pip 2011-12 ap nrhm

1

NATIONAL RURAL HEALTH MISSION – ANDHR APRADESH

THE PROGRAMME IMPLEMENTATION PLAN (PIP) 2011-12

EXECUTIVE SUMMARY

1. The state of Andhra Pradesh is situated on the globe in the tropical region

between 12014' and 19054' North latitudes and 76046' and 84050' East longitudes. It is

bounded on the North by Maharashtra, on the North-East by Orissa and Madhya Pradesh, on the East by Bay of Bengal, on the South by Tamilnadu and on the West by

Karnataka States. The state has a long coastal line extending over 960 km from

Ichapuram sands in Srikakulam district to Pulicat lake in Nellore district.

Administratively, the state spreading over 2,76,814 sq.km. and has been divided into 23 districts, 1123 revenue mandals, having 29,994 villages and has 10 tribal notified areas

spread across the state.

2. The Government of Andhra Pradesh has demonstrated its commitment to

achieve sustainable improvement in the health status of its population with strong focus

on improving health outcomes for all sections of people, especially women, children and

vulnerable group of population such as Schedule Castes, Schedule Tribes, etc. During the past few years, the Government of Andhra Pradesh has taken several new

approaches to improve access to quality health care.

3. Revitalisation of the Primary Health System: The Government‟s endeavour is to

strengthen the public health care system for effective prevention and efficient

management of diseases; provision of universal and comprehensive reproductive and

child health services; strengthening the referral system; and improving the quality of hospital care in conformity with the Indian Public Health Standards (IPHS). In this

direction, the Government have converted two-hundred and three (203) Government

Dispensaries (GDs), Government Civil Hospitals (GCHs), Subsidiary Health Centres (SHCs) and Mobile Medical Units (MMU) into Primary Health Centres (PHCs) /

Community Health Centres (CHCs) in the state. This measure has contributed to the

creation of a rational primary health structure in the rural areas of the state characterized

by three inter-related and hierarchically organized institutions of health care, i.e., sub-centre, primary health centre and community health centre / Area Hospital. In this

process of primary health institutions‟ rationalisation, the Government have established

Three Hundred Sixty (360) Community Healthand Nutrition Clusters (CHNCs) across the state with a view to provide comprehensive health services to population ranging

from one to three lakhs through a network of four to ten proximate PHCs and a Referral

Hospital – a CHC / Area Hospital / District Hospital / Teaching Hospital ; in order to

achieve the following objectives:

Strengthen preventive, promotive, curative and referral health services through

rational deployment of human, material and infrastructure resources available with the CHNC area;

Strengthen first referral units (FRUs) – CHCs and Area Hospitals – and provide

them with comprehensive emergency obstetric and neonatal care service facility;

2

Strengthen the Primary Health Centers by ensuring they function round the clock

throughout the year by providing additional human resources, infrastructure, etc.

Strengthen the referral system, i.e., the linkage between the village, Sub-centre,

PHC, CHC / Area Hospital and the District / Teaching Hospitals;

Establish an effective planning, coordination, facilitation and monitoring system

for a cluster of four to ten PHCs; and

Strengthen community outreach through fixed day visit to sub-centres and

villages by the medical and para-medical staff;

4. Institutional Strengthening: The government has ensured for effective integration of public health services, the government has created the post of Commissioner of Health

and Family Welfare with overarching responsibility over the Directorates of Public

Health, Family Health, Institute of Preventive Medicine, AP Vaidya Vidhana Parishad, AP AIDs Control Society and the Indian Institute of Health and Family Welfare. At the

Government level, a single Principal Secretary has been assigned responsibility for all

primary and secondary health systems, ending decade long arrangement of dispersed

authority. The government is in the process of establishing a HR Directorate. Concurrently, the six regional health directorates and twenty three DMHO institutions

are being strengthened through fundamental institutional reengineering.

5. Human Resources: The Government have commitment to strengthening the

health services, and rationalised all Specialists working in various health facilities and

posted them against the existing vacancies in the CHC/AH (FRU‟s). Further, to fill the

gaps 194 Specialists, 989 Medical Officers, 1700 Staff Nurses on regular basis and 691 Staff Nurses on contractual basis under NRHM have been appointed in the state. To

strengthen the Regional Directors a trained Bio-Statisticians have been posted as

Regional Data Managers to monitor NRHM activities in the region. All the DPMUs is now headed by a Public Health Officer to support the DMHOs, to monitor IMNCI,

School health activities all districts have been established with IMNCI coordinators and

school health coordinators as envisaged in the PIP 2010-11.

6. Programme revitalization: The institutional reengineering has shown impact both

in terms of access and quality of health care at all levels. The organisational reform is

being accompanied by strategic realignment of programme design, implementation methodology and monitoring systems. The programme implementation plan have been

aligned with the specific needs and requirements of the local communities. The strategic

focus will steadfastly remain on maternal and child health, disease prevention and

effective management and overall health promotion. Considering the diversity of the state, the interventions and the delivery mechanism will be customised for the needs and

expectations of the target groups.

7. The NRHM Project Implementation Plan (PIP) for 2011-12 is a salubrious

document with the proposed programmatic realignment to achieve rapid but sustainable

improvement in the health outcomes. The PIP has its principal focus on improving the

reproductive and child health services and the resultant outcomes. However, equal importance is accorded to disease control interventions; strengthening the human

resources, infrastructure, capacities and capabilities; strengthening of monitoring and

technical support systems, etc. Highest priority is assigned to addressing the needs of tribal people living in remote and interior areas and to ensure effective health care

services to people vulnerable from the social, economic and nutrition angles.

3

The PIP 2011-12 have covered all the programmes / interventions including disease control programmes, human resource, monitoring evaluation and situation analysis,

contents of the chapters structured with Executive Summary, Key Objectives, Critical

analysis and gap identification, Implementation Strategies, Expected Outcomes and

budget proposal so prepared duly quantifying the physical targets.

Sectoral Priorities – Budget Allocation

8. One of the objectives of NRHM is to increase the budget outlay for the health

sector to three percent of gross state domestic product (GSDP) and around eight percent of state budget. The state budget outlay for 2011-12 is around 1.2% of GSDP and 4.0%

of the total budget outlay. However, it is significant that the state allocation for health

sector has increased from Rs.1587.54 crores in FY 2005-06 to Rs.4562.78 crores in FY 2011-12 (provisional), an increase of about Rs.3000 crores. NRHM allocation constitutes

about 30% of total state allocation for health and family welfare department.

9. The approved budget for NRHM during 2010-11 was Rs.961.13 crores, of which an amount of Rs.670.01 crores was released – excluding the unspent balances. Of this,

an amount of Rs.593.22 crores has been spent. During 2011-12, state proposes a total

budget of Rs.1318.76 cores, which includes 15% state share. GoAP has already indicated state share of Rs.158.61 towards implementation of NRHM activites during 2011-12.

The summary of budget is as follows:

(Rs. Crores)

S N Activity

Proposed

Budget

2011-12

% increase

over

2010-11

1 RCH Flexible Pool 334.96 64.20

2 Mission Flexible Pool 510.36 69.47

3 Strengthening of Routine Immunization 24.93 35.97

4 National Disease Control Programme 67.93 16.76

5 Monitoring & Evaluation 11.97 100.00

6 Direction and Admn. (Treasury route) 346.61 24.41

7 Pulse Polio 22.00 9.13

Total 1318.76 49.79

4

CHAPTER-1

OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11

10. Andhra Pradesh is the fifth largest State in India in terms of geographical area

and population. The State has a population of 880.23 lakhs. The decadal population

growth rate of the state was 14.59 during 1991-2001 decade, compared to the national

growth rate of 21.54. The projected current population of the state is around 880.23 lakhs (1.10.2010 Estimates). With an area of 275,068 sq. kms, the state accounts for

approximately 8.37 percent of the total landmass of the country. The state is divided into

three distinct regions on the basis of homogeneity, contiguity and economic criteria for the purpose of better planning and development. These regions are – Telangana,

Rayalaseema and Costal Andhra. The state has 23 districts, which are divided into

1,125 mandals.

11. As per Census 2001, the population density (per square kilometre) in the state has

increased from 242 in 1991 to 277 in 2001. Scheduled Castes constitute 16.2 percent of

population and Scheduled Tribes constitute 6.6% of population. According to Census 2001, the literacy rate in the state (60.5 percent) is lower than the national average (64.8

percent). The male and female literacy rate was about 70.3 percent and 50.4 percent

respectively, which is lower than the national average (75.3 percent for males and 53.7

percent for females). The sex ratio and child sex ratio (0-6 age group) of the state is 978 and 961 respectively, which is higher than the corresponding national figures of 933 and

927, indicating the prevailing gender norms in the state.

Socio-Demographic Profile of Andhra Pradesh

Rural Urban Total

1 2001 Census population (in lakhs) 554.01 208.09 762.10

2 Estimated Population (in lakhs) 639.89 240.34 880.23

3 % of population over total pop. 72.7% 27.3%

4 Male population (in lakhs) 323.49 121.50 444.99

5 Female population (in lakhs) 316.40 118.84 435.24

6 Sex Ratio (Females per 1000 males) 983 965 978

7 Sex-Ratio (0-6 children) 963 955 961

8 Growth rate (%) +13.94 +16.34 +14.59

9 % SC Population 18.4 10.2 16.2

10 % ST Population 8.4 1.8 6.6

Source: Registrar General of India, 2001

Rural Scenario

12. As per the 2001 census, there are 28,123 villages in the state out of which 26,613

are inhabited. Approximately 6 percent villages in the state had a population of less than 500 and another 20 percent villages had population in the range of 500-1250. Moreover

72.7% population live in rural area. However, districts like Hyderabad, Visakhapatnam,

Krishna, Guntur, Warangal have relatively large urban population.

5

Census

Year

Rural

Population

Percent of Rural

Population

Decadal growth

Rate

1961 2,97,09,447 82.56 15.62

1971 3,50,99,708 80.68 18.15

1981 4,10,61,673 76.68 16.99

1991 4,86,21,008 73.11 18.41

2001 5,54,01,007 72.70 13.94

Urban Scenario

13. Andhra Pradesh has undergone rapid urbanization over the past fifty years. Census 2001 states that nearly 208.09 lakh people, which accounts for 27.3% of the

population, reside in urban areas. The corresponding figure in 1961 was nearly 62.74

lakhs accounting for 17.4 percent of the population.

Census

Year

Urban

Population

Percent of Urban

Population

Decadal growth

Rate

1961 62,74,000 17.40 15.76

1971 84,03,000 19.30 33.93

1981 1,24,88,000 23.30 48.61

1991 1,78,87,000 26.90 43.23

2001 2,08,09,000 27.30 16.34

Expected outcomes

Indicator NRHM

by 2012

Present status AP

Target India AP

IMR (per 1000 live births) 30 50# 49# 30

MMR (per 1,00,000 live births) 100 254** 154** 100

TFR (children per women) 2.1 2.7* 1.8* 1.7

Source: # SRS 2009; * SRS 2008; ** SRS Special Survey (2004-06)

Achieve a cure rate (TB - DOTS) of – 85% by 2012

Reduce prevalence rate of Leprosy to – 0.43 per 10,000 by 2012

Increase Cataract operations to – 6 lakhs per annum by 2012 (AP).

Reduce Malaria Mortality Rate to – 60% by 2012

Reduce Filaria / Microfilaria rate to – 80% by 2012.

6

Progress over the years

Infant Mortality Rate (per 1,000 live births)

77

6459

5449

0

10

20

30

40

50

60

70

80

90

SRS 1983 SRS 1993 SRS 2003 SRS 2007 SRS 2008

Source: Sample Registration System (SRS), RG, GOI

Maternal Mortality Ratio (per 1 lakh live births)

417341

195154

050

100150200250300350400450

1992-93 IIHFW

1998-99 IIHFW

2001-03 SRS

2004-06 SRS

Total Fertility Rate (children per women)

4.64.0

3.0

2.31.8

01122334455

SRS 1971 SRS 1981 SRS 1991 1998-99 (NFHS-2)

SRS 2008

Institutional Deliveries

34.3

49.8

68.6 71.8

0

10

20

30

40

50

60

70

80

NFHS-1(1992-93)

NFHS-2(1998-99)

NFHS-3(2005-06)

DLHS-3(2007-08)

14. An attempt is made to analyze the current status of NRHM specific indicators of

Andhra Pradesh on HMIS reports (April and September 2010) in comparison with NFHS- 3, DLHS-3 and CES, 2009.

Out come of surveys on Service Delivery

A - Child Health HMIS

2009-10

April–Sept

2010 Surveys Source

1 Expected Live Births 1,525,239 1,551,727

2 New born breastfed in less than 1 hr of birth against Expected Live Births

81% 81.3% 22.4% NFHS-3

3 Newborn weighed % against Expected Live Births 93% 92.8% 62.7% NFHS-3

4 Newborn weighed less than 2.5 kgs % 9% 7.1% 19.4% NFHS-3

B - Child Immunization

5 Fully Immunized Children 99% 94.9% 46.0%

NFHS-3

68% CES,

09

6 Children given BCG 101% 96.4% 92.9% NFHS-3

7 Children given 3 doses of OPV 99% 93.7% 79.2% NFHS-3

8 Children given 3 doses of DPT 99% 94.0% 61.4%

NFHS-3

89.9%,

CES,09

9 Children given Measles 98% 95.2% 69.4%

NFHS-3 90.4%,

CES, 09

7

C - Maternal Health

10 Pregnant women registered for ANC 108% 102% -- --

11 ANC registered in First Trimester 72% 67.9% 67.3% DLHS-3

12 Antenatal Care 3 check ups 93% 89.0% 89.4% DLHS-3

97% CES, 09

13 Home Deliveries (%) 8% 5.1% 27.7% DLHS-3

14 Home Deliveries assisted by SBA (%) 5% 3.5% 13.9% DLHS-3

15 Institutional Deliveries (%) 90% 84.6% 71.8% DLHS-3

94.3% CES, 09

16 Post natal check up within 48 hrs of delivery (%) 87% 97.0% 79.5% DLHS-3

NRHM /RCH-II Outcomes

A. Current status 15. Andhra Pradesh‟s MMR at 154 (SRS 04-06) has declined from 195 in SRS 01-03

and is the fifth lowest after Kerala, Tamil Nadu, Maharastra and West Bengal. The IMR

(SRS 2008) at 52 has reduced from 59 (SRS, 2003), but is nowhere close to the target of

30 for 2012. TFR at 1.8 (SRS 2008) is better than the national target for 2012. The early neo-natal mortality (death within one week from child birth) recorded more than 50

percent of infant mortality in the state.

16. Andhra Pradesh‟s progress during the four- year period between DLHS2 (2002-04) and DLHS 3 (2007-08) is varied:

Universal antenatal coverage reported by mothers since 2002, mothers having

three or more ANCs increased marginally from 86% to 89.4% between survey

periods and to 97% by 2008 (CES, 2009).

Mothers having full ANCs decreased from 44.2% to 37.9% during survey

period. However, the CES 2009 survey reported 46%.

Significant increase in institutional deliveries from 59.4% to 71.8% between

the survey periods. It reached 94.3% by 2009 (CES, 2009).

Early initiation of breast feeding ((< 1 hour) increased from 41.8% to 47.8%

but CES 2009 survey indicated 27.2%.

Full immunization in children of 12-23 months increased from 60.2% to 67.1% while CES 2009 survey reported 68%

Children with diarrhea receiving ORS has decreased from 57.8% to 43.3%

but has shown marginal increase of 54.5% as reported by CES (UNICEF)

2009.

Service Delivery Summary

2009-10 vs April to September 2010

2009-10

April –

Sept.

2010

2009-

10

April –

Sept.

2010

ANC

ANC Registration

against Expected Pregnancies

108% 111%

TT1 given to Pregnant

women against ANC Registration

92% 88.9%

3 ANC Check ups

against ANC

Registrations

86% 87.4%

100 IFA Tablets given to

Pregnant women against

ANC Registration

94% 93.9%

8

Deliveries

Un-reported Deliveries

against Estimated

Deliveries

2.2% 1.3%

HOME Deliveries( SBA&

Non SBA) against

Estimated Deliveries

7.5% 0.6%


against Estimated

Deliveries

90.3% 90.9%

HOME Deliveries( SBA&

Non SBA) against

Reported Deliveries

7.7% 5.7%

Institutional Deliveries against Reported

Deliveries

92.3% 94.3% C Section Deliveries against Institutional

Deliveries( Pvt & Pub)

19% 18.1%

Births & Neonates Care

Live Births Reported

against Estimated Live Births

102% 98% New borns weighed against

Reported Live Births 91% 94.8%

Still Births (Reported) 12,193 6,245

New borns weighed less

than 2.5 kgs against

newborns weighed

9% 7.7%

Sex Ratio at Birth 946 940 New borns breastfed within one hr of Birth against

Reported live Births

79% 83%

Child Immunization (0 to 11 months)

BCG given against

Expected Live Births 101% 96.4%

Measles given against


OPV3 given against


Fully Immunised Children

against Expected Live

Births

99% 94.9%

DPT3 given against Expected Live Births

99% 94.0%

A. Antenatal Care I. More than 94% of pregnant women registered for ANC of which 87% availed

three ANC (the lowest reported in Warangal (70%) and the highest in Ranga

Reddy, Medak, Kadapa and Hyderabad districts (97 – 99 percent)). II. 30% of Total ANCs (94%) have been registered as JSY beneficiaries during the

period April to September 2010 in the state. Vizianagaram, Mahabubnagar,

Khammam, Chittoor and Kadapa districts have been reported 42% of total JSY

beneficiaries registered. III. The ANC registrations in first trimester by pregnant women remained at 67.3%

during the period April to September 2010 from 72% HMIS (2009-10). The

DLHS-3 (2006-07) survey reported two-thirds (67%) of ANCs registered during first trimester of pregnancy. The proportion of first trimester ANC registrations

(66%) reported in Vizianagaram, East Godavari, Prakasam, Medak and

Mahabubnagar districts is less than the state average.

IV. 89% of pregnant women have received the First dose of TT immunization. The districts that reported lower than 75% of TT-1 vaccination are Kurnool,

Nizamabad, Prakasam, Visakhapatnam, Vizianagaram and Warangal.

V. 93% of pregnant women received the second dose of TT immunization for the current pregnancy. However, the proportion of second dose of TT reported in

9

Vizianagaram, Visakhapatnam, West Godavari, Warangal and Nizamabad

districts is below state aggregate (74 to 87 percent). VI. About 3% of pregnant women are suffering with severe anemia (Hb<7). The

HMIS data upto Sept. 2010 showing that, an alarming situation of severe anemia

in districts of Vizianagaram (17.2%), Khammam (8.5%), Medak (5.9%) and

Adilabad (4.4%). VII. Half of the pregnant women in Hyderabad, Khammam, Chittoor,

Visakhapatnam, and Vizianagaram districts reported Hemoglobin below 11. This

clearly indicates strengthening and monitoring of nutritional interventions in the districts.

VIII. In the reference period, five percent of new cases among pregnant women at the

institutions were detected with high Blood Pressure (BP>140/90) in the state. In

the districts Srikakulam, Vizianagaram, West Godavari, Nellore, Chittoor and Adilabad, more than 7% of new cases with High Blood pressure were reported.

IX. Nine out of ten (93%) pregnant women in every district received 100 IFA tablets.

A comparison of HMIS data with survey results indicates a lower percentage of IFA consumption of 48% (DLHS-3; 2006-07). The RCH-II Baseline Survey

(2007) also indicated that the percent of pregnant women who received /

purchased 100 or more IFA tablets was 54% and consumption of all tablets stands

around 33.2%.

B. Delivery and Post Natal care

Surveys Home Public Private Total

DLHS-3 28.3 29.0 42.7 100.0

HMIS (April to Sept, 2010)

5.4 38.8 55.9 100.0

a) The percentage of institutional deliveries increased to 94.6% as per HMIS data

(April to September 2010) from 92.3% HMIS (2009-10). A significant improvement was recorded from 72% in 2006-07 (DLHS-3).

b) 56% of deliveries were conducted in private institutions (according to HMIS

data). The private sector deliveries recorded more than 75% in Karimnagar (83%),

Ranga Reddy (78%), Nellore (77%) and Guntur (76%) districts.

Trends in Institutional Deliveries in Andhra Pradesh

32.9

49.861.463.7

69 76

92.394.3

0102030405060708090

100

NFH

S-1

(92

)

NFH

S-1

(98

)

20

02

-04

(DLH

S)

20

03

(EC

Surve

y)

20

05

-06

(NFH

S-3)

20

06

(Base

line

)

HM

IS

(20

09

-10

)

HM

IS

(20

10

)

10

c) The percentage of mothers who received JSY benefit in the state worked out as

5.6% during the period April to September 2010 (Home based (0.25%), public institutions (14.5%) and private institutions (0.12%) respectively.

d) Home based deliveries declined from 23% in 2007-08 (DLHS-3) to 5% (HMIS,

April to September 2010 HMIS data). More than 10% of home based deliveries

were reported in Adilabad, Kurnool, Mahabubnagar, Prakasam, Srikakulam, Visakhapatnam and Vizianagaram districts. It is to be observed that only half of

the home-based deliveries in Mahabubnagar and Vizianagaram were attended by

skilled personnel.

e) Less than three-fourths (74%) women were discharged within 48 hours of delivery

from public health facility. However, the ratio of women delivered in public

institutions to total deliveries was recorded below 20% in Karimnagar, Ranga

Reddy and Nellore districts. As per JSY norms, a minimum stay at the institute of 48 hours is required both for newborn and the mother after delivery.

f) Out of institutional based deliveries in the state, three-fourths (76%) are normal

type delivery, 18% are C-Sections and 5.6% are complicated pregnancies.

g) 34% of C-Sections are conducted in private institutions as compared to 8.5% in

public health facilities. In the districts, deliveries conducted by C-Section are

sizeable with Srikakulam (26%), Guntur (28%), Nizamabad (31%), Nalgonda

(32%), Khammam (32%) and Karimnagar (48%) throwing light on the surging rates of C-Section cases.

