, 39000 smart cards have been issued in three districts i.e. Ferozepur, Patiala, and Gurdaspur. Indoor cover to BPL families will be provided through Govt. and Private empanelled hospitals. In the coming year, more districts are expected to be covered.

STATE ILLNESS FUND ( Punjab Nirogi Yojana) The State has established a Corpus to provide financial assistance to the poor people (BPL families) for life threatening diseases up to Rs. 1.50 lakh. In the Corpus Centre and the State provide fund in the ratio 1:2.   The assistance can be provided up to Rs. 3.00 lakh i.e. Rs. 1.50 lakh more from Rashtriya Arogya Nidhi (National Illness Fund). So far financial assistance amounting to Rs. 2.75 lakh has been provided to four beneficiaries in the state. The State has requested the GoI to allow economically poor people apart from BPL families to avail financial assistance under the Corpus.

TELEMEDICINE In the year 2005-06, PHSC initiated the process for providing healthcare services through telemedicine. Three hospitals MKH Patiala, SDH Dasuya and SDH Ajnala were linked with PGIMER, Chandigarh with the aid of ISRO.   During the year 06-07, a project proposal was got approved from GoI for linking three Medical Colleges and twenty District Hospitals with an outlay of Rs. 414 lakh. Link has been established through C-DAC for three medical colleges and sixteen district level hospitals.

SUPER SPECIALITY CANCER HOSPITALS  The State Govt. has decided to establish under Public Private Partnership (PPP) mode, one super specialty cancer and trauma hospital in the Civil Hospital Mohali and one super specialty cancer and cardiac hospital at Bathinda.   The land in the hospitals will be offered to the private healthcare providers on lease basis. The lease money will be utilized for betterment of the hospitals. The PIDB has been nominated as a nodal agency for promoting these projects.

TRAUMA CENTERS 2 Trauma centres at CH Amritsar and Pathankot have been established. Trauma centre Jalandhar is under construction. Trauma Centre at Khanna is to come up in 2009-10.

JAN AUSHADI Department of Pharmaceuticals has opened a Government Medicine Shop in CH Amritsar where Medicines from CPSU would be made available to the people at fair price on 24/11/2008. Such Medicine fair price shops would be opened in the remaining 19 District Head Quarter Units in 2009-10.

RECRUITMENTS ON REGULAR BASIS Recruitment of 156 posts of Medical Officers (Specialist Doctors) on regular basis is under process through Departmental selection committee. 45 more posts of specialist doctors have been advertised. Punjab Public Service Commission has been requested to recruit 100 posts of Medical Officers. 400 Multi Purpose Health Worker (M) and 35 Clerk have been recruited on regular basis. 130 MPHW (M) and 23 MPHW (F) recruited on contract basis.

AIDS CONTROL   The State to receive about Rs. 13.41 crore from GoI for AIDS Control in 2008-09. 3 Treatment Centres (ART) – Amrtisar, Jalandhar & Patiala have been set up for diagnosis and treatment of AIDS Patients. 3 Community Care Centres are also being set up at these places. Integrated Counseling and Testing Centre (ICTC) – 57 Centres for testing and counseling of HIV persons are functioning. 14 more are being set up to cover all the Sub Divisions. As per official record 4949 AIDS patients are under treatment. The number of HIV patients registered in ICTC is 12833 upto November, 2008.

AYURVEDA AND HOMEOPATHY (AYUSH) Full time qualified Doctor has been appointed as Director Ayurveda through Punjab Public Service Commission after 25 years. At present 5 Ten-Bedded Ayurvedic Hospitals, 17 Swasthya Kendras, 507 Ayurvedic/unani dispensaries are functioning in the state.   AYUSH Doctors are being provided in all the Hospitals including PHCs. All kinds of treatment would be available under single roof in Government Institutions. Out of 121 contractual posts of Ayurveda MOs, 99 Ayurveda MOs have already been recruited, 22 MOs of reserved categories (9 SC, 1 FF, 2 Sports, 3 Handicapped, 6 Exn, 1 General) have yet to be appointed. Written test & Counseling for appointment of 112 Homeopathy MOs done. Appointment letters being issued. Very shortly, the regular posts of the Ayurveda department shall be filled through Punjab Public Commission.

AYURVEDA & HOMEOPATHY (AYUSH) Herbal garden – Herbal garden which is beneficial for Ayurvedists and farmers of Punjab is being established at village Dayal Pura Sodian (8 acres donated by a Sodhi Family) near Zirakpur District Patiala. Inauguration by Hon’ble Health Minister, Punjab on 28th November 2008.   Establishment of 7 ISM wing in district hospitals at Amritsar, Bathinda, Hoshiarpur, Gurdaspur, Jalandhar and Sangrur under process.

