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NRHM SPIP 2011-12 JHARKHAND
11. Human Resources & Programme Management Unit Human resource and adequate infrastructure are the most critical components of
development programmes. Health in particular is very much sensitive to the adequate
human resources and infrastructure as it directly linked with life of human beings.
After the independence the Government of India has provisioned for the human
resources and infrastructure for health along with other community development
programmes. Since than many policies have been framed and modifications have been
carried out in the frame work of health development. Human resource in health has
been the prime consideration in all such policy decisions.
Inception of National Rural Health Mission (NRHM) has opened new door in meeting
the challenges in human resources in health. Provisioning of adequate human resources
in clinical and management has been made in NRHM helped in filling the gaps in health
human resources.
Jharkhand in particular was also facing challenges in meeting the health needs of the
people due lack of adequate number of health resources and proper infrastructure.
Many health service delivery points were not having own buildings and were running in
rented buildings. Also there sufficient staffs were not recruited to man these health
institutions. Lack of sufficient accommodation has also resulted in the staff not residing
in the premises affecting the 24X7 availability of the health services. Most of the Health
Institutions were located below district level and most of them are in dilapidated
condition.
To address these, various
interventions were planned and are
being implemented under the NRHM.
The main interventions initiated were
the availability of untied funds,
infrastructure improvement and
deployment of human resources,
engagement of ASHAs and
involvement of village level health and
sanitation committees (VHC). The Mission seeks to operationalize functional health
Health facilities in Public Health, Jharkhand
District Hospital 21
Sub-Divisional Hospital 6
Referral Hospitals 32
CHC 194
PHC 330
HSC 3958
Medical Colleges 3
Nursing College 1
Nurses Training School (GNM) 3
ANMTC 10
Homeopathy College 1
Ayurveda College 1
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NRHM SPIP 2011-12 JHARKHAND
facilities in the public domain through revitalization of the existing infrastructure
through construction or renovation wherever required, deployment of skilled service
providers and availability of drugs and equipments. The institutions will be
strengthened and upgraded considering the recommendations provided as per Indian
Public Health Standards (IPHS).
The institutional mechanism from the state level to districts and downward has been
operationalised to monitor Programme performance, provide timely guidance, improve
decision making and taking mid-course corrections. In all 24 Districts of the state,
District Programme Management Units has been setup with the provision of mobility
and inputs to carry out office functions. The integration of new structure at district level
with existing departmental structure was facilitated. Efforts were made to clarify roles
and responsibilities in this evolving system.
The state has shown considerable growth in filling the Human Resource gaps in the
clinical services. The emphasis has been to get adequate number of doctors and
paramedics. Human resource for health is another major issue where the State health
system is struggling. Current staffing is as follows,
Status of Health Human Resource
Sl. Category Total Required
as per IPHS
Sanctioned (Regular)
Existing (Regular)
Existing (Contractual)
Existing Total
(Regular+ Contractual)
Shortfall (Required-
Existing)
1 Specialist 1453 174 84 0 84 1369
2 ANM 8906 4666 2978 4098 7076 1830
3 Staff Nurse 2408 304 216 362 578 1830
4 Male Health Worker
3958 1035 418 1636 2054 1904
5 Pharmacist 629 501 100 244 344 285
6 Lab Technician 629 446 85 332 417 212
7 Radiographer 257 54 30 96 126 131
8 Medical Officers 1237 1681 1376 457 1833
Table 11.1
The paucity of medical professionals especially the Specialists limits the public health
facilities in providing higher level of services. A mismatch exists in the State between
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NRHM SPIP 2011-12 JHARKHAND
the available Medical and Para medical professionals and the demand for their services.
More Specialists and Para medical professionals are required to fill up this gap.
Moreover despite number of trainings held, rationalization of manpower is yet to take
place. To overcome this, the State has initiated public private partnerships, out sourcing
health facilities and programmes to public/private sector and NGOs. There is also
dearth of well-trained public health professionals and managers to effectively steer the
public health programs. Manpower Management in the State would be undertaken vide
various initiatives like reorganizing & rationalizing the existing manpower, Web enabled
system to capture district level cadre information, cadre reforms of the Medical Officers
and other clinical Staffs, sanction for the post of Specialists Medical Officer, cadre rules
for paramedics and health educator, OT assistant, clerks, pharmacists, lab technicians,
X-ray technicians to be finalized in FY 2011-12. Timely promotion of various cadres of
staff like medical officers, specialists, administrative cadre as well as of paramedical
staffs and other workers to Supervisory category continued to be a problem and this
has been given sufficient attention. Though the state has reasonable number of MBBS
doctors, there is an acute shortage of specialist medical officers. The shortage of
specialists like obstetricians and Anesthetists are obstructing the state plans to
operationalise all district hospitals as First Referral Units. Recruitment of Medical
officers and paramedics- The process of recruitment is lengthy and takes about four to
six months. The number of applicants is quite limited because of dearth of doctors and
paramedics in the state.
It is felt that the state needs to restrict the turnover of doctors on contract. It is
proposed that a study may be undertaken to assess the situation and recommend
remedies, however it is assumed that hike in the salary of the specialists for serving in
rural areas will help to curb the turnover to same extent and an HR policy will be
finalized.
Progress so far
Strategies Progress Comments
Strengthening of existing ANM Training Centers
Complete All the existing 10 ANM Training Centers have been made functional. A study has been commissioned for developing the road map of improving the functioning of ANM TCs in the State. Up-gradation of ANM TCs including equipping the library and class rooms with books and other
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teaching aid has been done. Department has initiated the process of contractual engagement of faculties for ANM TCs, for meeting the shortage of faculties.
Operationalisation of new ANMTCs In Process Process of operationalisation of 10 more ANM Training centers has been initiated, that will be made functional in the current FY.. Department is already in negotiation with TELCO, Usha Martin group, Tata Memorial Hospital, Apollo Hospital, Seva Sadan and Gurunanak Hospital. Some more proposals for establishment of ANM TCs are expected in this year.
Capacity building of the ANMs In Process Skill building programmes for the in-service ANMs for better service delivery has been developed and is being imparted. Career progression plan for the ANMs is also being developed
Facilitation of the morale of the staffs
In Process The Department also proposes to develop conducive and supportive working environment. The officials including Health and Family Welfare Department who have done outstanding work will be recognized and awarded with an appreciation certificates. The department will review the service rules, recruitment policy and other cadre rules while bringing more clarity in the roles and responsibilities of contractual and regular staffs. The policy will be developed while using contingency funds allocated to state and district under human resources development.
Recruitment In process In the Left Wing Extremist districts of the State, recruitment of 500 ANMs and 500 MPWs is in process and is likely to be completed by End of January, 2011. Recruitment of 150 specialist doctors has been almost completed and would be placed in different facilities by the end of January 2011.
Table 11.2
Plan for 2011-12
11.1. Response to shortage of human resources
Though the state has reasonable number of MBBS doctors; there is an acute shortage
of specialized clinical manpower along with support staffs in the clinical and non-clinical
categories. There is a shortage of specialist Doctors like Obstetrics/Gynecologists,
Pediatricians and anesthetists in the state restrict the CHCs and FRUs to be function as
per norms. Many positions in the support categories are lying vacant in CHCs, PHCs and
other health facilities. In view of vast number of vacancies in the nursing and
paramedical categories, State has already initiated the process for recruitment of staffs
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against the existing vacancies. In view of staff shortages with respect to the IPHS norms,
process for sanctioning of posts for regular appointments has been initiated by the
Department. Sanction of posts and recruitment process against the sanctioned posts
are being defined and is likely to be completed in a phased manner. For addressing the
shortage of trained para-medical personnel, the state has already recruited nursing and
paramedical staffs on contract with support from NRHM.
11.1.1 Remuneration of clinical staffs 11.1.1.1 Remuneration to ANMs and MPWs recruited under NRHM 11.1.1.1.a. As per the IPHS norms there at least two ANMs should be provided in of the
each HSC. Despite of governments endeavor to fulfill the gap there is still shortfall of
1830 positions of ANMs in the state. Also, in view of shortage of nursing staffs, ANMs
are being placed at PHCs and CHCs for making the facilities 24X7 functional.
Apart from the regular ANMs, currently about 5000 ANMs are being supported by
NRHM. To retain the existing ANMs state is proposing to extend the funding support for
5000 ANMs to cater health services. Remuneration of Rs. 9,000/- per month for the
year 2011-12 has proposed in this regard.
Sl Name of the Post Total Nos. Existing
Unit Salary (Rs/Month)
Months Fund required for Salary (in lakh Rs.)
1 Salary of Contractual ANMs under NRHM
5000 9000 12 5400.00
Table 11.3 Budgeted under Sec. 9.1.1 under Infrastructure & HR of RCH
11.1.1.1.b. Remuneration to ANMs and MPWs for Left Wing Extremists Area. Against the planned recruitment of 500 ANMs and 500 MPWs in FY 2011-12, for the
Left Wing affected districts of the State; the process of recruitment is in process and will
be completed in the last quarter of the FY.
For this additional health work force, sum of Rs. 8000/- pm is being proposed for
coming year.
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Also ANMs posted at left wing districts will be trained in SBA and HBNC services on
priority basis.
Budget Requirement
Particulars Unit Unit Cost Total Cost (In Lacs)
Additional ANM for left wing (500 ANMs x 12 month )@ Rs 8000/ pm 6000 8000 480.00
Male Health worker in left wing Districts (500 MPWs x 12 month ) @ Rs 8000/- pm 6000 8000 480.00
Grand Total 960.00
Table 11.4 Budgeted under Sec. 9.1.2 & 9.1.6 under Infrastructure & HR of RCH
11.1.1.1.c. Incentive scheme for ANMs of Left Wing Extremists Area All the ANMs recruited in the Left Wing Extremists districts will be provide with
additional incentives for conducting deliveries.
ANM trained on SBA and providing continue health service from the HSC and
conducting deliveries will be provided with incentive of Rs 500/- per month.
Budget Requirement
Category of Recipients Units Unit Cost Total Cost (In Lacs)
Incentive to ANMs of Left Wing Extremists area (500 HSC x 2 ANM x 9 months) 9000 500 45.00
Table 11.5 Budgeted under Sec. 9.1.3 under Infrastructure & HR of RCH
11.1.1.2. Remuneration of Staff Nurses
State the 500 staff nurses recruited in FY 2009-10 and deployed in different PHCs and
CHCs. Also there in FY 2010-11 state was planned to recruit 400 staff Nurses for the
LWE Districts. Recruitment for all these positions is in process and will be completed by
January, 2011.
Therefore, in order to retain the existing work force and remunerate the new recruits of
Staff nurses, state is proposing following sum of budget in the coming year.
Sl Name of the Post Total Nos. Existing
Unit Salary per month
Months Total fund required (in lakh Rs.)
1 Staff Nurses 500 13000 12 780.00
2 Staff Nurse for LWE area 400 12000 12 576.00
Grand Total 900 1356.00
Table 11.6 Budgeted under Sec. 9.1.4 & 9.1.5 under Infrastructure & HR of RCH
11.1.1.3. Remuneration of Specialist and Lady Medical Officers at CHCs
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NRHM SPIP 2011-12 JHARKHAND
In the FY 2010-11, state had planned to recruit 150 Specialists Doctors (Gynaecologist,
Paediatrician, Physician, Surgeon and Anesthetist) who are supposed to be placed in 63
block level facilities that have been planned to be upgraded into FRUs in the same year.
Process for recruitment has already been completed and Specialist Doctors would be in
position by January, 2011. Their posting will be rationalized as per their specialization
and community health needs. These specialist doctors will be recruited on contract and
will be paid an honorarium of Rs. 40,000/- & 50,000/- per month as per the
specialization. In the coming FY State is proposing to provide remuneration to all the
150 specialist doctors.
Also there salary to the 25 Lady Medical officers posted at CHCs is being proposed in
the coming year. Salary for the specialists would be as follows:
Category Approved Salary (Rs P.M.) Number
MOs – MBBS 30,000/- 25
Specialists
Post graduate diploma
Post graduate degree
40,000/-
50,000/-
150
Table 11.7
Sl. # Name of the post Total Numbers existing/ Required
Unit Salary per month
No. of months
Total fund required (in lakh Rs.)
1 Existing Lady medical Officer on contract
25 35000 12 105.00
2 Number of Specialist Doctor to be recruited in FY 2010-11
150 65000 12 1170.00
Grand Total 175 1275.00
Table 11.7 Budgeted under Sec. 9.1.7 & 9.1.8 under Infrastructure & HR of RCH
11.1.1.4 Remuneration of para-medical staffs
State has recruited 400 Lab Technicians, 150 Radiologists and 200 Pharmacists as
planned in FY 2009-10. State proposes to retain all these para-medical staffs for the
coming FY 2011-12.
Sl #
Name of the post Number recruited
Unit salary per month (Rs)
Number of months
Total amount (in lakh Rs.)
1 Lab Technician 400 9500 12 456.00
2 Radiologist 150 11000 12 198.00
3 Pharmacist 200 9500 12 228.00
Grand Total 750 882.00
Table 11.8 Budgeted under Sec. 9.1.1 under Infrastructure & HR of RCH
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11.1.2. Remuneration to Quality Assurance Cell For improving the functioning of the public health facilities and help in strengthening
the processes for the providing quality public health care services throughout the State,
provision for QA Cell was proposed in FY 09-10 with the following Staff positions:
1 State level consultant for Quality Assurance this position will be part of
SPMSU.
5 Consultants on regional level to monitor the functioning of facilities and up-
gradation of facilities for providing better health care services.
Currently 5 Regional Consultants – QA are in place and working for the five
administrative divisions in the State. Recruitment of State Consultant is yet to be done
as State is facing difficulty in getting the suitable candidate for the position.
Position Current Salary PM Proposed Salary PM in 2011-12
Consultant (Quality Assurance) - State level 30000 35000
Consultant (Quality Assurance) – Regional 25000 28000
Table 11.9
State is proposing to retain all these positions in the coming FY. To provide competitive
remuneration with respect to other agencies and retain the staff state has proposed for
marginal increase in the salary of the aforementioned staffs.
Along with it additional Rs. 5,000/- per month for each consultant Quality assurance is
provisioned for the mobility support and communication charges.
Budget Requirement for Remuneration to QA Cell
Particulars Units Unit Cost Total Cost (in Lacs) Consultant (Quality Assurance) - State level (1 x 12 months) 12 35000 4.20
Consultant (Quality Assurance) – Regional (5 x 12 months) 60 28000 16.80
Mobility Support and communication charges to the consultants for QA (6 x 12 months)
72 5000 3.60
Grand Total 24.60
Table 11.10 Budgeted under Sec. 9.1.14 under Infrastructure & HR of RCH
11.1.3. Strengthening the Management of the District Hospitals
For better management of the hospital affairs state has initiated process of recruitment
of hospital managers for district and sub district level health facilities. Hospital
Managers have been supposed to look after routine maintenance and administration of
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the hospital as well as ensure cleanliness in the hospital campus and proper waste
disposal mechanism.
In the year 2009-10, positions of 30 Hospital Managers were approved.
State has already recruited 7 Hospital Managers and is in process of recruitment of 23
Hospital Managers. These positions will be in place by February, 2011.
In order to compete with the salary packages for the similar positions of other agencies
and to retain the Hospital Managers state proposes marginal hike in the salary in
coming year.
Position Current Salary PM Proposed Salary PM in 2011-12
Hospital Manager 22000 25000
Table 11.12
Along with it additional support for establishment of hospital management has also proposed in 18 facilities.
Sl #
Name of the post Numbers required
Approved unit Salary per month for FY
2010-11
Proposed Salary for FY
2011-12
Months
Total fund required (in
lakh Rs)
1 Hospital Manager 7 22000 25000 12 21.00
2 Hospital Manager 14 22000 22000 12 36.96
3 Support for establishment of
HMs 18 50000 50000 1 9.00
Total
66.96
Table 11.13 Budgeted under Sec. 9.1.15 under Infrastructure & HR of RCH
11.1.4. Strengthening Cold Chain and Logistics Management
11.1.4.1. To strengthen the logistics management and maintenance of cold chain so as
to smooth and regular the supply of vaccine, drugs and other logistics from state level
to HSCs additional dedicated manpower are in place.
Staffing in Cold Chain and Logistics Management
Position Number
State Cold Chain Officer 1
Vaccine and Logistics Manager 1
Vaccine & Logistics Manager -Regional Level 1
Technical Assistant Cold Chain - State level 1
Technical Assistant Cold Chain - Regional Level 1
Refrigerator Mechanic 27
Total 32
Table 11.14
State is proposing to retain all above staff positions in the coming year.
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Sl. # Name of the position Number appointed
Salary per month (Rs.)
Number of months
Total Salary (in lakh Rs.)
1 State Cold Chain Officer 1 45,000 12 5.40
2 Vaccine and Logistics Manager 1 27,500 12 3.30
3 Vaccine & Logistics Manager (Regional)
1 25,000 12 3.00
4 Technical Assistant – cold chain (State level)
1 27,500 12 3.30
5
Technical Assistant – cold chain (Regional)
1 22,000 12 2.64
6 Refrigerator Mechanic 27 11,000 12 35.64
Grand total 32 53.28
Table 11.15 Budgeted under Sec. 9.1.16.1 -9.1.16.5 under Infrastructure & HR of RCH
11.1.4.2. It was planned in the FY 2010-11 to recruit additional manpower for logistics and vaccine management. Process for recruitment is in final stage and recruits will be in place by February, 2011.
Additional Manpower in Cold Chain and Logistics Management
Position Number
PROMIS Manager (State) 1 Store Keeper cum PROMIS Operator (District) 24
Store Keeper cum PROMIS Manager (State & Regional level) 9
Cold Chain Handlers 27
WIC/WIF Operator (State & Regional level) 3
Total
Table 11.16
State is proposing to retain to new recruited staffs in the coming year.
Sl. # Name of the position Number
proposed Salary per
month (Rs.) Number of
months Total Salary (in
lakh Rs.)
1 PROMIS Manager (State) 1 15000 12 1.80
2 Store Keeper cum PROMIS Manager
(State & Regional) 9 14000 12 15.12
3 WIC/WIF Operator (State & Regional
level) 3 10,000 12 3.60
4 Store Keeper cum PROMIS Operator
(District) 24 12000 12 34.56
5 Cold Chain Handlers 27 10,000 12 32.40
6 Outsourcing of Regional WIC /WIF cleaning - Deoghar, Ranchi, Giridih
3 4000 12 1.44
Total 64
88.92
Table 11.17 Budgeted under Sec. 9.1.16.7 -9.1.16.13 under Infrastructure & HR of RCH
11.1.5. Provisioning of Mobile phones expenses for service providers
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NRHM SPIP 2011-12 JHARKHAND
For strengthening the monitoring and reporting, it is proposed to provide mobile
phones to the ANMs, MOICs and District RCH Officers (other programme officers have
already provided with mobile phone under different programmes).
Therefore, State has proposed to provide mobile phones expenses to the ANMs and
MOICs of the high focus 92 CHCs and RCH officers of 24 districts.
Budgetary Requirement for Provisioning of Mobile phones expenses
Particulars Units Unit cost Total Cost
Mobile phone expenses to ANM 500 350 2100000
Mobile phone expenses to MOIC 100 500 600000
Mobile phone expenses to District RCH Officer 24 500 144000
Total 3000 2844000
Table 11.18 Budgeted under Sec. 9.1.12 under Infrastructure & HR of RCH
11.2. Strengthening Programme Management Unit
To plan, coordinate and implement, i.e., for overall management of the health
programmes envisaged within NRHM, Programme Management Units has been
established at the State, Districts & Block levels.
11.2.1. Filing up positions of programme management staffs at all levels
11.2.1.1. At state level for efficient management of various functions following staff
positions have been provisioned at State Programme Management Unit.
Details for staffing at State Programme Management Unit are as follows,
Staff Positions at State Level
Sl. No.
Name of the Positions Salary as approved in PIP 10-11 (Rs/m)
Approved In positio
n
Vacant
1 Consultant – MIS 42,000 1 1 0
2 NGO Coordinator 42,000 1 0 1
3 Consultant - M & E 42,000 1 1 0
4 Consultant - HRD 42,000 1 1 0
5 Consultant-Training 42,000 1 1 0
6 Consultant – Media 28,000 1 1 0
7 Consultant – MCH 35,000 1 0 1
8 Consultant-Logistics & Procurement 35,000 1 0 1
9 State Consultant – QA 30,000 1 0 1
10 Regional Consultant-QA 25,000 5 4 1
11 Cold Chain officer 42,000 1 1 0
12 Vaccine & Logistics Manager 25,000 1 1 0
13 Technical Assistant- Cold Chain 25,000 1 1 0
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NRHM SPIP 2011-12 JHARKHAND
14 State Programme Manager 42,000 1 1 0
15 State Finance Manager 42,000 1 0 1
16 State Accounts Manager 30,000 1 0 1
17 State Data Officer 25,000 1 0 1
18 Demographer 26,500 1 1 0
19 Statistical Supervisor 20,000 1 1 0
20 Data Manager (State HQ) 22,000 2 2 0
21 System Analyst 24,000 1 1 0
22 Executive Documentation and Planning
28,000 1 0 1
23 Co-ordinator- ARSH & PCPNDT 28,000 1 0 1
24 Executive Assistant (Prog Mgmt) 18,000 1 0 1
25 Executive Assistant (Accounts) 18,000 1 0 1
26 Executive Assistant (Training) 18,000 1 0 1
27 Executive Assistant (NGO Coordinator)
18,000 1 0 1
28 Executive Assistant (HR) 18,000 1 0 1
29 Assistant (MD Cell) 18,000 1 0 1
31 State Project Coordinator - Sahiya 25,000 1 1 0
32 Admin & Finance Officer – Sahiya 18,000 1 1 0
33 Coordinator – FP 28,000 1 0 1
34 IEC Coordinator – FP (USAID support) 22,000 1 0 1
35 Demographer – FP (USAID support) 20,000 1 0 1
36 Accountant – FP (USAID support) 18,000 1 0 1
37 Data Entry Operator – FP (USAID) 12,000 1 0 1
38 Coordinator – AYUSH 28,000 1 0 1
39 Computer Operator – AYUSH 12,500 1 0 1
40 Computer Operators 12,500 50 44 6
Total 10,34,000 93 64 29
Table 11.19
Recruitment of the vacant positions at State level has been initiated and all the positions would be filled by January, 2011 with support from NHSRC.
State will continue the services of all the staff positions at SPMU in the coming year.
Sl. No. Name of the Positions Approved Proposed
salary (11-12) Months
Fund required
(Lakh Rs)
1 Consultant – MIS 1 45000 12 540000
2 Consultant - M & E 1 45000 12 540000
3 Consultant - HRD 1 45000 12 540000
4 Consultant-Training 1 45000 12 540000
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5 Consultant – Media 1 30800 12 369600
6 Consultant – MCH 1 35000 12 420000
7 NGO Coordinator 1 35000 12 420000
8 Consultant-Logistics &
Procurement 1 35000 12 420000
9 State Programme Manager 1 45000 12 540000
10 State Finance Manager 1 40000 12 480000
11 State Accounts Manager 1 33000 12 396000
12 State Data Officer 1 27500 12 330000
13 Demographer 1 30000 12 360000
14 Statistical Supervisor 1 22000 12 264000
15 Data Manager (State HQ) 2 25000 12 600000
16 System Analyst 1 26400 12 316800
17 Executive Documentation and
Planning 1 28000 12 336000
18 Co-ordinator- ARSH & PCPNDT 1 28000 12 336000
19 Executive Assistant (Prog Mgmt) 1 18000 12 216000
20 Executive Assistant (Accounts) 1 18000 12 216000
21 Executive Assistant (Training) 1 18000 12 216000
22 Executive Assistant (NGO
Coordinator) 1 18000 12 216000
23 Executive Assistant (HR) 1 18000 12 216000
24 Assistant (MD Cell) 1 18000 12 216000
25 Coordinator – FP 1 28000 12 336000
26 Computer Operators 50 14000 12 8400000
Budgeted under Sec. 11.1.1 -11.1.1 & 11.2.1 -11.2.5under Progm Management of RCH
11.2.1.2. District level
District Programme Management Unit has been established in all Districts of the State. Current status of District level PMUs are as follows:
Sl. No.
Name of Position Salary as approved in PIP 10-11 (Rs/m)
Approved In position
Vacant
1. District Programme Manager 30,000 24 21 3
2. District Accounts Manager 25,000 24 19 5
3. District Data Manager 22,000 24 20 4
Table 11.20
Process for filling up the vacancies at District level has been initiated and will be completed by January, 2011. All the staff positions at district level will be retained in the coming year.
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NRHM SPIP 2011-12 JHARKHAND
Sl.
No. Name of the Positions Approved
Proposed
salary (11-12) Months
Fund required
(Lakh Rs)
Remarks
1 District Programme
Manager 24 33000 12 9504000
Budgeted under Sec.
11.3.1 -11.3.3 under Progm Management
of RCH
2 District Accounts
Manager 24 27500 12 7920000
3 District Data Manager 24 25000 12 720000
Table 11.21
11.2.1.3. Block level For the proper management of health programmes at block level, block Programme
Management Unit have been established. All the positions at BPMU, 194 Block
Programme Managers (BPM) and 194 Block Accounts Manager (BAM) have been filled.
Present status of BAM and BPM are as follows,
Sl. No.
Name of Position Salary as approved in PIP 10-11 (Rs/m)
Approved In position
Vacant
1. Block Programme Manager 13,000 194 175 19
2. Block Accounts Manager 12,000 194 170 24
Total 25,000 388 345 43
Table 11.22
Recruitment process of vacant BPMU positions is going on and all such position will be filled by March, 2011. Services of the all BPMU staff positions will be continued in the coming year.