Delivery status


2009-10 April – Sept. 10

Total Population 82,893,403 88,023,000

Expected Deliveries 1,564,895

1,551,727

775,864

(April to Sept.10)

Home SBA 75,171 (5%) 29,702 (3.8%)

Home Non SBA 42,650 (3%) 14,023 (1.8%)

Institutional 1,413,202

(90%) 721,674 (93.0%)

Total deliveries reported 1,531,023 765,399

Unreported Deliveries 33,872 (2%) 10,465 (1.4%)

11

Home (SBA & Non SBA) & institutional

deliveries to expected deliveries (%)

Unreported

Deliveries

1.4

Home Non SBA

1.8

Institutional

93

Home SBA

3.8

Home (SBA & Non SBA) & institutional

deliveries to reported deliveries (%)

Home Non SBA

1.8

Institutional

94.3

Home SBA

3.9

Comparison of type of deliveries

HMIS data and DLHS-3 survey

28.2

5.7 5.713.9

4.0

71.8

94.3 94.3

0

10

20

30

4050

60

70

80

90

100

Home Deliveries Home Deliveries

assisted by SBA

Institutional

Deliveries

DLHS III HMIS (Apl-Sep, 2010) CES, 2009

Comparison of institutional deliveries:

HMIS and DLHS-3 survey

28.3

5.7

29.0

38.342.7

56.0

0

10

20

30

40

50

60

Home Deliveries Public institutions Private Institutions

DLHS III HMIS, Apl to Sep 2010

District-wise institutional deliveries to reported deliveries

81

.6 83

.9

85

.6 87

.7

87

.7

89

.0

89

.0 92

.5

92

.8

93

.3

94

.3

95

.5

95

.8

96

.3

96

.7

97

.6

98

.2

98

.3

99

.1

99

.3

99

.3

99

.5

99

.7

10

0.0

0

10

20

30

40

50

60

70

80

90

100

Ad

ilab

ad

Ku

rno

ol

Pra

kasa

m

Viz

ian

agar

am

Srik

aku

lam

MB

NR

Viz

ag

Kad

apa

Kar

imn

agar

Nal

gon

da

An

dh

ra P

rad

esh

Kh

amm

am

Me

dak

Ch

itto

or

An

anta

pu

r

Ne

llore

Ran

ga R

ed

dy

Niz

amab

ad

Gu

ntu

r

Kri

shn

a

War

anga

l

We

st G

od

avar

i

East

Go

dav

ari

Hyd

% %

12

C - sections & complicated deliveries



(Public)


(Private)

2009 –10 April to

Sept. 2010 2009 – 10

April to

Sept.10

Total Deliveries 663,713 293,285 749,489 428,389

C Section 70,570 24,918 204,290 138,690

C Section% 11% 8.5% 27% 32%

Complicated Pregnancies

attended 47,380 24,404 31,286 18,534

Complicated Pregnancies attended %

7% 8.3% 4% 4.3%

C-Section, complicated & normal del.

against reported inst. Del. (Prt. & Public)

C-section

18.1%

Normal Deliveries

76.2%

Complicated

Pregnancies

attended

5.7%

District-wise C-Section deliveries to institutional

deliveries

3.8

6.7 7

.9 8.9 9.7 10

.4

10

.6

10

.8

15

.4

15

.5

15

.9

16

16 16

.3

17

.5

26 2

7.3

17

.9

18

.1

27

.9

31

.5

31

.6

32

.3

48

.3

0

10

20

30

40

50

60

Ch

itto

or

Ku

rno

ol

We

st G

od

avar

i

Kad

apa

Ne

llo

re

An

anta

pu

r

Ran

ga R

ed

dy

Viz

ag

Pra

kasa

m

Ad

ilab

ad

War

anga

l

Kri

shn

a

Me

dak

Hyd

era

bad

MB

NR

Viz

ian

agar

am

An

dh

ra P

rad

esh

East

Go

dav

ari

Srik

aku

lam

Gu

ntu

r

Niz

amab

ad

Nal

gon

da

Kh

amm

am

Kar

imn

agar

Treatment of complicated pregnancies and deliveries:


2009 – 2010 April to

Sept. 2010

Reported Deliveries 1,531,023 765,399

Reported ANC Registration 1,808,357 868,764

Complicated Pregnancies attended 78,666 42,938

Complicated Pregnancies Rate 5% 5.9%

C-Section Deliveries 274,860

(17.9%)

138,690

(18.1%)

PNC Maternal Complications 21,139 9,625

Abortions 12,965 7,595

Still Births 12,193 6,245

Complicated Deliveries Treated with

IV Antibiotics 46,073 23,887 (55.4%)

IV Antihypertensive / Magsulph

Injection 6,491

1,755

(4.1%)

IV Oxytocis 28,680 16,864 (39.2%)

13

2009 – 2010 April to

Sept. 2010

Blood Transfusion 2,028 544

(1.3%)

No. of Eclampsia cases treated 10,025 5,027

No. of severe anaemia (Hb<7) cases treated

70,906 25,129 (2.9%)

Duration of stay after delivery in public

institutions

2009-10 vs April to Sept. 2010

Stay for more than 48

hrs after delivery

26%

Stay for less than 48

hrs after delivery

74%

Duration of stay less than 48 hours after delivery

in public institutions - 2009-10 vs April to Sept.

2010

80.9 85

.2 87.4 92

.5

94.1

94.2

95.0

95.2

95.9

96.0

96.4

97.1

97.2

97.7

98.3

98.4

98.5

98.8

99.3

99.4

99.8

99.9

100.

0

0

10

20

30

40

50

60

70

80

90

100

Kurn

ool

Prak

asam

Adila

bad

MBN

R

Srik

akul

am

Viza

g

Vizi

anag

aram

Karim

naga

r

Andh

ra P

rade

sh

Nal

gond

a

Kada

pa

Chitt

oor

Med

ak

Kham

mam

Nel

lore

Rang

a Re

ddy

Niz

amab

ad

Anan

tapu

r

Kris

hna

Gun

tur

Wes

t God

avar

i

War

anga

l

Hyd

erab

ad

Percent of mothers paid JSY incentive to

reported deliveries - 2009-10 vs April to Sept.

2010

3

0.03

22

14.5

3

0.120

5

10

15

20

25

Home Institutional (Public) Institutional (Pvt.)

2009-10 Apr-Sep 2010

District-wise mothers paid JSY incentive to

reported deliveries (%) 2009-10 vs April to

Sept.2010

0.0

0.0

0.0 2.

6

2.7

3.3

3.3 4.

9

4.9 5.8

10.8

11.1

12.3

13.0

13.5

14.3

14.5

20.5 22

.3 23.9

24.9

43.7 46

.8

55.6

0

5

10

15

20

25

30

35

40

45

50

55

60

Kad

apa

Kar

im N

agar

Me

dak

East

Go

dav

ari

Ch

itto

or

Ku

rno

ol

Niz

amab

ad

MB

NR

Srik

aku

lam

Kri

shn

a

Kh

amm

am

Ne

llore

Hyd

era

bad

Viz

ian

agar

am

Ad

ilab

ad

War

anga

l

An

dh

ra P

rad

esh

Pra

kasa

m

Viz

ag

An

anta

pu

r

Ran

ga R

ed

dy

Nal

gon

da

We

st g

od

avar

i

Gu

ntu

r

ANC services


775864

868764

579924

258935

759614 772160

811172 816037

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

Exp. Prg. Total ANC

reg.

ANC Reg.

1st tri.

ANC Reg.

JSY

3 ANC

Checkups

TT1 TT2 100 IFA

tab. Given

Pregnancy complications reported during ANC

registration


4.4

0.6

29.3

2.9

0

5

10

15

20

25

30

35

40

Hypertensive cases

detected at institution

Eclampsia cases managed

during delivery

ANC women having Hb

level<11

ANC women having

severe anaemia (Hb<7)

treated at institution

14

Pregnant women registered for ANC in first

trimester


52.0

63.067.0 66.866.0

0

10

20

30

40

50

60

70

80

90

100

NFHS-2 (1998-99) NFHS-3 (2005-06) RCH Baseline

(2007)

DLHS-3 (2007-08) HMIS (Apl-Sep

2010)

Percent of pregnant women registered for ANC in

first trimester


51.9

52.0 54

.7 59.3

59.6

61.5

61.7

61.7

62.0

63.8

65.2

66.8

66.8

67.3

68.4

70.5

72.0

72.2

72.2 75

.2

75.5 80

.4 84.7 88

.0

0

10

20

30

40

50

60

70

80

90

100

Med

ak

Pra

kasa

m

MB

NR

Kri

shn

a

Niz

amab

ad

HYD

An

anat

apu

r

East

Go

dav

ari

Gu

ntu

r

Viz

ian

agar

am

Kar

imn

agar

Wes

t G

od

avar

i

An

dh

ra P

rad

esh

Nel

lore

War

anga

l

Viz

ag

Ran

ga R

edd

y

Ku

rno

ol

Nal

gon

da

Ad

ilab

ad

Kh

amm

am

Ch

itto

or

Srik

aku

lam

Kad

apa

% 3 ANC checkups against reported ANC

registration - 2009-10 vs April to Sept.10

0

20

40

60

80

100

120

Waran

gal

Prakasam

Kh

amm

am

Visakh

apatn

am

Krish

na

Srikakulam

Nizam

abad

Vizian

agaram

East Go

davari

Gu

ntu

r

West G

od

avari

An

dh

ra Prad

esh

Nello

re

Ch

itoo

r

Mah

abu

bn

agar

An

anth

apu

r

Ku

rno

ol

Nalgo

nd

a

Karim

nagar

Ran

ga Red

dy

Ad

ilabad

Kad

apa

Hyd

erabad

Med

ak

Post natal checkup against reported deliveries:

HMIS (April to Sept 2010)

87

95

18

5

0

10

20

30

40

50

60

70

80

90

100

PNC within 48 hrs after deliveries PNC bet 48 hrs and 14 days of deliveries.

HMIS-2009-10

HMIS Apl to Sept 2010

C. Newborn care and Breast feeding

h) The percentage of new born weighed at birth is universal across all districts. However, the DLHS-3 survey reported only 63% in the state during 2006-07.

i) A wide gap is observed in case of new born weighted below 2500 grams between

the DLHS-3 survey (19%) and HMIS (9 %). It is noticed that, very high in

Karimnagar (67%) and Prakasam (24.8%).

j) A wide gap is reported between HMIS and survey data in terms of newborn

breastfed within one hour of child birth. Nine out of ten (93%) newborns were

breastfed within one hour of delivery as compared to 22.4 (DLHS-3, 2006-07) and 29.3% (CES-2009) surveys.

k) Nine out of ten (96% to 100%) of infants 0 to 11 months old received BCG, DPT

1-3, OPV 1-3 and measles vaccine in the state. A comparison of HMIS data with

survey data indicated wide gaps. The measles vaccine increased from 69.4% (NFHS-3) to 88.6% (DLHS-3, 2007-08) and has lately reached 90.4% (CES, 2009)

in state.

15

Live Birth

– Males

Live Birth

- females

Live

Birth -

Total

Sex

Ratio at

birth

Still

Birth

Abortion

( Induced/

Spontaneous)

802,176 758,726 1,560,902 946 12,193 12,965

Reported births: HMIS (April to Sept 2010)

775863 759551719852

55455

630509

0

100000

200000

300000

400000

500000

600000

700000

800000

Estimated Live

Births - Apr to

Sep 2010

Reported Live

Births - Apr to

Sep 2010

Newborns

weighed at

birth

No. of

Newborns

having weight

less than 2.5kg

Newborns

breast fed

within 1 hour

District-wise neonates weighing to reported live

births (%) HMIS (April to Sept 2010)

85.9

86.5 90

.2

90.5

92.2

93.5

93.5

93.7

94.0

94.8

94.8

96.8

97.5

97.9

98.3

98.3

98.4

99.6

99.8

99.9

100.

0

100.

0

100.

0

81.5

0

10

20

30

40

50

60

70

80

90

100

Ad

ilab

ad

Pra

kasa

m

Niz

amab

ad

Med

ak

MB

NR

Viz

ian

agar

am

Kar

imn

agar

Srik

aku

lam

Nal

gon

da

Kad

apa

Viz

ag

An

dh

ra P

rad

esh

East

Go

dav

ari

Kh

amm

am

Ran

ga R

edd

y

An

anta

pu

r

Ch

itto

or

Nel

lore

War

anga

l

Wes

t G

od

avar

i

Kri

shn

a

Hyd

erab

ad

Gu

ntu

r

Ku

rno

ol

Comparison of new born care characteristics:

31.622

8376.9

63

95

17 19

810

20

30

40

50

60

70

80

90

100

Newborn breastfed in less

than 1 hr of birth

Newborn weighed Newborn weighed less

than 2.5kgs

RCH-Survey, 2007 NFHS III HMIS(Apr-Sept 2010)

Immunization (0 to 11 months) against reported

live births:

96.4 94.0 94.0 95.0 95.0

10

20

30

40

50

60

70

80

90

100

BCG OPV3 Fully

Immunised

District-wise fully immunized (0-11 months)

children against reported live births (%)

Child Immunization Comparison of HMIS

(April to Sept.10) and UNICEF (CES 2009)

Survey

9599

68

96 10194

9994

99

9095 98

90

10

20

30

40

50

60

70

80

90

100

110

Fully

Immunised

BCG OPV3 DPT3 Measles

HMIS (Apr-Sept 2010) HMIS (2009-10) CES, 2009 (UNICEF)

16

D. Hospital Service delivery

l) Inpatients form just 5% of total outpatients. About 18% of the general admissions in the in-patient department comprise children.

m) In the outpatient department, the share of AYUSH patients is 4.5% during the

period April to September 2010 as compared to 2.8% during 2009-10.

n) During the reference period, 3.7% underwent HIV test, 3.9% reported HIV positive to HIV tests conducted and 1.56% of pregnant women tested for HIV in the hospitals as positive.

o) Ten percent of total out patients reported severe anemia (HB<7 gm) in the laboratory tests.

Hospital service delivery: HMIS (April to Sept.10) Operation

major

(General and

spinal

anaesthesia)

Operation

minor (No or

local

anaesthesia)

AYUSH Dental

Procedures

Adolescent

counselling

services

Total OPD Total IPD

42,716 166,830 1,017,909 111,281 56,538 22,162,251 1,049,179 (Children

18%)

Operation

major

(General and

spinal

anaesthesia) as

%ge of OPD

Operation

minor (No or

local

anaesthesia) as

%ge of OPD

AYUSH as

%ge of

OPD

Dental

Procedures as

%ge of OPD

Adolescent

counselling

services as

%ge of OPD

IPD as

percentage

of OPD

0.2% 0.75% 4.5% 0.5% 0.3% 4.73%

E. Other Services

Performance of permanent family planning methods:

HMIS (April to September 2010)

2009-10

April to

September 2010

% age of reported

Sterilization

(Apl. to Sep 2010)

Total Sterilization 945,075 391,607 -

NSV 22,223 4983 1.3%

Laproscopic 105,256 39915 10.2%

MiniLap 523,081 175267 44.7%

Post Partum 294,515 171442 43.8%

Male Sterilisation 22,223 4983 1.3%

Female

Sterilisation 922,852 386,624 98.7%

Abortions April – September 2010

Total Abortions Abortion Rate

7595 1.0% (1.1% during 2009-10)

17

Abortions: HMIS (April to September 2010)

MTP more

than 12

weeks

6%

MTP less than

12 weeks

15%

Abortion(Spo

n&Induced)

79%

RTI cases reported in public & private institutions

Total OPD Total RTI/STI cases Number of wet mount tests

conducted

22,162,251 330,209 (1.7%) 15871(4.8%)

RTI cases reported in public & private institutions:


Male

42%

Female

58%

Laboratory services in hospitals: HMIS (April to September 2010)

Total OPD Total HB

tested

Total HIV

Tested

Total

Population

22,162,251 662,480 821,978 84,333,000

HB test

conducted as

%age of OPD

HB<7gm as

%age of HB

tested

HIV test

conducted as

%age of OPD

HIV

positive as

%age of

HIV tested

HIV positive as %age of

HIV tested among pregnant

women

2.99% 9.2% 3.71% 3.9% 1.56%

Vaccine preventable childhood disease:


Diphtheria Pertussis Tetanus

Neonatorum

Tetanus

others Polio Measles

39 0 0 0 0 151

18

Childhood Disease - Others - Apr'10 to Sept'10

Diarrhoea and

dehydration Malaria

Number admitted

with Respiratory

Infections

55,131 428 15,039

Reported infant & child deaths: HMIS (April to September 2010)

Infant

Deaths

within 24 hrs of birth

Infant Deaths

between 24hrs

& under 1 week

Infant Deaths

between 1

week & under 1 month

Child Deaths

between 1

month & under 1 year

Child

Deaths

between

1yr under 5years

Total Deaths

860 3953 2583 2706 2069 12171

Infant & Child deaths against reported infant & child deaths:


Infant deaths

between 1 week &

under 1 month

20%

Child deaths

between 1 month

& under 1 year

22%

Child deaths

between 1 yr

under 5 yrs

15%

Infant deaths

within 24 hrs of

birth

8%

Infant deaths

between 24 hrs &

under 1 week

35%

19

Causes of Infant & Child Deaths - April to September 2010

Sepsis Asphyxia LBW

Up to 1 Weeks

of Birth

Between 1

week & 4

weeks of

birth

Total

Up to 1

Weeks of

Birth

Between 1

week & 4

weeks of

birth

Total

Up to 1

Weeks of

Birth

Between

1 week &

4 weeks

of birth

Total

104 58 162 299 110 409 602 296 898

Pneumonia Diarrhoea Fever related

Between 1

month and 11

months

Between 1

year & 5

years

Total

Between 1

month and

11 months

Between 1

year & 5

years

Total

Between 1

month and

11 months

Between

1 year & 5

years

Total

111 33 144 39 51 90 76 153 229

Others Measles Others

Up to 1 Weeks

of Birth

Between 1

week & 4

weeks of

birth

Total

Between 1

month and

11 months

Between 1

year & 5

years

Total

Between 1

month and

11 months

Between

1 year & 5

years

Total

1503 957 2460 6 1 7 1349 814 2163

Causes of Infant & Child Deaths against total reported causes of Infant & Child

deaths:

Others

70%

Fever related

4%

Diarrhoea

1%

Pneumonia

2%

LBW

14%

Sepsis

3%

Asphyxia

6%

20

Maternal Deaths & Causes – April to September 2010

Abortion Obstructed/prolonged

labour Severe hypertension/fits

6-14 yrs 15-55

yrs. Total

6-14

yrs

15-55

yrs. Total 6-14 yrs

15-55

yrs. Total

0 6 6 0 6 6 0 49 49

Bleeding High Fever Other Causes

6-14 yrs 15-55

yrs. Total

6-14

yrs

15-55

yrs. Total 6-14 yrs

15-55

yrs. Total

0 59 59 1 11 12 0 265 265

Maternal Deaths & Causes against Total reported causes of Maternal Deaths

Other causes

65.6%

Severe

hypertension

12.1%

Bleeding

14.6%

High fever

1.4%

High Fever

3.4%

Abortion

1.5%

Obstructed/prol

onged labour

1.5%

21

CHAPTER-2

POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS

S N Strategic areas Issues that need to be addressed

1. HR policies for Doctors,

Nurses paramedical staff

and programme management staff

The government is contemplating one year

compulsory rural internship for all MBBS

graduates and two years of mandatory assignment with secondary hospitals for all post-graduates

Filling up of OBG, Paediatrition, Anaesthetist

posts has been taken up by way if redeployment of

specialists from PHCs to CHCs / A.Hs / D.H. and balance vacancies by way of fresh recruitment in

FRUs i.e., CHCs, A.H. and D.Hs.

Recruitment of Doctors and para medics is being carried at District level based on demand for 24x7

hr MCH centres, FRUs, Blood Bank & Blood

Storage centres, for which a committee has been

constituted with the District Medical & Health Officer, Addl. DM&HO and District Program

Management Officers (NRHM) to identify the

institutions where additional manpower is needed for providing felt need services.

The selection process of specialist Doctors & Staff

Nurses is being done in a transparent manner by

displaying merit lists of selected candidates in web site.

To impart professional development skills all the

Senior Medical Officers/ MO‟s are being trained at IIH&FW, Hyderabad for 72 days.

Rationalization of service areas of Sub-centres,

PHCs has been taken up.

A policy has been devised to ensure continuance of the tenure and sustainability of HR, transfers are

banned in respect of all contractual staff till the

project completed.

2. Accountability and Performance appraisal

To ensure facility based monitoring necessary steps have been taken-up to sustain the functional

system HMIS has been extended to SHC level .

For appointment & renewal pf contract period for

contractual employees under NRHM, through an independent agency external evaluation of the

individual performance on the identified bench

marks to hike the wages and continuance of services.

3. Policies on drugs,

procurement system and

Logistics management

The government has introduced a new policy for

the streamlined procurement of medicines,

consumables, medical and surgical equipments

22


with increased budget outlay. The government has

decided to procure and position only high quality

generic medicines in all health facilities through a transparent and efficient manner. The government

will soon issue a comprehensive policy for

procurement of equipment and supplies. To implement the procurement policies effectively, the

AP Health and Medical Housing and

Infrastructure Corporation (APHMHIDC) is being

strengthened. Twenty-three drug storage facilities are being constructed across the state with an

outlay of Rs 55 Crores.

4. Equipments Necessary steps are being taken up to monitor all the equipments available and their functionality in

all the DH/AH/CH and teaching hospitals will

kept on website and will be monitored by

DM&HO‟s /DCHs concerned and will update the website on regular basis.

5. Ambulance Services and

Referral Transport EMRI (108) Ambulance service provision for all

normal deliveries and complicated high risk

deliveries and provision of transport for dropping back from institutions to village required and

necessary budget provision under NRHM.

Control rooms at each district head quarters have been established for timely response and provision

of services

6 Maintenance of buildings.

Sanitation, Water, Electricity, laundry,

kitchen

Special provisions have been made to maintain

Sanitation, Bore facilities, protected water supply are assured.