SCHOOL HEALTH PROGRAMME School Rheumatic and Congenital Heart Diseases Control Programme launched in collaboration with PGIMER. The State Govt. will bear the cost of surgery and treatment of students suffering from Rheumatic Heart Disease and Congenital Heart Disease. 30 cases of RHD/CHD identified in the State, out of which 11 cases referred to PGI Chandigarh for treatment. Special School Health Checkup camps organized on the occasion of Independence day on 14.8.2008 at CHCs and Sub Divisional Hospital level in which special stress was made to check the nutrition status and medicine given to needy children. Special Eye checkup camps were organized on the occasion of Gandhi Jayanti on 3.10.2008 at CHCs, SDH & District Hospitals. 56601 school children were examined and 5300 children were found reflective error and provided spectacles free of cost.

DENTAL HEALTH Dental fortnight organized at the level of Sub Divisions/Community Health Centres and all districts of the State. 74 camps organized, 71,168 patients were examined and given free Dental treatment. 1,28,000 School children were also examined in these camps. 1574 free dentures were distributed to the poor and needy patients.

ESI (EMPLOYEE STATE INSURANCE) Government of India made ESI Act in year 1948. In Punjab it started in year 1953 from District Amritsar. At present 6 ESI Hospitals and 70 ESI Dispensaries are functioning in the State and are catering to the health needs of more than 5,89,639 registered ESI Workers and their families whose monthly pay is more than Rs. 10,000/- The above hospitals and Dispensaries have been divided into 4 Zones for better Administrative Control. All expenditure is done in the ratio of 1:7 between State and ESI Corporation. In year 2007-08 total Budget – Rs. 39.91 crore. An additional Rs. 2 crores for machinery was allocated. In year 2008-09 Rs. 44.51 crores plus Rs. 2 crores for machinery was allocated.

ESI (EMPLOYEE STATE INSURANCE) ESI Hospital Mandi Gobindgarh started in the year 2008-09. ESI Dispensaries No. 2, Mandi Gobindgarh started in the year 2008-09. Tie up with Super-speciality Hospital started for workers needing super specialist treatment in major cities. Medicine worth Rs. 6 crores bought and disbursed to various hospitals and dispensaries falling under ESI Department. Tender for purchase of equipment/ Machinery is in the pipeline. A.M.A are being employed in dispensaries with less than 500 IPs. Proposal for One Dental College, Ludhiana and One Medical College is under active consideration.

PROBLEMS & INITIATIVES

(1) New Districts - The department has requisite staff sanctioned only for 12 old districts. All the required posts have not been sanctioned for the 8 new districts which were created after 1992. Shortage is more acute for the 3 districts recently created. We are shortly moving the case to Finance Department for sanction of the required strength.   (2) Food/Drug Inspector - At present, there is only one Food Inspector and one Drug Inspector in a district. This strength is grossly inadequate since all the areas, there has been massive increase in the number of drug stores and food establishments. Department is preparing a proposal for sanction of more post of Drug Inspectors and Food Inspectors as per the required norms. Atleast every sub-division should have one Food Inspector and one Drug Inspector.

(3) Health Block - There are only 118 Health Blocks and 142 Rural Development Blocks. There is need to create 24 blocks with accompanying staff.   (4) Shortage of Doctors - The department has acute shortage of Doctors and other Para-Medical staff. About 60 to 70 Doctors go to Medical Education Department and about 150 Doctors retire every year. In addition, at present the department is short of 600 Doctors.

The meeting held with Hon’ble Finance Minister and it was decided that   We should recruit Doctors on annual basis in lieu of doctors who retire or who are sent to Medical Education Department. We should recruit 200 doctors every year so that the entire shortage of doctors is met. (5) Extra Incentive - The department would formulate a proposal for giving extra incentive of Rs. 5000/- to Rs. 10,000/- and Rs. 10,000/- to Rs. 20,000/- for MBBS and Specialist Doctors serving in remote and extremely remote areas. This incentive would be available to both regular and NRHM doctors. This proposal would be included in the PIP of NRHM for the year 2009-10.

(6) Recruitment - We are also preparing a proposal for continuous recruitment of doctors outside the purview of PPSC. This has already been done by Haryana and that is the only solution to address the problem of shortage of doctors.   (7) Equipment/Drugs - Government would give top priority to supply of equipment and drugs in the Hospitals. It would be ensured that there is no shortage of these two items. (8) Funds for Infrastructure - Government of Punjab created huge infrastructure. Secondary level hospitals were upgraded about 10 years back under the World Bank Project. No funds were given for maintenance of PSUs and Sub-Centres. There is provision under NRHM for repair of these facilities but the funds are inadequate. Government of Punjab should release more funds for the maintenance of infrastructure.

THANKS