Sl.
No. Name of the Positions Approved
Proposed
salary (11-
12) Months
Fund
required
(Lakh Rs)
Remarks
1 Block Programme Manager 194 13000 12 30264000 Budgeted under Sec. 11.4.1 -11.4.2 under Progm Management
of RCH
2 Block Accounts Manager 194 13000 12 30264000
Total 388 605.28
Table 11.23
11.2.2. Improving HR management of PMU staffs at all levels
Most of the positions under Programme Management unit at all levels have been filled.
Process for filling up the vacant positions has already been initiated and will be
completed before March, 2011.
Details of PMU staffs are as follows,
Category Required In Position Gap
State Program Management Unit 93 64 29
District Program Management Unit 120 87 33
Block Programme Management Unit 388 345 43
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Grand Total 601 496 105
Table 24
11.2.2.1. Policy for Human Resource
More than 600 professionals are presently working at various levels as part of
programme management Unit in Jharkhand. For strengthening the PMUs at all levels
development of HR policy is required for better HR management, performance
management systems against set standards, leave regularizations, salary disbursal,
TA/DA etc. Therefore state has proposed to develop HR policy for its health staffs in FY
2011-12.
Particulars Unit Unit Cost Total Cost (in
Lacs)
Remarks
Development of HR Policy and Cost for recruitment process
1 25 25 Budgeted under Sec. 11.1.18 under Progm Management of RCH
Table 11.25
11.2.2.2. Introducing the performance management system
It is also proposed to introduce performance management system for enhancing the
performance of the PMU personnel. As part of appraisal system, pay band will be
introduced with annual increment system. As part of performance management
system, contractual services of SPMU, DPMU and Consultants will be renewed annually
based on performance. Initial contract for the PMU staffs will be done for 2 years and
will be further renewed as per the performance. The annual enhancement in
honorarium after completion of one year service will be done based on the
performance in the preceding year. The enhancements in honorarium will be maximum
up to 10 % or of the preceding year’s amount as approved in the HR policy, depending
upon performance.
11.2.2.3. Joint MDPs will be conducted for all DPMU, SPMU and consultants alongwith
Civil Surgeons, Additional Chief Medical Officers and Dist. RCH Officers to develop the
District level teams for better understanding and make the functioning smooth.
11.2.2.4 Leadership and Management Trainings for developing leadership and
management skills for state and district level teams will be arranged in this
year. Management training will also be conducted for the medical officers
working at the primary health centres and community health centres.
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11.2.2.5 It is also proposed to introduce performance management system for enhancing the performance of the PMU personnel. As part of appraisal system, pay band will be introduced with annual increment system. Proposed pay band for the existing PMU personnel would be as follows:
Sl # Category Salary Band (Rs per month) Remarks
1. State Level Consultants 35,000/- to 60,000/-
2. State Programme Manager 35,000/- to 60,000/-
3. State Finance Manager 28,000/- to 60,000/-
4. State Accounts manager 25,000/- to 50,000/-
5. State Data Officer 22,000/- to 40,000/-
6. Systems Analyst 20,000/- to 30,000/-
7. Computer Operators 10,000/- to 16,000/-
8. District Programme Manager 25,000/- to 40,000/-
9. District Accounts Manager 20,000/- to 32,000/-
10. District Data Officer 18,000/- to 30,000/-
11. District Program Co-ordinator 22,000/- to 35,000/-
12. Block Programme Manager 12,000/- to 22,000/-
13. Block Accounts Manager 10,000/- to 20,000/-
Table 11.26
11.3. Training Institutes
The major challenge faced by the Department of Health and Family Welfare is large
number of vacancies against the sanction positions in clinical services and
administrative support services. In view of it, State has already initiated the process for
the manpower planning for its future requirements of clinical and non clinical services.
Lack of Training Institutions in public health department at all levels in the State is a
major concern. It is major hindrance in the efforts for developing the capacities as well
as manpower for the future requirements. At present, there are very few training
Institutions working at District and State level. 10 ANM Training Centers are functional
at District level with annual output of 600 ANMs. All these training centers are situated
in the District Hospital premises. Along with this, 3 GNM Training Schools and only one
college of Nursing is working in the State. At regional level, State has only one training
center. Only three medical colleges are functional in the State with out-put capacity of
190 per annum. Only one Nursing school for GNM and B. Sc. Nursing courses is
functional. Training Institutions for the LHVs, Male Health Workers, Nursing and para-
medical staffs are yet to be made functional.
It is proposed that a hierarchy of training Institutions will be developed in the State.
These training institutions will work as the resource organizations for various training
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activities. Efforts have been initiated and study has been conducted with support from
UNICEF for development of road map for strengthening the existing ANM Training
Centers as resource organization at District Level. Development of training Institutes at
State and Divisional level will be taken up in FY 2011-12 with technical support from
NHSRC and development partners like PHFI, UNICEF etc. All the training activities will be
co-ordinate and monitored through the training institutions to be set up at regional
level.
Institute of Public Health (IPH) has been notified as apex body for training and
development in Public Health, which will also work as the training resource organization
for the Department. Institute of IPH is now equipped with better training facilities. A
Hostel has also been developed for IPH for strengthening the residential trainings.
Gap of availability of teaching faculties and experts in IPH has also been thought to be
taken up in FY 2011-12. Also, two of the existing training centers at Divisional level will
be developed as regional training centers in the State. Regional training centers will
work as the extension of IPH at Divisional level for imparting training of health
functionaries at various levels. State will further explore the opportunity for setting up
of 3 more regional training centers in the State for intensifying its in-service capacity
building efforts in the coming years. The study will be taken up in collaboration with
UNICEF and other development partners.
State Health resource Center (SHRC) has been made functional in this FY. Efforts are
being done for further strengthening of SHSRC as a resource organization for the Public
Health in the State.
11.3.5. Jharkhand Lok Swasthya Sewa Vistaar Yojana (JLSSVY) The Jharkhand Lok Swasthya Sewa Vistaar Yojana (JLSSVY) is a programme for
improving health services in difficult area through provision of incentives for health
service providers.
Management of Human Resources for Health (HRH) is widely acknowledged to be an
essential domain for addressing health care services. This is especially true for public
health interventions that aim to ensure health access for the economically poor and
socially excluded sections of society. This shortage can have an extremely adverse
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impact on the provision of health care services, more so in deprived and low income
regions that bear the highest burden of diseases. Developing a policy framework for
HRH thus assumes critical importance for a state that professes to be committed to
providing quality health care to the “last person of the last household of the last
village”.
Jharkhand’s public health system faces a variety of human resource challenges,
primarily associated with an overall lack of health professionals in key areas. Health
facilities areas are found to be severely under staffed especially in low income districts
at lower levels of the health system. This poses a major hurdle for efforts to scale up
health systems to reach out to remote and marginalized regions. The severity of the
problem is effectively demonstrated by the gaping divide between demand and supply.
When it comes to the service delivery issues, huge number of the Jharkhand health
facilities, including a larger amount of district hospitals in the state, has a long way to go
in order to reach the minimum levels of service provision.
When analysing the reasons, it is evident that there is a clearly severe HRH crisis
prevailing in the state, which is even challenging when it comes to difficult areas. Any
effort to address these challenges needs to adopt a holistic approach aiming for
comprehensive reforms in the health sector. Acknowledging the critical role of
workforce policy in health sector reforms, and the urgent need to identify the
unreached, the National Rural Health Mission (NRHM) launched a country wide
initiative to identify areas that are difficult to serve and need special solutions. It was
decided that these areas would qualify for intensive focus and additional financial
support through NRHM. Having completed the health facility classification, Jharkhand
Rural Health Mission (JRHM) now seeks to initiate the process for developing an
incentivisation policy to support and motivate health professionals working in the
state’s identified difficult areas. Through this policy State intends to concentrate its
efforts towards increasing HRH in rural areas and consequently bridging the gap
between HRH availability and the existing unmet needs of the community especially in
the area of Reproductive and Child Health.
Looking at these issues comprehensively, the Jharkhand Rural Health Mission Society
has decided to come up with “Jharkhand Lok Swasthya Seva Vistaar Yojna”, with a
designated plan for incentivising health service providers at various levels. Framework
of this scheme is based on a study of various state level initiatives in adopting and
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facilitating similar incentive mechanisms in rural health systems across India. Based on a
review of such initiatives, lessons and implications are drawn out to enable formulation
of an effective programme for improving Jharkhand’s rural health systems. This scheme
will be implemented based on the policy approval by the state, on the Jharkhand Lok
Swasthya Sewa Vistaar Neeti.
11.3.6. Goals and Objectives of “Jharkhand Lok Swasthya Seva Vistaar Yojna”
In the initial period of its implementation, the policy aims to support health services
focusing maternal and child health services in the targeted areas where the provision of
services are poor for various reasons, primarily the crisis related HRH shortage and HRH
motivation. Towards this end, the main objective of the policy is to motivate and retain
key health professionals and workforce posted in Jharkhand’s identified hard to reach
areas and to attract more workforce to those areas.
11.3.7. Expected Outcomes of the Scheme
Increased availability of desired set of human power at all levels, especially in highly
difficult areas
Improved Staff motivation and commitment
Improved performance of facilities against standards set
Better coverage of otherwise excluded people- scheduled populations, BPL category
populations and other vulnerable groups
11.3.8. Mapping and Notification of Health Facilities Covered under the Scheme
Health challenges in remote regions, areas with difficult terrain and with high
percentage of socially excluded communities, are more acute due to shortage of human
resources including doctors and paramedics. The health challenges in such areas call for
special focus and innovative solutions. Accordingly, it was decided that through NRHM
additional financial support (for human resources, infrastructure maintenance and
logistics supply chain management etc) would be made available to such areas. The task
of classifying the health facilities into difficult, most difficult, and inaccessible areas was
undertaken through the states governments. Besides, the existing norms like terrain,
left wing extremism, tribal concentrations followed by some states, other factors like
absence of proper road communication, electricity, telecommunication services, public
transport and climatic factors were also taken into consideration while preparing the
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area categorization. Based on the criteria, various health facilities were classified into
different Categories as given below, which will be notified in the specific formats as
finalised in the policy.
11.3.9. Health Facility Categorization:-
SN Level of Facility
Category
Total Difficult (A) Most Difficult (B)
Extreme Difficult/ Inaccessible (C)
1 Sub Centre 528 222 180 930
2 PHC 88 37 30 155
3 CHC/RH 64 20 36 120
4 District Hospital 6 5 8 19
686 284 254 1224
Table 11.27
11.3.10. Mapping of HRH under the Scheme
Mapping of HRH is essential for ensuring strategic planning and facilitating adherence
to the plans. The HRH mapping for Module-I is intended to asses RCH related HRH
requirement and availability in Jharkhand's Rural Health Care Systems. The assessment
will cover all facilities ranging from sub-centers to district hospitals (DHs). The mapping
exercise will entail mapping and coding of HRH, Listing of all key health professionals
into an HR database, and rationalisation of workforce based on coded/categorised
facilities. With focus on all the above components, the HRH mapping exercise will be
conducted regularly on an annual basis to ensure information updating. The output
from this exercise will serve as a ready reference in HRH planning as well as
management, which is is also expected to provide basis for rationalizing future planning
for HR placements, promotions and transfers in the state.
11.3.11. Incentive Plan- Jharkhand Lok Swasthya Sewa Vistaar Yojna
For incentivising the critical health services, the Jharkhand Jan Swasthya Vistaar Neeti
will run a scheme called “Jharkhand Lok Swasthya Sewa Vistaar Yojna”, adopting the
method of differential financing. Under this, each level of facility will be placed with a
annual lump sum grant for covering payment of incentives for all levels of staff in the
said facility. Basic unit of monthly incentive shall be decided and notified for each level
of staff, and multiples of this unit would be finalised for a specific level, based on the
category and performance grade of the facility. For each facility, gradation shall be done
based on the performance criteria set for that level of facility, which shall derive the
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actual percentage of the incentive bracket to be paid to each individual, over and above
their routine monthly salaries and emoluments. In order to become eligible for getting
the incentive, all staff members need to be working in the specific hospital/health
centre, ie, the incentives are not calculated just based on the place of posting, but
based on the place of actual working.
Basic Unit of Monthly incentives for different staff cadre in each level of facilities shall
be decided, with a higher amount of unit for contractual staff (shown as y in the tables
below) if compared to the regular staff (shown as x in the tables below), considering the
issues of job security, non- availability of other emoluments than salary etc. Similarly
the how much times ‘x’ or ‘y’ to be paid to a person shall be decided based on the
facility level of his/her work and the position of his or her work. These details shall be
worked out as part of the policy to be approved by the state. The initial value for X is
proposed to be INR 1000 and Y is proposed to be INR 1200; finalisation, hike or
amendment in these units may be done as approved and notified by the Society, if
deemed necessary. An illustrative example for the payment structure is given below.
Incentive Eligibility pattern for Different categories:-
Sl Level of staff
Mode of employment
Unit of incentive payment
Incentives for Category A Facilities
Incentives for Category B Facilities
Incentives for Category C Facilities
A1 Meeting minimum performance indicators
A2 Meeting Medium Performance indicators
A3 Meeting Best Performance indicators
B1 Meeting minimum performance indicators
B2 Meeting Medium Performance indicators
B3 Meeting Best Performance indicators
C1 Meeting minimum performance indicators
C2 Meeting Medium Performance indicators
C3 Meeting Best Performance indicators
Regular
nx
50% 75% 100% 100% 125% 150% 150% 175% 200% Contractual
Ny
Table 11.28
11.3.12. Mechanism for Payment of Incentives:
All these incentives shall be paid on a quarterly basis, as a cumulative package of 3
months incentive amounts. After the interim period, these incentives shall be paid
strictly after the performance reviews by the respective review teams constituted for
the purpose, which should be conducted within a month of the last day of the quarter.
A lump sum annual grant shall be placed with RKS/HMS of the facility (block facility
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HMS/RKS for the subcentres) for meeting the payments based on the quarterly
approvals.
An operational guideline for the scheme shall be prepared for the scheme wherein all
processes, criteria, incentive levels and amounts, framework for payment, grievance
redressal mechanisms etc shall be specified. This will be done immediately after the
finalisation of policy by the state.
11.3.13. Budget Implications
This is a pilot plan to improve field level health performance that is expected to
contribute to improved maternal & child health. Based on a number of criterions as
elaborated in the previous section, the health facility categorization was completed for
Jharkhand, as detailed below.
SN Facility
Level
Total Difficult (A) Most Difficult (B) Inaccessible (C)
1 Sub Centre 528 222 180 930
2 PHC 88 37 30 155
3 CHC 64 20 36 120
4 District Hospital 6 5 8 19
686 284 254 1224
Table 11.29
The budget estimate was calculated on the basis of the state health facility categorization as above, and based on the categorization a staff plan was drawn out as given below:
SN Staff Category Difficult (A) Most Difficult (B) Inaccessible (C) Total
1 MO (MBBS only-General Physician) 480 194 268 942
2 Specialist (Obs/Gyn, Ped, Anesth) 228 90 156 474
3 Specialist (Others) 152 60 104 316
3 Staff Nurse 538 264 392 1194
4 ANM 1296 541 494 2331
5 Lab. Tech 158 62 74 294
6 All other staff 392 154 200 746
Total 2694 1149 1414 5257
Table 11.30
With the above number of officials to be paid incentives at the specified rates, different levels of facility shall need and approximate grant as worked out below, based on the payment requirements at different levels. Projection of Lumpsum grant to be kept with the facilities: Facility/Position qty Av. Incentive
unit Average Number of units
Months Percentile of units
Total average Payment
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ANM 1 1100 5 12 150% 99000
MPW 1 1100 5 12 150% 99000
Total 198000
PHC
Doctors 2 1100 8.5 12 150% 336600
Nurse 2 1100 5 12 150% 198000
Lab Tech 1 1100 4 12 150% 79200
other staff 3 1100 3 12 150% 178200
Total 792000
CHC
Specialist 4 1100 9.5 12 150% 752400
Doctors 3 1100 7.5 12 150% 445500
Staff Nurses 5 1100 6 12 150% 594000
Gen Nurse 3 1100 4 12 150% 237600
Lab Tech 2 1100 3 12 150% 118800
Others 6 1100 2 12 150% 237600
Total 2385900
District Hospital
Specialists 7 1100 7.5 12 150% 1039500
Doctors 10 1100 5.5 12 150% 1089000
Staff Nurse 12 1100 4 12 150% 950400
Gen Nurse 3 1100 3 12 150% 178200
Lab Tech 3 1100 2 12 150% 118800
Other staff 10 1100 1 12 150% 198000
3573900
Table 11.31
When these are adjusted and averaged to different categories, we are reaching to a projection of annual lump sum grants per facility as detailed below: Sl Level of Facility Amount of Lump Sum Grants for the Category of Facility
Category A Category B Category C
1 District Hospital 34 lacs 37 lacs 40 lacs
2 CHC/referral hospital/Block PHCs
designated as FRU
21 lacs 24 lacs 27 lacs
3 CHCs/Block PHCs not designated as
FRUs
15 18 21
4 PHCs with 24 x 7 BEmOC functions 7.0 8.0 9.0
5 PHCs not designated as 24 x 7 5.0 6.0 7.0
6 Sub centres conducting Deliveries 1.75 2.0 2.25
7 Sub Centres not conducting
Deliveries
1.5 lacs 1.75 lacs 2.0
Table 11.32
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Based on the above calculations above, requirements into averages for each levels and
categories of facilities. The total budget needs based on this exercise comes to about
INR 58 crores. However, we see that the preparatory time to get the policies passed
and notified, basic mapping and classification/grading work all shall take time. Also, we
may limit the first year implementation to one or two levels and categories of facilities
only, to be scaled up in the consecutive years. With all this, we are looking forward for
an allocation of 10 crore rupees during 2011-12. We expect we can scale this up and
continue this scheme during coming years as well.
11.3.14. Projected Budget:
Facility Level
Category Total
Facilities Total
Incentives Difficult (A) Most Difficult (B) Inaccessible (C)
Number Unit cost
Tot. cost
Number Unit cost
Tot. cost
Number Unit cost
Tot. cost
Number Tot. cost
Sub Centre
528 1.6 844.8 222 1.9 421.8 180 2.15 387 930 1653.6
PHC 88 6 528 37 7 259 30 8 240 155 1027
CHC 64 18 1152 20 20 400 36 24 864 120 2416
District Hospital
6 34 204 5 37 185 8 40 320 19 709
686
2728.8 284
1265.8 254
1811 1224 5805.6
Budget Requirement for Initial year 1000.0
Table 11.33 Budgeted under Sec. 9.1.13.1 under Infrastructure & HR of RCH
Result based Financing for Improving the Performance of Government Run Healthcare
Institutions
1. Background
It is commonly acknowledged that the service providers for health care service
deliveries face several challenges in implementing various schemes and programmes at
different level. The poor infrastructure, bottlenecks in logistics and supply chain
management, uneven workload without robust planning and monitoring mechanism
etc work as major causes behind de-motivation of the employees leading to poor
performance and output of the systems as a whole. Performance based
financing/incentives especially for the frontline service providers have produced
positive result in different countries in getting desired output. Motivating the
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community members (pregnant mothers) without self-motivation on the part of ANM
or FLWs etc although has been expected but not been fruitful in reality. For improving
the certain health seeking indicators amongst the community members DoHFW,
Government of Jharkhand, wants to incentivize the performance of the personnel
working for healthcare service delivery.
2. The Proposed Scheme/Norms
In order to improve the indicators of maternal and child health the DoHFW, Jharkhand, wants to provide incentives to the health personnel might be given for the same-
- To increase the institutional Delivery
- To improve the basic infrastructure of the facilities as set by the state
Government
The proposed norms is for improving the performance of the District Hospitals and CHCs of two districts which will be selected for piloting the scheme in the districts having large number of reported home deliveries. The district hospitals which conduct around 150 deliveries per month and the CHCs which conduct around 75 deliveries per month will be selected to operationalise this scheme for piloting this idea. This scheme will be part of the hospital friendly health initiative undertaken by the state Government. 3. Financial incentives
The financial incentives per case will be distributed amongst the following personnel as per the percentage mentioned ANM- 35% Staff Nurse- 35% MO – 10% Administrative Staff- 10% Corpus Money- 10%
Indicators Incentive Means of Verification
Increase the Institutional Delivery over and above 20% of the present status
Rs 500/- per case to be given to Facilities
Monthly Report
Improve basic infrastructure of facilities in different phases as to be set by state Government
Rs 50,000/- to be given to the facilities for achieving next target. 20% of total Rs 50,000/- (approx) to be awarded to health personnel.
Physical inspection and UC report
Result Based Financing (Institutional Deliveries)
Level 1 Level 2 RBF (Result Based Financing)
Base line Desired level (per month) Incentives per month @ 500 per case
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No. of deliveries 10 % increase in ID per case over and above desired level 2
Physical Infrastructure
Base line (Minimum Basic Facility Survey )
Desired level Incentives Bi annualy @ 50000 per facility
Labour Room
Avaliable and operational in well condition
20 % of the total incentive (of Rs 50000) to the service providers
Toilet
Emergency Drugs
Equipments
Minor repair
Electricity
Running Water
Level 1 : Current Status
For Institutional Delivery – The current status of institutional delivery to be assessed as per the monthly report available from the district.
For Physical Infrastructure- The state level team will undertake field visits to assess the critical broad indicators as mentioned above.
Level 2: The benchmark which will ensure the fulfillment to get incentives.
Total Budget for RBF for promoting Institutional Delivery
Facility
Current Institutional Delivery (total)
benchmark (10%)
Desired (25%)
Incentives to be given on cases (%)
Unit Rate
Total Amount
Total Amount per year
District Hospital (2) 300 330 375 45 500 22500 270000
CHC (6) 450 495 562.5 67.5 500 33750 405000
Indicator 2 Current Status Benchmark
Unit Rate Total Amount
Incentive for Health staff (20% of total)
DH (2) and CHC (6)
Facility Survey
As per set standard 50000 400000 80000 400000
Total Budget 1075000
Budgeted under Sec. 9.1.13.2 under Infrastructure & HR of RCH
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12. Addressing Gaps in Infrastructure
Infrastructure and facilities for Healthcare, not on a purely commercial basis, which
satisfy a public need. To ensure one progress of any state, it is important to ensure that
its people are healthy and have round the clock easy access to adequate health
infrastructure.
In the state at least one CHC is required in each block as per the present population.
Apart from the new CHCs that need to be built according to the norms. It is needed to
upgrade the PHCs into CHCs and increase the bed strength to 30 at least in each of
them immediately. The total number of CHC will be 188.
The gaps in accommodation are huge. PHCs do not have the required number of
quarters for Doctors as well as nurses. Whatever the existing quarters are there, they
are in a very sorry state. There is acute shortage of quarters for Paramedics and other
staff at all the PHCs. In the campus residential accommodation for all staff is required
not just for few is very necessary if we really want to have our CHCs working for 24
hours a day and 7 days a week.
Most of the quarters for the Doctors, Nurses, paramedics and other staff needs to be
immediately renovated and quarters need to be constructed according to the minimum
manpower norms for CHCs.
As far as APHCs are concerned, 117 APHCs are functioning without any facilities with
damaged building. They are either functioning in the sub-centre building or Panchayat
Bhawan. Almost 117 APHCs are functioning in government buildings but building
condition is very poor. In this regards 185 APHCs are running in rented buildings and 28
APHCs have no buildings. All APHCs are devoided of electricity, lacking of water supply
because Hand pumps are not functioning properly. There are no residential facilities for
staff.
Apart from the new PHCs (all APHC will converted into PHC) that need to be built
immediately. We need to construct building for the 1005 PHCs or the existing building
need to be taken over and upgraded according to the PHC norms. All PHCs which do not
have facility for electricity should be immediately provided with the electricity. Existing
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PHCs, which do not have any kind of water supply need to be provided with a bore from
where they can have their own water supply round the clock. Staff quarters need to be
built for all the new 1005 PHCs. This will definitely help in the long run of a dream of
PHCs functioning for 24 hours a day and 7 days a week. Most of the PHCs do not have a
separate labour room or any kind of privacy during delivery. Until and unless all the
PHCs are equipped with the proper facilities and privacy, there will never be support
from the locals residing in the vicinity of the public facility for institutional delivery
whatever else we do for achieving 100% institutional delivery.
Out of 3958 existing Health Sub-Centre 1732 HSCs are running in Government building,
1953 HSCs are running in rented building and 273 HSCs are running in rent free building.
Almost all the Government buildings are in poor conditions and immediately renovation
/ new constructions are required. But 1732 HSCs are not in IPHS norms, so the
Government building will be also required new building. As per population norms and
geographical conditions 2858 new more sub-centers are required to provide better
health facility to the community. The total number of new buildings is required 4766
and others are renovated including rented buildings & rent free buildings i.e. (1732
existing building + 2858 new + 1953 rented + 273 rent free buildings). The total
requirement of HSC buildings are 6816.
The current Infrastructure Situation: Out of 212 blocks in Jharkhand are proposed to be converted to CHCs but are still
awaiting sanction from the Government. Currently 194 PHCs, 330 APHCs and 3958 HSCs
are functioning in the state. 22 State hospitals & 6 Sub – divisional hospitals are located
in the various states of Jharkhand state. So there is no need of CHC built there. The
state wise details are as follows:
States
Population covered PHCs
Existing (In No.)
APHCs Existing (In No.)
HSCs Existing (In No.)