To provide diet kitchen arrangement have been

made

7 Diagnostics Essential Standards for Medical Laboratory Programme is being implemented in all the

Government Medical Laboratories in the state.

The Standard Operating Procedures were

implemented in all laboratories.

Internal control mechanisms are implemented to

assure the reliability of results.

All laboratory equipments are being calibrated.

The trainings were provided to all laboratory staff and MO.

8 Patient‟s feedback and

grievance redressal Patients feedback and grievance redressal

mechanism is present all hospitals.

Complaint boxes are placed in most of the hospitals and superintendent or MO in charge of

the hospital will take necessary action to patients

compliments.

23


9 Private Public Partnership

(PPP) Emergency Medical Services are being carried out.

The Family Planning services are being provided

by the accredited private health institutions.

Vaccines under UIP are being supplied to private

health institutions free of cost for child

immunization. Private institutions are involved in RNTCP, NLEP, NBCP and other national disease

control programmes, by referring the cases to

Govt. FRUs

10 Intersect oral convergence Effective coordination with key line departments like Social Welfare, Education, AYUSH,

APSACS, ICDS, RWS, SERP & W&CWD etc is

being maintained in providing quality of health

services to rural poor.

11 Community mobilization Active community participation will be ensured by

mobilizing community through ASHAs and

AWWs. Various contests to reward best

performers, to generate interest in particular activity/practice.

12 IEC Comprehensive communication strategy is worked out

at districts on local issues and needs focusing on urban slums, coastal and tribal areas and other settlements,

and envisaged to be integral component of the State

and Districts and has a critical role in achieving the

objectives of National Rural Heal Mission (NRHM).

Make the leap from” Awareness to Behavioral

Change”

From being “instructive” to being empowering and

From taking the “Genetic approach” to “individualized approach”.

13. Civil Registration System

(CRS) Nodal Agency for Civil Registration System (CRS)

is Director of Public Health in coordination with

tahsils and VOs in rural areas Municipal corporations / municipalities in urban areas.

14. Supportive Supervision Government of Andhra Pradesh has issued

detailed job responsibilities of all the staff. The filed

activities of the all field staff are being regularly supervised by the next level of supervisory officer.

The filed activities of the staff are also assessed

during the review meetings at various level. Regular trainings are provided to field staff.

15. Monitoring and Review Regular review meetings were conducted at

various levels to monitor and review all the health

programs. Core committee meetings are regularly conducted by the Honorable Minister for Medical,

Health and Family Welfare.

Senior Officers conference are conducted in every

24


month at the Commissionate of Health and Family

Welfare to review all the state and district level

health programmes.

16 Meetings of State Health

Mission/Society/District

Health Society

Governing Body and Executive Committee

meetings of the State Health & Family Welfare

Society as well as District Health & Family Welfare Society are being held on a regular basis.

17 Medical Colleges (New

Colleges and Up gradation of existing ones)

There are 13 Government & 23 Private Medical

Colleges for imparting training to the Medical graduates.

Of the total number of 4800 graduates passing

every year, 1,800 are from Government Medical

Colleges & 3000 are from Private Medical Colleges.

There are 24 Medical Colleges which are offering

PG Courses with 1948 seats, out of which 1094 are

in Govt. and 854 are in Private Colleges.

Recently, one new Medical College has been

sanctioned in Niamabad. Presently every District

in AP is having at least one Medical College either Govt. or Private Medical College

18 Nursing Schools State has 16 Govt. / 283 Private MPHA(F) Training

Schools, 14 Govt. Nursing Colleges / Schools.

Present training schools are catering the need of the State.

19 Paramedical education Present no.of trainining schools are catering the need

of the State.

20 Capacity building Prime objective of Capacity building under NRHM is to upgrade the skills and knowledge of all health

Personnel.

This is being achieved through integrated training

programmes that will further encompass the vast training needs to address various issues in planning

and operationalisation of health facilities in the

State

25

CHAPTER-3

CONDITIONALITIES

a) Release of the first trench of funds:

1) A full- time Mission Director for NRHM (for States having resource envelop of

more than Rs 50 crores), other than the administrative Secretary. MD NRHM would not hold additional charge outside the Health Department.

o A post of Mission Director exclusively for NRHM has been created and the same has been filled up by an IAS officer in the rank of Director.

2) A full- time Director/Joint Director/Deputy Director (Finance) (depending on

resource envelop of State), not holding any additional charge outside the Health Department, from the State Finance Services

o The post of Chief Finance Officer in the cadre of Joint Director on deputation from Finance Department has been filled.

3) A commitment to increase State Plan Budget for 2011-12 by at least 10% over and

above the 15% State share under NRHM.

o Overall Health Budget for the last 5 years is as follows:

(Rupees in crores)

Year Budget

allotted

% of

Increase

Allocation

to primary

health 2005-06 1587.54 11.89 880.57

2006-07 1895.34 19.39 1000.94

2007-08 2509.10 32.38 1119.44

2008-09 3150.84 25.58 1218.48

2009-10 3542.50 12.43 1234.34

2010-11 3982.78 12.43 1408.54

2011-12 4633.17 16.33 1890.87

b) Release of second trench of funds:

1) HR POLICIES & SYSTEMS as mentioned at S.NO. 1 of the Management

imperatives, measures should be initiated to ensure rational deployment with

stability of tenure by way of a clear transfer policy and facility based monitoring for results.

o State will take necessary steps to ensure the compliance of the GoI

Guidelines

26

2) DRUG POLICY & SYSTEMS, including a sound procurement and logistics

mechanism as mentioned at S.NO. 3 of the management Imperatives, with the objective of minimizing out-of-pocket expenses.

o As far as Andhra Pradesh is concerned, the A.P. Health & Medical

Housing Infrastructure Development Corporation (APHMHIDC) is identified as a nodal procurement agency. The Corporation is functioning

with No Profit and No Loss basis. No grants-in-aid are provided to the

Corporation and it is sustaining on its own resources by way of collection of supervision charges on the works executed as per the GO MS 1357 dt.

19.10.2009

3) The compliance status in respect of the 31 Conditionalities mentioned below is provided for the year 2010-11 in the prescribed format.

o The following Conditionalities that have been intimated in the previous years will apply for this year also.

S.

No

Conditionality Compliance Status

1. All posts under NRHM are on contract and

based on local criteria. The contract should

be done by the Rogi Kalyan Samiti /District Health Society. The stay of

person so contracted at place of posting is

mandatory. All such contracts are for a particular institution and non transferable.

The contracted person will not be attached

for any purpose at any place.

As per NRHM Guidelines all posts should

be on contract basis in respect of

Paramedical and other contingent workers will be paid from NRHM funds, in case of

Medical Officers, posts will be filled up on

regular time scale of pay as per the State Government Policy and pay will be drawn

through Treasury.

2. The state agrees to credit 15% of the State share to the account of the State Health

Society in two installments. The State also

aggresses to enhance the over-all

expenditure on health by the State Government by a minimum of 10 percent

per year.

State Government has agreed to fulfill the

conditionality

3. Blended payments comprising of a base salary and a performance based

component, should be encouraged.

Performanced benchmark have been fixed for individual institutions and if they have

achieved more than benchmark will be

awarded performance incentive.

4. State Government must fill up its existing vacancies against sanctioned posts,

preferably by contract. Top most priority in

contractual recruitments should be for

backward districts and for difficult, most difficult and inaccessible health facilities.

State has already initiated to recruit the existing vacancies against sanctioned

posts located in backward districts,

difficult, Most difficult and inaccessible

areas.

5. Delegation of administrative and financial

powers should be completed during the current financial year. If not already done.

The Government has carefully reviewed

the situation and established an integrated financial management system for NRHM

for effective, transparent, responsive

27

S.

No


mechanism has been established at state

and district level to sustain the

standards of accounting and financial management system, Wide G.O. Ms.

No.339, Dated:4-12--2010.

6. State shall set up a transparent and credible

procurement and Supply chain management system and Procurement

Management Information System

(PROMIS) State agrees to periodic

procurement audit by third party to ascertain progress in this regard.

Already addressed, please refer the para in

DRUG POLICY & SYSTEMS of second trench of funds

7. The State shall undertake institution

specific monitoring of performance of Sub Centre, PHCs, CHCs, DHs, etc.

At present, functional HMIS reporting

system is being monitored the performances from district to state head

quarters.

This year system will extended to facility

level (SC/PHC/CHC) for qualitative monitoring of performances

8. The State shall operationalise an on-line

HMIS in partnership with MOHFW.

Already addressed

9. The State shall take up capacity building exercise of Village Health and Sanitation

Committees, Rogi Kalyan Samiti and other

community /PRI institutions at all levels.

Necessary steps have been initiated to address the issue

10. The State shall ensure regular meetings of all community Organizations /District

/State Mission with public display of

financial resources received by all health facilities.

Complied with, State and District Health Mission meetings are being conducted

regularly and all financial matters is

hosted in the Departmental web site.

11. The State Govts. shall also make

contributions to Rogi Kalyan Samiti and

transfer responsibility for maintenance of health institutions to them.

Necessary steps will be taken in

consultation with other concerned

departments.

12. The State shall prepare Essential Drug lists

of generic drugs and Standard treatment

Protocols, and give it wide publicity.

Essentail drugs list have been prepared

and implementing in the State, to

strengthen further GO is being issued.

13. The State shall focus on the health

entitlements of vulnerable social groups like

SCs, STs, OBCs, Minorities, Women,

migrants etc.

The issue is addressed and further focus

will be given to vulnerable groups.

14. The State shall ensure timely performance

based payments to ASHAs/Community

Health Workers.

Necessary guidelines have been issued to

the Districts for effective and prompt

payment of performance based incentives to ASHAs

15. The State shall encourage in patient care

and fixed day services for family planning.

It is followed in Andhra Pradesh

28

S.

No


16. The State shall ensure effective and regular

organization of Monthly Health and

Nutrition Days and set up a mechanism to monitor them.

It is being conducted at village level at

other stages modalities are being

workedout.

17. All performance based payments /

incentives should be under the supervision

of Community Organizations (PRI)/RKS.

It is being followed

18. The State agrees to follow all the financial

management systems under operation

under NRHM and shall submit Audit

Reports, FMRs, Statement of Fund Position, as and when they are due. State

also agrees to undertake Monthly District

Audit and periodic assessment of the financial system.

State has taken all the measures to

undertake Monthly District Audit and

periodic assessment of the financial

system for onward transmission to GoI regarding NRHM funds

19. The State agrees to fast track physical

infrastructure upgradation by crafting State

specific implementation arrangements. State also agrees to external evaluation of

its civil works programmes.

To speed up the process, a special

organization called APMSIDC is already

established under the supervison of an IAS office as Managing Director.

20. The State Govt. agrees to co-locate

AYUSH in PHCs/CHCs, wherever feasible.

Morethan 600 doctors are already

working in the PHCs/CHCs

21. The State agrees to focus on quality of

services and accreditation of government

facilities.

Already two hospitals are accreditated

with ISO certification and this year state is

planning to go far all secondary grade hospitals and laboratories of tertiary care

hospitals for ISO certification.

22. The State/UT agrees to undertake

community monitoring on pilot basis, wherever not tried out as yet, and scale up

with suitable model wherever piloted

earlier.

For this we are planning to conduct

community based social auditing in 1000 villages and modalities are workedout and

it will be commenced from June 2011.

23. The State/UT agrees to undertake

continuing medical and continuing nursing

education.

State is agrees to continue the medial and

nursing education

24. The State agrees to make health facilities handling JSY, women and child friendly to

ensure that women and new born children

stay in the facility for 48 hours.

It is already mandatory activity and to encourage 48 hours of stay in hospital,

incentives to ANMs and ASHAs and to

pregnant women / mother are being

provided.

25. The State Governments shall, within 45

days of the issue of the Record of

proceedings, issue detailed District wise approvals and place them on their website

for public information.

Complied with and district level ROPs

will be prepared as per the conditionality

29

S.

No


26. The State agrees to return unspent balance

against specific releases made in 2005-06, if

any.

There is no unspent balances are

available.

27. The State is entitled to engage a second

ANM to the extent that it provides for

MPW (Male) or the contractual amount of 2nd ANM be paid out of State Budget and

Third functionary may be engaged from

NRHM Fund.

Are being addressed

28. The State shall put in place a transparent and effective human resource policy so that

difficult, most difficult and inaccessible

areas attract human resources for health.

State is following transparent HR policy while recruiting.

29. The State agrees to fast track physical infrastructure up-gradation by crafting State

specific implementation arrangements.

State also agrees to external evaluation of its civil works programmes. The State shall

provide names of all facilities where civil

works are undertaken and also certify that

the location of these facilities is such that poor households can seek services from

them. Prior approval of place of

construction by GoI will be mandatory before taking up new construction under

NRHM. Thrust must be on meeting

infrastructure gap in backward districts and

difficult, most difficult and inaccessible facilities.

To speed up the process, a special organization called APMSIDC is already

established under the supervison of an

IAS office as Managing Director. List of civil works taken up under NRHM have

been already communicated to GOI.

30. The State agrees that the provision for

EMRI operational cost to States will be on declining basis. For first year operational

cost will be 60%, 2nd year 40%, 3rd year

20% and nil thereafter.

State is already following

30

S.

No


31. The State agrees to comply with the

following over a period of six months:

System for assured and affordable referral

transport for pregnant women and sick

children/infants.

Facility upkeep (including maintenance of building – sanitation, laundry, water,

electricity, kitchen) and grievance redressal

mechanisms.

Performance benchmarks for staff prior to

renewal of contracts and incentives.

Availability of functional equipments at all

facilities.

Assured referral transport is functional

Grievance redressal system and facility up keeping is effectively functioning.

Performance evaluation is being taken up

before continuing the contracts and

incentives

Failure to demonstrate strong evidence of progress on the above conditionality would

affect release of funds under NRHM.

31

CHAPTER – 4

SCHEME / PROGRAM UNDER NATIONAL RURAL HEALTH MISSION

A. RCH FLEXIPOOL

17. The National Rural Health Mission (NRHM) has been launched with the aim to

strengthen the architecture of the health system; enable effective management of increased allocations; and promote policies that strengthen public health management

and service delivery. The Reproductive and Child Health II (RCH-II) Project forms an

integral part of NRHM, the goals of which include reduction of child and maternal deaths as well as achieving population stabilization, gender and demographic balance.

RCH GOALS AND TARGET

RCH II

GOAL

Current Status Andhra Pradesh

Target for

2011-12

MMR 154

(SRS 2004-06) <100

IMR 49

(SRS 2009) <30

TFR 1.8

(NFHS-3)

1.8

(sustained)

18. The Reproductive and Child Health Programme (RCH), addresses the issue of

reduction of Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate

through a varied range of initiatives. Key activity of RCH is to increase institutional deliveries, by giving the incentives for pregnant mothers through Janani Suraksha

Yojana and training of ANMs and nurses for safe delivery and management of sick

children have also helped in a major way, Further to accelerate, 6 high focused districts

identified by the GoI, parallel to the above efforts, up gradation of 360 health facilities to provide emergency obstetric care and to improve access to SBAs made a significant

difference to health outcomes, led to a huge increase in institutional deliveries during the

years 2005-10.

32

OVERVIEW OF RCH-NRHM PERFORMANCE (2005-11): FACILITY OPERATIONALISATION AND TRAINED SERVICE

PROVIDERS

Area Indicator Number of facilities/HR Service utilization* (average per month per

facility/ trained provider)

Planned

(2005-11)

Achievement

(2005-11, till

30.11.10)

% achmt. Plan for

2011-2012

Services Based on

performance

during Apr-

Nov 2010

Projection

for

2011-12

Facility

Operationalisation

No. of FRUs

Operationalised

360

CHNCs

122 CHCs

58 AH 7 MCH

187 Total

50% 173 C-sections 3443 2600

MTPs 156 209

Male sterilizations 606 800

Female sterilizations

7243 7500

No. of 24x7 PHCs Operationalised

1200 800 67% 424 Normal deliveries 5411 9116

MTPs - -

Male sterilizations 118 177

Female sterilizations

3279 4918

IUD insertions 1292 1938

No. of sub-centres operationalised as delivery points

0 0 0 284 Normal deliveries 0 852

IUD insertions 0 568

No. of SNCUs operationalised

- - - - Newborns treated

No. of NBSUs operationalised

- - - - Newborns treated

Capacity Building EmOC training - - - 60 C-sections

LSAS training - - - 20 C-sections

SBA 5000 2188 40.04% 1600 Deliveries conducted

33

ANNEX 3b

MONITORABLE INDICATORS (1)

SN. INDICATOR

2010-11 2011-12

Baseline Q1 Target Q2 Target Q3 Target Q4 Target Annual Target

(Apr-Nov 2010)

HF State HF State HF State HF State HF State HF State

districts total districts total districts total districts total districts total districts total

A Maternal Health

A.1 Service Delivery 241046 1020516

A.1.1 % Pregnant women registered for ANC in the quarter

22.14 88.57 9.00 21.25 9.00 21.25 9.00 21.25 9.00 21.25 36.00 85.00

A.1.2 % PW registered for ANC in the

first trimester, in the quarter 16.82 67.31 7.25 21.25 7.25 21.25 7.25 21.25 7.25 21.25 29.00 85.00

A.1.3 Institutional deliveries (%) in the quarter

23.54 94.18 7.50 25.00 7.50 25.00 7.50 25.00 7.50 25.00 30.00 100.00

A.2 Quality

A.2.1 % unreported deliveries in the quarter

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

A.2.2

% high risk pregnancies identified - - - - - - - - - - - -

(a) % women having hypertension 0.53 0.81 0.25 0.50 0.25 0.50 0.25 0.50 0.25 0.50 1.00 2.00

(b) % women having low Hb level 21.02 35.00 7.88 13.12 7.88 13.12 7.88 13.13 7.88 13.13 31.53 52.50

A.2.3 % of Home Delivery by SBA (i.e. assisted by doctor/ nurse/ ANM)

5 20 1.00 4.00 1.00 4.00 1.00 4.00 1.00 4.00 4.00 16.00

A.2.4

C-sections performed (%)

(a) in Public facilities 0.35 4.38 0.13 1.64 0.13 1.64 0.13 1.64 0.13 1.64 0.52 6.56

(b) in private accredited facilities 11.84 13.44 3.25 3.40 2.75 2.90 1.75 2.10 1.25 1.60 9.00 10.00

A.2.5 % of deliveries discharged after at least 48 hours of delivery (out of public institution deliveries)

25.00 96.45 8.00 25.00 08.00 25.00 08.00 25.00 8.00 25.00 32.00 100.00

A.2.6 % of still births 0.87 0.82 0.28 0.28 0.22 0.22 0.18 0.18 0.12 0.12 0.80 0.80

A.2.7 %age of maternal deaths audited 12.13 53.91 17.00 19.00 19.00 21.00 25.00 27.00 39.00 33.00 100.00 100.00

A.3 Outputs

A.3.1 % of 24x7 PHCs operationalised as per the GoI guidelines

56.00 50.00 35.00 35.00 30.00 30.00 20.00 20.00 15.00 15.00 100.00 100.00

A.3.2 % of FRUs operationalised as per the GoI guidelines

53 232 13.25 58 13.25 58 13.25 58 13.25 58 53 232

34

SN. INDICATOR

2010-11 2011-12


(Apr-Nov 2010)



A.3.3 % of Level 1 MCH centres operationalised

194 821 - - 44 266 - - 45 267 99 533


234 562 - - 41 341 - - 41 341 82 682


26 147 - - 22 70 - - 22 75 44 145

A.3.6 % ANMs/ LHVs/ SNs trained as SBA

- - - - - - - - - - - -

A.3.5 % doctors trained as EmOC 0 9 5 10 5 10 5 10 5 10 20 40

A.3.6 % doctors trained as LSAS 0 0 3 5 3 5 3 5 3 5

A.4 HR productivity

A.4.1 % of LSAS trained doctors giving spinal anaesthesia

- Nil Nil - - - - - - - - -

A.4.2 Average no. of c-sections assisted by LSAS trained doctors

- Nil Nil - - - - - - - - -

A.4.3 % of EmOC trained doctors conducting c-sections.

- Nil Nil - - - - - - - - -

A.4.4 Average no. of c-sections performed by EmOC trained doctor

- Nil Nil - - - - - - - - -

A.4.5 Average no. of deliveries performed by SBA trained SN/LHV/ANM

- - - - - - - - - - - -

A.4.6 % of SBA trained ANMs conducting deliveries

10% 40% 4.75% 18.94% 4.75% 18.94% 4.75% 18.94% 4.75% 18.94% 18.95% 75.76%

A.5 Facility utilization

A.5.1 % of FRUs conducting C-section 4.00 4.45 1.25 1.50 1.50 2.25 2.00 2.75 2.25 3.50 7.00 10.00

A.5.2 Average no. of c- sections per FRU 6091 30990 2284 11621 2284 11621 2284 11621 2284 11621 9136 46485

A.5.3 Average no. of MTPs performed in FRUs

455 1407 171 527 171 527 171 527 171 527 284 2108

A.5.4 Average no. of deliveries per 24x7 PHCs

14916 56352 5593 21132 5593 21132 5593 21132 5593 21132 22372 84528

A.5.5 Average no. of MTPs performed per 24x7 PHC

- - - - - - - - - - - -

35

SN. INDICATOR

2010-11 2011-12


(Apr-Nov 2010)



A.5.6 % of SC conducting at least 5 deliveries per month

- - - 2.5% - 2.5% - 2.5% - 2.5% - 2.5%

36

A.2 Maternal Health 19. Under Maternal Health many initiatives have been implemented since

introduction of NRHM in 2005-06 to achieve reduction of IMR, MMR & TFR, communicable diseases burden, ensuring availability of Medical Officers, specialists,

Staff Nurses, ANMs, improving infrastructure facilities at Sub-centre, Primary,

Secondary & Tertiary level institutions, availability of equipments & Drugs for all the

patient attending for safe delivery services.