HSC Functioning in
Rented Building
HSC Functioning in
Rent free Building
Bokaro 1777662 8 16 116 53 27
Chatra 791434 6 8 93 23 5
Deoghar 1165390 8 5 181 118 0
Dumka 1106521 10 36 258 125 4
Jamtara 653081 4 15 132 77 0
Dhanbad 2397102 8 28 137 77 0
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E. Singhbhum 1982988 9 16 242 204 0
Garhwa 1035464 8 10 111 58 5
Giridih 1904430 12 15 180 20 0
Godda 1047939 7 9 188 111 10
Simdega 514325 7 7 155 88 1
Gumla 832447 11 13 242 138 8
Hazaribagh & Ramgarh
2277475 14 19 203 41 15
Koderma 499403 4 5 65 15 0
Lohardaga 364551 5 10 73 2 3
Pakur 701664 6 9 121 62 4
Palamu 2098359 10 21 172 132 10
Latehar 560898 7 10 99 12 0
Ranchi & Khunti 2785064 20 32 502 166 123
Sahibganj 927770 7 10 141 67 4
Saraikela 873613 8 12 194 153 10
W. Singhbhum 1233945 15 15 342 211 41
Jharkhand 26945829 194 330 3958 1953 270
Sanction of Facilities against Norms: There has been a creation of 6817 new sub centres and
1005 new PHCs and 188 CHCs in this period. This has brought up the creation of public health
facilities to what has been stated as required as per national norms. Currently, the state has
3958 sub centres and 330 PHCs which meets the current national norms. In the case of CHCs, we
have meeting almost one CHC per block- though it needs more CHCs to meet the national
norms. On the other hand, the requirement of district hospitals has been met except for 3
districts where the existing district hospitals have been upgraded as 100 – 300 bedded hospitals.
Additional Infrastructure to be Created / Sanctioned as required as per IPHS norms under NRHM
Sl. No. Districts
CHCs PHCs HSCs
No. of Building Required 0n IPHS Norms
Population covered
Existing (In No.)
Proposed
(In No.)
Required PHCs as per IPHS Norms (In No.)
Existing APHC
(In No.)
Additional
PHCs to be
created under NRHM
Proposed as per IPHS
Norms (In No.)
Existing (In No.)
Additional HSCs to
be created under NRHM
1 Bokaro 1777662 8 7 59 16 43 175 116 59 241
2 Chatra 791434 6 10 26 8 18 158 93 65 194
3 Deoghar 1165390 8 7 36 5 31 229 181 48 272
4 Dumka 1106521 10 9 46 36 10 303 258 45 358
5 Jamtara 653081 4 3 42 15 27 283 132 151 328
6 Dhanbad 2397102 8 7 80 28 52 479 137 342 566
7 E. Singhbhum 1982988 9 8 49 16 33 435 242 193 492
8 Garhwa 1035464 8 13 36 10 26 241 111 130 290
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9 Giridih 1904430 12 11 57 15 42 381 180 201 449
10 Godda 1047939 7 6 40 9 31 251 188 63 297
11 Simdega 514325 7 6 22 7 15 181 155 26 209
12 Gumla 832447 11 10 42 13 29 283 242 41 335
13 Hzr & Ramgarh 2277475 14 13 76 19 57 455 203 252 544
14 Koderma 499403 4 3 17 5 12 100 65 35 120
15 Lohardaga 364551 5 4 20 10 10 108 73 35 132
16 Pakur 701664 6 5 35 9 26 234 121 113 274
17 Palamu 2098359 10 11 28 21 7 321 172 149 360
18 Latehar 560898 7 6 21 10 11 188 99 89 215
19 Ranchi & Khunti 2785064 20 19 139 32 107 928 502 426 1086
20 Sahibganj 927770 7 8 40 10 30 299 141 158 347
21 Saraikela 873613 8 7 39 12 27 259 194 65 305
22 W. Singhbhum 1233945 15 15 55 15 40 417 342 75 487
Jharkhand 26945829 194 188 1005 321 684 6708 3958 2761 7901
CHC : The Existing PHCs will be upgraded into CHC.
PHC :
Existing 321 APHC will be upgraded into PHC. Besides this, 684
new PHCs will be in position. Thus the total Nos. are 1005
including existing & Proposed.
HSC :
Total 2761 HSCs are required in the Jharkhand State under NRHM
& Existing HSCs 3958 will be upgraded as per IPHS Norms. The
total nos. are 6791 including existing & proposed.
Creation of Buildings: There has been acceleration in creation of buildings also. Taking
funds from various sources – the table is given below:
Sl. No.
Institution NRHM State MSDP BRGF Welfare Department
1 CHC 18 126 15
2 PHC 5 81 43 10
3 HSC 73 319 1092 72 200
Associated Organizations:
1. Engineering Cell 2. Building Division 3. REO 4. Rural Development Special Division
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NRHM SPIP 2011-12 JHARKHAND
5. NREP 6. District Engineering Division 7. HSCL 8. NBCC 9. Housing Board
The details list of infrastructure are being const constructed under NRHM are given below:
353.59 159.00 0.00 194.59 353.59 0.00 59.13
353.59 150.00 50.00 153.59 353.59 0.00 200.00
353.59 50.00 50.00 253.59 353.59 0.00 50.00
318.00 150.00 0.00 168.00 318.00 0.00 63.00
318.00 50.00 100.00 168.00 318.00 0.00 97.58
318.00 50.00 0.00 268.00 318.00 0.00 50.00
353.59 50.00 87.61 215.98 353.59 0.00 76.15
353.59 50.00 50.00 253.59 353.59 0.00 50.00
353.59 50.00 50.00 253.59 353.59 0.00 300.00
367.81 50.00 0.00 317.81 367.81 0.00 50.00
376.53 50.00 50.00 276.53 376.53 0.00 17.39
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NRHM SPIP 2011-12 JHARKHAND
318.00 100.00 100.00 118.00 318.00 0.00 NREP-II 150.00
353.59 200.00 50.00 103.59 353.59 0.00 NREP-I 230.00
318.00 150.00 0.00 168.00 318.00 0.00 NREP-II FIR
318.00 200.00 50.00 68.00 318.00 0.00 HSCL 200.00
366.84 200.00 150.00 16.84 366.84 0.00 287.50
366.84 200.00 100.00 66.84 366.84 0.00 292.50
366.83 275.00 50.00 41.83 366.83 0.00 200.00
6227.98 2184.00 937.61 3106.37 6227.98 0.00 2373.25
149.41 64.75 84.66 0.00 149.41 0.00 33.92
129.49 50.00 79.49 0.00 129.49 0.00 79.00
129.49 50.00 79.49 0.00 129.49 0.00 79.00
Root Costing
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NRHM SPIP 2011-12 JHARKHAND
129.49 50.00 79.49 0.00 129.49 0.00 129.49
129.49 50.00 79.49 0.00 129.49 0.00 129.49
667.37 264.75 402.62 0.00 667.37 0.00 450.90
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
DC
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 22.49
22.49 10.00 12.49 0.00 22.49 0.00 3.23
22.49 10.00 12.49 0.00 22.49 0.00 0.00
22.49 10.00 12.49 0.00 22.49 0.00 0.00
22.49 10.00 12.49 0.00 22.49 0.00 17.59
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NRHM SPIP 2011-12 JHARKHAND
22.25 10.00 12.25 0.00 22.25 0.00 16.69
22.25 10.00 12.25 0.00 22.25 0.00 10.00
22.49 10.00 12.49 0.00 22.49 0.00 12.41
22.49 10.00 12.49 0.00 22.49 0.00 7.32
22.25 10.00 12.25 0.00 22.25 0.00 16.68
22.25 10.00 12.25 0.00 22.25 0.00 17.25
22.25 10.00 12.25 0.00 22.25 0.00 10.00
22.25 10.00 12.25 0.00 22.25 0.00 14.25
22.25 10.00 12.25 0.00 22.25 0.00 15.25
22.25 10.00 12.25 0.00 22.25 0.00 15.75
22.25 10.00 12.25 0.00 22.25 0.00 15.96
22.25 10.00 12.25 0.00 22.25 0.00 15.23
22.49 10.00 12.49 0.00 22.49 0.00 12.00
22.49 10.00 12.49 0.00 22.49 0.00 12.00
22.49 10.00 12.49 0.00 22.49 0.00 12.00
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NRHM SPIP 2011-12 JHARKHAND
22.49 10.00 12.49 0.00 22.49 0.00 12.00
739.77 330.00 409.77 0.00 739.77 0.00 527.98
22.49 15.00 0.00 7.49 22.49 0.00 NREP 3.00
22.49 15.00 0.00 7.49 22.49 0.00 NREP 3.00
21.16 15.00 0.00 6.16 21.16 0.00 15.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00 NREP 15.00
22.49 15.00 0.00 7.49 22.49 0.00 NREP 15.00
22.23 15.00 0.00 7.23 22.23 0.00
22.23 15.00 0.00 7.23 22.23 0.00
15.00 15.00 0.00 0.00 15.00 0.00 3.17
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00 9.36
22.49 15.00 0.00 7.49 22.49 0.00 7.32
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
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NRHM SPIP 2011-12 JHARKHAND
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00
22.49 15.00 0.00 7.49 22.49 0.00 22.49
22.49 15.00 0.00 7.49 22.49 0.00 22.49
22.49 15.00 0.00 7.49 22.49 0.00 NREP 21.00
22.49 15.00 0.00 7.49 22.49 0.00 NREP 21.00
22.49 15.00 0.00 7.49 22.49 0.00 15.00
22.49 15.00 0.00 7.49 22.49 0.00 15.00
22.49 15.00 0.00 7.49 22.49 0.00 15.00
22.49 15.00 0.00 7.49 22.49 0.00 15.00
22.49 15.00 0.00 7.49 22.49 0.00 BDO 7.00
22.49 15.00 0.00 7.49 22.49 0.00 BDO
890.26 600.00 0.00 290.26 890.26 0.00 224.83
73 1630.03 930.00 409.77 290.26 1630.03 0.00 752.81
Infrastructure is the backbone of streamlining the health programme up to the
community level. Candidly the architectural improvement has been made in the various
dimension of infrastructural up gradation under the NRHM programme.
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NRHM SPIP 2011-12 JHARKHAND
Proposal of New Construction of CHC, PHC, HSC and 500 bedded Hospital at Dumka
It is essential to mention that 18 CHCs, 5 PHCs and 73 HSCs will be completed in the
financial year 2011-12 under NRHM programme. Keeping in view 15 CHC, 40 PHC, 250
HSC and 500 bedded Hospital have been proposed for construction in the FY 2011-12.
The total time of completion of HSC construction is 6 months, PHC and CHC is 18
Months. So we will propose the 50% of the total amount of PHC and CHC in the
financial year 2011 – 12 and next 50% for ongoing construction of PHC and CHC in FY
2012-13.
500 bedded Hospital at Hansdiha (Dumka)
Santhal Pargana region is backward, poor and in utter deprivation yet in modern era.
So much so this hilly terran area is not having any specialized medical facilities,
particularly the medical institutions despite of the fact that it had a very good history of
ancient education. Maharishi Arvind had established his holly ashram since long back.
Mahatama Gandhi mentioned about this place in his biography. Swami satyanand set
up his Yoga Ashram at Rekheya, which is also visited by large number of foreign tourists
every year. The Mandar Mountain of Samudra Manthan fame is nearly 40 kms away
and the famous Vikramshila University is hardly 100 kms away from Deoghar.
But in current time, needless to say the reduction on public health spending and the
growing inequalities in health and health care are taking its toll on the marginalized and
socially disadvantaged population of Santhal Pargana. Recently published report say’s
that “a child in the ‘Low standard of living’ economic group is almost four times more
likely to die in childhood than a child in the ‘High standard of living’ group. Child born in
the tribal belt is one and half times more likely to die before the fifth birthday than
children of other groups. Children below 3 years of age in scheduled tribes and
scheduled castes are twice as likely to be malnourished than children in other groups. A
tribal mother is over 12 times less likely to be delivered by a medically trined person. A
tribal woman is one and a half times more likely to suffer the consequences of chronic
malnutrition as compared to women from other social categories.
These figures speak for themselves and being to the fore unequal distribution of
resources and the effect of it on public health parameters. This unequal distribution of
resources is further complimented by inability access to healthcare due to various
access difficulties. Setting up the super specialty hospital at Hansdiha (Dumka) mainly
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NRHM SPIP 2011-12 JHARKHAND
because it’s geographically central location and ease of commuting for the paitents
from all across Doghar-Dumka and Godda. Secondly the above mentioned area is one of
the most backward areas where medical facilities and creation of health awareness are
really needed.
It is very much indispensable to mention that we need the new construction of CHC,
PHC, HSC and ongoing construction of HSC for better endurance and easy access the
health services to the community. Hence the estimated budget for new infrastructure
has been proposed. The Total Budget worth Rs. 14109.80 Lacs (One Hundred Forty One
Nine lakhs and Eighty Thousand only).
Components/ Activities Unit Unit Cost
(Rs.in Lakhs)
Physical Target
Financial Outlay (Rs.in Lakhs)
Remarks
2011-12 2011-12
New HSC construction HSC 22.49 250 5622.50 Budgeted under Sec. 6 under New Construction of NRHM Additionality
New PHC construction PHC 129.49 40 2589.80*
New CHC construction CHC 318.00 15 2385.00*
Ongoing construction of HSC HSC 7.50 335 2512.50
Construction of 500 Bedded Hospital in Dumka
per constr.
1000.00 1 1000.00
14109.80
* only 50% of the required fund has been demanded in FY 2011-12.
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NRHM SPIP 2011-12 JHARKHAND
13. Community Mobilization
Progress so far as per SPIP 10-11
Vision for Community Participation in 2011-12
Operational Objectives
Plan of action for the Financial Year 2011-12
Budget require for FY 11-12
The thrust of the National Rural Health Mission (NRHM) is to establish a fully functional,
community owned, decentralised health delivery system with inter-sectoral
convergence at all the levels, to ensure simultaneous action on a wide range of
determinants of health including social and gender equality. From narrowly defined
schemes, the NRHM has shifted the focus of health initiatives to a functional health
system at all levels, from village to the district with active Panchayati Raj Institutes (PRI)
and communities that are motivated and mobilised to access and demand services.
To ensure community participation and to make public health delivery system fully
functional and accountable to the community ‘Communitization’ has been identified as
a key working strategy under NRHM. It implies the capacity building of community in
identifying their own health needs, analyzing the causes of their problems, prioritize
and planning as per their needs and problems, rigorous monitoring & evaluation
ensuring that the accessibility, quality, behavioral and policy issues are as per defined
standards, reviewing the progress made through these interventions and Human
Resource Management and flexible financing.
Progress so far as per SPIP 10-11
Strategy as per PIP (10-11)
Status Comments
Sahiyya selection and capacity building
40,964 Sahiyyas (ASHAs) have been selected by the VHCs and Villagers through the Gram Sabha. Training on Module V i.e. Leadership Module completed for all Sahiyyas.
Today the Sahiyya is an empowered woman with an identity of her own.
VHC strengthening 30,012 Village Health Committees have been constituted Bank account has been opened for 26,636 VHCs and untied funds for these VHCs have also been transferred
The formation of VHCs and meetings of the same at the village level has provided the much needed platform to the community to raise its voices and issues.
VHC capacity building VHC member’s preliminary orientation on roles and
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NRHM SPIP 2011-12 JHARKHAND
Strategy as per PIP (10-11)
Status Comments
responsibilities carried out at block HQs across all 24 districts of the state. Orientation of VHCs and Sahiyyas on Operationalization of Village Health and Nutrition Day conducted in November and December, 2010.
Support team for community
participation under NRHM
VHC and Sahiyya Resource Centre (VSRC) team in place at the state level District Programme Coordinators (DPC) has been placed in 21 districts of the state to facilitate and promote community participation initiatives. 6 Regional coordinators placed in the six regions of the state to support the district teams and to liaison with officials as a part of the VSRC team State Training Team (STT) identified and trained (50/2 per district) Block Training Team (BTT) identified and trained (212X4= 848 i.e. 4 per district, primarily women)
VSRC team supports training, monitoring, and preparation of materials and planning of activities mandated under NRHM. Assessment of all STTs and BTTs on training capabilities has been conducted.
Materials/IEC/modules preparation
5th
module on leadership designed and prepared for Sahiyya VHC module on ROLES/RESPONSIBILITY and village health plan designed and prepared for VHC members. Sahiyya bulletin and appeal from the Mission Director prepared and sent for distribution. Sahiyya pass book and VHC register prototype prepared and sent to districts for printing. Disease and nutrition book (6A & B) prepared for review.
Specific Activities and innovations carried out
in ongoing financial year to strengthen
Community Action are:
1. 60 ,Sahiyya help desk training done and desk established in 16 districts and 22 CHCs
2. Pilot JAN-SAMVAD (public hearing) held at Angara Block of Ranchi District and tools developed for community based monitoring. All 20 District Programme Coordinators has been trained on CBM.48 BTTs form all 24 districts have been trained on CBM.
3. Sahiyya facilitation structure designed/Sahiyya Saathi identification under process.
4. Cluster meeting structure designed and field tested.
5. Sahiyya Sammelan process and materials finalized.
6. Sahiyya Sandesh Yatra concept designed for roll out.
7. Data base for Sahiyyas and VHC designed and Data entry in process
Table 13.1
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NRHM SPIP 2011-12 JHARKHAND
SOME FACTS AND FIGURES
Cluster formation for carrying out the VHC Trainings was done. The number of
Clusters formed was 2184.
Supportive supervision was provided to the statewide Sahiyya Training on Leadership.
The numbers of Sahiyyas trained during this training were 39,264.
The impact of all these activities has been encouraging and can be listed as follows.
1. Dialogue with Sahiyyas restarted and established at various levels.
2. Sahiyyas activated, motivated and capacitated through intensive cascade trainings
and interpersonal communication
3. Village health committee sensitized about their roles and responsibilities.
4. Village health committee bank accounts opened and untied fund transferred.
5. Transparent and rational use of untied funds initiated and expenditure report
sought.
6. Community mobilization on health issues initiated
7. The participation of community in health camps, sterilization and tubectomy camps
increased.
8. The immunization, institutional delivery and OPD patient’s numbers increased
reposing faith in the health system.
9. Training resource pool established under VSRC
10. Jharkhand specific modules and materials developed
11. The community /health system interaction and dialogue established and improved.
11.1. Vision for Community Participation in 2011-12:
The Vision of ‘Promoting Community Participation’ under NRHM upholds five
dimensions- social mobilization, Capacity building, Programme support system,
monitoring & evaluation and learning by doing (innovation) towards ensuring health
for all.
The dimensions are often reflected in particular operational designs that are based on
several common institutional arrangements, a multi-sectoral and cross functional
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NRHM SPIP 2011-12 JHARKHAND
framework and a dynamic people-centered relationship among the various
stakeholders.
While Capacity building efforts are not new in the broad spectrum of activities
undertaken in community participation initiatives in the state of Jharkhand this year the
strong emphasis will be given on an integrated enabling environment for sustaining the
ongoing efforts and building people-institutes at grassroots. For example, efforts for
Village Health Planning and capacity building of local government (Panchayati Raj
Institutes) are critical element of the overall enabling environment for community
empowerment.
13.2 Operational Objectives:
To ensure the presence of trained social health activities (Sahiyya) in all the
populations of the state based on the norms.
To have functional Village Health Committees with bank accounts in all the
villages of the state based on the norms for the same.
To sensitize and capacity build of the newly elected PRI members on the public
health issues.
To empower at least 75% of VHCs to prepare Village Health Plan.
To ensure least 80% of the VHCs are organizing Village Health and Nutrition Days
in their respective villages.
To complete the Sahiyya training on the Disease and Nutrition modules (12
days) and equipping them with new born care (HBNC) kit and counseling flip
charts (Salter weighing machines, thermometers, watches)
To strengthen the mentoring mechanism for Sahiyya, VHC and other
community initiatives at Panchayat, Block, District and State Level.
13.3 Plan of action for the Financial Year 2011-12
Strategies
Activities proposed for 2011-12
Introducing novel strategies for community mobilization (2011-12)
Expected Outcomes
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NRHM SPIP 2011-12 JHARKHAND
13.3.1. Strategies:
13.3.1.1 CAPACITY BUILDING:
To increase the effectiveness of roles with respect to implementation of NRHM at
community level, capacity building of Sahiyya, Sahiyya Sathi, Village Health Committees
and newly elected PRI members as well as newly formed VHCs and Sahiyyas for
Primitive Tribal Groups is a key strategy. Necessary orientation with respect to
programme management shall be provided to District Programme Coordinators and
Training Teams. Orientation and hand holding of VHCs for preparing village health plan
and proper utilization of untied funds has been carried out in the last year as a part of
this process.
TRAINING ROLL OUT STRATEGY
The trainings shall be imparted based on cascade approach having 3 levels State,
Regional and the actual training at block level. A two days capacity building package for
Block Training Team members mainly on Training Methodology, Team Building, and
Motivations will be designed and imparted. A state level Tot will be conducted and all
The VHC & SAHIYYA RESOURCE
CENTRE
(STATE LEVEL)
STATE TRAINING TEAM
(2 per district)
BLOCK TRAINING TEAM
(4 per block)
VHC SAHIYYA
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NRHM SPIP 2011-12 JHARKHAND
the BTTs (844) will be trained at district level. With the aim of establishing Sahiyya
mentoring team at the district level as well to facilitate the effective implementation of
the Sahiyya Programme, 21 District Programme Coordinators have been placed at the
district level. In order to enhance the capacity of DPCs on Result Based Management
and Rights Based Approach in community processes a four days residential training
programme will be designed and imparted to the DPCs. The participants will learn how
to strengthen the public health delivery system and essential competencies to think and
act systematically for managing the district level communitization processes.
13.3.1.2 Programme Support System:
A support structure for Sahiyyas (approximately one per 20 Sahiyyas) is proposed at
each block PHC area, wherein selections are to be based on active participation in
Sahiyya programme or other critical social processes. The process of selection of
members of this support structure called Sahiyya-Sathis has already been initiated. So
far, 974 (till the month of Dec, 2010) Sahiyya Sathis have been selected. Apart from
ensuring on the Job trainings, the Sahiyya Sathis will organize VHC meetings, Sahiyya
meetings, Village Health and Nutrition Days, Community Based Monitoring processes
etc.
National Health System Resource
Centre
District Program Coordinator
Admin and
Finance
Officer
Jharkhand State Health Resource
Centre
CINI-VSRC Support
Team
State Program
Coordinator
STT BTT Regional
Coordinator
Village Health
Committee
Sahiya Saathi
Sahiyya
Community Participation Cell
Village Health Committee-Sahiya Resource Centre (VSRC)
(CINI, ICCHN, NHSRC and Jh Rural Health Mission)
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NRHM SPIP 2011-12 JHARKHAND
The Sahiyya Sathis will be provided with specially designed ‘Activity Planner’ to
facilitate them for effective planning and implementation of their activities. Sub-center
level Sahiyya Days and convergence meetings will be institutionalized with the active
leadership from the Panchayat leaders and Sahiyya- Sathis will facilitate the meetings at
Sub Center level.
Periodical monitoring and reviews as well as report collection of Sahiyyas active role
shall be done through the Sahiyya Sathis, who is expected to work for about 15 days in
a month. Block level Sahiyya trainers called Sahiyya Prashikshikas (4 in number) shall be
brought in to ensure effective training and coordination of this team, after completing
their training loads calculated upto 10 days in a month. All these volunteers shall be
paid on a day-compensation against livelihood loss basis compensated volunteers. A
similar structure is suggested in the ASHA national guidelines as well.
Apart from this the district level and state level Sahiyya mentoring system will be
activated through regularizing the review meetings etc.
Streamlining incentives payment mechanisms for Sahiyyas and forging linkages
between Sahiyyas and other front line workers like ANMs, AWWs, para teachers &
Strengthening the District Level Sahiya Mentoring Team to guide the District
Programme Coordinators and Block Level Teams shall also constitute the Sahiyya
Support System. ‘Sahiyya Diaries’ and planning formats for better programme
implementation and smooth payment shall aide the above process.
13.3.1.3 CONVERGENCE
Convergence meetings (ICDS, PHED, SSA, HEALTH, PRI, and VHC) at Sub center level to
plan and review the activities of the month under the chairmanship of Panchayat
Leader.
13.3.1.4 Establishing a ‘Community Based Information System’ (CBIS) system
In line with HMIS to track and measure the real impact of the Sahiyya Programme based
on indicators set in HRHM.
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NRHM SPIP 2011-12 JHARKHAND
13.3.1.5 Institutionalizing the monthly review meetings
At different levels (Block, District and State) for establishing better coordination.
13.3.1.6 Conducting research, advocacy and documentation of the best practices and
innovations
13.3.1.7 Social Mobilization Strategy:
Quarterly Sahiyya Sandesh Bulletin is being published as an organ of community action,
other than the routine IEC and media campaign by the state. District level Sahiyya
Sammelan shall be one of the key annual events where Sahiyyas, VHCs, officials from
block, district to the state level come at one platform. A state level sharing workshop
shall also be organized, to create an enabling environment for the community level
initiatives. A web-based information platform for community action under NRHM
Jharkhand also shall be developed and uploaded for public reference.
However the modification of the above strategies will be made based on the field level
inputs.
13.3.1.8 Monitoring and Evaluation Strategies:
The monitoring and evaluation strategy of Community processes of the state has been
in build with the programme support structure to establish an effective feedback and
review mechanism.