Key Objective

20. Reduction of the currently estimated MMR of 154 per 100,000 live births in the

state to less than 100 per 100,000 live births by 2012, and commensurate reduction in

the maternal morbidity rate, particularly among the women in rural areas of the state; and reduction in the prevalence levels of RTI/STI in the general population by 50% of

the levels existing in 2005.

RCH II Goal Andhra Pradesh

Current Status Target

10-11 11-12

MMR 154

(SRS 2004-06)

<120 <100

IMR 49 (SRS Jan 2009)

<42 <30

TFR 1.8

(NFHS-3)

1.8 1.8 Sustained

To ensure access to quality comprehensive (basic and emergency) maternal and

reproductive health care to women in AP

To provide a comprehensive package of maternal and nutritional health services

to the tribal, scheduled caste, coastal fishers, migrant labour and other identified

marginalized vulnerable women.

Situation analysis, critical gap identification:

21. Achievement of goals of NRHM for the state is not upto the expected level as there are service gaps in the implementation of maternal health care services. The main

draw backs are lack of effective MCH tracking, assured referral services for high risk

pregnancies, inadequate functioning of 24x7 MCH centers, FRUs in Tribal & hard to reach areas, high number of home deliveries, non adherence of 48 hrs stay after

delivery, inadequate post-natal care service, high percentage of anemia in pregnant

women, inadequate maternal death audit at the facility and in the field.

22. It is proposed to establish systems for improving MCH tracking, ANC

registrations, Institutional deliveries, quality MCH services at 24x7 hrs PHCs, FRUs for

decreasing delivery load at tertiary care hospitals, operationalizing more no. of Sub Centres as delivery points in tribal & inaccessible areas, improving infrastructure

facilities, availability of human resources, skill upgradation of service providers,

effective monitoring & supervision system at facility level and community level. A new

37

comprehensive mother and child health card will be given to each registered pregnant

women at all Government Health Institutions and private hospitals recognized PVT OBG specialists.

Gaps identified

Still 30% deliveries are not at Govt/PVT institutions as the percentage of

institutional deliveries are 71.9%

The following district have recorded high no of home deliveries such as

Srikakulam, Vizianagaram, Anantapur, Kurnool, Adilabad, Karimnagar,

Warangal, Khammam and Mahabubnagar.

To address the problem the following interventions will be implemented in 2010-11

o Special focus to operationalise more no of subcenters as delivery points in the

districts and to increase SBA assisted deliveries by using ASHA services/indigeneous trained persons in tribal areas.

o Proposed to operationalise more no of CHCs / Area hospitals as FRUs in the

state to reduce the delivery case load at tertiary care hospitals and to increase

no of deliveries at primary and secondary level institutions.

o To utilize the scheme of Rs.600/- (Rs.200/- to ASHA + Rs.250/- for referral

transport + Rs.150/- for boarding and lodging to pregnant women in tribal

areas) to 100% level.

o Proposed outreach camps with obstetrician and pediatrician services to

reduce anemia in pregnant women, to identify high risk pregnant women and

plan for safe delivery at Govt institutions and to provide treatment and

nutritional counseling to children & pregnant women.

o Proposed to provide diet for atleast 3 days for all pregnant women and one

attendant coming for institutional delivery at 24x7 hrs PHCs and for 7days at

existing delivery waiting homes in ITDA areas.

o To implement VHNDs at all villages more effectively by synchronizing with women and child welfare dept. at all levels and by community monitoring

along with mobile VHNDs in hard to reach areas.

o To reduce Maternal deaths proposed to implement MCH tracking more effectively by way of up loading name based data of all registered pregnant

women, delivered women and children through on line mechanism and by

on line monitoring system.

o To implement MDR at facility level and community level in all 23 districts.

o Proposed to establish 10,20 & 10 bedded maternal emergency care unit in all

ITDA project areas and in high focus districts, either at CHC / AH / DH

which is nearer to the community.

38

Key Strategies of the Programme:

23. The following strategies will be implemented for achieving of the expected goals of NRHM in 2011-12.

100% ANC registration & 100% 3 ANC checkups by ANM & 1 checkup by

Medical Officer, identifying anemic pregnant women specially in tribal, interior rural areas with specialist camps, provision of diagnostic services and drugs in all

the ITDA project areas and high focused districts where the MMR is high and

through fixed Day health services by PHC mobile services.

Name based tracking of all pregnant women from habitation/village level to State level by MCH teams at Village, Sub center, PHC, CHNC & District level

with Data management and on line tracking services from PHC to State level. A

separate Data management unit is to be established under Joint Director (M&E) for receiving reports and sending to GOI at State level by integrating all

Statistical sections & Data management unit of NRHM.

Linking JSY to Ante-Natal care, Intra-Natal care and Post-Natal care & to 48 hrs

stay after delivery for quality MCH services.

Targeting SC/ST and other vulnerable groups in ITDA project areas and urban

BPL pregnant women for improved maternal health care services through

separate help line control rooms and monitoring units with PO ITDA & concerned Additional DM&HO / Dy. DM&HO / SPHO..of ITDA areas.

Improving Maternal Nutrition in 4,100 poor villages with High SC/ST

population through VHNDs by counseling on food habits/ NDCC with

coordination of SERP.

The existing 156 CEMONC centres will be integrated into 360 CHNCs for

improved Maternal & child care services.

Revitalization and rationalization of service areas of Sub centres, PHCs and

health functionaries at different level in all districts to improve the health care services and accessibility to the community.

Conversion of at least 75% PHCs into 24x7 MCH centres by March 2012 and

availability of at least 3 Staff Nurses and 1 MO at each of the 24x7 MCH centres.

Operationalization of 360 CHNCs and FRUs referral services for improving the

functioning of sub centre, PHC level maternal health care services as well as safe

institutional deliveries as per IPHS standards at all FRUs.

Ensuring 48 hrs stay in all categories of health institutions by each post delivery woman by linking to JSY payment at all health institutions.

Special outreach health camps in all tribal & high focused districts for pregnant

women & adolescent girls for reducing Anemia, Age at Marriage, personnel

39

hygiene, Birth planning, assured referral transport, promoting institutional

deliveries, complete PNC checkups and counseling services.

Line listing of high risk pregnancies & increased monitoring & services for such

women for complete ANC coverage, assured Birth planning, assured referral

transport, institution delivery & PNC care & counseling services.

Implementation of Rs.600/-to pregnant women in tribal districts (Rs.200 for ASHA + 250 for referral support + 150 for boarding & lodging.

Community monitoring of all pregnant and lactating mothers at VHNDs.

Name based tracking of all mothers, 4 ANC cheakups 2 TT, 120 IFA days by

MCH teams of village / sub center / PHC / CHNC Mother & Child health and Nutrition cards to all, Community celebration of mother and child days every

month and advanced birth planning and institutional deliveries and targeted

skilled birth attendance (SBA) for those unable to reach institutions.

Diet provision for each pregnant woman & one attendant for 3 days at all 24x7

hrs PHCs (Rs.100 per day for 3 days) from untied component of RKS funds and

for 5/7 days at Birth Waiting homes in tribal ITDA projects.

Assured Drop back transport facility for all delivered women (BPL) in all Tribal ITDA project areas from the Rs.250/- component of Rs.600/-

Ensuring safe abortion services at all FRUs by ensuring availability of specialist,

equipment and drugs along with trainings.

RTI / STI Services at 24x7 hrs PHCs / CHCs / Sub Division hospitals / District

hospitals by ensuring trainings, counseling services and drugs.

Establishing one NRC in each district on priority basis first in all other 18

districts including high focused districts by March 2012 in coordination with Clinton foundation and Women & Child Welfare Dept., and NIN.

Steps for operationalization of sub centres as delivery centres in hard to reach,

inaccessible, interior areas and tribal pockets of all the districts.

Up gradation of 200 24x7 MCH centers for L1 to L2 facilities by March 2012.

Up gradation of all CHNCs / Sub division hospitals to L2 to L3 facilities by

March 2012.

Increasing skills of MOs in emergency OBG, Life saving, Anesthetic skills, SBA

training of ANMs & Staff Nurses, ASHAs training on module 6 & 7, MTP training to MOs, RTI / STI trainings and trainings to the Staff Nurses,

Nutritionist of NRCs & MDR workshop‟s.

Steps for reducing home deliveries by ensuring delivery services at all identified sub centers FRUs & 24x7 hrs MCH centres by Birth planning of pregnant

women for institutional delivery, assured referral transport, free Iron folic acid,

40

T.T, HB, Urine investigations, free delivery services, PNC care & steps for

tracking unreported / missed out ANCs and unreported deliveries.

Effective implementation of VHNDs at each village once in a month by ANM,

AWW & ASHA for 100% coverage of antenatal services, birth planning,

identification of FRUs for delivery services, timely payment of JSY & counseling

to all pregnant & lactating women on personnel hygiene breast feeding, nutrition and common reporting system for health & Women & Child Welfare Dept., by

synchronization on geographical, functional and monitoring supervision areas.

Better coordination & convergence with women & child welfare department, Rural Development (SHGs), Panchyathraj institutions, tribal welfare, education

department for better MCH services.

Compulsory review of MCH services at PHC, CHNC, district once in a month &

at State level on physical and financial components, infrastructure, HR, equipment, drugs, trainings & quality of services.

Weekly review of MCH services at PHC & CHNC & district level and monthly

at state level.

Effective implementation of M.D.R. at district & State level by confidential review of Maternal Deaths in coordination with Fogsi, UNICEF, IIHFW &

IMA.

Implementation Methodology

Based on CBR of each district, the target for Antenatal pregnant women,

institutional deliveries are being communicated for each district by Dy. Director (Demography) from the O/o CH&FW for 2011-12 based on mid year population.

At district level the DM&HO is responsible for allotment of Targets to all PHCs

in the district facility wise targets community health centres, Area Hospitals and

district hospitals are allotted separately by Commissioner, APVVP.

Targets tertiary care hospitals are not allotted by O/o CH&FW.

In view of the above observations, it is proposed to integrate allotment of target

for ANC‟s institutional deliveries to PHCs / CHCs / AH / DH and teaching institutions and for improving & capturing details of ANC registrations, ANC

check ups, Institutional delivery through HMIS at state level.

To achieve this, detailed guidelines will be prepared & will be circulated to the

concerned HODs.

After allotment of targets, the following review mechanism are proposed for

implementation in 2011-12.

41

At State Level:

Once in 2 months performance review by Commissioner of Health & Family

Welfare with HODs, Addl. Director (MCH) & concerned Joint Director.

Once in 3 months performance review by Prl. Secretary of HM&FW with

CH&FW, HODs/Addl. Director (MCH) & concerned J.D.

Review once in 2 months with all DM&HOs & DCHS by CH&FW along with HODs.

Once in a month performance with all superintendents, OBG specialists of CHCs

/ AH/DH and Teaching institutions at district level by DM&HO / DCHS /

Suptd., of Teaching hospitals jointly.

Quality cell at State & district level by DD (DEMO).

At State - Addl. Director (MCH), JD (MHN), JD (M&E), Data Manager

Quality cell at District level:

DM&HO, DCHS, OBG Specialist, Pediatrician, S.O (FW) and S.O USP,

DPMO / DPO to monitor quality of Maternal Health Care services for different

levels of Health institutions in the discuss every month

Quality cell at CHNC:

SPHO, PHN and health educator to monitor for all PHCs and sub-center level

Maternal health care services every month

The detail guidelines and formats will be circulated for implementation in 2011-

12

Scheme wise methodology:

Tracking of all pregnant women and children up to 5yrs for habitation / village,

subcenter level, PHC level, CHNC level and district level will be monitored by

concerned MCH teams at different levels

Physical progress of ANC registration, birth planning, high risk pregnancies, institutional deliveries, assured referral transport and post natal care services will

be monitored at PHC/CHNC/Dist/State level every month by proposed quality

cells at different levels.

Review of Maternal deaths at facility level & community level will be

implemented in all 23 districts in 2011-12.

The performance under facility wise monitoring for normal deliveries, assisted

deliveries, caesarian sections, safe abortion services, RTI / STI cells & services will be monitored by proposed review committees at various levels.

The implementation of ASHAs scheme will be monitored & reviewed by

proposed ASHAs mentoring cells at state level & district level, CHNC level &

PHC level in 2011-12.

42

The implementation of JSY scheme will be monitored by Addl. Director (MCH),

JD (MHN), JD (M&E) of S.P.O (NRHM), Nodal Officers (NRHM) for APVVP, Nodal Officers (NRHM) of DME at state level.

At district level the Addl. DM&HO / all programme officers, SPHOs are

responsible for monitoring & verification JSY implementation.

24x7 hrs PHC services:

24. The Addl. Director (MCH), JD(MHN), JD(CHI), JD(M&E), DD(DEMO) and

Data Manger (NRHM) will monitor physical performance & quality of services of 24x7

hr MCH centres in the state. The Addl. DM&HO/Programme Officers / SPHOs /

SO(UIP), DPMO / DPO are responsible for monitoring physical & financial performance and quality of services at 24x7 hrs MCH centres at district level.

CEMONC centres:

25. The DM&HO/DCHS / Superintendents concerned CHCs / AH / DH, Addl.

DM&HO, SO(UIP), DPMO are responsible for monitoring the physical & financial performance and quality of OBG services at district. The Addl. Director (MCH),

JD(MHN), JD(CHI), JD(M&E), CPO (NRHM), DD(DEMO) and Data Manger

(NRHM) are responsible for monitoring physical & financial performance & quality of services in the state.

Blood Banks & Blood Storage Centres:

26. The CH&FW, PD (APSACS), Commissioner, APVVP, Director of Health, MD,

APHM&HIDC Drug control authority, JD (Blood Safety), State Secretary, IRCS, JD(MHN), are the committee members proposed for monitoring the administrative

functioning and quality of Blood safety at state level every month necessary guidelines &

formats, MIS reporting will be implemented in 2011-12.

27. At district level under chairmanship of District Collector, DM&HO, DCHS,

District Secretary, IRCS, Addl. DM&HO (AIDS & Leprosy) will be monitoring team at

district level for review of physical & financial performance and quality of Blood safety at district level.

Nutritional Rehabitation Centres (NRCs):

28. Review & monitoring Committee under NRC will be implemented every month

by CH&FW, Addl. Director (MCH), JD(MHN), JD(CHI), JD(M&E), Representatives from UNICEF & Clinton Foundation at State level I 2011-12. At district level the

DM&HO / DCHS / PD, ICDS, Suptd., and Pediatrician, Nutritionist will monitor the

quality of services for NRCs.

29. All schemes allotted to JD (MHN) will be reviewed at State level by CH&FW,

MD (NRHM), Addl. Director (MCH), CPO (NRHM), JD (MHN), JD (CHI), JD

(M&E) once in 2 months at state level. For financial releases, the JD (MHN) will submit requirements for releases of budgets & CFO will release the budgets for JSY, ASHAs

Performance Based Incentives, ASHA Day Meetings, Best ASHA Award, 24x7 MCH

43

centres, CEMONC centres, Blood Banks & Blood Storage Centres (if NRHM budgets

available), Budget, requirements of FRUs, NRC, MDR schemes.

RTI / STI

30. RTI/STI programme implementation plan as per NRHM PIP consist of the 2

broad activities viz., 1) Health facility strengthening for provision of RTI/STI services

through minimum infrastructure development, Supply of drug kits and consumables to practice “Syndromic Case Management (SCM)” and 2) Training of Health care workers

such as Medical Officers, Staff Nurse, Lab. Technicians, ANM, ASHA and MPHA

(M&F) as per National Guidelines. The following are the responsibilities of SACS and

NRHM as per NACP-NRHM convergence guidelines.

Distribution of roles and responsibility among NRHM and NACP

Role of SACS Role of NRHM

SACS will supervise and monitor STI/RTI programme at state level in

close co-ordination with

NRHM/RCH programme officer.

SACS to provide technical support in training, quality supervision and

monitoring of STI/RTI services at all

health facilities, this overseeing the implementation.

Jointly with NRHM review and

refine information, supervision &

monitoring process for monitoring access & quality.

SACS to prepare feed back for

NACO, NRHM and SPMU

Order to all DM &HOs regarding monitoring & supervision of the

program, training, quality and access of

services to community, health facilities

to follow NACO approved standard operative protocols, procurement of

colour coded drug kits by NACO

through SACS

NRHM/RCH programme officer will

develop annual PIP content of STI/RTI

services in consultation with SACS for

training and procurement needs.

Prepare list of health facilities with MO

& LT in place either regular or

contractual

Prepare list of facilities where MO & LT

are already trained on NACO modules

Prepare list of facilities where MOs &

LTs are to be trained

Forcasting of drug kits

31. Procurement and supply of drugs and testing kits for STI/RTI services fro

NRHM facilities will continue to be done by NACO with funding support of NRHM at central level.

32. For tracking access, quality, progress and bottlenecks in RTI/STI programme

implementation, the common information & monitoring system developed by NACO and NRHM is to be followed.

1. Health facilities for provision of RTI/STI services:

Training should be as per the GoI guidelines on RTI/STIs.

44

Holistic Plan including training of staff, provision of drugs, lab investigations and

convergence with the NACP (THROUGH SACS) is advised for comprehensive RTI/STI services.

Funds for strengthening of facilities for RTI/STI services have to be kept.

Funds for heads like equipments, infrastructure etc. should be budgeted under

respective RCH II/ NRHM head.

Ensure privacy and full treatment as per National Guidelines on Prevention,

Management and Control of RTI infections including STIs.

Ensure that Wet Mount is available for Diagnosis at health Facilities.

Funds should also be kept for monitoring the operationalisation of RTI/STI services.

33. The Table showing the minimum required infrastructure & consumables at PHC/CHCs for provision of Quality RTI/STI services

List of required infrastructure & consumables at PHC/CHCs

S.No Name of the Item Existing or

Not

Required

Quantity

Remark

1 Wooden/Aluminum Partition for Privacy

Not 1 May be done at PHC level from NRHM/HDS funds

2 „U‟ cut examination table with steps

Yes/Not 1 May be procured through APHMHIDC & supplied

to the non available health facilities from NRHM / RCH II funds

3 Angle poised lamp Yes/Not 1 --do--

4 Steel Cusco‟s Vaginal Speculums-Small (5),

Medium (5), Big (5).

Yes/Not 5+5+5=15 --do--

5 SIMs speculums with the retractors

Yes/Not 5+5+5=15 --do--

6 Proctoscopes-Small, Medium, Large

Yes/Not 5+5+5=15 --do--

7 Sterilizer Yes/Not 1 --do--

8 Disposable Gloves,

Syringes, Needles

Yes/Not As per

requirement

--do--

9 Waste disposal System

Yes/Not As per requirement

--do--

10 Hand held magnifying glass

Not 1 --do--

11 RPR Kits Yes/Not As per

requirement

--do--

12 VDRL rotator Yes/Not 1 --do--

13 Compound Microscope

Yes/Not 1 --do--

14 Glass slides & Cover slips

Yes/Not As per requirement

May be purchased from NRHM/HDS funds at

local/Dt level.

15 PH paper NO As per requirement

May be purchased from NRHM/HDS funds at local/Dt level.

45

Referral Linkages:

34. The RTI/STI patients who have not responded to Syndromic Case Management

after completion of the due course of the treatment shall be referred to State Reference

Centres linked to the districts for evaluation.

2. RTI/STI Training:

State should plan to operationalise health facilities for RTI/STI services.

State is requested to plan for RTI/STI training, as per GoI norms.

Funds for the operationalisation and monitoring of RTI/STI services should be

kept.

Training of sub district level health functionaries posted at FRUs/CHCs and

PHCs may be done by utilizing the training resources (faculty, training material)

of the NACP (through SACS). This is an agreed action under the convergence framework.

The trainings shall be undertaken in the ‘CASCADE MODEL’.

The PO-DTT, District RCH incharge officer/DPO-NRHM, ADMHO (A&L)

shall be given training at IIHFW, Vengalaraonagar, Hyderabad with and the

training will be facilitated by STD Component of APSACS under the financial

support from RCH II/NRHM.

The trained team conducts the trainings at District level for the following health

care workers with the technical assistance of Regional Resource Faculty (RRF)

from Medical Colleges as Resource persons.

The trained Medical Officers will give half day orientation to the MPHA (M&F), ANM, APMO, DPMO & ASHA workers at PHC level.

35. The Regional Resource Faculty (RRF), District RCH incharge officer, ADMHO (A&L) and PO-DTT shall be provided training by State Resource Faculty (SRF) at State

Level preferably at IIHFW, Hyd‟bad with financial sharing from NRHM & NACO

(SACS) funds. The STD component of APSACS will coordinate & facilitate the process

with NRHM & IIHFW.

CASCADE model of Trainings:-

The DPO-NRHM, PO-DTT & ADMHO (AIDS &

Leprosy) shall be trained at IIHFW, Hyd’bad

The Medical Officers (2), Staff Nurse (1), Lab. Technician (1) shall be trained by RRF and

District officials

The Regional Resource Faculty shall be

trained at IIHFW, Hyd’bad by APSACS & SRF

The MPHA (M&F), APMO, DPMO, ANM and ASHA workers will be Half day orientation by

Medical Officers

46

SCM Colour coded drug kits:

36. The Syndromic Case Management related 7 Colour coded drug kits shall be

procured centrally by NRHM, MoHFW, GoI and supplied to the O/o DMHO directly. In turn the O/o DMHO should supply these kits to all PHC and CHC facilities in the

district.

Recording & Reporting:

37. The PHCs & CHCs should submit the one page STI/RTI reports to the DMHO

by 3rd of every month. The O/o DMHO will upload the same to the State NRHM office by 5th of every month. The consolidated state report shall be shared with the SACS and

submitted to the NRHM, Govt. of India by 7th of every month.

The Monitoring Plan:

38. The quarterly/Half yearly monitoring aims at 1) Ensure the provision of Quality

RTI/STI services as mentioned in national guidelines, 2) Ensure the practice of Syndromic Case Management across all health facilities and provision of Partner

Treatment, 3) Ensure that all RTI/STI attendees & ANC mothers are get tested for

RPR/VDRL and 4) Ensuring the referral Linkages with the other services.

The Monitoring team consists of the following personnel.

1. NRHM:- a. JD-MHN

b. JD-M&E

c. DMHO d. DPO-NRHM

2. SACS:-

a. JD-Basic Services Division

b. DD-STD c. AD-STD

d. Sr.Cl officer – TSU, APSACS.

e. PO-STI services, TSU, APSACS. f. ADMHO (A&L)

g. DPM

h. State Resource Faculty (SRF)

i. Regional Resource Faculty (RRF).

39. Each health facility shall be visited by any of the team member once in 6 months

totaling to 2 times in a year. During the visit, the official has to administer the monitoring and grading tool and submit the filled in copy to the Medical officer, Supt. of

the hospital, District Head and with NRHM/SACS. The subsequent visiting official

shall follow upon the action taken to observations made and suggestions given by the

previous visited officer. By the end of FY 2011-12, it needs to be achieved that all health facilities are reporting within the time limits and 80% of health facilities are coming into

the grade „A‟.

47

Risk Analysis: The Major challenges for reduction of MMR in A.P are

a) Reduction of home deliveries for 1,20,000 in 2010-11 to 60,000 especially in the following districts.

b) Increasing operationalization of 24x7 hrs MCH centres & FRUs in the state. The

main problem in FRUs is lack of interest on the post of obstetricians, pediatricians and Anaesthetists in majority of CEMONC centres at FRUs to fill

up the gap Additional Incentives may be considered for OBG, Pediatrician &

Anaesthetists and Staff Nurses in all CEMONC centres / FRUs where the posts

are vacant for 1 to 2 years.

c) Simultaneously focus may be given to improving the midwifery skills of Staff

Nurses, MPHA(F) for conducting normal deliveries at Sub centres, PHCs,

CEMONC centres, FRUs in hard to reach, inaccessible & interior areas.

d) Special consideration / quota for local MPHA(F) trained candidates in ANM

MPHA(F) training schools.

e) Ensuring of 48 hrs stay by all delivered women at institutions to achieve this diet

provision for at least 3 days at all 24x7 hrs MCH centres & CEMONC centres is to provided for delivered women & one attendant.

f) Reduction of Anaemia in pregnant women is an important indicator. As per

NFHS-3 survey among between 15-49 years age pregnant women 51.7% are anemic in rural area & 58.2% in Urban area, 100% distribution of IFA tablets to

all adolescent girls, pregnant women is to ensured along with follow up services

for recovery.

g) Assured referral transport for all pregnant women is essential through 108 services. At present the coverage through 108 services is 20-25% of pregnant

women. This is to be increased to at least transport services to 50% of all pregnant

women.

h) Ensuring availability of Blood components, equipment for caesarian section,

specialist doctors is critical for safe delivery services.

i) Ensuring effective 3 to 6 post-natal visits to all post-natal women at down level is

important to reduce post-natal complications & maternal deaths.

j) Effective Maternal deaths audit at community level in all 23 districts and

improving under reporting of Maternal deaths is to be addressed by way of proper

sensitization of all health functionaries at DH / AH / CHNCs / PHCs & Sub Centres.

48

Maternal Health outputs:

Sl.

No.

Particulars Achievement

in 2010-11

Target for

2011-12

Addition

during the

year 1) ANC registration >95 >98 3%

2) Institutional Deliveries >91% >95% 4%

3) 24x7 MCH centres 1200 424 25%

4) Functional FRUs 17 DH 117 AH

(58+59), 121 CHC

23 DH, 117 AH

121 CHC 360 CHNC

5) Functional Sub Centre as delivery points 533 284

6) NRCs 5 7 33%

7) MCH Tracking of pregnant women & children (0-5 yrs)

23 23

8) Maternal Death Audit at districts 23 23

9) VHNDs 18940 20144

Special Features for 2011-12:

Partograph recording at all CHCs/AH/DH & Teaching hospitals in delivery

rooms is not implemented at present; this will be implemented 2011-12 at all 24x7

MCH Centres and FRUs, DH & Teaching hospital.

Monitoring of post training service delivery activities by trained MOs, Staff Nurses, MPHA(F) is not being monitored at State & District level to be

implemented in 2011-12.

Exact requirement, Drugs for all institutions based on D.P & I.P services is not submitted by PHCs / CHCs / AH / District Hospitals.

Lack of specialist care services at CHCs/AH/DH after 2.00 P.M except for

attending call duties and most of the delivery cases diverted to Pvt. Hospitals.

Contributing to high number of caesarian sections in the state. Necessary guidelines will be prepared in consultation .

Lack of effective coordination between DCHS & DM&HOs and between MOs of

PHCs & Superintendents of FRUs.

Lack of adequate information on inclusion of procedures under Arogyasri Insurance scheme at PHC, CHC, AH, DH levels in the district.

Lack of optimum utilization of space in the various hospitals.

Lack of inventory management at PHC, CHC, AH & DH levels and condemnation of unused equipment & furniture is not being done.

Lack of periodic Drug stores verification by district level programme officers.

Prescription of drugs out side inspite of availability in the hospitals.

49

No Bin Cards are maintained for each drug.

Ayush doctors services mainstreaming, Ayush medical officers services may be utilized either for FDHS & School Health services in the field.

Effective coordination between CH&FW & APHM&HIDC at state level & at

district level.

Review meetings once in a month at State & District level to review progress of budget utilization for construction of all health facilities, repairs etc.,

Budget Proposed under Maternal Health Strategy for 2010-11

S N Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Referral Hospital Strenthening

a) Salaries to Obstetrician Specialists

i) Specialist doctors in Small towns Salary 38000 74 337.44

ii) Specialist working in Remote & Interior rural areas

Salary 45000 45 243.00

iii) Specialist working in Tribal areas Salary 50000 62 372.00

iv) Salaries to Staff Nurses Salary 12910 525 813.33

b) Salaries to Theatre Assistants Salary 6700 326 262.10

c) Honororium to Anesthetist for

conducting C-Sections

Honorarium 1000 12000 120.00

Total 2147.87

2 24-hours MCH Centres

a) Salaries for Staff Nurses Salary 12910 2200 3408.24

b) Salaries for Contingent Workers Salary 4900 2200 1293.60

c) Dietary support to Maternity

Waiting homes in PHCs

50 132000 66.00

Total 4767.84

3 Janani Suraksha Yojana

a) Total Rural BPL deliveries Beneficiaries 700 305288 2137.02

b) Total urban BPL deliveries Beneficiaries 600 138507 831.04

c) 5% Administrative expenses 148.40

d) ASHA Performance Based incentives for Pregnant Women having Institutional Deliveries in Govt. Hospital / PHC

Incentives 200 583240 1166.48

Total 4282.94

4 Maternal Death Review(MDR):

a) Maternal Death Audit

i) Monitoring & Review mechanism

Review 600 2000 12.00

Total 12.00

b) Infant Death Audit

50


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 i) Monitoring & Review

mechanism Review 300 49000 147.00

Total 147.00 5 Mother & Child Tracking Tracking 100.00

6 MTP Services Services 10.60

7 RTI/STI Services

a) District Officers Training 94250 2 1.89

b) Medical Officers Training 258000 23 59.34

c) Staff Nurses Training 129000 23 29.67

d) ANM Training 7125 2000 142.50

Total 233.40

8 Midwifery Training for ANMs, Staff Nurse & MOs

Training 100.00

9 Blood Bank & Blood Storage

Centres

a) Apparatus & Equipments Maintenance 1950000 19.50

b) Civil Works Maintenance 2000000 20.00

c) Training and Capacity Building Maintenance 2000000 20.00

d) Contingencies including Annual Maintenance

Maintenance 13550000 135.50

e) Hiring of Transport Vehicles Vehicle 4480000 44.80

Total 239.80 Maternal Health Total 12041.45

51

A3: CHILD HEALTH The Objectives of the child health interventions include:

1. Universal access to quality comprehensive neonatal health care services.

2. Provision of comprehensive health and nutritional services to all infants.

3. Access to comprehensive health and nutritional services to 1-5 year old children.

4. Special health and nutrition package of services to the tribal, Schedule caste and other vulnerable children.

1. IMR (SRS 2009) 49

2. Goal Overall NRHM 2012 30

Situation analysis:

2.1 Mortality

Indicators

NFHS 2 NFHS 3 SRS 07 SRS 08 SRS 09 Trend

Analysis Neonatal Mortality Rate

43.8 40.3 33

Infant Mortality Rate

65.8 53.5 54 52 49

There has been a decrease of six points since 07 in the IMR and to bring it down to 30 by 2015

(MDG4) would require an annual drop of 5 points.

Under Five Mortality

85.5 63.2

Child Mortality 21.0 10.2

Process indicators:

2.2 ANEMIA NFHS2 NFHS 3 CES 09 Trend Analysis Percentage of children (under 5 years) of age with anemia

72.3 79.0 -- --

Slight improvement in NFHS 3 over NFHS 2

2.3 IYCF NFHS 2 NFHS 3 DLHS 2 DLHS 3 CES 09 Trend

analysis Children under 3yrs breastfed within one hour of birth

10.3 22.4 41.8 47.8 27.2

There is a major difference between DLHS 3 and CES 09 and this is an area of concern which needs to be addressed.

Children age 6 months and above exclusively breastfed for at least 6 months

NA NA 41.9 32.3 52.2

Though an improvement over DLHS 3 nearly 50% children are still not exclusively breastfed.

Children aged 6-24 months received solid/ semisolid foods and are still breastfed

9.4 63.7 NA 55.0 66.4

Improvement of 11 points in CES 09 over DLHS 3

Children aged 0-5 months exclusively breastfed

74.6 62.7 NA NA 75.7

52

2.4 DIARRHOEA & ARI NFHS 2 NFHS 3 DLHS 2 DLHS 3 CES 2009 Trend

analysis Children with Diarrhea in the last two weeks who received

ORS

39.6 36 57.8 43.3 54.9

There has been an improvement in use of ORS over the years. However it is still below 60

Children with Diarrhea in the last two weeks who were given treatment in any facility

69 61.4 86.0 68.9 74.6

Recent CES 2009 shows an improvement in the treatment of diarrhea at facilities over the DLHS 3

Children with ARI or fever in the last two weeks who were given treatment at facilities

NA 66.6 80.4 74.0 88.2

Significant improvement (14 points) in treatment of ARI from DLHS 3 to CES 09.

Training under child health

4.1 Progress till date - no. of trainings conducted/

health persons trained / districts covered

Planned for

2010-11

Held/ Trained (till

Dec 2010

IMNCI

- No. of trainings 14

- No. of persons trained 324

- No. of Districts implementing 13 2

Pre- Service IMNCI

- No. of trainings

Not Planned

1


- No. of Districts implementing 1

F-IMNCI

- No. of trainings

Not Planned

5


- No. of Districts implemented

Navjaat Shishu Suraksha Karyakram (NSSK)

- No. of trainings 22


- No. of Districts implemented 23

Strategies:

40. Facility Based New Born care: The state has an IMR of 49 per thousand live births (SRS 2009) and majority of these deaths are contributed by the neonatal deaths.

The state initiated major community based and facility based neonatal care interventions to address this issue. The state has started the process of establishing a three tier facility

based new born care system which includes the setting up of special care neonatal units,

neonatal stabilization units and new born care corners. The state health officials with support from UNICEF Hyderabad visited Madhya Pradesh to study the facility based

new born care set up. Following this visit UNICEF Bhopal provided hand holding

support in designing the first two SCNUs in Warangal. Two teams were formed

53

involving the officers who visited Madhya Pradesh along with the Executive engineers

from APMSIDC and UNICEF‟s child health consultant. These teams visited the identified health facilities and prepared draft designs for the SCNU which was finalized

by the APMSIDC architects in AutoCAD. UNICEF Hyderabad provided the financial

and technical support for this activity. The state will be following the three tier facility

based new born care as shown in the flow diagram below. Special Care New Born Units will be established in all tertiary care hospitals, new born stabilization units (NBSUs) in

all area hospitals and CHCs and a new born care corner in every delivery room in the

state.

COMMUNITY

PHC 24X7

CHNC /FRU

DISTRICT HOSP

Facility Newborn care in Public Sector

NEW BORN CARE corner

(1 bed)

Radiant Warmer,

Suction Machine,

Neonatal Resuscitator (Ambu Bag)

Laryngoscope, Oxygen Hood,

NEONATAL STABILISATION UNIT

(4 beds)

SPECIAL CARE NEW BORN UNIT

Four beds for every 1000 deliveries. 36 “20 bedded” SCNUs and 8 “12 bedded” SCNUs in

Tribal Areas

Facility Based Neonatal CareAt Delivery Sick newbornFacility

SCNUs:

41. The state has decided to set up twenty bedded SCNUs in select level III MCH

facilities having an annual delivery load of more than 4000 deliveries. However in view of having at least on SCNU in every district this norm of 4000 deliveries was relaxed for

a couple of districts viz. Karimnagar and Medak (Sangareddy). The state has decided to

set up/ strengthen 44 SCNUs. 36 of these SCNUs would be 20 bedded and eight SCNUs

to be set up in tribal areas will be 12 bedded. The SCNUs will be set up in hospitals under the Directorate of Medical Education and the Andhra Pradesh Vaidya Vidhan

Parishad as shown in table I.

Table I: Distribution of SCNUs in various hospitals:

Hospitals under Director Medical Education APVVP Total

Region TH with Ped

Department.

TH with

OBGY

Department.

TH with

Both

Departments.

RIMS APVVP

Telangana 1 3 3 1 10

Andhra 0 1 4 2 10

Rayalseema 1 1 2 1 4

2 5 9 4 24 44

TH - Teaching Hospital, RIMS – Rajiv Gandhi Institute of Medical Sciences,

APVVP – Andhra Pradesh Vaidya Vidhan Parishad

54

Table II: List of Hospitals identified for establishing SCNUs

Type of Hospital Name

Directorate of Medical Education

Teaching Hospital with only Pediatric Dept.

MGM Hospital Warangal, and Ruia Hospital SVRR Thirupati

Teaching Hospital with only OBGY Dept.

GMH Warangal, CKM Warangal, GMH Koti, Hyderabad Victoria Hosp Vizag and GMH Thirupati Chittoor

TH with both Pediatrics and Obstetrics Department.

Niloufer Hospital, Gandhi Hospital, Modern Maternity Pitluburz, KGH Vizag, GGH Guntur, RMC Kakinada (EG),

SMC Vijayawada (Krishna), GGH Anathapur, GGH Kurnool,

RIMS ( Rajiv Gandhi Institute of Medical

Sciences)

RIMS Adilabad, RIMS Ongole, RIMS Srikakulam, RIMS Kadapa

Andhra Pradesh Vaidya Vidhan Parishad (APVVP)

Telangana Region

DH Khammam, AH Bhadrachalam, DH Karimnagar, DH

Nizamabad, DH Mehaboobnagar, DH Tandur (Rangareddy), DH Sangareddy (Medak), DH Nalgonda, AH Utnoor (Adilabad) AH Eturnagaram (Warangal)

Andhra Region

DH Tenali, MCH Nellore, MH Vijayanagaram, DH Rajamundry (EG), DH Eluru (WG), DH Machilipatnam (Krishna), AH Paderu (Vizag), AH Parvathipuram (Vijayanagaram), AH Narsipatnam (Vizag), Rampachodavaram (EG),

Rayalseema Region DH Nandyal (Kurnool), DH Produttur (Kadapa), DH Hindupur ( Ananthapur), AH Srisailam (Kurnool)

42. The establishment of SCNUs has been planned in two phases. The state has

committed to initiate setting up 25 SCNUs in Phase I under the NRHM PIP 2010-11.

The 8 tribal SCNUs and 11 non tribal SCNUs i.e. 19 SCNUs will be set up in Phase II under the PIP 2011-12

Current status:

43. At present there are 14 hospitals under the department of Medical and Health in

the state providing Level II /III new born care services. Out of these functional 14 SCNUs the state has committed to start the strengthening of 7 SCNUs* and set up 18

new SCNUs through the budget sanctioned in the NRHM PIP 2010-11. The state has

also committed to provide essential new born care through 121 New Born Stabilization

Units and 540 NBCCs. The district wise list of institutions selected for strengthening / setting up SCNUs in Phase I (2010-11) is given in the table below

List Of Institutions for setting up SCNUs in Andhra Pradesh in Phase I (2010-11)

Sl Districts Name of Institution Status Ped Control 1 Warangal MGM Hospital Old Yes DME

2 CKM Maternity Hospital New DME

3 GMH Maternity Hospital New DME

4 Khammam Dist. Hospital Khammam New APVVP

5 Medak Sangareddy Dist Hospital New APVVP

6 Karimnagar Dist. Hospital Karimnagar New APVVP

7 Mehaboobnagar Dist Hospital New APVVP

8 Adilabad RIMS Adilabad Old Yes DME

9 Nalgonda District Hospital Old APVVP

55

10 Nizamabad Dist. Hospital Nizamabad New APVVP

11 Hyderabad Maternity Hospital Koti New DME

12 Rangareddy Dist Hospital Tandur New APVVP

13 Guntur GGH Guntur Old Yes DME

14 Vizianagaram Maternity Hospital New APVVP

15 Visakhapatnam King George Hospital Old Yes DME

16 Victoria Maternity Hospital New DME

17 SPSR Nellore MCH Hospital New APVVP

18 East Godavari Dist HQ Hospital Rajahmundry New APVVP

19 Rangaraya Med. College, Kakinada Old Yes DME

20 West Godavari District HQ Hospital Eluru New APVVP

21 Krishna Dist. HQ Hospital Machilipatnam New APVVP

22 Chithoor GMH, Thirupathi New DME

23 Kurnool Government General Hospital Old Yes DME

24 Kadapa District Hospital Produttur New APVVP

25 Ananthapur Srikrishna Devaraya Med. College New Yes DME

Con

trol Hospitals

Existing New Total

DM

E Teaching Hospital with Only Pediatric Dept 1 0 1

Teaching Hospital with Only Obstetric Dept 0 5 5

Teaching Hospital with both Departments 5 1 6

District Hospitals / Area Hospitals under APVVP 1 12 13

Total 7 18 25

44. The state has 14 operational SCNUs which are being run through the available

resources and need to be further strengthened in terms of renovation, human resources and equipment. The strengthening of 7 SCNUs has been included in Phase I and 6*

SCNUs in Phase II in the FBNC plan of the state. (*The SCNU in RSP Children‟s

Hospital Nellore to be shifted to the MCH Hospital and hence not included in strengthening)

The statistics of neonatal admissions and mortality in these 14 SCNUs is given below.

Sl

No

Name of Hospital District Control Admissions Deaths

2009 2010 2009 2010

1 SVRR Medical College & Rui Hospital Thirupati

Chittoor DME 1963 2030 356 356

2 Rangaraya Medical College & General Hospital Kakinada

East Godavari DME 1403 1882 347 390

3 Modern Maternity Hospital Pitluburz OMC

Hyderabad DME 4046 4284 227 190

4 Niloufer Hospital OMC Hyderabad DME 14173 14820 2233 2307

5 Gandhi Medical College & Hospital Secunderabad DME 2110 2391 460 317

6 Kakatiya Medical college & MGM Hospital

Warangal DME 2798 2750 438 474

7 Siddhartha Medical college & Hospital Vijayawada

Krishna DME 930 1150 212 258

8 Andhra Medical College & King George Hospital

Vishakhapatnam DME 1995 2029 231 250

9 Guntur Medical College & General Hospital

Guntur DME 1850 2167 478 649

56

10 Kurnool Medical College & General Hospital

Kurnool DME 2072 1939 647 700

11 RIMS Kadapa Kadapa DME 720 784 NR NR

12 RIMS Adilabad Adilabad DME 839 893 121 130

13 District Hospital Nalgonda Nalgonda APVVP 1056 810 46 37

14 RSP Children's Hospital Nellore Nellore APVVP 267 383 88 57

TOTAL 36222 37528 5884 6115

45. There are 12 SCNUs operational under the Director of Medical Education and

two SCNUs under the Andhra Pradesh Vaidya Vidhan Parishad. These SCNUs in these facilities have to be strengthened to the Indian Public Health Standards. The state has

committed to start the process immediately. The table above indicates that the 14

SCNUs are admitting nearly 36000 - 38000 neonates every year with nearly 6000

neonatal deaths (16.6% case fatality rate). These facilities are saving nearly 30000- 32000 neonates annually. With the establishment of all the forty four SCNUs and the NBSUs it

is expected that the state would be able to save more new borns every year and with

quality management the case fatality rate is also expected to come down.

46. The list of institutions for setting up SCNUs in Phase II (PIP 2011-12) is given

below:

List Of Institutions for setting up SCNUs in Andhra Pradesh in Phase II

Sr

No Districts Name of Institution Status

Ped

Dept Control

1 Hyderabad Modern Maternity Hosp Pitluburz Old Yes DME

2 Gandhi Hospital Old Yes DME

3 Niloufer Hospital Old Yes DME

4 Guntur DH Tenali New APVVP

5 Srikakulam RIMS Srikakulam New Yes DME

6 Krishna Siddhartha Medical College Old Yes DME

7 Prakasam RIMS, Ongole New Yes DME

8 Chithoor SVRR, Thirupati Old Yes DME

9 Kurnool District HQ Hospital Nandyal New APVVP

10 Kadapa RIMS, Kadapa Old Yes DME

11 Ananthapur District Hospital Hindupur New APVVP

List Of Institutions in Tribal Areas for setting up SCNUs in Andhra Pradesh

1 Warangal AH Eturnagaram New APVVP

2 Khammam AH Bhadrachalam New APVVP

3 Vishakhapatnam AH Narsipatnam New APVVP

4 AH Paderu New APVVP

5 Vijayanagaram AH Parvathipuram New APVVP

6 East Godavari AH Rampachodavaram New APVVP

7 Adilabad AH Utnoor New APVVP

8 Kurnool AH Srisailam New APVVP

Control Hospitals Existing New Tribal

DME Teaching Hospital with Only Ped. Dept

Teaching Hospital with Only Obst. Dept

Teaching Hospital with both Departments 6 2 0

APVVP District Hospitals / Area Hospitals 0 3 8

Total 6 5 8

57

Action Plan:

47. In continuation with the facility based new born care activities started in the

previous years under NRHM the state has proposed to be set up thirteen new SCNUs

(Eight 12 bedded SCNUs in tribal areas and five 20 bedded in non-tribal areas) and strengthen six SCNUs this year under the NRHM PIP 2011-12. Thus the state will have

a total of 44 SCNUs (25 under PIP 2010-11 and 19 under PIP 2011-12)

48. The details of the activities and processes involved in setting up and

operationalizing these SCNUs are given below.