The strategies like the regular field visits by the Sahiyya Sathis, Monthly Sahiyya Days at
Sub-centre level, Monthly meetings of Sahiyya-Sathis at Block Level, Monthly Block
Coordinators meets at the district level, and quarterly DPC Review meets at the state
level shall also ensure concurrent review and feedback of the programme. This year an
internal review is in process under the guidance of the Jharkhand State Health Resource
Centre (JSHRC) to review all the activities related to communitization in the state and to
prepare a roadmap for the future.
13.4 Activities proposed for 2011-12
13.4.1 Human Resource:
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NRHM SPIP 2011-12 JHARKHAND
Strengthening the VSRC with three (3) thematic experts, in addition to the current staff
strength of one SPC, One Account & Administration officer and 24 DPCs.
SL. BUDGET HEAD UNIT MEASURE
Unit Cost Total Amount (in
Lakh Rs.)
Remarks
HUMAN RESOURCE COST
1 STATE PROGRAMME CO-ORDINATOR
Month 35000*12*1 4.2
Budgeted under Sec. 1.4 under
VSRC Human Resource
Cost of NRHM
Additionality
2 Coordinator- Training (New Recruit)
Month 30000*12*1 3.6
3 Content Editor consultant(New Recruit)
10 days in a Month
1000*120days 1.2
4 ADMINISTRATION & FINANCE OFFICER
MONTH 22000*12*1 2.64
5 DISTRICT PROGRAMME CO-ORDINATOR
MONTH 27000*12*24 77.76
6 LAPTOP for State VSRC team and 4 DPC (7 person)
SET 35000*7 10.5
7 Travel support for VSRC QRT 250000*4 10
8 Phone/ Internet/ Data Card for VSRC
QRT 75000*4 3
TOTAL 112.9
Table 13.2
13.4.2 Capacity Building: This will encompass-
Sahiyya training on the Disease and Nutrition modules (12 days) and equipping
them with newborn care kit and counseling flip charts (Salter weighing machines,
thermometers, watches)
Capacity Building Programme for Sahiyya Sathis on necessary skills to support the
Sahiyyas and to facilitate the sub center level meetings.
Capacity building of trainers’ team to sharpen their training skills.
Four Days residential training programme for DPCs on Results Based Programme
Management and Rights Based Community Action Programming.
As per recommendations from the Common Review Mission Team and other
development partners as well as experts it has been decided to bring all Sahiyyas to
the same level of knowledge and awareness. The Module VI and VII training shall
cover all the topics encompassed till Module IV and hence would also act as a
refresher for the 20,000 (approx.) Sahiyyas who had received training on the
same.
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NRHM SPIP 2011-12 JHARKHAND
Capacity building and induction training of Sahiyya Sathis(6 days) apart from training
on modules on Facilitation and Supervision skills.
Sensitization of District health societies and health personnel ,DPMU,BPMU on
Communitization
Hamlet wise Sahiyya selection and VHC formation in PTG areas
Capacity building of PTG Sahiyyas and VHCs and training pool creation for the same
Table 13.3
Capacity Building of PRIs: The NRHM Framework for Implementation clearly
articulates the role of PRIs in NRHM and hence the capacity building of newly
elected PRI members is essential. A consultation workshop on ‘Roles of PRIs in
SL. BUDGET HEAD Training Details No. Budget Details Amount Remarks
A TRAINING
A1 STATE TRAINING INCLUDING TRAINIING FOR DPC
16 days Training for Asha 6 & 7 module , VHC,Asha facilitator(Sahiyya sathi), PTGs Sahiyya and PRI functionaries
76 76DPC and STT*16days*Rs.800
9,72,800
Budgeted under Sec. 1.1 under
ASHA Training of NRHM
Additionality
A2 REGIONAL TRAINING
16 days Training for Asha 6 & 7 module , VHC,Asha faciliitatoor(Sahiyya sathi), PTGs Sahiyya and PRI functionaries in trg sites and regions
850 850 BTT* 16 days*Rs.675
91,80,000
A3 SAHIYYA TRAINING
12 days Training for Asha 6 & 7 module
41000 41000*12days*300 14,76,00,000
A4 VHC TRAINING 2 days training on 100000 100000*2 days*Rs.65 1,30,00,000
A5 TRAINING OF PRI WITH VHC PRESIDENT
1 day 84000 84000*1day*Rs. 60 50,40,000
A6 TRAINING OF ASHA FACILITATOR(SAHIYYA SATHI)
2 day 2184 2184*2days*Rs.220 9,60,960
A7 PTG SAHIYYA SELECTION
For 100 hamlet 100 Hamlet
100*2000 2,00,000
A8 ,TRAINING,MATERIAL COST,
3 days 100 100*3days*Rs.300 90,000
A9 TRAVEL SUPPORT FOR PTG SAHIYYA
MONTH 100 100*12 month*500 6,00,000
TOTAL 17,76,43,760
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NRHM SPIP 2011-12 JHARKHAND
Public Health’ will be organized by UNICEF involving Tribal Welfare Department,
Social Welfare, Department of Panchayati Raj, Jharkhand State AIDS Control Society.
A vision document ‘The Role of PRIs in Public Health: Road map for Jharkhand’ will
be prepared with the support from UNICEF. Based on the vision document VSRC will
prepare the training module for the PRIs as well for the Health Functionaries and
the Training programme will be rolled out. Sensitization of PRIs on community
processes from Panchayat to district level shall be carried out.
13.4.3 Training Modules and IEC
Developing and printing of modules for Sahiyya and VHC trainings
Specific Training Modules for PTG Sahiyyas
Printing of Sahiyya bulletin and flip chart for Sahiyyas.
Printing of score cards and report formats for CBM.
Drug kits for Sahiya will be procured and distributed and refilling system will also
be established.
SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT
B COMMUNICATION AND TRAINING MODULE
B1 SAHIYYA SANDESH Monthly magazine
45000 45000*12month*Rs.8 48,00,000 Budgeted under Sec. 1.2 under
DEVELOPMENT of COMMUNICATION MODULE AND
TRAINING MODULE of
NRHM Additionality
B2 SAHIYYA MODULE Training module
42000 42000*3*Rs.45 37,80,000
3 VHC MODULE Training module
31000 31000*1*Rs.45 13,95,000
B4 PRI MODULE Training Module
85000 85000*Rs. 20 17,00,000
TOTAL 1,16,75,000
Table 13.4
13.4.4 Community based Monitoring: This will encompass-
Orientation of VHCs on Community based monitoring and social security schemes
(4days).
Community Based Monitoring (CBM) exercise in each village of Jharkhand through
score cards and Jan-Samvad.
State, district and PHC level sensitization, and implementation on CBM processes
Page 50 of 129
NRHM SPIP 2011-12 JHARKHAND
SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT Remarks
D Community Based Monitoring (CBM)
D1 State sensitization on CBM EVENTS 3 3*Rs.50000 1,50,000 Budgeted under
Sec. 17.1-17.3 under Community Based Monitoring (CBM) of NRHM
Additionality
D2 District sensitization and district sharing of findings of CBM
EVENTS 2 24 district*1 event*Rs.50000
12,00,000
D3 Training of the CBM teams and People’s dialogue(Jan Samvad) at PHC level For presentation and discussion on reports of the CBM teams
EVENT 1 48 blocks*Rs.20000 9,60,000
TOTAL 23,10,000
Table 13.5
13.4.5 Reviews and meetings:
Institutionalizing Cluster meeting/block meeting/district meetings and report flow
mechanism on trainings, meetings, untied fund utilization and specific problems will
form a part of the activities.
SL BUDGET HEAD DETAILS NO. BUDGET DETAILS
AMOUNT
E SAHIYYA MOBILISATION AND ADVOCACY SAHIYYA PROGRAMME
E1 SAHIYYA SAMMELAN AT DISTRICT LEVEL YEARLY
Events 24 24*Rs.60000 14,40,000
Budgeted under
Sec. 1.3 under
SAHIYYA MOBILISATION AND ADVOCAC
Y of NRHM
Additionality
E2 CLUSTER LEVEL MONTHLY MEETING OF THE SAHIYYA ,AWW,ANM AND VHC REPRESENTATIVE (2184 no. of cluster)
Events 12 12*2184cluster*Rs.100
26,20,800
E3 Supportive supervision by BLOCK TRAINERS for 6 days per month for supporting ASHA facilitators and block meetings and participating distt meetings
Nos. 848 848*Rs.300*72days
18,31,68,00
E4 Supportive supervision by STT for 6 days per month for Facilitating block meetings and distt meetings and participating in state level meetings
Nos. 50 50*Rs.500*72days
18,00,000
E5 Operational Cost to Sahiyya Help Desk for 98 help desk
Nos. 98 98*12sahiyya*48days*Rs.200
11,28,96,00
E6 Asha Facilitator(Sahiyya Sathi) Remuneration for 2184 sahiya sathi per month
Month 1500 2184*Rs.1500*12
3,93,12,000
TOTAL 7,47,79,200
Table 13.6
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NRHM SPIP 2011-12 JHARKHAND
13.4.6 Innovations:
Sahiyya Help Desk in all PHCs and CHCs will be established and effectively
functioning.
Organizing Sahiyya Sammelan in every six months at block and district level
Sahiyya feedback system for complaint redressal
Preparing Village Health Plan and Panchayat Swath Yojna at all the Panchayats
Establishing Sahiyya rest room in all district hospitals and CHCs
13.4.7 Documentation of best practices and conducting advocacy workshops for
sharing the best practices.
13.4.8 Designing communication strategy with special focus on bulletins and
periodicals as well as orientation of frontline workers on interpersonal
communication skills
13.5.1 Introducing novel strategies for community mobilization (2011-12)
SL BUDGET HEAD DETAILS
NO. BUDGET DETAILS
AMOUNT
F Innovative activities for Community programme
F1 Saas bahu Sammelan in every cluster (2184) (Quarterly)convergence with ICDS - Mother support group
Events 4 4*Rs.250*2184 cluster
21,84,000
Budgeted under
Sec. 17.4 under
Innovative
activities for
Community
programme of NRHM
Additionality
F2 Flag at Sahiyya House Nos. 40964 40964*Rs.50 20,48,200
F3 Exposure visit of VSRC members/DPC/STT/BTT/Sahiyya sathi/ Sahiyya
Event 1 Rs. 3,00,000 3,00,000
F4 Award (Bicycle) for sahiyya -24 at state, 72 at District and 424 at block
No. 520 520*Rs. 3000 15,60,000
F5 Award for Best Veer Birsa Unnat Village for 520 villages(VHC)
No. 520 520*Rs.3000 15,60,000
F6 Corpus fund for supporting Sahiyya against Accidents and Deaths (Sahiyya Sahayta Nidhi)
No. 41000 41000*Rs. 10 4,10,000
TOTAL 80,62,200
Table 13.7
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NRHM SPIP 2011-12 JHARKHAND
13.5.2 Convergence with ICDS and formation of mother support groups (Mata Samiti)
At every cluster in every quarter for discussing hygiene, nutrition, birth preparedness,
ANC/PNC and gender related issues: The Sahiyyas and Sahiyya Scathes along with
Aanganwadi workers shall play a key role in organizing and facilitating these Sammelan.
Need based issues or those that are vital to the overall health of women and children
shall be taken up at these events. Inter personal communication and other tools like
role plays shall be used to ensure effective dialogue and impact with the target group.
13.5.3 Corpus fund for Sahiyyas against accidents and disabilities:
One of the key tasks of the voluntary health workers is conducting referrals and
escorting patients for various health services which require a lot of movement in and
out of their respective villages which makes the task risky. Hence it is proposed to form
a corpus fund for all Sahiyyas across the state. This would be a mark of respect to this
cadre of voluntary health workers. Contributions to the fund would be on a 50-50
sharing basis wherein per Sahiyya contribution would be 1/- and the state would
contribute another 1/- for each Sahiyya, which would then amount to a total of about
80,000/- corpus fund for Sahiyyas.
13.5.4 Celebrating International women day (March 8):
This day may be used a platform to honor the work of key front line workers and
Sahiyyas and to showcase the community level innovations and achievements brought
about through Commoditization under NRHM.
13.5.5 Panchayat Swasthya Yojna:
The village Health Planning Process will be conducted at every villages to enable the
villagers to identify the key health issues and to plan for addressing the same under the
leadership of VHCs. The Village Health Plans will be consolidated at Panchayat level
under ‘PANCHAYAT SWASTHYA YOJNA’ and further it will be incorporated in BHAP. This
would be carried out by the key VHC members in close coordination with the PRI.
13.5.6 Setting up of VHC offices at villages at respective ICDS centers:
An office space for VHC at the ICDS centers shall ensure convergence of activities on
one hand and help the VHCs build better linkages with the system on the other.
13.5.7 Putting up flags at each Sahiyya’s house on 7th April to give prestige and fix
responsibilities
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NRHM SPIP 2011-12 JHARKHAND
13.5.8 Wall painting on each village depicting details about VHC, ambulance and other
important information
13.5.9 Community Based Information System (CBIS):
Based on key output and Impact indicators a MIS reporting structure will created line
with HMIS to track the progress and effect of communitization Process in this state.
13.5.10 Conducting Exposure Visits:
Interstate, district, block and village Exposure visits will be conducted for the VSRC
Team, DPCs, STTs, BTTs, Sahiyya Sathis, Sahiyyas and VHC members to get exposure
with the recent trend in communitization process as well as to share their experiences.
This will also enhance the skills of the participants as well as will as will act as stimulus
for motivation and promote cross learning.
13.5.11 Social Inclusion:
Primitive tribal group Sahiyyas in PTG hamlets will be selected and special training
modules, curriculum will be design and fix incentive packages for them will provide
towards achieving social inclusion. This strategy will be effective to reach out to the PTG
groups and to reach out to the mobile communities.
At the same time VHCs at hamlet level in PTG areas will be formed to focus on the
special health needs and issues of the PTGs and the PRIs of schedule areas will be
encouraged to take active leadership. Special incentives for them have been proposed
in the tribal health plan.
13.5.12 Community Based Birth Preparedness:
A community based birth preparedness programme will be designed and piloted in two
districts will the financial and technical support from UNICEF. This intervention will
helped to create and evidence based model at the state level for birth preparedness
involving Community, Sahiyya, VHCs, PRIs and service providers.
5.13 Cash or other incentives/awards shall be provided for Sahiyyas working in Hard to
reach area will be provided to facilitate their movement to each and every household.
13.5.13 Village Health Awards-
Any village that meets the below mentioned criteria shall be awarded as “Veer Birsa
Unnat Gram”. The village wise criteria of assessment for the same are : 80 percent
immunization, 100 percent institutional deliveries, proper utilization of untied funds
based on village health plans formulated by the VHC.
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NRHM SPIP 2011-12 JHARKHAND
11.6 Expected Outcomes:
Increase in institutional deliveries
Early identification and referral of danger signs in pregnancy
Increase in percentage of women receiving ANC/PNC services
Increase in the percentage of complete immunization amongst children
Timely information of epidemic outbreak.
Timely identification of malaria cases and treatment with Referrals
Reduction in diarrheal deaths through timely treatment and referrals
Accurate record of births and deaths
Tracking of pregnancy and mother and child
Decentralized planning reflecting people’s concerns, needs, problems and
priorities through capacity building of the community.
More sensitivity and transparency in health system functionaries.
Increase in numbers of mothers initiating colostrums feeding and
supplementary feeding.
Identification of TB patients and increase in number of patients completing
DOTs.
Increase in number of couples adopting family planning measures.
Transparent, rational and timely utilization of untied fund.
Home visits to all pregnant/lactating mothers by Sahiyya.
First aid, counseling and primary treatment of minor illnesses and availability of
identified drugs in the villages.
Sahiyya Incentives (AWARDS for Best Performing ASHAs) To ensure community participation and to make public health delivery system fully
functional and accountable to the community, ‘Communitization’ has been identified
as a key working strategy under NRHM. It implies the capacity building of community in
identifying their own health needs, analyzing the causes of their problems, prioritize
and planning as per their needs and problems, rigorous monitoring & evaluation
ensuring that the accessibility, quality, behavioral and policy issues are as per defined
Page 55 of 129
NRHM SPIP 2011-12 JHARKHAND
standards, reviewing the progress made. For this process, ASHA (Sahiyya)under NRHM
plays the vital role to link the community with the health care facilities.
Under NRHM in Jharkhand a total, 40,964 Sahiyyas (ASHAs) have been selected by the
VHCs and Villagers through the Gram Sabha. Training on Module V i.e. Leadership
Module completed for all Sahiyyas. For regular supportive supervision total 2184 cluster
has been formed with the support of Sahiyya , VHC members, PHC representatives and
VSRC team. Each cluster contents 15 to 20 villages according to geographical location,
socio-eco boundaries and power relations and accessibility to health facilities .In each
cluster one Sahiyya Sathi ,among the Sahiyyas has been nominated , who will be
responsible to periodic meetings at cluster level and other interventions under NRHM.
60, Sahiyya Help Desk in LWE districts and District hospital has been formed and
functional. Today the Sahiyya is an empowered woman with an entity of her own.
The impact of Sahiyyas activities has been encouraging and can be listed as follows.
12. Dialogue with Sahiyyas restarted and established at various levels.
13. Sahiyyas activated, motivated and capacitated through intensive cascade trainings and
interpersonal communication
14. Village health committee bank accounts opened and untied fund transferred with the
facilitation of Sahiyya.
15. Transparent and rational use of untied funds initiated and expenditure report sought.
16. Community mobilization on health issues initiated, Sahiyyas also involved in VHNDays at
village level.
17. The participation of community in health camps, sterilization and tubectomy camps
increased due to Sahiyyas initiatives.
18. The immunization, institutional delivery and OPD patient’s numbers increased reposing
faith in the health system due to Sahiyyas active involvement, support for the beneficiaries
and Sahiyya Help Desk.
The Sahiyyas has been provided performance based incentives for many activities under NRHM,
and for National Programme. For the PIP11-12, indifferent programmes following are the
incentives proposed for the programmes-
Sr.No Programme Amount in SPIP 11-12(Rs in
Lakh)
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NRHM SPIP 2011-12 JHARKHAND
1 ASHA payment under NRHM additionalities 496.69
2 Incentive to ASHA under JSY 1201.71
3 Incentive to ASHA under Family Planning Services 1057.5
4 Incentive to ASHA under IDP 10.86
5 Incentive to ASHA under Immunization 369
6 Incentive to ASHA under NLEP 10.5
7 Incentive to ASHA under NVBDCP 208.79
8 Incentive to ASHA under NBCP 2
9 Incentive to ASHA under RNTCP 13.75
Streamlining incentives payment mechanisms for Sahiyyas and forging linkages
between Sahiyyas and other front line workers like ANMs, AWWs, para teachers &
Strengthening the District Level Sahiya Mentoring Team to guide the District
Programme Coordinators and Block Level Teams shall also constitute the Sahiyya
Support System. ‘Sahiyya Diaries’ and planning formats for better programme
implementation and smooth payment shall aide the above process.
Apart from these all performance based incentives, the State has felt that
Sahiyyas are really contributing their efforts to reach the NRHM goals, and to
recognized their efforts, for best performance in family palnning week, total 48
Sahiyyas for all 24 districts has been facilitated by the state in programme year 10-
11.To recognize their efforts and to motivate them for the Healthy community life
practices, the state has proposed the BEST SAHIYYA AWARD of Rs-5000/-( Five
Thousand) for one thousand Sahiyyas in the state.With the criteria of 100 percent
immunization, 100 percent institutional deliveries, proper utilization of untied funds
based on village health plans formulated by the VHC with the facilitation of Sahiyya.
Sr.No Programme Amount in SPIP 11-12(Rs in Lakh)
1 BEST SAHIYYA AWARD for 5000 sahiyyas 50
Following expected outcome can be achieved through providing this award
An Increase in institutional deliveries
Early identification and referral of danger signs in pregnancy
Increase in percentage of women receiving ANC/PNC services
Page 57 of 129
NRHM SPIP 2011-12 JHARKHAND
Increase in the percentage of complete immunization amongst children
Timely identification of malaria cases and treatment with Referrals
Reduction in diarrheal deaths through timely treatment and referrals
Accurate record of births and deaths
Tracking of pregnancy and mother and child
Increase in numbers of mothers initiating colostrums feeding and supplementary
feeding.
Identification of TB patients and increase in number of patients completing DOTs.
Increase in number of couples adopting family planning measures.
Transparent, rational and timely utilization of untied fund.
Home visits to all pregnant/lactating mothers by Sahiyya.
First aid, counseling and primary treatment of minor illnesses and availability of
identified drugs in the villages.
The assessment of Sahiyyas performance will be carried out in an innovative way as well. The Sahiyyas have been provided the Sahiyya Passbook in which all their activity and incentives has been recorded and VHC will also appraise the Sahiyyas performance. A team comprising of elected representatives of Panchayats, representatives of development partners as well as experts from the concerned line department of government will visit each of the villages. The overall co-ordination will be provided by the district level administration. During the Annual Sahiyya Sammelan (Annual Meet) at District level the awards will be given to these best performing sahiyyas along with the certificates.
DURG KIT FOR SAHIYYA
SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT Remarks
C DURG KIT FOR SAHIYYA Budgeted under Sec. 22.6.2 under General Drug & Supply of NRHM Additionality
C1 SAHIYYA KIT REFILLING OF DRUG KIT
41000 41000*Rs.600 2,46,00,000
TOTAL 2,46,00,000
Page 58 of 129
NRHM SPIP 2011-12 JHARKHAND
13.7 Budget require for FY 11-12
STATE PROGRAMME IMPLEMENTATION PLAN 2011-12 (BUDGET SUMMARY)
Sl. No.
PIP Head VSRC Budget Head No. of Days Unit Amount (in Lakh Rs.)
B.1.1 ASHA TRAINING
State & RegionalToT 101.52
SAHIYYA TRAINING 12 41000 1476
VHC TRAINING 4 100000 130
SAHIYYA SATHEE TRAINING 3 2184 9.61
DEVELOPMENT OF COMMUNICATION MODULE AND TRAINING MODULE
Event Event 116.75
SAHIYYA MOBILISATION AND ADVOCACY SAHIYYA PROGRAMME
Event Event 747.79
Community participation of PTGs Event Event 8.90
B.1.2 ASHA Drug Kit PROCUREMENT OF SAHIYYA DRUG KIT
600 41000 246.00
B8 PRI SENSITIZATION
PRI SENSITIZATION Event Event 50.40
B15 CBM CBM Event Event 23.10
B.14.5 Other Innovation
Innovative activities for Community programme
Event Event 80.62
B.1.3. VSRC VSRC HR 112.90
GRAND TOTAL 3103.59
Page 59 of 129
NRHM SPIP 2011-12 JHARKHAND
14. Mobile Medical Unit (MMU)
State of Jharkhand is mainly a plateau and most of the land is covered by dense forest.
Jharkhand consists of 40% of the schedule population out of which 28% percent is
scheduled tribes and 12% is scheduled caste. Majority of the Tribal group still lives in
the forest land or in the remote areas with open land and forest near to them. Being a
plateau it has many hard to reach areas and inaccessible localities. Poor infrastructure
has added more burden to it. Lack of proper maintenance and management of the
Government healthcare facilities has depilated the situation of healthcare delivery
services. Moreover Health seeking behavior of the Tribal people of Jharkhand is
somewhat different from other habitant; these groups usually have no proper
accessibility to health facilities as communities reside in clusters in the far-flung areas.
Mainly the rural communities are ridden with poverty therefore; people usually do not
prioritize health or seek health. Far-flung areas in the state of Jharkhand are unaware
about health infrastructure and facilities provided by the department of health and
family welfare. Therefore, we can conclude that the overall health seeking behavior and
accessibility of the healthcare facilities of the state is very poor.
Rational:
State of Jharkhand is in process of creating a vast public health infrastructure of Sub-
centres, Public Health Centres (PHCs) and Community Health Centres (CHCs). There is
also a large cadre of health care providers (Auxiliary Nurse Midwives, Male Health
workers, Lady Health Visitors and Health Assistant Male). Yet, this vast infrastructure is
able to cater to only 20% of the population, while 80% of healthcare needs are still
being provided by the private sector (1). Rural India is suffering from a long-standing
healthcare problem. Studies have shown that only one trained healthcare provider
including a doctor with any degree is available per every 16 villages. Although, more
than 70% of its population lives in rural areas, but only 20% of the total hospital beds
are located in rural area. Most of the health problems that people suffer in the rural
community are preventable and easily treatable. In view of the above issues, the
Mobile health Units can ensure health care services to the last person of the last village.
This project is designed to cater to the health and unmet needs of rural communities of
Jharkhand with special focus on those residing in unserved, underserved and hard to
reach areas. The project aims to improve the availability of and access to quality health
Page 60 of 129
NRHM SPIP 2011-12 JHARKHAND
care services. Jharkhand Rural Health Mission society initiated the project with 24 MMU
(Mobile Medical Unit) in 2008-09, based on the success full experience the department
had scaled up to 66 MMU (24 + 42 MMUs), and this year it has proposed to provide 37
more MMUs to the NGOs in order to cater hard to reach, unserved , underserved area.
Progress so far - Mobile Medical Unit
Strategy 2010-11 Progress Comments
Operationalisation of new
MMUs
In Process 37 new MMUs have been
started. The process has
been decentralized to the
districts.
Meeting the unmet health
needs of rural people
In process 989938 persons has been
observed and got
treatment,
X-ray examination of 21048
persons and Pathological
examination of 194942
persons have been done,
11131 ECGs and 1837
ultrasound were done
through the MMUs
between April to December
2010.
Since inception MMUs has catered to 2956638 patients, out of which total X-ray
conducted is 73843, Total Pathological Test conducted is 499723, Total ECG conducted
is 28459, Total Ultrasound conducted is14649, and number of total cases referred
is 143250 in 25629 total working days of the MMUs. This is a very significant number
and with the inception of 37 new MMUs this figure will increase drastically. This will
also improve the reach to the far flung rural areas. This year onward state has decided
to decentralize the process of MMU operationalization to the District Health Society.
Page 61 of 129
NRHM SPIP 2011-12 JHARKHAND
State will monitor and provide necessary support for the proper functioning and
operation of the MMUs.
Cumulative Status of MMU- April 2010 to December 2010
Page 62 of 129
NRHM SPIP 2011-12 JHARKHAND
Sl.
No.
District
Name Name of Organization
Date of
MMU
Initiation
Total no.
of patient
observed
Cumulat
ive
report
on X-ray
Cumulati
ve report
on Patho.
Test
Cumulativ
e report
on no. of
ECG
conducted
Cumulativ
e report
on no. of
Ultarsoun
d
conducted
Cumulativ
e report
on Cases
reffered
1 Bokaro
Human Rural
Foundation 12/8/2009 24403 0 4034 479 229 1150
Human Rural
Foundation 12/8/2009 24859 0 3415 1530 351 2669
Vikas Bharti (OLD) 23/04/08 24054 867 7119 122 0 1745
2 Chatra
Marksman Welfare
Society 3/8/2009 9921 0 254 9 13 119
Vikas Bharti (OLD) 13/03/08 22897 129 4187 0 0 767
3 Deoghar
NEEDS 27-08-09 0 0 0 0 0 0
Human Rural
Foundation 2/9/2009 8209 0 816 0 0 195
Vikas Bharti (OLD) 23/04/08 21104 435 4871 170 0 2340
4 Dhanbad
Sri Lal Jee
Prashikshan Kendra 4/8/2009 8708 301 1661 275 64 211
T.S.R.D.S 12/1/2010 7049 0 0 0 0 6
Human Rural
Foundation 14-08-09 19827 0 2181 859 184 2168
Vikas Bharti (OLD) 21/04/08 18332 1118 4901 156 48 1101
5 Dumka Citizen foundation 24-08-09 12515 235 2788 0 0 1014
Vikas Bharti (OLD) 15/02/08 19867 471 5216 345 0 1449
6 East
Singhbhum
Pragati 26-8-09 0 0 0 0 0 0
Aadarsh Seva
Sansthan 3/11/2009 0 0 0 0 0 0
T.S.R.D.S 1/8/2009 5181 0 0 0 0 38
Vikas Bharti (OLD) 26/03/08 21979 553 5356 857 43 973
7 Garhwa Vikash Bharti 2/8/2009 18426 412 2663 118 0 785
Vikas Bharti (OLD) 5/2/2008 20401 615 3364 262 0 782
8 Giridih
Vikash Kendra 5/8/2009 14944 0 535 311 249 641
Human Rural
Foundation 17-08-09 27559 3 1265 376 113 1994
Vikas Bharti (OLD) 18/04/08 24096 655 3347 268 44 2069
9 Godda Citizen foundation 7/8/2009 12092 376 4032 113 0 390
Vikas Bharti (OLD) 25/03/08 24283 208 4235 100 0 1027
10 Gumla St. Michal H. Centre 1/8/2009 10624 36 2830 1 0 411
St. Lievens H. Centre 1/8/2009 8635 469 1549 22 0 1544
Page 63 of 129
NRHM SPIP 2011-12 JHARKHAND
Vikas Bharti (OLD) 24/02/08 22523 440 6344 206 0 1069
11 Hazaribagh
T.S.R.D.S 0 0 0 0 0 0
Marksman Welfare
Society 2/8/2009 20670 0 293 105 109 320
Vikas Bharti (OLD) 23/04/08 0 0 0 0 0 0
12 Jamtara
Dynamic Tarang 1/8/2009 10328 338 3524 226 0 407
Citizen foundation 7/8/2009 11767 405 3564 178 0 763
Vikas Bharti (OLD) 22/4/08 21830 436 8602 200 0 757
13 Khunti
Sankalp Joyti 7/8/2009 16764 0 1759 0 0 739
Sankalp Kisan Vikas
Kendra 26-8-09 7898 631 1146 105 0 197
Vikas Bharti (OLD) 1/5/2008 23860 356 5570 194 53 1672
14 Koderma Pragati 26-8-09 0 0 0 0 0 0
Vikas Bharti (OLD) 21/4/08 29689 1161 6422 241 36 2004
15 Latehar Vikash Bharti 5/8/2009 16675 393 3085 75 0 631
Vikas Bharti (OLD) 23/4/08 20109 42 3585 165 0 504
16 Lohardaga
ICERT 1/8/2009 12566 295 4687 0 0 289
Madhur Muskan 28-12-09 6473 17 415 31 0 215
Vikas Bharti (OLD) 1/5/2008 21693 321 8031 275 0 971
17 Pakur Citizen foundation 15-8-09 16219 390 3626 0 0 180
Vikas Bharti (OLD) 6/4/2008 22845 1178 5300 140 0 1305
18 Palamu
Vivek For Vikas 3/8/2009 25114 1024 2706 505 193 536
Vikash Bharti 7/8/2009 20731 485 3222 0 0 754
Vikas Bharti (OLD) 28/2/08 24149 448 5240 99 0 417
19 Ramgarh
Sankalp Kisan Vikas
Kendra 4/9/2009 7264 234 583 17 0 198
Vikas Bharti (OLD) 6/5/2008 23962 1159 5424 158 0 1097
20 Ranchi
Madhur Muskan 2/1/2010 2412 64 366 2 20 96
RINCHI 14-8-09 7771 346 2044 19 49 122
SID 12.08.09 11524 0 1040 0 0 388
Vikas Bharti (OLD) 20/4/2008 24426 744 4611 135 8 1386
21 Sahebganj
Dynamic Tarang 1/8/2009 13911 1202 4142 126 0 1047
Vikash Bharti 2/8/2009 15607 251 4760 47 0 511
Vikas Bharti (OLD) 5/4/2008 17928 278 6072 127 0 497
22 Saraikela
ICERT 1/8/2009 12431 156 1160 25 0 154
T.S.R.D.S 3/8/2009 4473 0 0 0 0 14
Vikas Bharti (OLD) 3/4/2008 23630 402 3407 293 31 819
23 Simdega Citizen foundation 20-08-09 12362 153 1892 79 0 606
Vikas Bharti (OLD) 28/2/2008 21090 392 6544 622 0 1182
24 West T.S.R.D.S 0 0 0 0 0 0
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NRHM SPIP 2011-12 JHARKHAND
Broad Objective:
To cater to the health and unmet needs of rural communities of Jharkhand with special
focus on those residing in unserved, underserved and hard to reach areas
Specific Objectives:
a. To provide all the primary health services in underserved villages/regions in
selected blocks of the districts through Mobile Medical Units where health
facilities such as PHCs, CHCs or private health care facilities are absent or
limited.
b. To improve uptake of curative and preventive health services such as
immunisation, antenatal and post natal care, and general OPD services, in the
identified villages/regions, with the aim of reducing the incidence of common
illnesses and lowering maternal mortality and infant mortality.
c. To converge and facilitate with the ANM, AWW, SAHIYYA and village health
committee for betterment of the Health services.
d. To provide all the diagnostic facilities in the rural area
Services
MMU will be operational six days a week and will conduct all the duties as
mentioned below
a. All OPD services
b. Blood and urine, X-ray, ECG, Malaria test.– ensuring that there is no
contravention of the PCPNDT Act,
c. General physician consultation, obstetric and gynecological consultation,
ANC checkups,
d. Family planning services including IUCD insertion and RTI/STI diagnosis and
treatment
e. Immunization of children including Vitamin A supplementation with measles
Singhbhum RINCHI 14-9-09 6648 120 1250 0 0 68
Vikas Bharti (OLD) 16/12/200
7 22631 304 3907 363 0 1530
Jharkhand Total 989938 21048 194942 11131 1837 49033
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NRHM SPIP 2011-12 JHARKHAND
f. Treatment of minor ailments and minor injuries including supply of drugs to
patients.
g. Prophylaxis and treatment of Anaemia with IFA Tablets.
h. IEC and counselling.
i. Provide appropriate referral services to malnourish children, delivery cases,
TB cases, leprosy cases.
j. Will cooperate in all the Service related to various public health
programmes.
Activity plan, approved by the Concerned Deputy Commissioner / Civil Surgeon
of the area of operation with a copy being sent to District Health Society and
JRHMS, should be strictly followed.
The van will be operated on a predetermined route plan on regular basis every
month. The tour /camp plan detail need to be submitted to the DC/CS and Block
Medical Officers at least 15 days in advance.
MMU to have minimum number for staff as given below, there has been slight
change in the number of staff from the earlier agreement to ensure that the
medical staff is always available in the MMU.
S.No. Staff Number
1. Doctor – MBBS (Male) 1
2. Lady Doctor – MBBS 1
3. ANM or Staff Nurse 1
4. Lab technician 1
5. X Ray Technician 1
6. Driver 1
7 Helper 1
All minor maintenance and repair work for the vehicle or equipment should be
undertaken by the operator on the weekly off days.
Operational guideline and Inspection for the MMU
1. The mobile medical unit would be operational in consultation and direct
supervision of the Deputy Commissioner and Civil Surgeon of the concerned
district.
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NRHM SPIP 2011-12 JHARKHAND
2. DRHS shall have right to inspect, ask for the report and review the MMU
performance and Operator has to extend necessary support.
3. Operator / NGO shall adhere to the advices / opinion given by the Deputy
Commissioner /Civil Surgeon of the district concerned for extending health
services to targeted beneficiary for which it is intended for.
4. Route planning for the placement of mobile health units will be done after the
mapping and demarcation of the outreach areas.
5. Cluster of 5-6 surrounding villages will be formed and camps will be organized at
cluster level to cover maximum number of patients.
6. Frequency of the visit will be finalized based on area mapping. It would also
prioritize the need of the community.
Monitoring and Evaluation
a. There will be a district level monitoring and Evaluation committee for the proper
operationalization of Mobile Medical Unit headed by Deputy Commissioner / Civil
Surgeon of the respective districts and Medical Officer In charge (MOIC) of the
respective block in which area the MMU would operate.
b. Monthly review meeting will be held at district level to ensure proper utilization and
review of the services provided by MMU.
c. Committee will develop monitoring plan which would be used for Monitoring and
Evaluation of the MMU.
d. Operator / NGO will submit a progress report once in every month in the prescribed
Performa / format provided by the DRHS.
Plan for 2011-12
Strategies and Activities
14.1. The state had been using mobile medical services to increase the reach of
medical and health services to inaccessible areas and disadvantaged population
groups. Currently state has 66 operational mobile medical units run by NGOs in
different districts. This year 2010 another 37 mobile medical unit will be made
operational. These new mobile medical unit will be provide mobile medical
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NRHM SPIP 2011-12 JHARKHAND
services specially in tribal areas on Hat-Bazaar days / RCH and PTG camp days
apart from the regular six days a week services. Since the state has procured
sufficient no. of MMUs, now it will focus on their proper utilization and quality
service delivery. This year state will mainly focus on their monitoring; evaluation
and their performance, therefore each district to nominate nodal officer who
will ensure their proper utilization and service delivery on daily basis. State,
regional and district Quality Assurance team will asses the performance on
monthly basis on the basis of the following Performance parameters which help
in gauging performance of MMUs like,
a) Frequency of Visit
b) Following of Schedule
c) Advance Intimation of Schedule
d) Duration of Stay and Timing of MMU
e) Doctors accompanying
f) Availability of Medicine / essential drugs
g) Cured of illness in last visit
h) People satisfaction about skill and behaviour
i) Location of MMU
j) Average distance travelled to MMU
k) Average time taken per patient
l) Availability of diagnostics
m) Follow up of Patients.
n) Family planning services and medicines
GPS tracking system will be placed in the MMUs so that they can be easily traced and
services can be optimized.
Community mobilization will be done through the active involvement of Sahiyya and
Village Health Committees already functional in the state of Jharkhand.
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NRHM SPIP 2011-12 JHARKHAND
Budget Requirement
Particulars Unit Cost Total Cost for 103
MMU (In Lakhs)
rEMARKS
Monthly Running cost
300000/- per MMU
3708.00
Budgeted under
Sec. 12.1-12.2
under Mobile
Clinic of NRHM
Additionality
Wear and Tear of the Tyres and spare
parts
Management and Maintenance of the
Equipment
Insurance for the MMUs whose free
insurance is getting over
GPRS for 103 MMUs 15000 / - 15.45
14.1.1 Mobile Medical Units/Emergency Referral Transport: State specific requirement
of MMUs needs to be assessed realistically. Performance parameters which help in
gauging performance of MMUs like,
a) Frequency of Visit
b) Following of Schedule
c) Advance Intimation of Schedule
d) Duration of Stay and Timing of MMU e) Doctors accompanying f) Availability of
Medicine g) Cured of illness in last visit h) People satisfaction about skill and behaviour
i) Location of MMU j) Average distance travelled to MMU k) average time taken per
patient l) Availability of diagnostics
m) Follow up of Patients etc need to be reflected in the MMU plan.
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NRHM SPIP 2011-12 JHARKHAND
MAMTA WAHAN
Jharkhand is a state which is still struggling with its quality referral
network to save both the mother and child. As we are all aware that most
of the maternal deaths occur due to three delays. These delays are from
community to facility, from primary level facility to secondary level facility
and from secondary level facility to tertiary level facility. If we analyze the
data of MAPEDIR of the state we found that the women who died almost
80% of them did not have the access to any formal means of
transportation.
It has also been observed that nearly 60% of deaths in hospital happen in
the first hour of admission. 60% who die in an emergency could have been
saved had quality care been available to them earlier. With a view to
providing emergency transportation & promote care to victims of
accident, risk pregnancy cases and other medical emergency like cardiac,
cancer, asthma, snake bite, case of burn have been managed by
Emergency Medical Services.
Bottlenecks
Long distances from 24 x 7 delivery centers’/facility with poor connectivity
_ Lack of referral transport to connect Rural community to Health centers
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NRHM SPIP 2011-12 JHARKHAND
Objective
To establish a quality referral/ emergency service system across the
state in a Private Public Partnership mode.
To reduce at least 25% maternal mortality and morbidity rates in an
emergency.
Strategy
24x 7 Free Emergency Transports along with Call Center
24x 7 Call center will be established at district level for coordinated contact at all
levels. Already piloted in Khunti district of Jharkhand
The Call Centers will be located in all 24 districts headquarter
The system will function on a three tire system which will help to establish a
connect rural community with Health centers.
The three tier system will be
Mapped vehicle will be used to bring women from facility to the
center
Ambulances will be used from Primary facility to secondary or
tertiary care
After the heal from facility to back to community free of cost
Fleet of 167 government owned ambulances owned by government and given to
different NGOs
State Government has promised to procure 110 ambulances to be given to the
Health department.
Ambulances of other agencies like Rotary, Faith Based organizations at various
locations
Mapping of other vehicles that can be utilized for this purpose
Emergency transport of pregnant women & sick children will be the main focus.
In districts of Ranchi & Dhanbad it will also be utilized during any type of
Emergencies
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NRHM SPIP 2011-12 JHARKHAND
_All vehicles will be equipped with Mobile phones for coordination.
The tracking of the vehicle will be done through call center level
Sahiya will be accompanying the pregnant women or the sick child to the
institution.
Operational Cost
The operational Cost will be borne from the NRHM fund parked in the district for this
purpose. Mechanism of detailed operational cost will be developed and will be shared at
all levels.
The total requirement will be as follows:
Sl.
No
Activity Unit Unit Cost Total
Months
Total Amount
(in Lakh)
Remarks
01 Operational Cost
includes servicing
277 30000.00 10 831 Budgeted under
Sec. 12.3 under
Mobile Clinic of
NRHM
Additionality
02 Mobile Operational
Cost
277 300.00 10 8.31
Total 839.31
The operational Cost of the Call Center has already been budgeted in the Maternal
Health Part.
Partnership
The Mamta Wahan will function in public private partnership mode.
MIS & Reporting
The data will be captured at the call center level. Follow up mechanism will also be
developed for the mother and child. The Call Center is also having the MIS in place and
currently used in Khunti.
The report generated will be shared at all levels.
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NRHM SPIP 2011-12 JHARKHAND
15. Mainstreaming of AYUSH
The Indian Systems of Medicine and Homoeopathy (ISM&H) were given an independent
identity in the Ministry of Health and Family Welfare in 1995 by creating a separate
Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
(AYUSH) in November 2003. The department is entrusted with the responsibility of
developing and propagating officially recognized systems, namely, Ayurveda, Yoga,
Naturopathy Siddha, Unani, and Homoeopathy. This was done in explicit realization of
contributions these ancient and holistic systems can make towards the health care of
the people. These systems have marked superiority in addressing chronic conditions
and offer a package of promotive and preventive interventions.
The AYUSH systems of medicine and its practices are well accepted by the community,
particularly, in rural areas. The medicines are easily available and prepared from locally
available resources, economical and comparatively safe. With this background, it will be
more useful for the mainstreaming/integration of AYUSH systems in National Health
Care Delivery System under “National Rural Health Mission (NRHM)”.
Jharkhand in particular, is habitated with rich flora and fauna. The people particularly
the rural people making use of the herbal medicines extracted from the herbal plants
found in the forests. Therefore integration of AYUSH with modern system of medicine is
supposed to improve the health condition of the people of Jharkhand.
All the AYUSH activities in the state are being coordinated by a well established AYUSH
department under department of Health and Family Welfare, Jharkhand. Department is
headed by a Director with 2 Dy. Directors respectively for Ayurveda and Unani unit of
AYUSH. There is need of 1 deputy director of homeopathic. 22 districts AYUSH Medical
Officers (DAMO) has been appointed in the entire 24 district for streamlining the AYUSH
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NRHM SPIP 2011-12 JHARKHAND
services at the facilities at district level still need 2 more DAMO. Jharkhand state AYUSH
medical council has been formed but need staff along with registrar.
Sl District Name Regular
Sanctioned In position Extra in-charge
Vacant
1 Director AYUSH 1 1 0 0
2 Add. Director AYUSH 1 1 0
3 Deputy director (Ayurvedic) 1 1 0
4 Deputy director (Homoeopathic) 1 1 0
5 Deputy director (Unani) 1 1 0
6 registrar, JS AYUSH Medical council 1 1 0
7 District AYUSH medical officer 22 22 0 0
Table 15.1
AYUSH Existing Human Resource
For better co-ordination of the various activities, doctors and Para medics have been
posted at the various health facilities. Figure indicates there is huge shortage of medical
officer in all Heads of AYUSH only 149 in position against the 454 sanctioned posts. It’s
an urgent need to fill all this post as earlier to boost the AYUSH health services.
Table 15.2
Heads of AYUSH Regular
Sanctioned In position Vacant
Ayurvedic 274 91 183
Homoeopathic 119 47 72
Unani 61 11 50
Total 454 149 305
District Name
Ayurvedic Unani Homeopathic
Sanctioned In position
Vacant Sanctioned In position
Vacant Sanctioned In position
Vacant
2 3 4 2 3 4 2 3 4
Ranchi 16 14 2 4 3 1 3 2 1
Gumla 7 4 3 2 0 2 4 3 1
Lohardaga 3 2 1 2 1 1 3 3 0
Simdega 11 4 7 3 0 3 6 1 5
Hazaribagh 1 1 0 1 1 0 1 1
Koderma 11 2 9 3 0 3 6 6
Chatra 11 3 8 3 0 3 6 6
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NRHM SPIP 2011-12 JHARKHAND
Giridih 3 3 0 1 0 1 2 2
Dhanbad 2 2 0 2 1 1 2 2 0
Bokaro 11 0 11 3 0 3 6 3 3
Dumka 9 6 3 2 0 2 4 3 1
Jamtada 11 1 10 3 0 3 7 2 5
Godda 4 2 2 2 1 1 1 1 0
Pakur 11 3 8 3 0 3 6 2 4
Deoghar 2 2 0 2 0 2 1 1 0
Sahebganj 6 4 2 3 0 3 4 4 0
Palamu 3 2 1 1 0 1 1 1
Gadwa 11 1 10 3 0 3 6 1 5
latehar 11 4 7 3 0 3 6 4 2
East. Singhbhum
11 6 5 3 2 1 6 3 3
West Singhbhum
16 11 5 2 1 1 7 4 3
Sarikela 14 9 5 3 0 3 6 4 2
Additional PHC
88 5 83 0 1 1 22 4 18
Ayush medical Board
1 1 1 1 1 1
Total 185 86 99 54 10 44 94 43 51
Table 15.2
Third grade Staff pattern also indicates that there is wide gap in position. It would be
urgent priorities to fill the gaps.
Sl Designation Class – 3
Sanctioned In position Vacant
1 Stenographer Cum Typist 22 11 11
2 Clerk cum Storekeeper 119 9 110
3 Ayurvedic compounder 145 61 84
4 Unani compounder 54 26 28
5 Homoepathic compounder 94 44 50
Table 15.3
AYUSH Existing Infrastructure Status:
Overall 24 districts have 267 dispensaries along with 22 joint dispensaries to provide
health care services.
Sl Districts No. of Dispensaries No. of Joint Dispensary
1 Bokaro 17 1
2 Chatra 19 1
3 Deoghar 2 1
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NRHM SPIP 2011-12 JHARKHAND
4 Dhanbad 3 1
5 Dumka 14 1
6 East Singhbhum 17 1
7 Garhwa 22 1
8 Giridih 3 1
9 Godda 4 1
10 Gumla 10 1
11 Hazaribag 0 1
12 Jamtara 17 1
13 Khunti (included with Ranchi) 0 0
14 Koderma 17 1
15 Latehar 17 1
16 Lohardaga 5 1
17 Pakur 14 1
18 Palamu 2 1
19 Ramgarh (included with Hazaribagh)
0 0
20 Ranchi 20 1
21 Sahibganj 10 1
22 Saraikela 19 1
23 Simdega 13 1
24 West Singhbhum 22 1
Jharkhand Total 267 22
Table 15.4
Progress so far
Strategies in 2010-11 Progress Comments
Establishment of AYUSH Clinics under Centrally Sponsored Scheme
In process Recruitment of doctors and paramedics for AYUSH clinics in 97 PHCs and 48 CHC is in process.
Recruitment In process Recruitment of computer operator has been done. Recruitment of AYUSH Coordinator and Store keeper is in process which is likely to be completed by the 2
nd
week of Feb 2011
IEC In Process Allocation for IEC has been disbursed to districts. Activities are being taken up by the districts
Capacity Building In Process Training of AYUSH doctors on Primary Health Care and NDCP is in process. Trainings of ANMs on AYUSH and Compounders on medicine preparation have not been initiated due to un availability of staffs.
Table 15.5
Plan for Year 2011-12
Broad Objective
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NRHM SPIP 2011-12 JHARKHAND
Mainstreaming of AYUSH in the health care service delivery system to
strengthen the existing public health system.
To draw up schemes for,
Promotion of all the systems under AYUSH
Promotion, cultivation and regeneration of medicinal plants used in
these systems.
Standardization of AYUSH Education & continuing Medical Education (CME);
research & development; IEC & international collaboration.
Strategy and Activities
15. 1. Strengthening of AYUSH
Integration of AYUSH in to the regular health service delivery system has been
visualized in NRHM. Though the state has taken up several initiatives in order to put up
AYUSH in the main way along with other systems of medicine the slow pace of in
implementation of activities came up as major bottleneck in realizing the objectives of
AYUSH.
To accelerate the implementation of programme strengthening of the institutions
under AYUSH is therefore one of the major concern of the state.
In year 2011-12 state is proposing to take up activities for strengthening of the AYUSH
as follows,
15.1.1. Establishment of AYUSH clinics in PHC and CHCs
State is proposing to establish AYUSH clinics in the 97 PHCs and 48 CHCs in the coming
year under the Centrally Sponsored Scheme. Establishment will cover the cost of human
resources for AYUSH, medicines and equipments.
Facilities Establishment of AYUSH Clinics proposed in 2010-11
Establishment of AYUSH Clinics proposed in 2011-12
Total Establishment of AYUSH Clinics by
2012
PHC 97 153 200
CHC 48 52 100
Total 145 205 300
Table 15.6
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NRHM SPIP 2011-12 JHARKHAND
Budget Requirement for Establishment of AYUSH clinics in PHC and CHCs
Particulars Units Unit Cost To be supported by Department of AYUSH.
Establishment of AYUSH Clinics in PHCs 153 1000000
Establishment of AYUSH Clinics in CHCs 52 2200000
Total
Table 15.7
15.1.2. Strengthening of the Management System of AYUSH State level / District level
Although there the AYUSH Directorate functioning, need for management and technical
capacities has been sought in making the AYUSH properly functional.
In the FY 2010-11, it was proposed to create necessary managerial post in the State and
District level for effective implementation and supervision of different activities under
AYUSH. This is process and likely to be completed by 2nd week of February 2011.
In the coming FY, salary for the all those posts has proposed.
Budget Requirement Strengthening of the Management System of AYUSH
Particulars Unit Unit Cost Total Cost (In Lacs)
Remarks
Salary to Technical Coordinator / Consultant AYUSH ( 1 x 12 Months) (Pay band 28000-35000)
12 28000 3.36 Budgeted under Sec. 11.1.17.1-11.1.17.2
under Staff for Ayush of Progm Mngmt of
RCH Salary to Computer Operator ( 1 x 12 Months)
12 12500 1.50
Total 4.48
Table 15.7
15.1.3. Strengthening of the Jharkhand State AYUSH Medical Council
Jharkhand State AYUSH Medical Council is the apex institution that deals with various
affairs of AYUSH initiatives in the state. The council has recently constituted and started
functioning. Its major activities include registration of AYUSH doctors in the state and
conducting examination and registration of AYUSH-Compounders (Dip. in Ayurvedic
Pharmacy, Dip. in Homeopathy Pharmacy, and Dip. in Unani Pharmacy).