49. Renovation: The renovation of the facilities and the procurement of new born care equipment will be done by the Andhra Pradesh Medical services infrastructure

development corporation (APMSIDC).

Human Resource:

Pediatricians:

50. Teaching Hospitals with pediatric departments (15 SCNUs): For sustainability of the new born care services and long standing requests by medical colleges the state has

proposed to set up an additional unit for neonatology in these hospitals. These units would have an associate professor, two assistant professors and four senior residents.

The Director Medical Education will start the process for getting approval for the same.

Till these units are set up the existing faculty from the pediatric department will oversee

the functioning of the SCNU which will have four pediatricians (senior residents) working round the clock and their remuneration would be supported under NRHM.

They would be paid a monthly remuneration of Rs 40000/- The state will recruit 60

pediatricians for the 15 SCNUs in these hospitals.

51. Other Non Tribal SCNUs (21 SCNUs): In all other 21 non tribal SCNUs under APVVP and DME (without pediatric department) the state will recruit four pediatricians

for each SCNU to provide round the clock services. Each pediatrician will be paid a

salary of Rs 50000/- per month. The state will require 84 pediatricians for these 21 SCNUs.

52. SCNUs in Tribal Area Hospitals (8): The state has planned to set up 12 bedded SCNUs in these eight hospitals which are highly remote and tribal. The state will place

two pediatricians in each of these units and will pay a monthly remuneration of Rs

90000/-. The state will recruit 16 pediatricians for these eight SCNUs.

53. Staff Nurses: There will be 12 staff nurses in the 36 “20 bedded” SCNUs and six staff nurses in the eight tribal SCNUs for providing round the clock services and they will be paid a monthly remuneration of Rs 13000/-. The state will thus recruit 432 staff

nurses in the 36 nontribal SCNUs and 48 staff nurses in the eight tribal SCNUs, i.e. a

total of 480 staff nurses.

58

54. Support staff: There would be three support staff for round the clock cleaning and housekeeping, three security personnel, one lab technician and one data entry

operator in each of the 44 SCNUs.

55. Maintenance: The 36 non tribal SCNUs will be given an annual budget of Rs 10.00 Lakhs for maintenance and the eight tribal SCNUs Rs 5.00 Lakhs as annual

maintenance.

56. New Born Stabilization Units (NBSUs): The state has planned to set up four

bedded NBSUs in Level III facilities excluding those which will have SCNUs and other Level II MCH Facilities. This too will be done in two phases viz. the in the first phase

121 NBSUs will be set up and the remaining 233 NBSUs will be set up in phase II and

are included in this year‟s PIP 2011-12. The sick neonates will be stabilized in these units for the initial few hours and referred to the nearest SCNU for further treatment. If

the baby stabilizes it could be managed in the NBSU as well.

57. Renovation: The setting up of NBSUs involves renovation (civil works and electrical works) of the identified space (Approx 400-600 sft) within the existing facilities

near the labour room. Sample design for setting up NBSUs in a CEmONC center and setting up a NBSU in a ward have been developed by APMSIDC. Budget of Rs five

Lakhs has been earmarked for each NBSU for renovation. This will include aluminum

partitions, flooring, roofing with Gypsum POP, air conditioners, blinders for the

windows and electrical works for the equipment.

58. Equipment: The new born care equipment for the NBSUs will be procured by

APMSIDC as per the specifications and built in maintenance for three years. (Annexure)

Human Resource:

59. Pediatricians: The state has 115 pediatricians working in the 121 facilities

identified for setting up of NBSUs. These pediatricians who are at present attending the routine pediatric work will also be responsible for operationalizing the 115 NBSUs. The

deficiency of six pediatricians in the identified facilities will be filled by APVVP on

priority basis.

60. Staff Nurses: The state will be appointing one staff nurse for every NBSU. She will however be a part of the hospital staff and will work along with the labour room staff nurses in rotation. The hospital superintendent will ensure that one staff nurse will

be available for the NBSU round the clock.

61. Support staff: The support staff available with the hospital will also be responsible for the housekeeping of the NBSU on a regular basis.

62. New Born Care Corners: All health facilities where deliveries are taking place will have a new born care corner in the labour room. All Level III MCH facilities will

have additional NBCCs in operation theatres as well. The state has committed to set up 540 NBCCs in the first phase i.e. by August 2011 and 758 NBCCs in the year 2011-12

(PIP 2011-12).

59

The equipment required for the NBCCs to be procured by APMSIDC. The existing

health staff in the hospitals will be responsible for utilization and maintenance of the NBCCs.

Budget for Child Health activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

I Special Care New Born Units

(SCNU)

1 SCNUs in Other Areas

a) Maintenance and consumables Maintenance 1000000 21 210.00

b) Pediatricians Salary 50000 84 504.00

c) Staff Nurses Salary 12910 252 390.40

d) Data entry operator Salary 9500 21 23.94

e) Lab Technician Salary 9000 21 22.68

f) Support Staff Salary 6700 63 50.65

g) Security Salary 6700 63 50.65

Total 1252.32

2 SCNUs in Teaching Hospitals

with Paed. & Both

(OBG+Paed) Departments








Total 822.52

3 SCNUs in Tribal Areas








Total 343.51

SCNU Total 2418.35

II New Born Stabilization Units

(NBSU)

1 Staff Nurses Salary 12910 378 585.60

2 Maintenance Maintenance 175000 378 661.50

NBSU Total 1247.10

III New Born Care Corners

1 Maintenance Maintenance 20000 1405 281.00

Total

281.00

60


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

IV Nutritional Rehabilitation

Centers

1 Human Resources

a) Social Worker Salary 8000 23 22.08

b) Staff Nurses Salary 12910 138 213.79

c) Nutritionist / Data entry Operator

Salary 10000 23 27.60

d) Cook / Care Taker Salary 6700 46 36.98

2 Compensation / Incentives

a) Care givers and Patients

i) Wage loss compensation + Food for each mother during inpatient care (15 beds for 20 days)

Compensation 150 6900 124.20

ii) Wage loss compensation for follow-up visit


iii) Cost of food for caregiver and child at follow-up visit

Food 50 920 5.52

iv) Cost of Transportation for

inpatient treatment ( to and fro)

Transport 200 920 22.08

v) Cost of Transportation for follow-up after discharge

Transport 200 460 11.04

b) Incentives for Pediatricians Incentives 5000 46 27.60

c) Incentives-Community Workers Incentives 100 460 5.52

3 Maintenance / Contingency Fund

Maintenance 5000 23 13.80

515.73

Child Health Total 4462.18

61

A4: FAMILY PLANNING

63. The State is implementing the Family Planning scheme since 1952 and

formulated its Population Policy in the year 1997-98. Even though the State has

relatively poor socio economical status compare to the other southern states of India the effective implementation of the State specific Population Policy resulted in reduction of

TFR to below replacement level i.e. 1.8 (NFHS-3).

64. In the Andhra Pradesh among the couple who utilizes family planning services the female sterilization contributes 63%, male sterilization contributes 3% and all spacing

methods put together 1.1%. The age at marriage of the State 16.1 years and 18% of the

women become pregnant before 19 years are the major concerning factors of the state. Hence the state now formulating the new Population Policy by focusing holistic need

based Family Planning methods to sustaining the TFR at the present level and giving

more emphasis on Age at Marriage/ spacing and limitation method/ Advise on sterility

/Planning for arrival of the 1st child/ Sex Education / Education of parenthood / Nutrition/ Genetic / Marriage Counseling.

Objective:

Sustain the present TFR – 1.8

Strengthening the facility based human resource and infrastructure to Shift

the Camp sterilization approach to fixed day approach at facility level.

Intensive Campaign to promote age at marriage.

Proper spacing and limitation of Births by providing Sex Education /

Education of parenthood & Nutrition to the acceptors and special focus on

IUCD.

Increasing the male participation from current level 4% to 5%.

Safety & Quality assurance to the Family Planning acceptors.

Insurance coverage to the acceptors and service providers to improve the

confidence among the acceptors.

Addressing the problem of Infertility.

Monitoring & Evaluation for effective implementation.

Implementation of Family Planning in A.P. - Situation analysis:

65. As per 2001 census, the population of A.P was 762.10 lakhs with decadal growth of 14.59, it accounts for 7.42% of India‟s population. Midyear estimated population of

A.P for 2010 is 866.9 lakhs.

The Status of Total Fertility Rate in AP

NFHS – 1 NFHS – 2 NFHS – 3 Target

(2012)

A.P. 2.59 2.25 1.79 1.5

India 3.39 2.85 2.68 2.1

62

Other vital Population indicator of A.P

Indicator A.P India

Birth Rate (SRS 2009) 18.3 22.5

Infant Mortality Rate (SRS 2009) 49 50

Maternal Mortality Ratio (SRS)

1997-1998 1999-2001 2001-2003 2004-2006

197 220 195 154

398 327 301 254

Total Sex Ratio (Census 2001) 978 933

Child Sex Ratio (Census 2001) 964 927

Contraceptive prevalence Rate (NFHS III 2005-06) 67.6 56.3

% of girls marrying below 18 years (DLHS -3) 28.7 21.5

AP Family Planning indicators DLHS-2 Vs DLHS-3:

Indicator DLHS-2

(2002-04)

DLHS-3

(2007-08)

Family Planning

Any method (%) 62.8 65.3

Any modern method (%) 62.4 65.1

Female sterilization (%) 58.2 60.3

Male sterilization (%) 3.1 3.9

Maternal and Child

Mothers who received antenatal checkup (%) 94.3 95.9

Mothers who had at least one TT injection (%) 86.5 93.4

Institutional deliveries (%) 59.4 71.8

Safe delivery (%) 67.8 75.6

Children 12-23 months fully immunized (%) 62.0 67.1

Status of Family Planning -DLHS-III (All in %)

Sl.

No. Districts

Use of Any

Family

Method

Female

Sterilization

Male

Sterilization

Total

unmet need

in FP

1 West Godavari 78.7 74.7 2.8 4.4

2 East Godavari 78.5 71.4 3.8 7.2

3 Khammam 74.1 70.6 3.1 4.3

4 Guntur 72 69.9 0.5 8.4

5 Krishna 71.6 66.4 3.7 7.3

6 Warangal 70.5 55.5 14.5 7.7

7 Vizianagaram 70.4 62.5 9 9.5

8 Prakasam 70.3 68.3 0.9 8

9 Karimnagar 68.7 49.3 18.7 10.8

10 Srikakulam 67.3 63.5 2.5 7.7

11 Visakhapatnam 67.2 41.8 21.6 10.3

12 Chittoor 65.5 63.9 0.4 10.7

13 AP 65.3 8.5

14 Anathapur 64.6 62.2 0.4 9.6

15 Hyderabad 64.6 60.3 2 10.1

16 Nalgonda 62 60.2 1.7 8.6

63

17 Nellore 61.8 59.6 1 8.2

18 Rangareddy 59.9 58 0.6 8.1

19 Nizamabad 58.6 56.1 1.9 11.5

20 Kurnool 57.7 56.5 0.3 9.5

21 Adilabad 57 53.4 2.6 13.8

22 Mahabubnagar 54.1 53.5 0.1 11.1

23 Medak 53.3 51.9 0.8 10

24 Kadapa 51.4 49.6 0.5 15.1

Strategy:

66. A.P has achieved the replacement level of population by bringing down the TFR

to 1.8 (NFHS-III) which is equal to the developed countries. The achievement comes because of state commitment to implement the state specific Population Policy to

stabilize the population of state in spite of having relatively low economic & social

development index. It is achieved through the commitment of the implementing agency

by providing the permanent method on camp mode and institution based fixed day service.

67. Presently the state would like to shift its approach from the permanent method to Age at marriage/ spacing and limitation method/ Advise on sterility /Planning for

arrival of the 1st child/ Sex Education / Education of parenthood / Nutrition/ Genetic

/ Marriage Counseling. As the state having average age at marriage is around 16.1 years

ultimately increased the span of reproductive period among the married women, the literacy and social status of the population compelled the state to adopt permanent

method on need basis.

1. Age at marriage

68. Age at marriage is influenced by many complex economic, social and health

factors. The NFHS-III reveals that the average age at marriage in A.P. is 16.1 years and

18% of the women become pregnant before 19 years is one of the most concern factor for the maternal health and population stabilization because it is linked with higher total

fertility rates and early childbirth. It poses increased risks of maternal and newborn

mortality or morbidity. Hence, Health and Family Welfare Department planning to

work in convergent with the Women and Child Development Department, Education Department, Rural Development and committed NGOs that working in the rural areas

of Andhra Pradesh to delay the age at marriage to achieve the improved health and

nutrition status.

Strategy planned:

69. Even though the Illiteracy and Poverty are the major reason for the age at

marriage we believe that the awareness, sensitization in the tribal and rural areas along

with capacity building of the health staff on counseling can bring the change in the mind set of the people in long run on marriage age of the women. Hence the following

strategies are proposed.

64

Building the awareness:

Promoting awareness on various health problem that arising out of the early

marriage among all stakeholders including parents, relatives, panchayat members,

through the Health workers, NGOs, social workers, Community Based Organizations (CBOs), school teachers, Aganwadi workers, Accredited Social

Health Activist (ASHAs), Religious, Political leaders. And also involving

electronic and printing media.

Design, develop and use Information, Education and Communication (IEC)

materials and Behavior Change Communication, which helps creating negative

associations with child marriage; can create „new social norms‟

Using the mass media, community media; conducting puppet shows, street plays, theatre wall writings.

Initiate campaigns on Stop Early Marriage conduct discussions in public forums,

meetings, training programmes (starting at the Gram Panchayat level) essay

competition in the schools and also in the rural women.

Generating awareness among organizers of mass-marriages by ensure that these

marriages are registered.

Sensitization

Initiate consultation meetings with stakeholders at grass roots - with parents,

teachers, Anganwadi workers, ASHAs, SHG and Panchayat members, NGOs,

religious leaders and Politicians.

Counsel parents and encourage the involvement of mothers, elder daughter and

elder sons in campaign against the early marriage.

Sensitizing Gram Panchayat, caste leaders, religious leaders regarding the

importance of avoiding the early marriage.

Initiate a state wide movement (through rallies, marches, meetings) involving

grass root level women‟s group to bring the awareness on the age at marriage etc.

To achieve the above 4- Workshop proposed on sanitization at the PHC level through

the identified NGOs.

Capacity Building

Conduct workshops, consultations and trainings for ANM, ASHA, and other

medical staffs.

Train all Health Staffs at the PHC and SC level on the issue of age at marriage and rights of the girl child.

Encourage girls at the Schools to say „NO‟ to marriage; make girls themselves

aware of the evil effects of early marriage, their right to pursue education/ vocational training, etc. to shape up their future by themselves through

65

Govt./NGO‟s by taking incentive IEC campaign through the Bala Arogya

Raksha.

To build the capacity of the field staffs regarding the all kind of the medical and

legal drawbacks of early marriage and its result in population growth.

To improve the capacity of the field staff TOT at the state level, district level

proposed in turn they can train the field staffs at PHC level.

The recourse agency to conduct the training and proper monitoring may be

through identified NGO or the IIHFW.

One Day TOT at the State Level.

SN Participants training load

1 PODDT+PHN/CHO

+Add. DMHOs

3 Officials per districts X

23districts =69 Officials

Workshops at the PHC level

S.

N

Participants Training load

1 ANM+ASHA 50 participants per PHC

X 1624 PHCs

2. Sterilization services

70. The Commissionerate of Health and Family Welfare, A.P. is implementing all

the centrally sponsored Family Planning Interventions with additional support from State Government under State Specific Population Policy. The objective of the

programme is to cover all eligible couples protecting their reproductive rights and

improvement of services of their choice.

71. As per the requirement of the acceptors the following services are provided:

a. Mini Lap services at fixed days in the F.P Service Centers. b. Camp based DPL services where the fixed day services are weak.

c. Camp & Service Centre based NSV services to the male F.P acceptors.

Present Service coverage based on the report received form the Districts:

Sl.

No

Year Total

Sterilizations

Vasectomy Tubectomy

Achmt. % of

achmt

Achmt. % of

achmt.

1 2 3 4 5 6 7 1 2003-04 830812 31804 3.83 799008 96.17

2 2004-05 736417 28808 3.91 707609 96.09

3 2005-06 744271 26683 3.59 717588 96.41

4 2006-07 769253 26266 3.41 741327 96.37

5 2007-08 725217 28505 3.93 696712 96.07

6 2008-09 700273 29763 4.25 670510 95.75

7 2009-10 665400 22867 3.44 642533 96.56

66

72. Total sterilization ELA proposed for the year 2011-12 is 7.00 lakhs which is estimated based on the birth order of 2 and above in the districts.

73. To implement the programme the Government of India provides incentives to the

permanent method acceptors, surgeons and staff. The Government of Andhra Pradesh have been providing additional incentives to Family Planning Acceptors (BPL / SC /

ST), apart from Govt. of India package the total package provide as follows:

SN Categories Vasectomy Tubectomy Tub.

(APL

only)

CSS

(All)

NSP

(BPL/

SC/

ST)

Total CSS

(BPL/

SC/ST)

NSP

(BPL/

SC/ST

Total

1 Acceptor 1100 350 1450 300 280 580 -

2 Motivator 200 200 75 75 -

3 Drug & Dressing 70 50 - -

4 Surgeons charges 100 100 75 75 -

5 Anesthetist charges

0 0 25 25 -

6 Staff Nurse 15 15 15 15 -

7 OT technician 15 15 10 10 -

Total 1500 350 1850 500 280 780 -

(NGO /PMP Facilities/Voluntary Organisation)

SN Procedure To Facility

(CSS)

To Motivator

(CSS)

Total

1. Vasectomy (All) 1300 200 1500

2. Tubectomy (BPL/SC/ST only) 500 - 500

Providing Facilities to Sterilization held on Fixed Days at Health Facilities. 74. The following facilities proposed to the 1094 Family Planning Service Centers

which are providing the sterilization services on fixed day basis to ensure the basic

amenities and hospitality to the acceptors.

1. Generator with POL.

2. Hospitality and basic amenities

3. Washing of cloths and maintain the cleanness.

Family Planning Consumables and Repairs:

75. To meet the annual ELA of sterilization supply of the following sterilization

accessories proposed for the year 2011-12. FP accessories proposed for the year 2010-11

caries 10% increase from the previous year incurred expenditure by taking care of inflation and variation in price:

67

Family Planning consumables

o Supply of 20 types of consumables approved by the technical committee and budget incurred as per the Rate Contract of APHM

Family Planning Surgical Instruments: o Supply of 14 types of surgical instruments approved by the technical

committee and budget incurred as per the Rate Contract of APHM

&HIDC

NSV Kits:

o Supply of 2000 kits approved by the technical committee and budget

incurred as per the Rate Contract of APHM &HIDC

Laparoscopic accessories and repairs

o Accessories to the laparoscope is supplied to the districts in accordance with the need and also repairs of the accessories under taken every year

to ensure the availability of instruments in time to avoid the hindrance

to the programme implementation.

3. Spacing Methods

Revitalization of IUD services in the Districts. 76. As per the recent DLHS – 3 survey the contraceptive prevalence rate in Andhra

Pradesh is 65.1% where just 1.2% are using spacing methods among which IUD users is

only 0.4 %. It is highly disturbing even though the state achieved to bring down the TFR

1.8.

77. The state now determined to shift it approach in Family Planning by emphasizing

on offering high quality contraceptive services to eligible couples on a voluntary basis through the spacing methods. However, the acceptance of spacing methods still remains

low in this State.

Major identified difficulties in providing IUD services.

Lack of awareness on importance and conveniences of spacing method

Dogmas or social constrains in the adoption of the method.

Limited access to skilled service providers.

Low insertion skills among the providers resulting in higher complications

leading to non – acceptance.

Strategy

78. The State initiating the targeted intensive campaign and ToT was scheduled (conducted for 3 districts) for the skill development under the State Population Policy in

the districts. Ones the training is completed the implementation will be taken up on the

following manner.

IUD services at PHCs

68

Proposing fixed day services in the service centers.

Proposed to train one identified person as councilor to promote the intervention.

IEC activities.

IUD services at Sub Centres

IUD services will be also provided on fixed days.

ANM may be designated as councilor.

Incentive proposed to the ASHAs / ANMs for motivation.

Expenses towards infection prevention etc. would be met from the untied grant.

IEC activities will also be implemented to popularize the clinic day.

Providing IUCD on Camp mode: It is proposed to conduct 1380 camp in the state

covering all the 23 districts @ 5 camps per month.

Providing Incentive to ASHAs: It is proposed to provide the incentive to the ASHA if

the acceptors not becoming pregnant at least for one year from the date of IUD insertion.

4. Training and Capacity Building

79. Minilap training : Mini-Lap training programme is one of the components of Family Welfare programme and its main objective is to enhance the quality of service and ensure the trained and validated surgeons (as per the GOI guidelines) present in all

the service centers to meet the demand. The training is imparted by Senior Surgeon at

district Head Quarters Hospitals of the districts.

80. The Medical Officer, Staff nurse and MNO/Theatre Assistant of PHCs and other

institutions are trained by Senior Surgeon at training centers for 12 days. Each trainee

and trainer will be supplied with required subject material. A training calendar is proposed for every year to complete the training programme of Medical officer in Mini-

Lap techniques. From the year 2001-02 to 2010-11 (up to Nov.) 456 Medical Officers

and same number of Staff nurse, theater assistants were trained.