In the coming FY 11-12 state is proposing for quarterly review of activities of council.
Page 78 of 129
NRHM SPIP 2011-12 JHARKHAND
Budget Requirement for Strengthening of the Jharkhand State AYUSH Medical Council
Particulars Unit Unit Cost Total Cost (In Lacs)
Remarks
Quarterly Meeting / Sensitization Program (One day event)
2 35000 0.70 Budgeted under Sec. 10.1.1 under Ayush of NRHM
Addlt
Table 15.8
15.1.4. Strengthening of the Jharkhand State Medicinal Plant Board (JSMPB).
JSMPB is a registered society under the Society Registration Act, 1960 under the
Department of Health and Family Welfare, Govt. of Jharkhand.
JSMPB follow and work in field of Central Sector Schemes as per the guidelines of
National Medicinal Plant Board (NMPB).
In the current year as per the direction of 6th Standing Financing Committee (SFC),
Project Proposal for National Campaign for Amla and Sahjan has been sent for approval
from NMPB.
Also proposal from NGOs has been invited under the Central Sector Schemes of NMPB.
Recommendation from State Level Screening and Evaluation Committee (SLSEC) is
under screening.
At present the Board is functioning with only one Officer on Special Duty (OSD). Thus,
there is urgent need of supporting man power for making the Board fully functional.
Therefore in the coming year state is proposing for recruitment of manpower to
strengthen the JSMPB.
Budget Requirement
Particulars Unit Unit Cost Total Cost (In lacs)
Remarks
Account officer (1 x 9 months) 1 20000 1.80 Budgeted under Sec. 11.1.17.4-
11.1.17.5 under Staff for Ayush of Progm Mngmt of
RCH
Computer operator (1 x 9 months) 1 8000 0.72
Total 3.375
Table 15.9
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NRHM SPIP 2011-12 JHARKHAND
15.2. Provide AYUSH services under one roof with NRHM
The AYUSH health facility has to work under one roof and separate space would be
allocated exclusively for it in the same building of DH/CHC/PHC.
In case of not availability of separate space in the DHs /CHC/PHC civil works should be
undertaken from the funds provided to AYUSH Department for this purpose.
In this regard to mainstream AYUSH along with other systems of medicine state is
proposing following activities.
15.2.1. Mapping and Setting up of AYUSH health facilities
Mapping / Facility survey of the AYUSH facilities will be undertaken in the coming year.
The Jharkhand State Health Resource Centre (JHSRC) will undertake the facility survey
of AYUSH facilities in coordination with AYUSH department.
15.2.2 Develop Infrastructure for AYUSH
After the facility survey requirement of the infrastructure for AYUSH will be demanded
and proposal for the same will be sent to Department of AYUSH, GoI for approval.
15.2.3. Filling up the different HR positions under AYUSH
To support the activities under AYUSH there is need to fulfill the positions of adequate
staffs in the dispensaries and joint dispensaries.
In the FY 2010-11 establishment of State Level Warehouse of AYUSH (Ayurveda, Unani
and Homeopath) with three Store keepers was proposed. The recruitment of these
positions is in process which is likely to be completed by the end of February 2011.
In the FY 2011-12, salary for the store keepers has proposed.
Budget Requirement
Particulars Unit Unit Cost Total Cost (In lacs) Remarks
Recruitment of Storekeeper on contract (3 x 10 months)
3 12000 per month
4.32 Budgeted under Sec. 11.1.17.3 under
Staff for Ayush of Progm Mngmt of
RCH
Table 15.10
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NRHM SPIP 2011-12 JHARKHAND
15.2.4. Provisioning of storage of equipments will be made
15.2.5. Availability of AYUSH Drugs at all levels
Drugs for AYUSH will be made available at all levels by the Dept. of AYUSH, GoI.
15.3. Integration of AYUSH with Community processes
15.3.1. Drug kit that will be provided to Sahiyya will contain two AYUSH preparation
Purnavadi Mandur - Iron supplement Pudin Hara. Other drugs which are used in the
treatment of common diseases, control of communicable diseases as well as drugs
promoting the maternal and child health as well as improving quality of life could be
included subsequently.
The availability of drug will be supported by Dept. of AYUSH, GoI.
15.3.2. Training module for ASHA will be updated with information of AYUSH.
15.3.3. Sahiyya Sandesh Each issue of the sahiyya sandesh magazine will cover one
component of AYUSH.
15.4. Promotion of AYUSH
15.4.1. The state is proposing to organize AYUSH Mela at the district level. AYUSH
Doctors shall be involved in IEC, health promotion and also supervisory activities. Also
under RCH Camps AYUSH doctors shall be involved. AYUSH Mela will be organizing in all
22 AYUSH Operational districts.
Budget Requirement for AYUSH Mela
Particulars Unit Unit cost Total Cost Remarks
Organizing AYUSH Health Mela (1 x 24 districts)
22 50000 1100000 Budgeted under Sec. 10.2 under Ayush of NRHM Addlt
Table 15.11
15.4.2. IEC for AYUSH
Using the mass media Radio / TV, leaflets/handbills / posters, wall writing, folk plays will
be taken up for promoting AYUSH. This will be done in integration with IEC of other
health programmes.
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NRHM SPIP 2011-12 JHARKHAND
The budget of IEC for AYUSH is been integrated with the allocation of other health
programmes in the IEC section.
Budget Requirement for IEC
Particulars Unit Unit cost Total Cost Remarks
Budget for IEC 24 20000 480000 Budgeted under Sec. 10.3 under Ayush of NRHM Addlt
Table 15.12
15.5. Capacity building in AYUSH
15.5.1. Training of AYUSH doctors in Primary Health Care and NDCP – To update
AYUSH doctors on Primary Health Care and National Disease Control Programmes
(NDCPs), it has been proposed to provide them refresher training on Primary Health
Care and National Disease Control Programmes (NDCPs). Each State ToT covered 40
participants for one day in 2 batches.
Particulars Unit cost Unit Total Cost Remarks
State ToT (In 2 batch) on Primary Health Care and NDCP (Refresher Training)
50000 2 100000 Budgeted under Sec. 10.4 under Ayush of NRHM Addlt
Table 15.13
15.5.2. Training of ANMs and Anganwadi workers on AYUSH system of medicine
As an innovative strategy, the department of AYUSH needs to train the Anganwadi
workers working for Mother and Child Health and the ANMs, who are the grass root
level health care providers in Allopathic units. The Anganwadi workers can enhance the
child nutrition and Maternal Health by the AYUSH herbs. These ANM’s and Anganwadi
workers can propagate the AYUSH based preventive principles and herbal remedies for
common public.
Initially 500 ANM’s from the 100 tribal blocks will be trained on AYUSH based heath
principles for maternal and child health. The training will be conducted at the block
level with two days training by AYUSH dept.
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NRHM SPIP 2011-12 JHARKHAND
Budgetary Requirement for Training of ANM
Particulars Unit Unit Cost
Total Cost Remarks
District level one day training of ANMs on AYUSH based heath principles for maternal and child health (100 tribal block) (500 ANMs x Rs 500)
500 1000 500000 Budgeted under Sec. 10.5 under Ayush of NRHM
Addlt
Table 15.14
15.5.3. Refresher Training of paramedical staffs
For preparation, storage and dispensing of AYUSH medicine - The major supporting
staffs of the Ayurveda dispensaries are compounders. A large cadre of
101compounders working in AYUSH in the state. The compounder handles record and
medicines. Medicine preparation and dispensing to the patient is the primary work of
compounders. The compounders are not trained for preparation of simple Ayurvedic
herbal combinations. To enhance the performance of compounder and for the patient
to receive correct herbal combination for the ailments the compounder’s essential
needs to be trained. Right medicine to be dispensed is very essential for proper cure of
diseases and by training of compounders, the right method of dispensing of medicine
can be inculcated in the compounders Ayurvedic medicines need to be stored with
caution and basic understanding of the herbal combination. This basic understanding of
preservation of Ayurvedic herbs need to be incorporated in the compounder. Due lack
of skills among the compounders on preservation and preparation of herbs, wastage of
large quantity of Ayurvedic medicines is occuring.
Therefore, training of AYUSH compounders for better methods of medicine storage has
pllaned in the coming year. 101 compounders will be trained in 4 batches (each batch 4
days) at Government Ayurveda College on Medicine preparation, storage and
dispensing.
Budgetary Requirement
Particulars Units Unit Cost Total cost Remarks
Training of Compounders for medicine preparation, storage and dispensing
2 130000 260000 Budgeted under Sec. 10.6 under Ayush of
NRHM Addlt
Table 15.15
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15.5.4. Herbal Treatment and Research Hub
To broaden space of AYUSH services and to promote research and development on
AYUSH system of medicines with special focus on local system of medicine it has been
proposed to establish herbal treatment hub in the five districts namely West
Singbhum, Deoghar, Hazaribagh, Gumla, Palamu one each in 5 divisions of state.
Apart from treatment of ailments, these hubs are intended to promote medicine
system being used by the people since the ages. Also these hubs will undertake
research on the system of medicine to explore the potential of the system in curing
ailments. This hub will also undertake activities to conserve cultivate, regenerate the
herbs.
A detailed action plan will be developed by the State AYUSH department to start the
hubs. It has been proposed to avail the proposed districts with Rs. 500000 each for the
establishment of the hub in the first phase.
Budget Requirement for Herbal Treatment and Research Hub
Particulars Unit Unit Cost Total Cost Remarks
Establishment of Herbal Treatment Hub
5 500000 2500000 Budgeted under Sec. 10.67 under Ayush of NRHM Addlt
Table 15.16
15.6. PPP for AYUSH
To mainstream AYUSH in health Sector Jharkhand Rural Health Mission Society has
partnered with Kerala Ayurveda Treatment center with objective,
To create awareness about the Strengths of Ayurveda treatment and revive the
Indian System of Medicine
To integrate Ayurveda system with the health care delivery system as well as a
national program.
To upgrade the skill and develop a team of experts (therapists, doctors etc) who
will mainstream the activities under AYUSH
The success of the programme will help us to replicate the same in all the districts of
Jharkhand.
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The strategies adopted under the PPP as follows,
1. Strengthening the existing Ayurveda system Jharkhand
2. BCC / IEC campaign
3. Training / capacity building packages for doctors, paramedical staffs and therapists
4. Convergence and coordination with other government department and agencies
working in the same field
The operational area for the pilot program was selected in Ranchi division in all the five
districts namely Ranchi, Khunti, Gumla, Lohardaga and Simdega. In this partnership, an
ambulance has been provided for outreach services of Ayurvdeda services at the
community level. This ambulance has to provide five days services in each district based
on the micro plan develop by the Civil Surgeon.
To mainstream OPDs services two room has been provided in each district hospitals for
promotion of ayurveda treatment & therapy. Also KATC has to provide medicines to
cure the diseases.
Budget Requirement
Particulars Unit Unit Cost Total Cost Remarks
Ayurveda Treatment center 5 500000 2500000 Budgeted under Sec. 10.8 under Ayush of NRHM Addlt
Table 15.17
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16. Hospital Management society
Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society is a
simple yet effective management structure. This committee, which would be a
registered society, acts as a group of trustees for the hospitals to manage the affairs of
the hospital. It consists of officials from Government sector and members from NGOs,
local elected representatives and who are responsible for proper functioning and
management of the hospital / PHC. Each HMS has one Governing Board for policy
decisions and one Executive Committee for execution of the functioning of HMS. HMS
can accept funds from NRHM and other sources including the donations from private
parties. Each district hospital would get a grant of Rs 5 lakhs, each CHC (existing PHC)/
PHC (existing APHC)/ Sub Divisional Hospital (SDH)/ Referral Hospital/ Urban Family
Welfare Centre would get a grant of Rs 1 lakh each from NRHM flexi-pool. The RKS/
HMS is free to prescribe, generate and use the funds placed with it, as per its best
judgment for smooth functioning and maintaining the quality of services.
16.1 Objectives the RKS (Hospital Management Society)
Ensure compliance to minimal standard for facility and hospital care and
protocols of treatment as issued by the Government.
Ensure accountability of the public health providers to the community.
Introduce transparency with regard to management of funds.
Upgrade and modernize the health services provided by the hospital and any
associated outreach services.
Supervise the implementation of National Health Programmes at the Hospital
and other institutions that may be placed under its administrative jurisdiction.
Organize outreach services/ health camps at facilities under the jurisdiction of
the hospital
Display a Citizens’ Charter in the Health facility.
Generate resources locally through donations, user fees and other means
Establish affiliations with private institutions to upgrade services
Undertake construction and expansion in the hospital building
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Ensure optimal use of hospital land as per govt. guidelines
Improve participation of the society in the running of the hospitals
Ensure proper training for doctors and staff
Ensure subsidized food, medicines and drinking water and cleanliness to the
patients and their attendants.
Ensure proper use, timely maintenance and repair of hospital building
equipment and machinery.
16.2 Functions of the RKS (HMS)
To achieve the above objective, the Society shall direct its resources for undertaking
the following activities / initiatives:
Identifying the problems faced by the patients in CHC / PHC.
Acquiring equipment, furniture, ambulance (through purchase, donation, rental,
or any other means, including loans, from banks) for the hospital
Expanding the hospital building, in consultation with and subject to any
Guidelines that may be laid down by the State Government.
Making arrangements for the maintenance of hospital building (including
residential buildings), vehicles and equipment available with the hospital.
Improving boarding/ lodging arrangements for the patients and their attendants
Entering into partnership arrangement with the private sector (including
individuals) for the improvement of support services such as cleaning services,
laundry services, diagnostic facilities and ambulatory services.
Developing/ leasing out vacant land in the premises of the hospital for
commercial purposes with a view to improve financial position of the Society.
Encouraging community participation in the maintenance and upkeep of the
hospitals
Promoting measures for resources conservation through adoption of wards by
institutions and adopting sustainable and environmental friendly measures for
the day-to-day management of the hospitals e.g. scientific hospitals waste
disposal system, solar refrigeration systems, water harvesting and water re-
charging systems.
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16.3 Progress till date
All the health facilities such as CHCs/PHCs/DHs have been informed to form
Hospital Management Societies and register them. Accordingly, current status of
formation of HMS is given in table below:
Status of HMS formed
Sl. No. Name of the District No. of HMS Formed No. of Registered HMS
1 Bokaro 29 1
2 Chatra 17 1
3 Deoghar 14 14
4 Dhanbad 43 38
5 Dumka 44 1
6 East Singhbhum 28 0
7 Garhwa 20 20
8 Giridih 28 1
9 Godda 17 5
10 Gumla 24 24
11 Hazaribagh 25 1
12 Jamtara 13 1
13 Khunti 12 1
14 Koderma 13 1
15 Latehar 15 15
16 Lohardaga 16 1
17 Pakur 16 2
18 Palamu 33 1
19 Ramgarh 11 0
20 Ranchi 38 6
21 Sahebgaunj 20 19
22 Saraikela 20 1
23 Simdega 15 2
24 West Singhbhum 35 1
Jharkhand 546 157
Table 16.1
16.4 Utilization of Hospital Management Society (RKS) funds
Almost all the RKS have started utilizing their funds for welfare of patients.
Department has issued guidelines to utilise the funds to all RKS. Pattern of utilisation of
funds by RKS up to November 2010 is mentioned below:
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16.5 Plan of action – 2011-12
State Health Society will concentrate on optimizing the functioning of HMS
during current year. Guidelines to all HMS for utilization of funds and delegation of
powers have already been published. HMS training/workshop will be organized. This
will be completed at earliest and RKS will be supported for better role in planning and
management of hospitals during year 2011-12.
16.6 Budget requirement for HMS is given in table below:
Budget requirement for the year 2011-12
Rs. In Lakhs
Sl.no. Type of Facility No. of Facility
Total budget required
Unit rate Budget required
Remarks
1 District Hospital 21 5.0 105 Budgeted under Sec. 7 under RKS of NRHM
Addlt 2 Sub Divisional Hospitals/
Ref. Hospital/ CHCs/ PHCs/ 530 1.0 530
Total 546 635
Table No. 16.2
Table above indicates that budget requirement for RKS/HMS is Rs. 630 Lakhs.
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17. Untied Fund & Annual Maintenance Grant
17.1 Objective
To increase functional, administrative and financial resources and autonomy to
the field units.
To develop the physical infrastructure and centre specific activities for PHCs.
17.2. Strategy
Provide Untied Funds to Village Health Committees @ Rs. 10,000 each
Provide Untied Funds to Health Sub centres @ Rs. 10,000 each
Provide Untied Funds to Primary Health Centers @ Rs. 25,000 each
Provide Untied Funds to Community Health Centers @ Rs. 50,000 each
Provide Annual Maintenance Grant to Health Sub centres @ Rs. 10,000 each
Provide Annual Maintenance Grant to Primary Health Centers @ Rs. 50,000 each
Provide Annual Maintenance Grant to Community Health Centers @ Rs.
1,00,000 each
17.3 Activities
17.3.1. Village Health Committee
Any village level public health activity like cleanliness drive, sanitation drive,
school health activities, ICDS, Anganwadi level activities, household surveys etc.
Health care need of the poor household.
Community activities that involve and benefit more than one household.
Nutrition, Education & Sanitation, Environmental Protection, Public Health
Measures shall be key areas.
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17.3.2. HSC :
Minor modifications to sub centre- curtains to ensure privacy, repair of taps,
installation of bulbs, other minor repairs
Ad hoc payments for cleaning up sub centre, especially after childbirth.
Transport of emergencies to appropriate referral centers
Transport of samples during epidemics.
Purchase of consumables such as bandages in sub centre
Purchase of bleaching powder and disinfectants for use in common areas of the
village.
Labour and supplies for environmental sanitation, such as clearing or larvicidal
measures for stagnant water.
Payment/reward to ASHA for certain identified activities
17.3.3 PHC, CHC
Minor modifications to the Center- curtains to ensure privacy, repair of taps,
installation of bulbs, other minor repairs, which can be done at the local level
Patient examination table, delivery table, DP apparatus, hemoglobin meter,
copper-T insertion kit, instruments tray, baby tray, weighing scales for mothers
and for newborn babies, plastic/rubber sheets, dressing scissors, stethoscopes,
buckets, attendance stool, mackintosh sheet
Provision of running water supply
Provision of electricity
Ad hoc payments for cleaning up the Center, especially after childbirth.
Transport of emergencies to appropriate referral centers
Transport of samples during epidemics.
Purchase of consumables such as bandages in the Center
Purchase of bleaching powder and disinfectants for use in common areas
Labour and supplies for environmental sanitation, such as clearing or Larvicidal
measures for stagnant water.
Payment/reward to Sahiyya for certain identified activities
Repair/operationalsing soak pits
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17.3.4 Untied Fund & AMG released (April-Nov. 10’)
Rs. In Lakhs
Table 17.1
Budget Required for Untied Fund & AMG
Rs. In Lakhs
Table 17.1
Sl. Type of Facility Fund Released
% Expenditure (April-Nov 2010)
1 Untied Fund for CHC 97.0 64%
2 Untied Fund for PHC 29.25 63%
3 Untied Fund for SC 395.8 51%
4 Untied Fund for VHSC 2000 36%
5 Annual Maintenance Grant –CHC
194.0 58%
6 Annual Maintenance Grant –PHC
58.5 51%
7 Annual Maintenance Grant –SC 59%
Sl. Type of Facility Facility Unit Cost Budget Required
Remarks
1 Untied Fund for CHC 50000 194 97.00 Budgeted under Sec. 2
under Untied Fund
of NRHM Addlt
2 Untied Fund for PHC 25000 330 82.50
3 Untied Fund for SC 10000 3958 395.80
4 Untied Fund for VHSC 10000 32615 3261.50
5 Annual Maintenance Grant –SDH
100000 6 6 Budgeted
under Sec. 3 under
Untied Fund of NRHM
Addlt
6 Annual Maintenance Grant –CHC
100000 194 194
7 Annual Maintenance Grant –PHC
50000 120 60
8 Annual Maintenance Grant –SC 10000 1809 180.90
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18. CONVERGENCE
NRHM has laid emphasis on the aspect of convergence which is a cross cutting theme.
There are a heap of factors like nutrition, literacy – education, water and sanitation,
means of transportation and communication besides availability of health care which
results in the psycho-social well being of a person. Hence it is imperative to identify
and intertwine all these health determinants in a logical manner to impact positively in
the well being of a person and overall good health status of families.
The need of convergence is widely recognized in all areas to get optimum results in set
timeframe for the targeted audience and more so in the sector of health because the
determinants of health are varied and are spread over areas like drinking water and
sanitation, nutrition, education, livelihood, environment and social justice which cannot
be ignored if Health for all is intended.
For the achievement of said goal, convergence is needed at all the level of policy
making, planning, and framing of programmes till down to implementation and review
of the same. Coordination has to be made effective with other sectoral departments
like panchayati raj system, village health and sanitation committee, AWW, ANMs, ICDS,
Sahiyyas (ASHA) from the village level BDOs, MOs and other block officials from the
block level so on. At the district level, the District Commissioner, DPMU, DHS, CDPOs
(ICDS), DEOs and public health engineering works, social welfare, civil supplies dept,
PWD, Electricity Board. All these in one way or the other contribute and are inter
dependent and complement each other.
Different sectors have their own programs, strategies and human resources to cater to
the need of the mother and child. Convergence, in this sense becomes an important
strategy where different departments can come together, share their resources and
work towards a common goal. The functional issues have to be sorted out between
these departments. In Jharkhand, efforts have been made by government and non
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government sector on better coordination among intra department and inter
department especially in health programming.
The departments that are having close synergy with RCH are
Women Development and Child Welfare
Rural Development
Urban Development
Tribal Welfare
Panchayati Raj Institution.
Human Resource ( Education) Department.
Labour Department
Jharkhand State AIDS control society
The different methods to establish the convergence in letter and spirit will largely be in
the form of
Joint meetings at all levels for policy framing and designing implementation
strategies with activity timeline
Multi sectoral Capacity Building programmes
Assigning responsibilities for different convergence avenues
Common reporting mechanisms
Joint monitoring and review
It is also equally important to be kept in mind that at no time the duplication in the
form of activities and expenditure does happen which will be the loss of public money
and energy.
Objectives
To prepare bilateral convergence plans with various departments and facilitate
its implementation.
Department Topics for convergence
ICDS (Social Welfare) VHND- A common day for service
Malnutrition – Referral and Treatment
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Joint IEC plan
Human Resource Department School Health Programme
Drinking Water and Sanitation Linkage of the Sahiyya and VHC program for Total Sanitation
Campaign
Tribal Welfare Running of MESO Hospitals and other health programs under the
Tribal welfare scheme
Panchayat Raj Department The function of the VHC and the use of untied funds.
Joint action on Public Health at village level.
Urban Development USHA and Urban Health Outposts
Labour Department Effective Rolling out of RSBY scheme
Jharkhand State AIDS Control
Society
RTI/STI
HIV screening at ANC and referral to PPTCT
Establishment of Blood banks/ storage
Table 18.1
18.1 Strategies for convergence:
Developing joint plan of action for convergence activities and periodic joint
review of the same: The convergence meetings represented by nodal persons
from all relevant departments shall provide the required platform to develop a
joint plan of action based on issues identified and shared by the Sub-Group. The
Plan of Action shall be subject to periodic joint reviews and reports.
Supportive supervision: The nodal persons shall provide supportive supervision
to all convergence activities and also provide written feedback/input from time
to time.
Mapping of different stakeholders working on health and nutrition.
Utmost efforts will be to develop a close coordination among all the above mentioned
departments to carry out an overall programme implementation in the state.
18.2 Activities
1. Setting up of a Mission Convergence Unit at State NRHM
Under the leadership of the MD-NRHM, SPM and the Directorate-Health
Services the convergence plans are made
2. Joint Action Plans developed with six departments in a closed workshop mode.
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3. Bimonthly review at the level of Directors or Program Managers of the
programme.
18.2.1 Major activities:
Convergence with ICDS department/ Strengthening the Village Health and
Nutrition (VHND)
A synergy between the health and social welfare department is crucial for the overall
development of health. This amalgamation of the two departments can be seen in the
observation of the Village health and Nutrition day (VHND). VHND are organized once
a month at each Anganwadi center. During these days the ANMs, AWWs who hosts this
activity provides health care services especially maternal and child health services like
ANC, immunization, distribution of nutrition supplements to the community. ANM
provides immunization for children and also responsible for health nutrition education
and for management of common childhood illness. The Aanganwadi Worker [AWW]
provides them with food supplements and is also responsible for health and nutrition
education and for management of common illnesses. The Sahiyyas facilitates in
mobilizing the community (pregnant women, children, ANC/PNC cases, family planning
cases, LBW babies) and bringing them to avail the services of the VHND. At the end of
the day a common achievement report is also prepared. To strengthen this activity
monthly report will be prepared and to be shared with both the departments for
necessary actions. ANM will be responsible for preparing the report with the help of
AWW.
The State has proposed to strengthen the Village Health Committee and Mother’s
support group under the ICDS in all the villages to monitor and support in the maternal
and child health activities especially the supplementary food given regularly at the
Anganwadi and during the VHND.
Malnutrition Treatment Centers (MTCs) are established in most of the District
Hospitals of the state. Severely malnourished children are referred to the center by
AWWs. The Sahiyya facilitates in identifying the SAM children. The children are treated
for 15 days, nutritional counseling given to the mothers, they are discharged and their
follow up tracking is done at the Anganwadi centres by the AWW and Sahiyya. The
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State proposes to increase the number of MTCs to address the needs of the
community.