81. DPL training: The Medical Officers (OBG Specialists and M.S. General Surgery)

of PHC‟s and other institutions are trained by approved DPL training centres for 12 days. Each trainee and trainer will be supplied with required subject material. A

training calendar is proposed for every year to complete the training programme of

Medical officer in DPL techniques. At present there are 3 identified training institutions (GMH, Sultan Bazaar, Hyderabad, GMH, Nayapool, Hyderabad and Gandhi Hospital,

Secunderabad) for imparting training to medical officers.

From the year 1997-98 to 2010-11 (up to Nov) 403 medical officers and equal number

of staff nurse and theater assistants were trained.

Training load and budget proposed for the year 2011-12 as follows.

69

TOT for DPL

One TOT at the state level to all the DPL surgeons of the districts is proposed to

upgrade the skill and orient them toward the programme.

3. NSV training

82. At present there are 4 training centers in Karimnagar. Imparting training in NSV

since 1998 and (2) more training centers are identified to impart training in NSV

programme at Adilabad.

83. The Medical Officers of PHCs and other institutions are trained in 7 trainning

institution for 5 days and the entire trainees and trainers are supplied with required

subject material.

TOT: out of 150 validated surgeons (18) medical officers were identified as State

Trainers.

From the year 1997-98 to 2010-11 (up to Nov.) 549 medical officers were trained

TOT for NSV

One TOT at the state level to all the NSV surgeons of the districts is proposed to

upgrade the skill and orient them toward the programme.

4. Quality assurance in FP service delivery:

84. To ensure the quality in FP service delivery the state emphasis the quality

assurance in sterilizations by providing awareness & training to the medical officer and the staff nurses.

85. The Government of India communicated Standard Sterilization Manuals (2) the

TOT Training for State Officers was initiated. Directions of RSS Division, MoH&FW, and workshops on Standard Sterilization Guidelines – QAC measures have been

organized in co-ordination with IIH&FW successfully in the year 2007-08.

86. In 2007-08 TOT has been organized in IIH&FW for District Level Officers and

District Level dissemination workshops were conducted successfully.

Total No. of Districts … 20

Total No. of Doctors Trained … 1354

Doctors to be trained … 2000

Printed 10,000 manuals and distributed to all the Districts.

87. The Staff Nurses who are in charge of operation theatres of FP Service Centres / PP Units are most important people in implementing the guidelines issued under

Standard Sterilization manuals and QAC measures.

70

88. In co-ordination with IIH&FW the training have been organized effectively

involving the eminent Gynecologists, Microbiologists as Resource Persons, @ 2

districts per batch i.e. 50 to 60 Staff Nurses

Number of persons trained

SN Year Doctors Staff Nurse 1 2007-08 1354 nil

1 2008-09 446 297

2 2009-10 … 217

Proposed Training on Quality Assurance

89. Now the state initiating to conduct the reorientation training workshop to the

medical officer and the staff nurses on Quality Assurance. All the new recruiters and the

old will be covered in the training programme.

5. World Population Day Celebrations

90. World Population day celebrated every year on 11th July at the Districts level and 12th July at State level. On that day at the state and districts level initiates various

IEC/BCC activities on the Family Planning and presents awards to the Districts, F.P.

Surgeons, Staff for the best performance under various categories and also Cash incentives to eligible couples.

Budget Proposed under A.P. State Population Policy

1 Camp Expenditure for DPL/VAS /IUD- (under SPP) 97.8

2 FP Trainings (under SPP) 50.33

3 FP Consumables / Laparoscopic accessories / Repairs 270

4 World Population Day Celebration (under SPP) 76.00

Total 494.13

6. PC&PNDT activities

Workshops on Effective Implementation of the PC&PNDT Act

Sl.No. Particulars Budget

(in Rs.)

1 Training Kit (Folder, pad, pen, etc.) Rs. 500 x 35 persons 17,500

2 Boarding & Lodging @ Rs. 350 per participant x 35 persons x 2 Days 24,500

3 Honorarium for guest lecture @ Rs.1000 per session x 10 sessions 10,000

Lunch for Guest faculty & Coordinator@ Rs. 250 per faculty x 4

persons x 2 Days

2,000

4 Facilities charges:

1 Lecture Hall + Demo room charges @ 2500/- per day x 2 5,000

5 Typing & Photocopying of Training Material @ Rs.1000 x 35 35,000

6 Contingency & Transportation @ Rs. 5000 5,000

71

Sub Total 99,000

7 Institutional overheads @ 15% 14,850

8 TA & incidentals @ Rs. 1500 per participant x 35 participants 52,500

9 DA @ Rs. 200 Per day x 25 x 2 days 14,000

Grand Total 1,80,350

91. The above budget may be met from state share receive from the district collected as registration fee for registration of scan centers, Genetic counseling centers, ART

centers and other related bodies.

PC&PNDT Dissemination Workshops for Supporting Staff

Sl.No. Particulars Budget

(in Rs.)

1 Training Kit (Folder, pad, pen, etc.) Rs. 150 x 30 persons 4,500

2 Boarding & Lodging @ Rs. 350 per participant x 30 persons x 2 Days 21,000

3 Honorarium for guest lecture @ Rs.1000 per session x 10 sessions 10,000

Lunch for Guest faculty & Coordinator@ Rs. 250 per faculty x 4 persons x 2 Days

2,000

4 Facilities charges:

1 Lecture Hall + Demo room charges @ 2500/- per day x 2 5,000

5 Typing & Photocopying of Training Material @ Rs.1000 x 30 30,000

6 Contingency & Transportation @ Rs. 5000 5,000

Sub Total 77,500

7 Institutional overheads @ 15% 11,625

8 TA & incidentals @ Rs. 1500 per participant x 30 participants 45,000

9 DA @ Rs. 200 Per day x 30 x 2 days 12,000

Grand Total 1,46,125

92. The above budget may be met from District share collected as registration fee for

registration of scan centers, Genetic counseling centers, ART centers and other related

bodies.

93. Budget proposed for IEC activities to create awareness on PC&PNDT Act @

1.00 Lakh per District for 23 Districts towards Hoardings, Printing of Brouchers, Phamplets, Wall writings and Kala Jathas

Budget @ 1.00 lakh X 23 districts =23.00 Lakhs (from NRHM Funds)

72

Budget for Family Planning activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 FAMILY PLANNING

MANAGEMENT

a) Review meetings on Family

Planning performance and initiatives at the state and district level

Meetings 10000 4 0.40

b) Monitoring and supervisory visits to districts/ facilities

Monitoring 3000 12 0.36

c) Orientation workshops on technical manuals of FP viz. standards, QA,

FDS approach, SOP for camps, Insurance etc.

i) Orientation workshops Workshops 150000 1 1.50

ii) Printing of Manuals Printing 50 2000 1.00

iii) Workshops (District Level) Workshops 25000 23 5.75

Sub-Total 9.01

2 TERMINAL/LIMITING

METHODS (Providing

sterilisation services in districts)

a) Plan for facilities providing FEMALE sterilisation services on

fixed days at health facilities in districts


b) Compensation for sterilisation (Female)

Compensation 500 450000 2250.00

c) Compensation for sterilisation NSV (male)


d) Accreditation of NGOs / Voluntory Organizations for sterilization

services


Sub-Total 3165.64

3 SPACING METHOD (Providing

of IUD services by districts)

a) IUD services at health facilities in districts

Incentives 20 470000 94.00

b) Compensation to ASHA for 100% retention of IUD by clients

Incentives 100 200000 200.00

Sub-Total 294.00

4 Workshop on Population

Stabilization

a) State level Conference Conference 500000 1 5.00

b) District level Conference Conference 100000 23 23.00

5 BCC/IEC

activities/campaigns/melas for family planning

IEC/BCC 10000 360 36.00

Sub-Total 64.00

6 Implementation of PC&PNDT Act 23.00

Family Planning Total 3555.65

73

A5: ARSH Programme

94. Adolescents constitute 22% of the population and its age group is 10 to 19 years. It is not a homogenous group, vary in age, sex , marital status ,culture ,their level of

education. Hence their health status will have tremendous impact on mortality ,

morbidity, population growth scenario, and on health status of India .

95. ARSH strategy has been approved as a part of the National RCH – II program

implementation Plan. This strategy focuses on Adolescent Reproductive and Sexual

Health. Steps are to be taken to ensure improved service delivery for adolescents. Services include Counseling, promotive, preventive, curative and referral services. In

order to provide these services selected facilities in the district must be in a position to

provide prescribed package of services under ARSH strategy.

Key objectives:

96. Influencing the health seeking behaviour of the adolescents through existing

Public health system and services & Achieving the following

To provide services to all school going and out of the school children.

Reducing the age at marriage.

Reducing the teen age pregnancies

To facilitate them in reducing the MMR and TFR.

Reducing the incidence of nutrition related diseases eg: Anaemia.

Reducing the incidence of STI RTI and HIV & AIDS in adolescents.

Situation analysis:

At present there are no focussed services to reach these groups. No special trainings or special services ere provided to adolescents through existing health

care system. So there is ignorance, lack of health education and no good food

habits among these adolescents. This will leads to malnutrition, anaemia, and

high prevalence of STIs/RTIs and other communicable diseases. It was analysed that 68% of girls and 30% boys are anaemic in Andhra Pradesh as per NFHS

survey.

This ignorance has led to early marriages, population explosion, high MMR, and high IMR.

Due to non availability of counseling services at crucial times they are prone for

committing crimes and suicides. They are also exploited by the society by many

ways.

Key strategies:

GoI has recognized that the „Adolescent and reproductive and sexual health

needs‟ as one of the national health challenges. Special strategies are evolved &

implemented under RCH-II and NRHM.

GoAP has taken up the essential steps to provide ARSH services effectively

– while rationalizing the health services and strengthening of primary and

secondary health systems by constituting the 360 CHNCs,

– Strengthening school health program, Jawahar bala arogya raksha.

74

– constituting the MCH teams at habitation , Subcenter , PHC levels under MCH

– By working in the direction of achieving functional convergence of Rural development ,WDCW dept,,PR,

– Strengthening the monitoring system by creating a M&E cell at CFW with

a dedicated Joint director heading it.

– Constitution of Behavioural change communication, Information

Education & Communication Bureau at state level.

Program Components:

Counseling at schools and AFHS at schools in convergence with RRC and

JBAR,

.Training of all MOs, PHNs, MPHA(F) &(M), ASHA, AWW,

Area specific IEC/IPC and BCC ,

Monitoring and evaluation.

Implementation methodology:

97. A.P state ensures improved quality reliable adolescent friendly health service

delivery for adolescents through,

Service delivery

MCH teams at habitation and sub center level.

Medical officer and PHN at PHC level.

Obstetrician and Gynecologist services at CHNC level.

Tertiary care through Area hospitals / Teaching Hospitals.

Jawahar bala Arogya raksha for Adolescent school children.

Trainings: 1st Stage: Training to programme managers.

Duration: 1 day

Material: Orientation programme for Medical Officers to provide

Adolescent Friendly Reproductive and Sexual Health Services – Facilitators Guide and Handout

Printing of Material: Handout for Medical Officers and Facilitators guide for

LHVs, ANMs

Venue: IIHFW

Sensitization programme for DM&HOs, POs of ICDS, Dist. Education Officers

2ND Stage

The proramme managers will train Medical Officers using Facilitators guide and handouts

Duration: 3 days

Material: Orientation programme for Medical Officers to provide Adolescent

Friendly Reproductive and Sexual Health Services – Handout for Medical Officers and Facilitator guide for ANMs and LHVs

Printing of Material: Handout for LHVs, ANMs

Translation: Facilitator guide and Handouts for LHVs and ANMs

Venue: DTTs

75

3rd Stage:

Medical Officers would train ANMs, LHVs

Duration: 5 days

Material: Orientation programme for ANMs & LHVs to provide Adolescent Friendly Reproductive and Sexual Health Services – Handout for ANM and

Facilitator guide for ANMs and LHVs

Printing of Material: Handout for LHVs, ANMs

Translation: Facilitator guide and Handouts for LHVs and ANMs

Venue: DTT s and RTC

98. Risk Analysis: 40% of MMR and IMR is contributed by teenage adolescent mothers. Unless ARSH is implemented it will be difficult to reduce MMR and IMR.

They may do experimentation on sex, promiscuity and may results in high prevalence of HIV/AIDS.

Expected out comes:

We can provide services to all school going and out of the school children.

Age at marriage can be increased.

Teen age pregnancies can be prevented and this results in reduction of MMR< IMR and TFR

Nutrition and nutrition related diseases eg: Anaemia can be prevented.

Incidence of STI RTI and HIV & AIDS in adolescents will become low..

Training implementation cascade method State level master trainer

(Faculty MOHFW)

District level Trainer

(PODTT, Paediatrician, Gynecologist, Psychologist and Faculty IIHFW)

Mandal level Training to Medical Officers, ANMs and LHVs

Establishment of Clinics and Service Provider The programme would be implemented in the districts where age at marriage is low.

2. MENSTRUAL HYGIENE:

99. The Scheme on Menstrual hygiene is part of Adolescent Reproductive and Sexual Health. The Scheme aimed at promotion of menstrual hygiene among adolescent girls by

creating awareness and a form for discussion on age at marriage, nutrition, gender

issues, contraceptives, self esteem and negotiation skills. In view of lack of safe sanitary

facilities the girls face several problems during menstruation. In order to increase availability of sanitary facilities at affordable cost the GOI has initiate the present scheme

with the following objectives.

100. The program will be focused in rural areas with the following objectives:

76

To increase awareness among adolescent girls on menstrual hygiene, build self-

esteem, and empower girls for greater socialization

To increase access to and use of high quality sanitary napkins by adolescent girls

in rural areas.

To ensure safe disposal of sanitary napkins in an environment friendly manner

101. In order to achieve the objective the state is proposed to conduct trainings at

different levels which will be monitored by the program officers

Budget for Adolescent Health activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Establishment of Health Clubs Clubs 5000 1984 99.20

2 Fixed Day Health Clubs with Specialist Services & Consellers

Clinics 100 18720 18.72

3 Printing of Booklets & IEC activities 21.75

Urban Health Total 139.67

77

A6: SCHOOL HEALTH

102. The Government of Andhra Pradesh launched a revitalised School Health

Programme under the name Jawahar Bala Arogya Raksha (JBAR) on 14th Nov last year.

This initiative has resulted in basic health screening of about 10% of the state‟s population who are studying in the government and government aided schools and the

consequential referral services, as appropriate. The programme includes issue of

comprehensive Student Health and Education Record (covering ten years of health and

education details), booster immunisation, vitamin-A supplementation and bi-annual deworming. The health department is working in close collaboration with the school

education department and Sarva Siksha Abhyan (SSA) to develop an institutional

framework for effective implementation of school health programme with proactive teacher and parent participation.

103. Objectives of CHIP: is the prevention of illness as well as the promotion of health and well being of the students through:

Early detection and care of students with health problems

Development of healthy attitude and behaviour amongst the students

Ensure a healthy environment for children at school

Prevention of communicable diseases

Increased learning capabilities because of good health and nutrition

104. Progress in 2010-11: After the successful launch of JBAR, the following activities were undertaken:

Trainings on School Health were conducted at the State, District and Mandal

levels.

The Student Health and Education Records were also sent to all schools.

105. Currently, health screening is in progress for students across the state. By 10th of

April 2010, all children in Ashram Schools, Residential Schools, schools in tribal areas and high schools will be covered. If time, resources and funds are available primary and

upper primary schools will also be covered.

106. Implementation Strategy: The implementation will be in two phases:

a. Intensive Phase is between 1st and 10th April, 2011

78

b. For Ashram Schools/ Residential Schools, it may be planned that the MO and his/ her team reside in the school itself for the 2/3 day period. The

School Headmaster/ Principal/ concerned Management will ensure all

logistics of the team in the campus.

107. ‘Deworming and Personal Hygiene Day’: This will be celebrated on 24th of February 2011 in campaign mode in order to mass deworm and spread awareness about

the importance of personal hygiene. This activity will cover all 82 lakh students studying

Government and Government Aided Schools in Andhra Pradesh. Highlights of this

campaign will be as follows: a. All students between the ages 5-15 years will receive Mebendazole (500 mg)

or Albendazole (400 mg) for deworming.

b. All school staff, hostel staff and Mid-day Meal cooking staff must also be administered Mebendazole (500 mg) or Albendazole (400 mg) for deworming.

c. Treatment for students suffering from scabies and lice infestation will also be

provided.

d. Spread awareness about personal hygiene like hand washing, cutting nails, discourage use of common soap/towel etc.

Continuation Phase:

a) From the next academic year ie. June 2011, Thursdays will be School Health Days.

Thus, the PHC and the schools are aware of this day. b) The Medical Officers of PHC, with the team, will visit the schools in their area at-

least twice a year. In the first visit, the School Health Team will undertake a

thorough medical check-up of all children in the school and in the second visit, only high-risk children will be checked.

c) The MPHA (Male and Female) will visit the school once in every month. He/she

will follow-up children who have been absent from school for more than a week and

ensure that the child receives medical attention, if required. d) The teacher will regularly monitor the programme on a day-to-day basis. They will

also follow the monthly „Theme Schedule‟ that will be provided to them for Health

Education. e) Every Tuesday is School Health Referral day at higher medical centers. Children

requiring specialist services can avail of referral services on this day. A special

79

counter will be available for School Health referrals. ANM/ Teacher will follow-up

the referral cases.

108. In the years following 2011, as all children would have been screened, the

programme will have only the continuation phase.

Expected beneficiaries

School going adolescent boys (10 to 19 years of Age): 92,86,668

School going adolescent girls (10 to 19 years of Age): 86,16,384

Out of school youth working in various Industries, Agriculture & Labours:

1,43,336 boys and 1,32,991 (numbers need to be verified and corrected)

Innovations for the year 2011-12

109. SWASTHH (School Water and Sanitation towards Health and Hygiene)

Program: Through this programme, we will try to bring focus on health and hygiene for adolescent girls. The highlights of SWASTHH will be:

Training for health and education staff on Adolescent Problems

An ANM will be trained on adolescent hygiene and she will impart the same to adolescent girls during the regular school health visit.

110. FRESH (Focussing Resources Effectively for School Health) Day Celebration: In order to increase participation of parents, community and teachers in improving health of the children, FRESH days will be celebrated across the states in all schools on a

particular date. On this date, a festive mood will be created and information about health

and hygiene will be imparted. Parents will be invited to suggest/ contribute to improving

health and hygiene in schools/ homes.

Budget for School Health activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 One time capital cost:

i. Weighing scale W.Scales 500 16000 80.00

ii. Height measurement instrument Instruments 100 16000 16.00

Total 96.00

2 Student health cards, referral

cards, 2 registers per year

i. Students Health Cards per annum 1st year entry students.10 Lacs +

6th class entry students 8 Lacs total 18 Lac students

Cards 6.00 1800000 108.00

ii. Referral cards for 1 Lac children @ Rs.1 each X 1 times

Cards 1.50 100000 1.50

iii. Habitation Health Register Registers 50.00 20000 10.00

iv. Sick registers Registers 40.00 100000 40.00

v. Student Health Referral Register Registers 40.00 2000 0.80

80


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

vi. Referral follow up Register Registers 40.00 2000 0.80

vii. School wise Sick Register

maintained at Sub centre level

Registers 40.00 12600 5.04

viii. Monthly reporting formats Formats 0.20 600000 1.20

Total 167.34

3 Travel cost for referral (0.1% of all screaned) @Rs.100 per referral

Mobility 100.00 10000 10.00

4 IEC activties IEC/BCC 94.00

5 Training of Master Trainers at

state level

0.00

a) Honorarium to master trainers Honorarium 2500 6 0.15

b) Refreshment Refreshments 250 96 0.24

c) T.A. & DA TA/DA 1000 96 0.96

d) Stationery Stationary 150 96 0.14

e) Miscellaneous (Training hall rent

and others)

Others 15000 3 0.45

Total 1.94

6 Training of Mandal trainers at

Distrcit level



c) T.A. & DA TA/DA 150 5800 8.70


e) Miscellaneous (Training hall rent and others)

Others 3500 116 4.06

Total 29.58

7 Mandal level trainings



c) T.A. & DA TA/DA 50 125000 62.50


e) Miscellaneous (Training hall rent and others)

Others 20 125000 25.00

Total 387.50

8 School Health Program Mobility

support to Medical Teams

Mobility 900 64960 584.64

9 Monitoring & Evaluation M&E 25.00

10 Swasthh: School Water and

Sanitation towards Health &

Hygiene

a) Menstrual Hygiene 10 500000 50.00

b) TA & DA 100000 22 22.00

c) Vehicle decoration 50000 22 11.00

d) Hiring of the Vehicle / POL 50000 22 11.00

Total 94.00

11 Fresh Programme 50000 22 11.00

12 Urban School Health Programme 1000 1000 10.00

13 Specialist Camps at the Divisional level

25000 198 49.50

School Health Total 1560.50

81

A7: URBAN HEALTH

111. There has been a progressive rise of urbanization in the state of Andhra Pradesh

over the last decade. The primary health care infrastructure, particularly, in the urban slum areas is relatively fragile, and rapid urbanization is throwing up complex challenges

to the health system. There exist multiple issues which limit the reach of basic provisions

of health and basic services to all the people living in urban slum areas. Their low socio-

economic status combined with high incidence of illiteracy deprives them of the basic health care they need. Hence it is felt that extension & outreach services in the urban

slum areas are provided with special focus on maternal and child health care besides

preventive, promotive and curative health care services to one and all.

112. Under NRHM, the state of Andhra Pradesh has been providing primary health

care services to the people living in urban slum areas since 2005-06. A total number of

80 Urban Health Centres are presently functioning in the urban slum areas of the state which are being run through selected local NGOs. The continuation of these 80 Urban

Health Centres for the year 2011-12 will be implemented at an estimated cost of

Rs.817.52 lakhs.

Key objectives

To provide an integrated and sustainable system for primary health care services

in the urban slum areas, with emphasis on preventing and controlling

communicable diseases;

To promote reproductive and child health among the urban population, especially

the urban poor and the slum migrant population.

To increase availability and utilization of Health Services in urban slum areas.