Convergence with Education department :
Literacy is one of the critical social determinants of health status and the utilization of
health services. The education department can play a significant role in ameliorating
the barrier to avail health services. Presently both the departments – health and
education converge at the primary level health check up of school going children.
Usually school health is limited to areas of health care provided to school children
through institution of the school.
The School health programme is implemented in the state in collaboration with the
Department of education. Under the existing school health programme all primary
schools are visited by PHC doctors on a monthly basis for check-up relating to refractive
error correction, hearing, oral hygiene, basic medicine for some common problems like
deworming, iron supplements and skin diseases. Drug Kits are also supplied to each
primary level school. There is clearly a need for more intensive interaction between the
schools and the health authorities. Existing services of Mobile Medical Unit (MMU) will
also be extending to different educational institutions in rural as well as urban areas.
1. A bi- annual health checks with follow up and remedial action on illnesses
identified with the help of govt school teachers/para teachers
2. At least one annual dental check up with follow up and remedial action on
illnesses identified.
3. At least one annual eye check up including for refractive errors with follow up
and remedial action and where needed giving the spectacles.
4. Provision of micronutrients to students and services of referrals are provided to
the students of primary schools.
In the coming year state is proposing to organize health camps for the inmates of the
Kasturba Gandhi & Eklavya Residential Schools in convergence with the Welfare
department. Health check up of all the students of these schools will be ensured that
will cover regular health check up, hemoglobin, malaria, Kala Azar (for the Kala Azar
endemic districts). In addition to that IFA and chloroquin tablet will also be distributed.
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Mid Day Meal Scheme is under implementation by the education department with the
objective to retention of children in the schools and to compensate their nutritional
requirement.
In the coming year Department of Health proposed to have convergence with
education department in district where iodized salt will be provided to the school
children with meal. Supply of iodized salt to the schools will be ensured by the District
Health Societies (DHS) in their respective districts. Compliance of this will be essentially
reported to the state by the DHS.
Convergence with Department of drinking water and sanitation:
With the panchayati raj institutions coming up in the state, the Village health and
sanitation committees will be formed. Thus far the Village Health committees were
formed with the Sahiyyas, ANMs and AWWs being a part of it.
Under the Total Sanitation Campaign (TSC), installation of toilets has been initiated in
some villages. This year the state proposes for the construction of toilets and
installation of tube wells for safe drinking water in the HSCs which is in the
government land. The Village Health Committee and Sahiyya can coordinate with the
Water and Sanitation department to identify BPL and non BPL families for the
promotion of toilets for better sanitation.
Convergence with the Department of tribal welfare:
The department is providing medicines and other essentials supplies to the MESO
hospitals along with the Mobile Medical Unit to address the health needs of the tribal
population in the most vulnerable and hard to reach area. At present 9 such hospitals
are being supported by Department of Health which is being run by 4 NGOs under
Public private Partnership mode.
WHO are operationalising MESO hospitals.
Convergence with the Department of Labour:
The health department can converge with the labour department to provide the RSBY
scheme to all the PTG families uniformly. Presently the labour department is providing
the Health Insurance facility to BPL families under the RSBY scheme.
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Convergence meeting at different level department of social welfare and
Health:
Both the social welfare and health departments are providing nutrition, health and
IEC/BCC services, it is proposed that these departments will meet regularly at different
level for monitoring and reviewing of the programmes. Both the departments could
host the convergence meeting. In districts, convergence meeting will be arranged on a
monthly basis under the chairmanship of Deputy Commissioner of the district. In each
PHC level as well meetings will be arranged involving block level functionaries of both
the departments. At the state level the meetings could be arranged on a quarterly
basis.
Convergence Committee at different levels – block, district and state:
The Jharkhand Rural health Mission Society has been working for all inter-sectoral and
intra- sectoral convergence. The sub group within this society has been functioning
under the chairmanship of Secretary Health. These subgroups share regular updates to
the state programme coordination committee for developing future strategy. The
subgroups also focus on the inter-sectoral convergence issues. It comprises of members
from various departments of health and representative of development partners,
NGOs. A calendar of convergence meeting has been prepared on the basis that there
will be a meeting on mutually agreed date. At the district level, the convergence
meeting is called under the chairman ship of the DS with the presence of CS, DEO, DPO,
Zilla Parishad and so on.
Convergence with JSACS The state proposes to converge with JSACS for
one day orientation programmes on the basics of HIV/AIDS to MOs, ANMs, AWWs, Sahiyyas
RTI/STI screening
HIV screening at ANC and referral to PPTCT
Establishment of Blood banks/ storage.
Mapping of different Stakeholders working on health and nutrition:
The health department has maintained a data base of NGOs working on health and
nutrition, which would help in reaching out to the underserved areas to ensure better
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service delivery. Care has been taken to avoid duplicacy of work done by the different
stakeholders.
Table 18.2
Particulars Unit Unit cost Total cost Remarks
State Level Quarterly meeting/workshops/events 2 50,000.00 1,00,000/-
Budgeted under Sec. 29
under Convergenc of NRHM
Addlt
Meetings/events at district level/ Mapping of
different Stakeholders working on health and
nutrition for index preparation
2X24 35,000.00 16,80,000/-
Mapping of different Stake Holders 1 unit 1,00,000.00 1,00,000/-
Printing cost of directory 3000 150 4,50,000
Intersectoral Capacity Building (Orientation/
Training)
Dist & Block Level
24 50000 12,00,000
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Quality Assurance
National Rural Health Mission (NRHM) is in its 6th year. Since the inception of NRHM in
2005, Department of Health and Family Welfare, Government of India has taken up
several initiatives for improving the health care service delivery system in coordination
with state counterparts.
State of Jharkhand has also witnessed subsequent changes and developments in the
health sector after the advent of NRHM. Several initiatives have been taken up in order
to meet the health needs of the people of Jharkhand.
Providing quality health care services to its people is one of the major objectives that
the state intended to achieve. In view of this state has also provisioned that quality of
healthcare service must be ensured to every individual. To have done it is important to
assess and evaluate the programs and service delivery points on set standards. To meet
this objective State of Jharkhand provisioned for Quality Assurance Cell in the year
2009-10, consisting of one Consultant Quality Assurance at state level, five Regional
Consultant Quality Assurance and 30 Hospital managers. These professionals would be
responsible for the improvement of the Healthcare systems. Currently, five regional
quality consultants (RQC) and 7 hospital managers (HM) are in position. State and
regional quality assurance cell has been created in-order to ensure the quality outcome
of the NRHM/RCH and FP services along with strengthening the healthcare delivery
centers / facilities.
Progress so far
Strategies Progress Comments
Establishing Quality Assurance Cell at District Level
Completed District quality assurance cell is formed and functioning as per the government of India guideline to ensure quality of services for the family Planning services.
Operationalisation of State and Regional QA cell
Completed After the recruitment of the five regional quality assurance consultants, State and Regional quality assurance cell has been initiated. This cell will look after quality outcome of all the programs run under NRHM, RCH and other national programs apart from the Family Planning. QA cell will ensure quality and monitor all MCH activities which should also include monitoring of the training and facility.
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Appointment of State QA consultant yet to be done.
Notification of Nodal Officer for districts, Flying squad and formation of Maternal Death Audit Review Committee
Completed Two Nodal officers nominated by the Mission Director NRHM consisting of one member form Directorate and one NRHM consultant. These Nodal Officers were responsible for two districts and were to ensure that healthcare services are delivered as per the standard guidelines and funds are properly utilized. Flying squad were also nominated, whose task is to conduct sudden check of the healthcare services and systems. Maternal Death Audit review committee was formed inorder to review and inspect the Maternal death.
Plan for 2011-12
Broad Objective
Broader objective in quality assurance is associated with the concern that quality of
healthcare services will be ensured to every individual.
Specific Objectives
To ensure quality of services and monitor all MCH activities including monitoring of the training
To follow Standard treatment protocol in service delivery for all national programmes and locally common diseases will be made available at all healthcare delivery points / centers. (Standard Treatment/Operating protocol is the "Heart" of quality and cost of care. All the efforts that are being made to improved "hardware i.e. infrastructure" and "software i.e. human resources" are necessary but NOT sufficient. )
To maintaining ISO/BIS/IPHS/NABH accreditation
To perform clinical audits, quality improvement, mortality and morbidity reviews
To carry out supportive supervision visit to ensure the infrastructure status, manpower status
To conduct regular Continuing Medical Education (CME) programmes for health care professionals
To observe and ensure infection control protocols
To follow international/National external quality controls
To ensure ethical staff work practices
To perform regular audits of clinical standards by external organizations
To maintain State/National/International Hospital Accreditation Standards
Strategy and Activities
Quality Assurance cell has been formed at the state, regional and district level. The cell
will be managed by the State Quality Assurance Manager at the state level, Regional
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Quality Assurance Manager at the regional level and Hospital / Health Manager at the
District level.
It is proposed that in the year 2011-2012 Quality Assurance cell will widen its scope and
will work towards the systematic improvement of the Healthcare facilities. State and
regional level consultant along with the Regional Directors and Hospital managers will
regularly visit the facilities and conduct supportive supervision. State and regional
consultant are expected to visit Healthcare facility on regular basis to check the quality
outcome of the program and the services delivered at the facility. For their travel,
amount of Rs. 10000/- per month is proposed in the current financial year and amount
of Rs. 10000/- per month as the running cost of the regional quality assurance cell at
the regional and state level. There is a need of computer operator at the regional level
to compile the data and reports for the regional consultant; this will enhance the
output and task of the regional and state quality consultant.
The core areas of work for the Quality assurance cell for this financial year will be as
follows:-
1. System Strengthening 1.1. Strengthening of Hospital Management Society / RKS State will undertake strengthening of HMS/RKS in coordination with State Health
Resource Centre – Jharkhand. Every District Hospital and CHC has Rogi Kalyan Samiti /
Hospital Management Society to look after the functioning of the District Hospitals and
CHC and the services provided by the Healthcare staffs. Though these societies have
been formed and are functional, there has been little or no change in terms of the
quality services and proper utilization of the funds. Many HMS/RKS seldom meet or
they meet only to fulfill the meeting agenda. Therefore it is necessary to strengthen
theses societies and enable them to carry forward the task specified to RKS/HMS and
for the betterment of the patients.
In the financial year 2011-2012 state will concentrate on strengthening of these
societies and make them capable to carrying forward the RKS and HMS tasks. Special
team consisting of state officials, SPM unit and SHRC members will look after the
functioning of the HMS/RKS as external members. They will strengthen these societies
in order to improve and optimize the performance of District Hospitals. This team will
also ensure that proper planning and implementation process is being followed by the
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HMS/RKS and will optimize the utilization of healthcare facilities and health care
services
HMS-Strengthening Team (HMS-ST) will facilitate and strengthen the HMS/RKS at the
district level.
Member of the District and State Health Missions under RKS-ST
1. Mission Director – NRHM
2. State Health Director
3. Deputy Commissioners
4. Civil Surgeons
5. Deputy Superintendents
6. SHRC members
7. SPMU
8. DPMUs
9. Quality Consultant / Hospital Managers
10. BPMUs
Activities to be Under taken by HMS-Strengthening Team (HMS-ST)
1. Prepare Operational Guidelines for HMS
2. Planning for Hospital Development- : The vital component of HMS-ST a. Creation of Planning Team b. Mandatory Processes for Planning c. Conduct Gap analysis processes d. Making a long-term plan for achieving IPHS: e. Medium term plan for achieving hospital accreditation standards (ISO/NBHS) f. Develop Annual Facility Development Matrix to g. Annual Work Plan for Facility Development
h. Facilitating in getting the annual plans approved and displayed
3. Facilitating the Implementation of the Plan- collective action by HMS and hospital staff
4. Ensure regular HMS meetings, motivation building, responsibility fixations, appreciative inquiry and review processes
5. Annual External Evaluation and Accreditation Processes a. Evaluation of all the Healthcare programs
1. Evaluation of Stake Holder 2. Desk Review of HMS functionality 3. Evaluation of RSBY coverage and management 4. Evaluation of fund utilisation 5. Evaluation of Quality of care
b. Comparison with internal assessment and Peoples Charter
6. Annual Accreditation and Award Processes
7. Governance and Policy/Decision Making Processes for HMS under HMS-ST
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8. Community Accountability in HMS under HKS-ST
9. HMS-ST: roles, responsibilities, duties and powers for various HMS bodies and officials
10. Technical Assistance and Capacity Building inputs for HMS under HMS-ST
2. Certification of the Hospitals / Healthcare facilities 2.1. ISO Certification District Hospital, Deoghar has got ISO certification year 2008-09. Process for ISO
certification of District Hospital of Hazaribagh, West Singhbhum (Chaibasa) and Giridih
has been initiated in 2009-10. In order to complete the certification process and to
maintain these certificates certain amount is required for the training, purchase of
certain equipments and for the minor repair and management.
Budget Requirement
Particulars Units Unit Cost
Total Cost Remarks
Management and Maintenance of ISO certification
50000 5 2500000.00
Budgeted under Sec. 18.1 under Quality
Improvement of Hospitals of NRHM Addlt
2.2. Family Friendly Health Certification State is endeavoring to provide homely and friendly feeling to the patients and their
relatives during their visit to government hospitals. In the year 2010-11 amount of Rs.
140.60 Lakhs was sanctioned for the Family Friendly Health Initiative (FFHI).
Despite of State’s efforts things in all the District Hospitals have not improved. Facilities
for the patients and relatives are still in dull condition. Also the fund under HMS is
found not sufficient for management hospital affairs.
Therefore, in the coming year state has decided to provide financial support to all the
21 district hospitals in order to accelerate undergoing FFHI process. Rs. 3 Lakhs per
dstrict Hospitals (total 63 Lakhs) has propsed in this regard. Amount of Rs. 70 Lakhs was
diverted for completion of construction work.
Under FFHI process District Hospitals will have to take up activities as follows,
1. White washing of the Facility
2. Purchase of chairs / benches
3. Purchase of the safe drinking water equipment
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4. Minor repairing of the Toilets and Labour Room
For the year 2011-12 the FFHI certification process will be undertaken at a large scale and 25 facilities will be certified. Initially 17 District Hospitals and 7 best performing CHC will be certified and the rest facilities will be certified gradually.
Activities Under the FFHI Cerification
Broad categories Specific Criterion Verifiable Indicator
Creating environment for Service delivery
1. Running water in Labour room/OT/OPD/Toilets @ 24hrs
(i) Presence of Overhead tank
(ii) Running water supply
(iii) Elbow taps present in OT and labour room.
2. Hot water supply to Labour room / OT / wards
(i) Heating system for water
3. Protected drinking water (i) Purification system (Reverse osmosis)
4. Uninterrupted electric supply
(i) Emergency Light, Generator (High capacity-50-80 KvA)
(ii) Inverter (800 MA) in OT, Labor room and blood bank.
5. Service guarantees (i) Display of services available, timings and doctors availability
6. Seating arrangement available
(i) Seating facility for OP/IP patients
(ii) Seating facility for attendance.
(iii) Fans, lights, TV available in OPD and wards
7. Queue management system
(i) Numbering system in place
(ii) Electronic display of token
8. No junks inside hospital / premises
(i) Junk not occupying the wards and premises
9. Toilet clean, no leaking pipes, no blocked toilets
(i) Clean floor and functional door/latches
(ii) Monitoring sheets which have specified timings to clean with initials of person who cleans the toilets, with time mentioned.
(iii) Tap with running water present, no leaking taps.
(iv) No blocks in toilet.
(v) Washbasins are not stained.
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10. Clean and hygienic environment
(i) Floors cleaned with disinfectant.
(ii) Building whitewashed
(iii) No littering
(iv) Rainbow linen maintained / Clean linen
(v) Windows not broken
(vi) Wards have mosquito screens
(vii) Labour room cots not rusted
(viii) Mattress not worn out, cloth not torn, cotton / coir not coming out.
(ix) For labour room, labour boards not rusted, not broken, and no blood stains present.
(x) Fumigation machine (for OT) present and working
(xi) OT windows closed, anteroom present
(xii) electric switch board not broken/electric wires not exposed
(xiii) electric bulbs in wards, pathways and toilets
(xiv) Functional Phone/internet connection
C. IEC and Patients care
1. Provider talks courteously (i) Feedback system (as per format)
2. Patient Grievance redressal system present
(i) Grievance box with a lock whose key is with medical officer in charge.
(ii) Complaint book with action taken to the complaint, with date mentioned.
1. IEC Display (i) Display of OT maintenance protocol
(ii) Display of immunization chart
(iii) Display of Immediate & EBF message
(iv) Other informational messages
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2. Barrier free environment for disabled
(i) Hand rails (on way to toilet etc)
(ii) Ramps (on way to wards/OT/labour room etc)
3. Signage and directions present
(i) Signage’s / directions present
D. Equipments 1. OT equipments present (i) As per requirements
2. CSSD Equipment (ii) semi auto hydraulic auto autoclave machine / Washing machine
3. Housekeeping equipment s and Biomedical waste management systems
(iii) Purchase of Bins
(iv) Purchase of Trolly
(v) Construction of the common disposal Pit
E. Professional Standards and Technical Competence
1. Protocol for infection control, Universal safety precautions and Surgical safety guidelines (WHO)
(i) Protocols displayed (Safe child birth checklist and Active management of labor etc.)
(ii) Staff practices protocols (e.g. hand washing)
(iii) Printed check list in the case sheet
(iv) Printed partograph, recordings in the case sheet
(v) Soap available in OT
2. Bio-medical waste Management (BWM) followed
(i) Deep burial pit for anatomical waste is disposed
(ii) Needle cutter
(iii) no mix of infectious or non-infectious waste
(iv) Colour coded waste bins in each wards and departments
(v) Colour coding instructions displayed.
Client Provider Interaction
Access to Health Services
F. Service delivery & Continuity of care
1. 24 hour doctor availability and various register to be maintained
(i) Duty roster, causality register, Stock register, Lab register, Supply movement register, Delivery register Pediatric ward register, Immunization register
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G. FFHI Certification
(i) Certification process and consultation meeting for 25 facility
H. Workshop and Meeting
(i) Orientation and dissemination meetings.
I. Trainings (i) Training of the staffs
Budget Requirement for FFHI Certification
Particulars Units Unit Cost Total Cost Remarks
Gap Analysis - Assessment of the facility
25 20000 500000.00
Budgeted under Sec. 18.2 under
Quality Improvement of
Hospitals of NRHM Addlt
Creating service environment 25 200000 5000000.00
Client Provider interaction 25 30000 750000.00
Access to health services 25 50000 1250000.00
Equipments and Supplies 25 500000 12500000.00
Setting Professional Standards and technical Competence
25 60000 1500000.00
Service Delivery and Continuity of care
25 50000 1250000.00
FFHI Certification 25 1000000 1000000.00
Workshop/meeting/Dissemination 500000 12500000.00
Total 36250000.00
2.3. National Accreditation Board of Health and Hospitals (NABH) accreditation and certification Among District Hospitals in the five administrative divisions of the state three best district hospitals will be identified taking account of the condition of the infrastructure, systems and standards, manpower and quality of services being delivered at the facility. Since these facilities would have also undergone FFHI certification process, minimum effort will be required and cost of up gradation will also be less. The district hospitals of following districts will be selected, 1. Gumla
2. Lathehar
3. Simdega
Budget Requirement
Particulars Unit Unit Cost Total
NABH Standards for hospital accreditation
Guide book to NABH Standards for hospital 3 3000 9000 Budgeted under Sec. 18.5 under
Quality Improveme
nt of Hospitals of NRHM Addlt
Application fee (60000/-) and NABH Accreditation charges for Pre-assessment, Assessment and Surveillance (175000/-)
3 235000 705000
Orientation Workshop and Meeting state (200000/- ) and regional level (100000/-)
1 300000 300000
Up gradation of the facility 3 500000 1500000
Purchase of additional equipments 3 200000 600000
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Total 3114000
3. Standard Based Management and Recognition In accordance with the revised draft IPHS guidelines 2010 for hospitals, special
emphasis has been given for preparation of the standard operating procedures /
manual are to be prepared for each department and the activities. QA Cell will develop
this Standard Operating Processes Manual and will implement it in every Healthcare
facility so that quality of services will be measurable. SOPs will be developed in
consultation with the state of art healthcare setups like Armed Force Medical College,
Wockhardt Hospitals, Fortis Group of Hospital, TMH, Aravind Eye Hospital, AIIMs and
Ministry of Health and Family Welfare, GOI.
Budget Requirement
Particular Unit Unit Cost Total Remarks
Preparation of SOPs Manual (Workshop, Work group meeting, Field visits)
1 500000 500000 Budgeted under Sec. 18.3.1 & 18.3.2 under Quality Improvement of Hospitals of NRHM Addlt
Printing of the standards for all the Health care facilities
1 1000000 1000000
Total 1500000
4. Computerization of the District Hospitals Under NRHM most of the district hospitals have been either upgraded or newly constructed. All most all the district hospitals are either 100 bedded or more, with approximately hundred manpower working day and night to handle the patients, relatives and equipments. To manage such a huge infrastructure and manpower, proper management system and latest technology is required. NRHM Jharkhand has recruited 7 Hospital Managers in 2010 and in process for recruitment of rest 23 Hospital Managers. State is intended to upgrade hospital management system with latest technology for quality services to the patients. For the year 2011-12 State has planned for segmentation and computerization of the major and larger department in each district hospital–
1. Reception
2. Ward Management
3. Stores (LIFO/FIFO)
4. Laboratory (Lab)
5. OT / Labour Room
6. Housekeeping
i. Linen
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ii. Waste management / Cleanliness
iii. CSSD
7. Diet / Kitchen
8. Medical record Department
9. EPABX
10. Pharmacy
Each of these departments to be handled by the departmental In-charge and are to be
computerized so that delay in response can be minimized and data management is
improved at the facility level. The computer placed in this department will be
connected to LAN and software like Hospital Management Information System (HMIS)
software. Hospital Management Information System (HMIS) software will be consist of
different modules like Billing Module, IPD Module, OPD Module, Lab Module, Medical
Record Keeping, HR and Account Module and Housekeeping Module. These modules
will be installed once the Hospital manager are placed and as per the requirement of
the District Hospital and manpower available. Module can be purchased from the
reputed institute like Wipro, TCS or for the local companies.
Budget Requirement for Segmentation and Computerization
Particulars Unit Unit Cost Total Cost Reamrks
Computer with UPS (5 nos x 21) 210 60000/- 12600000 Budgeted under Sec. 18.3.3 under Quality Improvement of Hospitals of NRHM Addlt
Duplex Printer (5 nos x 21) 210 10000/- 2100000
Scanner (5 nos x 21) 210 5000/- 1050000
Total 7875000
5. Mentoring, Guidance and Training of Hospital Managers, Deputy Superintendent
(District Hospitals), MOIC and Quality Consultant
It has been thought that deployment of Hospital Managers will improve the various
administrative and management functions of the district hospital. In very short time
period they have been contributed very well in management of hospital affairs. Hospital
Managers in coordination with the DS – Deputy Superintendent and RQC are helped in,
1. Proper waste disposal. 2. Cleanliness of the hospital premises. 3. Preparation of the duty roster and ensuring that the services providers are
following it. 4. Queue management, file keeping and proper record keeping. 5. Proper maintenance and utilization of the equipment and 6. Calibration of the equipment
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Which were un recognized and un noticed due to absence officiating authority for
hospital management functions
In the coming year state is proposing to provide proper motivation, guidance, support
and training of these Hospital manager and Quality Assurance consultant.
6. Monitoring and Evaluation of the Healthcare Facilities and Services
6.1 Supportive Supervision and Medical Monitoring By Internal Facilitator - utilizing
Supportive Supervision Tool and Medical Monitoring Tool
Apart from regular visit done by the Quality Assurance team, Supportive Supervision
visits will be done on regular basis. Supportive Supervision will provide critical support
to health care service providers. Facilitative Supervision is based on widely accepted
quality management principles and emphasizes mentoring, joint problem solving and
two way communication. Evidence demonstrates that continuous implementation of
facilitative and supportive supervision generates sustainable performance and
improvement in quality of services provided. It is proposed to develop a pool of
facilitative supervisors from among the supervisory cadre at the district levels and
orient them on the facilitative approach to supervision. Supervisors will cross check the
HIMS reports and program implementation status of the districts at the block level.
6.2. Medical Monitoring for Quality Improvement Medical Monitoring is crucial for maintenance and improvement of services provided at
a health facility. Medical monitoring (using COPE/CME) will be done at District
Hospitals, Community Health Centers for the purpose of quality improvement using
standardized checklist. The following processes will be followed in Medical Monitoring,
Objective and ongoing assessment for readiness and process of service delivery
Identification of gaps
Providing constructive feedback and solutions
Development of action plan with the involvement of facility staff.
The state will utilize the services of trained Facilitative Supervisors for Medical
Monitoring.
A budgetary provision of Rs. 25000 is being proposed per district for logistical support
for Medical Monitoring visits.
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Budget Requirement for Medical Monitoring
Particulars Unit Unit Cost Total Cost Remarks
Logistical support for Medical Monitoring
visits
24 25000 600000.00
Budgeted under Sec. 18.4.1 under Quality Improvement of Hospitals of NRHM Addlt
6.3. Monitoring and evaluation of the Healthcare facilities By External Agencies / Interns from reputed institute like
i. TISS – Tata Institute of Social Sciences
ii. IHMR – Institute of Healthcare Management and Research
iii. AIIMS – All India Institute of Medical Sciences
Students from the reputed institute will be invited for one month internship program.
These interns will be stationed in a particular District for a month and will monitor and
evaluate the quality of services, programs and systems of the District Hospital, CHC and
PHC. At the end of the program they will submit the report; on the basis of this report
many important management decisions can be taken forward.
Budget Requirement for M & E by External Agencies / Interns from reputed institute
Particulars Units Unit Cost Total Cost Remarks
Evaluation by Interns (Internship) – TISS, IHMR, AIIMS (30 interns per year)
1 600000 600000.00
Budgeted under Sec. 18.4.2 & 18.4.3 under Quality Improvement of Hospitals of NRHM Addlt
Quality Assurance Cell workshop and meetings (Monitoring Visit of DQAC Member)
72 5000 1440000.00
Total 2040000.00
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Innovation
1. Public Private Partnership
To cater the State health need, the government of Jharkhand is facing the challenges’ of
instability of government as well as the qualified health manpower, insufficient
infrastructure at all facility level. In spite of these challenges government and various
organizations are committed to work for the betterment and upliftment of the people
and the community. NRHM has brought significant changes towards the Healthcare
services but still lot need to be done before the last person receives quality healthcare
services. In order to move a step closer towards the delivery of the quality of care
NRHM has come up with various flexible and innovative projects. Public private
partnership is one of the components. Public private partnership or PPP in the context
of the Health sector is an instrument for improving the health of the population. PPP is
to be seen in the context of viewing the whole medical sector as a national asset with
health promotion as goal of the health providers, private or public.
The term PPP comprises of Public means government or organization functioning under
state budgets, Private stands for profit/non-profit/voluntary sector and the
collaborative effort and reciprocal relationship between two parties with clear terms
and conditions to achieve the said objectives following certain mechanisms is the
Partnership.
PPP however does not mean privatization of the health sector. Partnership is not meant
to be a substitute for lesser provisioning of government resources nor an abdication of
Government responsibilities but as a tool for augmenting the public health system.
1.1.Broad Objective of PPP :
Involvement of the private agency in development and improvement of the Healthcare
services through partnership
1.2.Specific Objectives:
1. Strengthening of the Government Healthcare facility and services by
involvement of the private stake holders.
2. Creation of the Model and better Healthcare management system, which can
set an example to others and can be replicated.
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3. Improvement of the Healthcare services by involving Development partners
Under PPP, last year government of Jharkhand has proposed for outsourcing the PHC
(APHC) to the private agencies (NGOs, corporate) under the public private partnership.
Progress of the Public Private Partnership
Partnership with the agency is in progress and 10 PHC will be handed over to the
agencies by February 2011.
Following are the list of PHC to be handed over to the selected agencies
Region District Name of the Block /CHC
PHC
Santal Pargana 1 Godda Maherma Singari
2 Sahebganj Rajmahal Teenpahar
South Chottanagpur 3 Ranchi Rathu Mc Luiskiganj
4 Simdega Jaldega Basjoor
North Chottanagpur 5 Hazaribagh Badkagoan Badam
6 Giridihi Bagodar Atka
Palamu 7 Lathehar Manika Palahiya
8 Garhwa Ranka Chinia
Kolhan 9 West Singhbum Noamundi Barajamda
10 SarikelaKarshwan Gamria Hudu
1.3.Modalities of Implementation of the PPP is given as follows
As per an inventory made jointly by the Society and the agency, the condition of the
building / equipment handed over is also recorded. The agency will provide all the
Health/Medical / Family welfare services. The agency has to engage its own
Medical/Paramedical / Other staff for providing these services. The agency will ensure
that these personnel are always available at the pre decided timings. The personnel
should reside locally. In case of leave of any personnel the agency will provide an
alternative so that the PHC does not become non functional due to lack of required
personnel at any point of time. The existing staff at PHCs will be suitably redeployed by
the Society / Department to other PHCs/ PHCs.
Services that the agency / partner is required to provide
24*7 Emergency services OPD services for six days a week, as per the timings specified by the state
government 6 bed inpatient facility
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Make availability of essential medicines Minor operation theatre facility 24*7 Labour, and essential obstetric facility Availability 24*7 referral services Immunization services
Any change in the above pattern would be effected with the prior approval of the state
government
Minimum staff that has to be deployed under the PPP is as listed below
Sl. No. Category of staff No of Post
1 Medical officer -1 Male, 1 female(preferably) 2
2 Pharmacist 1
3 Staff nurse 2
4 ANM 2
5 Lab tech 1
6 Security 3
7 Group D - Ward boy cum Helper 1
8 Group D - Sweeper cum cleaner 1
9 Store keeper cum Accountant 1
Laboratory test facilities that the agency has to perform at the PHC level
Hb%, TLC, DLC, ESR Blood grouping and Rh typing MP (Malaria Parasite) test , widal test Routine stool Routine urine Pregnancy test Sputum for AFB Blood sugar VDRL
The agency will provide all the services free of cost. Standard of hygiene and health safety
The agency will maintain and run the PHC in a hygienic manner conforming to the
normal norms of health safety. The hospital waste is being disposed of in conformity
with the recognized and acceptable norms as specified by biomedical waste
management norms. The agency will assist the government for controlling any epidemic
or medical emergency in the area.
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Purchase of Drugs and Consumables
Agency will receive all the allotted fund, drugs and consumable from the state and
central as per the existing norms of the government. The agency is allocated funds by
the society (JRHMS) for procurement of drugs / consumables. All procurement of drugs
/ consumables can be purchased as per government norms.
Audit and Accounting
Separate books of accounts are to be maintained for PHC. Accounts are to be audited
by a chartered Accountant. SOE & UC is to be submitted on time. State government can
ask for a special audit of PHC accounts after giving 30 days notice.
Records and Reporting
The agency will maintain records and send reports in time as normally expected from
any PHC in the government system. The agency will preserve the records carefully and
hand over the same to the state government at the time of exiting from the project.
The agency will also maintain a record of proceedings of the meeting of the PHC
Planning and monitoring committee. Society may authorize officers to conduct
inspections at the PHC. The agency will also maintain a visitor’s book where authorized
government functionaries can record their views / suggestions after conducting an
inspection. Agency will submit Annual Progress report and also publish it after the
approval of the Society at the end of the year.
Review and Monitoring Structure
PHC planning and monitoring committee would be constituted at the PHC level
comprising the representative of the Agency, MOIC, Medical Officer, BPM and members
from Hospital Management society of the area.
Monthly Budget operationalisation of the PHC in the current financial year is
A
Monthly Budget for Running One PHC In PPP Mode
Particular
1 HR unit/Rate No. of Person
Total Per month
1.1 Medical Officer (Male) 30000 1 30000
1.2 Medical Officer (Female) 30000 1 30000
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1.3 Pharmacist 8500 1 8500
1.4 Lab Tec. 8500 1 8500
1.5 Staff Nurse 12000 2 24000
1.6 ANM 8000 2 16000
1.7 Store keeper cum Accountant 6000 1 6000
1.8 Group D (Ward boy cum Helper) 4000 1 4000
1.9 Group D (Sweeper cum Cleaner) 4000 1 4000
1.10 Security 4000 3 12000
1.11 Sub Total 115000 14 143000
2 Medicine 10000
3 Admin (Phone+ Fax+ Printing + internet) 3000
4 House keeping 2000
5 Sub Total 158000
6 Overhead (20%) (includes POL of generator, electricity, water, diet for the patients, minor maintenance of building )
31600
7 Total Monthly Operational Cost 189600
8 Total Operational Cost Per Year 2275200
9 Establishment Cost 100000
10 Purchase of 5KV Generator 250000
11 Total Yearly Budget 2625200
Total yearly cost for operational of one PHC under PPP is Rs 2625200 (Twenty Six lakhs
Twenty five thousand Two hundred only) for one PHC under the PPP in the current
financial year.
National Programmes
All national programmes of health and family welfare in the area assigned to the agency
are to be implemented by the agency in coordination with the existing field staff
specifically appointed by the government for such programmes.
Any drugs/vaccine/equipment made available by the central government / state Govt.
under any national programme for use at PHC will also be given to the agency.
Evaluation
External evaluation after every 6 month and Concurrent evaluation after every 6 month
Asset Creation
Any assets created at the PHC from the funds of this project or funds collected from the
community / other donor will be the property of the state government and will be
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handed back to the government as such after project duration is over. Assets register
must be present at the facility.
Assets created by agency from its own funds will also remain as the property of the Government.
Strategy
Once the PHC are outsourced or handed over to the Private agencies, society will
monitor the performance on regular basis and will ensure that these facilities are
performing better than the other government facilities so that they set an example to
the other facilities. On the basis of better services provide by these agencies, Society
can demand such efficient services from the government staff also.
For the financial year 2011-12 government will continue with the PPP mode for the
current 10 outsourced PHC and will hand over another 10 PHC to the private agencies
with the similar condition or with some modifications.
1.4.Budget requirement Activity Unit cost Physical Target Total Remarks
Total Operational Cost for Running existing PHC through PPP
2625200 20 525.04 Lakh Rs.
Budgeted under Sec. 15.1 under Public Private Partnership of NRHM Addlt
2. An approach to reduce the genetic load of Haemoglobinopathies (sickle cell
anemia & Thallasemia) in a district of Jharkahnd
INTRODUCTION:
Inherited hemoglobinopathies are major health problem in Mediterranean region,
Middle East, Indian sub continent, Far East and tropical Africa. Beta – thallesemia is
commonest single gene disorder in India.
Estimated carrier population could be 44 million with an addition of 13000 children
each year having major Hemoglobin disorder [Assuming a population of 100 million and
birth rate of 28 ].
Among the Indian Sub continent one of the most under assessed region is Chotanagpur
plateau comprising of Jharkhand, Chattisgarh and parts of Orissa. Jharkhand state has
got a major share of Hemoglobinopathy that is; Beta thallesemia and sickle cell
anaemia.
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2.1.OBJECTIVE –
1. Assessment & estimation of disease load of Sickle cell anemia and Thallasemia in
tribal and nontribal population.
2. Establishment of screening and diagnostic centre at Rajendra Institute of medical
Sciences, Ranchi, Jharkhand.
3. Establishment of day care centre for regular management of diagnosed patients of
sickle cell anemia and Thallasemia [heoglobinopathy]
2.2.BACKGROUND OF PROBLEM:
The state of Jharkhand is land locked territory bound by Districts of Rohtas,
Aurangabad, Gaya , Nawada, Jamui, Banka, Bhagalpur, and Katihar of Bihar in North ,
The districts of Malda, Murshidbad, Birbhum, Bardhwan , Purulia, and Medinipur of
West Bengal on the east , The districts of Mayurbhanj , Kenduhargarh , and Sundergarh
of Orissa , on the south , the districts of Raigarh , Surguja of Chhattisgarh and district of
Mirzapur of UP.on the west .
Estimated carrier state of Jharkhand region is approximately 0.15 million and about
1200 children are expected to join the pool of existing Hemoglobinopathies [assuming a
population of 30 million and birth rate of 28].
If adjoining regions of Orissa, Bengal, and Chhattisgarh are also added, these figures will
increase. This heavy genetic load causes physical, psychological trauma, mental
harassment, and numerous blood transfusions, with high cost of treatment without a
final hope of cure. In spite of all the problems, real genetic load remains unappreciated
at the level of community in Jharkhand.Though the tribal communities constitute a
major part of India, unfortunately they are highly vulnerable to many hereditary
disorders causing high degree of morbidity and mortality.
Various Study and Literature review shows that thalassemia and other
haemoglobinopathies are highly prevalent (0.028-18%) among the tribal communities.
Some types of deleterious mutation are restricted to some particular tribes. As for
example, tribes of Maharastra and Gujrat have shown prevalence of 619bp deletion
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mutations in 49.2% and 45.5% carriers, respectively. HbS (codon 6A→T) mutant allele is
widespread among many Indian tribes.
Since last 20 years the high frequencies of these mutant alleles is maintained by the
tribal populations probably due to consanguinity and endogamous mating for a long
period of time, along with ignorance, lack of awareness and conveyance, low-income
status and high cost of treatment make them vulnerable.
An interesting aspect of sufferers of the sickle cell anemia is, though having short life
span; it is believed that carriers (sickle cell trait) are relatively resistant to malaria. Since
the gene is incompletely recessive, carriers have a few sickle red blood cells at all times,
not enough to cause symptoms, but enough to give resistance to malaria. Because of
this, heterozygotes have a higher fitness than either of the homozygotes. This is known
as heterozygote advantage.
The malaria parasite has a complex life cycle and spends part of it in red blood cells. In a
carrier, the presence of the malaria parasite causes the red blood cell to rupture,
making the plasmodium unable to reproduce. Further, the polymerization of Hb affects
the ability of the parasite to digest Hb in the first place. Therefore, in areas where
malaria is a problem, people's chances of survival actually increase if they carry sickle
cell anemia.
Hemoglobinopathies are autosomal recessive condition and involve the globins moiety
of Hb molecule in thallesemia . The hereditary effect causes severe hemolytic anemia.
Beta globins gene on chromosome 11 has 22 mutations identified in Beta thalllesemia
in Indian patients. Most of the mutations are point mutation .Detection of mutation is
done by southern blot, ARMS – PCR, Reverse dot blot.
It has also been seen that major hemoglobinopathies are prevalent in tribal population
of Chhotanagpur plateau.
Following causes could be attributed.
Causes in increase of Homozygosity of Hemoglobinopathy gene in community -----
1. Marital consanguinity [Marriage among blood relatives]
2. Heterozygotes produce more children to compensate loss of Homozygos
children.
3. Terminal proximity.
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4. Endogamy.
5. The situation is further compounded by caste class hierarchy, geographical
barrier, climatic variation and echo diversity.
6. Natural selection and adaptation of globins gene to fight the menace of Malaria
*It is well known fact that malaria parasite can’t survive in hemoglobinopathic
patients]
Cost factor of disease:
Patient with beta thallesemia develop disabling disease in infancy or childhood. Most
children are severely anemic having Hepatosplenomegaly and skeletal abnormalities.
Sickle cell disease also poses frequent complications. Beta thalesemic are usually
inadequately transfused without prevention of iron overload. Death invariably awaits
them before adolescence. Cost of ideal treatment is tremendous and rises with each
additional child. All these facts demonstrate that prevention is only strategy and
plausible option for India.
The State propose a strategy to identify, estimate and assess the disease load of
hemoglobinopathy in 1 district of Jharkhand. This may gradually extend to whole of the
state.
2.4.Budget for the Strategy implementation –
Sl. Particulars Amount Remarks
1 Non – recurring ---[Instruments etc].- 13.80 lakh Budgeted under Sec.
16.3 under Public
Private Partnership
of NRHM Addlt
2 Recurring --- [ articles ] – 5.50 lakh
3 Establishment cost – 5.85 lakh
4 Cost of awareness program – 3.64 lakh
Total – 28.79 lakh
Annexure -1
Approximate list of Instruments (with price)
Non – recurring
Electrophoresis— 60 thousand
Binocular microscope – optima – 70,000
Osmometer – 1.5 lakh
Multipara monitor – 6 lakh
Patient intensive care bed – 1 lakh (4)
Auto infusion pump- 2 lakh – (4)
Mobile light on stands – 1 lakh
Oxygen cylinders – with mask – 0.50lakh (2)
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Suction machine – 0.50 lakh (2)
Total = INR 13.80 lakh
Recurring –
Lab articles- tubes, chemical, microtips etc.— 0. 50 lakh
Publicity materials- 1 lakh
Paper advertisements- 0.50 lakh
TA to staff & doctors – 1.50 lakh
DA to staff & doctors- 1.50lakh
Contingency 0.50 lakh
Total – INR 5.50 lakh
Annexure –2 List of article for establishment
2 Computer- 100,000
FaX, 15000
printer 20000
Furniture- 1lakh
Air conditioning – 1 lakh
LCD projector with screen – 1.5 lakh
Furnishing of space provided- 1 lakh
Total – 5.35 lakh
Annexure -3 Budget for awareness program of 1 district for the year 2011— 3.64 lakh
District – one
Population—10 lakh
Average no. of PHC – 10
Participants – Doctors – 50 Non medical persons --- 50 local panchayat officials =- 50 Paramedical staff – 50 AWD – 50 Teachers and professors – 50 Workers from Industry- 50 College students -50 Journalists + women’s and citizen’s organization – 50 Total - - - 350
No. of training – 7
Participants per training – 50
Duration of program – 1 working day [ 6 hours]
No. of trainers – 4
Budget for Doctor’s awareness and training program No. of program - one
Resource person – 2 from outside state TA [out side state ] @ 10,000 x2 = 20000
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2 from state TA [inside state] @ 5000 x2 = 10000
DA @ 1000 each x4 = 4000
DA for participants @ 200 x50 = 10000
Stationary – 5000
Contingency 3000
Working refreshments – 200x 50 = 10000
Total INR 57000
Budget for nonmedical person’s training program No. of program = 7
Resource person – 4 from state TA [inside state] @ 5000 x4 =20000
DA @ INR 1000 each x4 = 4000
DA for participants @ 200 x50 = 10000
Stationary 5000
Contingency- 3000
Working refreshments – 200x 50 = 10000
Total 52000
Grand total for 7 programs = 52000 x 7 = INR 364000
3. OCCUPATIONAL HEALTH HAZARDS CONTROL PROGRAMME in Jharkhand –
A Pilot in two districts
Occupational Health is one of the components of the National Health Policy 1983. It is
included in National Health Policy 2002. Ministry of Health & Family Welfare, Govt. of
India has launched a scheme entitled “National Programme for Control & Treatment of
Occupational Diseases” in 1998-99. The National Institute of Occupational Health,
Ahmedabad (ICMR) has been identified as the nodal agency for the same. Planning
Commission had identified occupational health as one of the priority areas and set up a
working group to prepare the Xth Five Year Plan on Occupational Safety and Health
comprising NIOH, DGFALI & DGMSf and secretaries of different state governments.
National Institute of Occupational Safety & Health (NIOSH) has developed a priority list
of 10 leading work-related illnesses and injuries. Three criteria were used to develop
the list: a) The frequency of occurrence of the illness or injury, b) Its severity in
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individual cases, and c) Its potential for prevention. Occupational lung disease is first on
the list. Silicosis, coal worker pneumoconiosis, asbestosis, sederosis, beriliosis,
stroniosis and byssinosis are still prevalent in many parts of the world as well as in
mining areas of Jharkhand, Assam, Orissa, Chhattisgarh, Andhra, Karnataka, Goa,
Tamilnadu etc in India. The prevalence of Occupational Asthma varies from 10% to
nearly all of the workers in certain high-risk occupations. NIOSH considers occupational
cancer to be the second leading work-related disease, followed by cardio-vascular
diseases; disorder of reproduction, neurotoxicity, noise induced hearing loss,
dermatological conditions, and psychological disorders. Silicosis and different other
forms of dust diseases also known its generic name pneumoconiosis is one of lethal and
incurable lung disease.
WHO has estimated that in India a population of 10, million ( 1 crore) is exposed to
silicosis and a report O K International, US working with stone query operators in India
reveals that silicosis kills 30,000 people a year in India.
In Jharkhand there is 15 thousand dust generating mines & units that includes
nearly 10000 stone crushers, 40-45 ramming mass units (quartz powder mill), 192 iron
ore crushers and 77 segments of (production & construction) areas are in operation
without dust control measures are identified as potentially crystalline silica exposed
areas. A conservative estimate is 25-30 lakhs people have been suffering from silicosis
in Jharkhand as history of mining and its processing in Jharkhand is of more than 200
years.
The said units do not take preventive measure to check silica dust pollution and there is
not a single designated centre for lung diseases in government hospital in Jharkhand.
The prevalence in ramming mass unit is 100% and average year of death is 33.5 to 35
years and in granite/basalt stone crusher prevalence ratio is 55% and average year of
death is 45- 50 years. Mostly the silicosis victims belong to tribal and other weaker
sections of the society who are engaged as daily wage earner in unorganised sector or
industrial belt of urban areas. More detail study is needed for effective intervention.
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A comprehensive plan and its implementation for prevention and control of health
hazards that may start with undertaking a pilot project for implementation as
pneumoconiosis identification & elimination programme in East Singhbhum &
Seraikella- Kharswan as decided in the meeting of 6th January 2011 under the newly
formed Occupational Health Hazards Control Cell of JRHM. Notably Delhi and some
other state governments are implementing similar project along with local NGO.
3.1.Strategy
Setting up of an Occupational Health Hazards Control Cell at the state level. This
body would work in close collaboration with the health and labour department
with the following objectives’
o Prepare a white paper on Occupational Health in Jharkhand.
o Prepare a working policy and a five year plan for Jharkhand that would
comprehensively cover the major Occupational diseases in Jharkhand.
o Initiate and supervise a pilot program for the prevention, treatment and
rehabilitation for Occupational Lung Diseases at Jharkhand.
Setting up of Occupational Disease Diagnosis Centre (ODDC) at Jamshedpur for
the early diagnosis and treatment of those who suffer from Occupational Lung
diseases catering to two districts of Jharkhand.
3.2.Outputs and Activities
1. Constituting the Occupational Health Hazards Control Cell under the State
Health Systems Resource Cell
a. Appointment of a nodal officer at the level of director for the cell.
b. A workshop conducted for Occupational Health Hazard that will lead to a
white paper on occupational health at Jharkhand.
c. Drafting a working policy and five year roadmap for Jharkhand
2. Setting up an Occupational Disease Diagnosis Centre (ODDC) at Jamshedpur
under a PPP mode with Occupational Safety and Health Association of
Jharkhand.
a. MoU with OHASJ
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b. Setting up of ODDC at Sonari PHC, East Singhbhum.
c. Preparation of inventory of the silica dust / iron ore / coal dust polluting
sites of unorganised, mining and industrial sites at East Singhbhum and
Saraikela-Kharsawan.
d. Trained Sahiyyas will identify the dust affected workers and community
and refer them to the ODDC.
e. Medical Screening conducted at the clinic for those referred through a
panel of trained doctors under the ILO classification
f. Referral to the respective CHC of all patients with Occupational Lung
Disease in the two districts
g. Orientation and training of Medical officers in the two districts on the
treatment and rehabilitation of patients suffering from Occupational
Lung diseases and related respiratory diseases.
3.3.Budget No Activity Budget
required Remarks
1 Workshop for Occupational Health Hazard 100,000 Budgeted under
Sec. 16.4 under
Public Private
Partnership of
NRHM Addlt
2 Setting up of ODDC 1,00,000
3 Preparation of inventory 2,00,000
4 Sensitization and Capacity building 1,00,000
Total 5,00,000
4.Innovations in Tribal areas:
In the state of Jharkhand and Orissa, Ekjut NGO has conducted a trial, using community
based women’s groups and in the past 2 years has shown proven results like 45 percent
reduction in newborn mortality and reduced maternal deaths in the study areas (study
population was 2,30,000 and included two districts of Jharkhand). The results have now
been replicated in newer areas and disaggregated results show that the poorest and
the marginalized had the maximum reduction in newborn deaths.
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Based on this and other evidences of community empowerment and reduction of
maternal and child health indicators, the state proposes to build that capacity of
Sahiyyas/Sahiyya Sathees to enable them to make home visits and facilitate monthly
women’s group meetings which will work towards ensuring the community capacities
to ensure improved newborn and child survival .
4.1.Proposed Plan (Empowering Women) in Santhal Pargana
The Department of Health will take up twelve blocks-two each from 6 districts ( Dumka,
Deogarh, Pakur, Jamtara, Godda and Sahebganj) of Santhal Pargana region for this
scale-up initiative during 2011-12.
150 women’s groups in each block will be facilitated to go through a monthly
Participatory Learning and Action (PLA) meeting cycle. Sahiyas will work with the
existing women’s groups in their respective villages or form new groups if there are
none. These groups will open up to non members during these monthly facilitation
meetings.
Capacity of Sahiyas Sathees/Sahiya to conduct these meetings will be built by the Block
Training Teams who in turn will be trained by the State Training Teams on participatory
methods. Ekjut has agreed to share all training modules tested and piloted by them and
share their training methods.
The process will be documented during this pilot and further improve the delivery of
this intervention in the second year of the programme .Lessons leant will be
incorporated for wider replication in subsequent years. Community empowerment
takes time and that community mobilization has to be a sustained community capacity
building effort. The PLA process will continue during the second year(2012-13) also and
expect that at the end of two years there will be significant improvement in hygienic
practices related to deliveries , percentage of women exclusively breast feeding their
babies, protecting them from hypothermia , early emergency referrals etc. We also
expect that there will be reduced newborn and maternal deaths and increased decision
making power among women.
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4.2.Proposed Plan of Action
4.3Budget
S.no DESCRIPTION UNITS RATE YEARLY COST Remarks
1
Participatory learning and action Cycle Manual In hindi preparation cost ( One time)Two manuals will
be prepared for two years (10 meetings per manual)
2,00,000
Budgeted
under Sec.
16.5 under
Public
Private
Partnership
of NRHM
2 Manual printings for 2400
Sahiyas+ 100 Trainers and others ( one time)
2500 Rupees 200 500000
3
Preparation of Picture cards sets( 10 cards per set ) for 2400
SAHIYAS+100 set for Trainers and backup.
2500
Rupees 150/
Picture card set
375000
5
Compensation to SAHIYAS for attending training programmes at block level 2400 SAHIYA x 6 days
training x Rupees 100 each
2400 Rupees 100
per day 1440000
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Travel Allowance to 2400 SAHIYAS for attending training
programmes at block level 2 times in a year
2400 Rupees 50
per visit 240000
Addlt
6 Administrative cost-(15% to the
total cost such as Travelling, communications, and other fees)
413250
7 Process Evaluation
6,00,000
Total
37,68,250