To build up an effective referral system from the Urban Health Centres to the FRUs.

To achieve 90% coverage of all pregnant women with comprehensive ante-natal

services such as TT immunization, regular periodical check-up, administration of

vitamin & iron supplements, counseling about nutrition, screening of high risk cases etc.

To increase institutional deliveries within the slum areas to at least 90% of the

total deliveries.

To increase coverage of children upto 100% with immunization against the seven

vaccine preventable diseases and administration of Vitamin‟A”.

To bring a substantial decrease upto 25% of the present level in infant and child

mortality occurring due to diarrhea and acute respiratory infections.

To bring an increase in the age at marriage of girls in the jurisdiction of the UHC

to at least 18 years of age for at least 80% of the total marriages.

82

To increase in the couple protection rate upto 70%.

To increase utilization of spacing methods, both by men and women, to reach at least 15% of the total couple protection rate.

To increase number of vasectomy cases upto 15% of the total number of

sterilization cases.

To implement all National Health Programmes and campaigns in the allotted area from time to time.

To increase overall health awareness and better health-seeking-behaviour among

the slum dwellers, reflected in reduced morbidity pattern, better management of

diarrhea and acute respiratory infections in children in the slum areas.

Key strategies of the programme

Universalizing Access:

113. Surveys, Studies and Action Research: Andhra Pradesh is urbanizing at a faster pace and is likely to have 40% of its population in the urban areas by 2020. The

dynamics of urban primary health care is not fully understood, as it has been assumed

that the private sector would address the health needs of the urban people. This,

however, is nowhere near reality. Therefore, the state proposes to undertake series of surveys and studies to understand the specific vulnerabilities of the urban poor; identify

pockets of urban poor, map the slums, estimate disease burden, health profile and service

availability. This will provide a firm ground for planning specific and targeted interventions for the urban poor. The survey will cover the municipal corporations and

Grade-1 municipalities during 2010-11.

114. Structural Reforms: The Municipalities would identify a suitable place for construction of UHC buildings on par with state government UHC buildings since the present 80 UHCs under NRHM are being run in rented buildings. Further, there is a

scope to take up the establishment of new UHCs in the remaining Municipalities /

Municipal Corporations which do not have Urban Health Centres.

ii) Strengthening Infrastructure:

115. The UHCs are currently ill equipped and will therefore be upgraded with adequate infrastructure, equipments and complementary facilities.

(iii) Partnerships:

116. Inter-sectoral Coordination: The department will work closely with the Municipal health systems to address issues pertaining to environmental hygiene and

health, disease outbreak and provision of health services. A sub-committee has been

constituted at the state level to improve coordinated action.

83

117. Private sector: The UHC staff will work towards improving institutional deliveries by referring the cases to Government hospitals which are very much available

in urban areas.

118. Mahila Aarogya Sanghams: Instead of Self Help Groups the UHC staff will

utilize the services of Mahila Aarogya Sanghams (MASs) members who are actively associated with Urban health related programmes.

Implementation plan

(i) Expected beneficiaries:

Uniform structure for delivery of urban health services will be extended to

targeted urban poor.

Integrated & sustainable health care, with more emphasis on improved Family

Planning and Child Health services will be provided in the small urban towns in the state, with special focus on the urban poor and other vulnerable groups,

especially those living in slums.

(ii) Facilities Upgraded

Construction of buildings for existing 80 UHCs under NRHM will be taken up.

Establishment of required number of new UHCs under NUHM may be taken up in the high focused districts i.e Mahaboobnagar, Khammam, Nellore and left

wing extremist areas.

(iii) Package of Services:

Early Ante-Natal Care registration at 12 weeks.

Effective antenatal Health Package delivery (Administration of TT immunization and IFA tablets)

Three antenatal check-ups with regular follow up.

Identification of High risk ANC cases and referring to higher institutions.

Full immunization of children against 7 vaccine preventable diseases.

Identification of infant related diseases like Diarrhoea, ARI and referring them to

the Higher institutions)

Motivation of eligible camps for temporary and permanent methods of F.P. with

focus on male participation.

(iv) Training Requirements : o Annual Training for the staff of UHC excluding class IV employees for updating

their skills and knowledge regarding maternal, child health & immunization and

other communicable and non-communicable diseases o Quarterly training to the Mahila Aarogya Sangham members and to age at

marriage (Kishore) girls and to mother and antenatal women.

Monitoring & reporting systems

119. There is provision of (6) Regional Co-ordinators to streamline the system of monitoring of functioning of UHCs as per prescribed guidelines. The Regional Co-

ordinators who are retired experienced doctors inspect the functioning of UHCs

regularly and guide the NGOs in carrying out the activities as per the aims and objectives

of the scheme. The NGOs are submit at the end of every month physical performance

84

and financial performance reports to the Municipal Commissionrs concerned in the

prescribed formats.

Special features for 2010-11

120. It is proposed to appoint one Additional ANM and one Laboratory technician per UHC in view of proposed implementation of programmes for malaria, TB, AIDS and

other communicable and non-communicable diseases. These programmes will be linked

with District concerned programmes officials. Additional ANM is required to cope up with the increasing population within the jurisdiction of the UHCs. This, in turn, will

bring improvement in the delivery of health care services.

Budget for Urban Health activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 1 Medical Officer Salary 16000 80 153.60

2 ANMs (3) Salary 5200 240 149.76

3 Laboratory Technician (1) Salary 6500 80 62.40

4 Community Organizer (1) Salary 4500 80 43.20

5 Assisting Staff (3) Salary 3900 240 112.32

6 Project Coordinator to NGO (1) Salary 3000 80 2.40

7 Contingencies Contingencies 3000 80 28.80

8 Drugs & Consumables Drugs 10000 80 96.00

9 Community & Staff Training Trianing 24000 80 19.20

10 Rents, Water & Electricity charges Others 4000 80 38.40

Total 706.08 Other Initiatives

11 Administrative costs (Recurring)

a) Regional Coordinators Salary 25000 6 18.00

d) Vehicle hiring Vehicles 17000 6 12.24

c) TA / DA for RCOs TA/DA 10000 6 7.20

12 Non-Recurring

a) Preparation of Urban Helath Plan Action Plan 10000000 100.00

b) Prining of Registers Printing 10.00

Total 147.44


85

A8: TRIBAL HEALTH

121. Total tribal population in Andhra Pradesh state is 50.24 lakh and consists of 35

major tribal groups, and many minor subgroups. They constitute 6.6% of total A.P state population.60 to 75% of the ST population lives in a continuous belt of in accessible hilly

forest areas extending from Adilabad district in north Telangana to Srikakulam district in

north costal Andhra Pradesh, spread over the geographic area of 31,485.34 square

kilometers. Nine ITDAs are established to achieve integrated development in these tribal areas. In spite of various interventions initiated the improvement in health indicators

status very low.

122. Human development indicators are very poor in these areas. MMR and IMR are

almost double in the tribal areas.

123. This has drawn the attention of the GoAP & it is realized that focused region specific, group specific interventions are required for improving the health status of the

ST population and reduction of IMR and MMR. The NRHM PIP 2011-2012 aims at

achieving institutional strengthening, inter department coordination, functional convergence, improvement of the staff performance, strengthening the program

implementation and establishment of effective monitoring systems.

Key objectives:

To implement an integrated and sustainable system for primary health care services delivery in the nine ITDA (Integrated Tribal Development Agencies)

areas.

To implement alternate MCH service delivery models for hard to reach areas in

the tribal region by construction of ANM quarters and Sub center complexes at one hundred locations in deep forest and difficult to reach areas.

To provide, food & stay facility and compensation of loss of daily wages for the

tribal pregnant women to encourage institutional deliveries by strengthening birth waiting homes.

Strengthening of 184 primary health centers by providing with necessary

equipment in addition to those provided regularly (additional cots for obstetric

use, Delivery tables, Generators, solar power etc.) to make 24 x 7 services effective.

Provision of integrated institutional tertiary health care to the ST s belonging to

primitive tribal group of CHENCHU community in Srisailam ITDA area.

BCC & IEC in local tribal languages in to wean them from superstitious health seeking behavior.

Inter department coordination, functional convergence with tribal welfare

department, and WDCD departments and establishment of special Tribal health project monitoring units at The State and ITDA level (as proposed by the Tribal

welfare department).

To encourage the MPHA (f) for conduction of deliveries in remote and unreached

sub center areas.

Provision of mobility (preferably suitable hired vehicle) to the PHC medical

officers and the CHNC medical officers.

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Identification and utilization of Tribal Health Volunteers Male (THV-M) after

giving training on identification of communicable diseases and reporting to the concern PHC MOs in time.

To provide emergency health facility for borders of tribal hostels.

Situation Analysis:

Many gaps exist in the primary health system in the tribal areas. Especially many

vacancies exist for the specialist posts.

It is observed that there are no permanent Sub center buildings or ANM quarters

constructed at the most of the sub centers in tribal areas especially in difficult to

reach areas .

Thirty seven birth waiting homes are constructed in tribal areas and handed over to the PHCs and other health institutions. Their potential could not be utilized as

the tribal women depend entirely on their day to day earnings. Pregnant women

also go to the work till one or two days before the delivery or incapable of

working. The family members are more inclined towards daily earning for survival.

Compared to plain area tribal PHCs require additional support and facilities like

solar power, electric generators, additional equipment, cots and beds for ensuring the availability of 24 x 7 MCH services at PHCs.

The disease prevalence rates, IMR and MMR are very high and integrated

institutional tertiary health care services are not available to the ST s belonging to

primitive tribal group of CHENCHU community living in Srisailam ITDA area. The patients are often referred to hospital located at very distant places resulting

in mortality.

Tribes of AP speak their own specific languages. Very few BCC & IEC programs are designed in local tribal languages. The health messages are not reaching the

ST population effectively. Superstitious health seeking behavior is prevalent

among these tribes resulting in very high IMR MMR.

It is also identified that the supervision over the health program management is very poor in tribal areas. The inter department coordination & program

management is ineffective. The commissioner tribal welfare proposed that „Tribal

health state project management unit‟ at the commissioner of Tribal welfare office

and „ITDA level Tribal health project monitoring units‟ at nine ITDAs be established.

There is no recognition or incentives for the efforts put up by the PHC staff in

conducting deliveries in remote and unreached sub center areas. Morale of the staff is very low. They need to be encouraged.

The vehicles are provided 20 - 30 years back to the PHCs and are not in working

condition. Medical officers and supervisory staff is not mobile in tribal areas as

the alternate transport is rarely available. The public health emergencies are poorly attended.

Specialist services are not available in tribal areas. Tribal citizens have to travel

long distances for seeking specialty care and have to spend money for travel.

There are many interior and hard to reach areas where communication is difficult

to pass on and information about communicable diseases is reaching late. Many

posts of MPHA (M) are vacant due to pending court cases.

87

There are many Tribal hostels having 500 to 700 students who needs emergency

medicare in times acute emergency. At present trained ANMs are providing first aid in the hostel.

Key strategies:

To Create & strengthen the integrated and sustainable system of primary health

care in the nine ITDA (Integrated Tribal Development Agencies) areas.

Construction of ANM quarters and Sub center complexes at one hundred

locations in deep forest and difficult to reach areas to provide essential MCH

services at difficult to reach tribal areas.

Operationalization and improvisation of birth waiting home facilities by providing food & stay facility and compensation of loss of daily wages for the

tribal pregnant women to encourage institutional deliveries.

Strengthening of 184 primary health centers by providing additional cots for obstetric use, additional Delivery tables, Generators, solar power, regular water

supply, safe drinking water source etc to make 24 x 7 services effective.

Construction of a multi specialty hospital at Srisailam for providing of integrated

institutional tertiary health care to the 50,000 ST s belonging to primitive tribal group of CHENCHU community living in Srisailam ITDA area.

BCC & IEC in local tribal languages in to wean them from superstitious health

seeking behavior.

Establishment of „Tribal health state project management unit‟ at the commissioner of Tribal welfare office and „ITDA level Tribal health project

monitoring units‟ at nine ITDAs.

Provision of performance based incentives to encourage the MPHA (f) for conducting deliveries in remote and unreached sub center areas.

Provision of mobility (preferably suitable hired vehicle) to the PHC medical

officers and the CHNC medical officers to attend the public health emergencies,

epidemics, routine regular monitoring.

To provide specialist services in tribal areas. Tribal citizens need not travel for

longer distances for specialist services.

To get timely information on occurrence of communicable diseases it is proposed

to identify THV-M in remote and hard to reach areas.

Provision of Emergency Medical to tribal hostel students.

Program Components:

Construction of ANM quarters and Sub center complexes at one hundred

locations.

Operationalization and improvisation of birth waiting home & providing food & stay facility and compensation of loss of daily wages for the tribal pregnant

women.

Providing additional cots for obstetric use, additional Delivery tables, Generators,

solar power, regular water supply, safe drinking water source etc to make 24 x 7 services effective.

Construction of a multi specialty hospital at Srisailam for primitive tribal group of

CHENCHU community living in Srisailam ITDA area.

BCC & IEC in local tribal languages.

88

Establishment of „Tribal health state project management unit‟ at the

commissioner of Tribal welfare office and „ITDA level Tribal health project monitoring units‟ at nine ITDAs.

Provision of performance based incentives to the MPHA (f).

Provision of mobility (By purchasing suitable vehicles and suitable hired vehicle)

to the PHCs & CHNCs.

Organising specialist camps in tribal area under the supervision of SPHO, with

experts.

Providing THV-M in remote and unreached areas to inform about occurrence of

communicable diseases to the PHCs. Selection will be need based and will be identified by MO of PHC in consultation with local sarpanch for a remuneration

of Rs 400/month.

For attending emergency calls and for providing treatment in times of acute illness Medical officer will be provided incentives.


All the funding will be done under NRHM during the year 2011.

Construction agency authorized by the GoAP will takeup ANM quarters and

Sub center complexes at one hundred locations.

Funds will be released to the PHCs/CHCs or health institutions for operationalization and improvisation & providing food & stay facility and

compensation of loss of daily wages for the tribal pregnant women where birth

waiting homes are present.

APHMIDC will supply additional cots for obstetric use, additional Delivery

tables, Generators, solar power, regular water supply, safe drinking water source

etc to make 24 x 7 services effective.

Construction agency authorized by the GoAP will take up construction of a multi specialty hospital at Srisailam for primitive tribal group of CHENCHU

community living in Srisailam ITDA area.

BCC & IEC in local tribal languages will be done by BCC cell in collaboration

with Tribal cultural research institute ( A govt agency).

Government of AP will issue necessary orders and guidelines for the

establishment of „Tribal health state project management unit‟ at the

commissioner of Tribal welfare office and „ITDA level Tribal health project monitoring units‟ at nine ITDA districts.

Funds will be released to the tribal PHCs for the provision of performance based

incentives to the MPHA (f) & will be monitored by SPHO of CHNC.

New vehicles will be purchased by the state as per the procurement policy existing in the state and funds will be released to PHCs for mobility for hiring suitable

vehicle.

Funds will be released to Senior Public Health Officer (SPHO) for organizing

specialist camps in are hospitals /Community Health Centers. SPHO with the support of PO ITDA and district collector will get specialists from medical

colleges/APVVP hospitals. Superintendents of concerned hospitals will support

the SPHO where the camps are conducted.

Providing THV-M in remote and unreached areas to inform about occurrence of

communicable diseases to the PHCs. Selection will be need based and will be

identified by MO of PHC in consultation with local sarpanch for a remuneration

89

of Rs 400/month. He will also be utilized for other works like spraying operations

conducted in NVBDCP and remuneration for that will be paid as per the guidelines issued time to time.

Names of the Doctors (along with phone number) who can attend for emergency

cases will be displayed in front of the hostel. At times of emergency these doctors

will be called on phone and after completion of treatment incentive will be paid to the doctors.

Monitoring and reporting system for assessment the performance M&E wing:

Periodic component wise progress and performance will be assessed by the

„ITDA level Tribal health project monitoring units‟ at nine ITDA districts and

„Tribal health state project management unit‟ at the commissioner of Tribal welfare office.

Joint director tribal health will ensure the effective program implementation and

enforcement of government policy implementation by various administrative interventions through Commissioner Family welfare.

Risk analysis:

Unless the proposed interventions are implemented and health program

management is closely monitored the IMR and MMR cannot be brought down or

the incidence of epidemics cannot be controlled in tribal areas.

Expected out comes:

Sustainable system for primary health care services delivery in all the nine ITDA (Integrated Tribal Development Agencies) areas established.

Permanent Sub center complexes and ANM quarters will be in place at one

hundred locations in deep forest and difficult to reach areas.

Food & stay facility and compensation of loss of daily wages for the tribal pregnant women to encourage institutional deliveries.

184 primary health centers will have necessary equipment in addition to those

provided regularly (additional cots for obstetric use, Delivery tables, Generators, solar power etc.) to make 24 x 7 services effective.

Integrated institutional tertiary health care to the ST s belonging to primitive

tribal group of CHENCHU community in Srisailam ITDA area will be in place.

BCC & IEC in local tribal languages will be available.

Special Tribal health project monitoring units (SPMU – TH) at The State and

ITDA level PMU-ITDA (as proposed by the Tribal welfare department).

To encourage MOs/SNs/ MPHA (f) for conduction of deliveries in remote

PHCs.

Suitable vehicles will be available to MOs to attend emergencies at any time and

hired vehicles will be available to remaining PHC medical officers for field visits.

Specialist services will be available in CHNCs.

Incidence of communicable diseases can be notify early and effective measures

can be taken immediately to arrest the diseases by having THV-M at remote and

hard to reach areas.

Emergency services can be provided to hostel students.

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Special features in 2010 -11 proposals:

Integrated hospital at Srisailam

Establishment of one „Tribal health state project management unit‟ and nine

„ITDA level project management units‟

One hundred Permanent sub center building complexes with ANM quarters.

Food and accommodation through birth waiting homes & compensation for loss

of wages to the tribal pregnant women.

Incentives and awards for effective performers (MPHA- f ).

Transport through permanent vehicles and hired vehicles for PHCs.

Specialist services will be available in Tribal areas.

Early detection of diseases in remote hard remote areas.

Emergency services will be provided to hostel students.

Budget for Tribal Health activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Human resources

a) Contracting Specialist Services Doctors 45000 54 291.60

b) Additional Staff Nurses SN 12910 60 92.95

Total 384.55

2 BCC- IEC activities

a) BCC in Tribal native languages –in collaboration with Tribal research and cultural institute –to change

superstitious health seeking behaviours & promotion of utilization of MCH services

ITDA 500000 9 45.00

3 Addl.Drugs & Supplies

a) CHNCs CHNC 100000 30 30.00

b) Additional Supply of medicines to

Subcenters through PHCs

SC 125000 184 230.00

c) PHCs PHC 50000 184 92.00

Total 352.00

4 Implementation of Tribal RCH

activities

a) Strengthening & providing

connectivity & Mobility

i) Hired vehicle services for PHC Medical Officers

Vehicles 20000 124 297.60

ii) Purchase of new vehicles for 60 PHCs

Vehicles 600000 60 360.00

iii) POL for each vehicle POL 5000 60 36.00

iv) Repairs and maintenance of vehicle Repairs 5000 60 3.00

v) Driver on daily wages Salary 200 1800 43.20

b) Incentives for the staff

i) Special performance based incentives for MO, SN, ANMs for

Incentives 200 1840 44.16

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(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 conducting deliveries above base line of 10 cases

ii) Cash award for best performing MO/SN/ANMs Rs 4000/each selected from each CHNC


c) Operationalization of birth waiting homes provision of food and compensation of loss of wages

i) For ensuring Hospital delivery and to stay in Birth waiting Homes(BWH) for 5 days for ANCs


ii) Patient attendant (Loss of Wages)

for following the ANC and 5 days stay in BWM


iii) Travelling for drop back the patient at home

Transport 200 740 17.76

d) Specialist Camps

i) Specialist camps in CHCs bi-

monthly one camp

Camps 55000 180 99.00

Total 993.12 5 Other Tribal RCH

Strategies/Activities

a) 8500 Male Tribal Health Volunteers Incentives 400 8500 408.00

b) Orientastion training for Male Tribal

Health volunteers

Training 200 8500 51.00

Total 459.00 6 Emergency Visits to Hostels in

Tribal Area by MO Incentives 100 920 11.04

Tribal Health Total 2244.71

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A9: VULNERABLE GROUPS

124. There is strong evidence that certain social groups, especially SCs and STs, and

other vocational groups like coastal fisher folk, stone breakers, landless labourers, weavers, etc. are distinctly disadvantaged when compared to others. Their health

outcomes are far worse than the general population. About 92% of the STs and 83% of

the SCs live in the rural areas of the state. More than one third of the SCs live in five

districts (East Godavari, Guntur, Krishna, West Godavari and Chittoor). ST population is covered by the Tribal plan under NRHM. It is also recognized that the loss of

employment and other similar circumstances resulted in mass migration of citizens from

rural areas to urban settlements. Most of this population lives in urban slums and temporary settlements.

125. The women of these groups are most vulnerable and are aware of the MCH

service availability nearest to them. Present public health system is not able to identify them and provide them these essential services. This results in high infant and maternal

mortality which is often unrecorded. Most of the children of these groups are either un -

immunized or partially immunized.

126. The poverty, ignorance, exploitation and lack of social security and inaccessibility

to legal protection make these women more vulnerable and are sexually exploited. STI &

RTI prevalence is very high among these groups. Inability to have the access to the curative services and lack of affordability resulted in decreased life expectancy. Street

children, Orphaned children, and children engaged in child labour is another most

vulnerable group to whom public health services need to reach.

Objectives:

127. Considering the fact that the overall health outcomes of the state are unlikely to

improve without targeted attention to the most vulnerable group of people:

To identify the above mentioned vulnerable groups by the concerned public

health staff of PHCs /UHCs/Sub centres, register and provide health services.

Designing special packages and targeted interventions for these groups to ensure improved access to health services to address their specific health care needs

Senior public health officers of the CHNCs may be identified as nodal officers

and funds may be release to them to support the PHCs to maintain effective surveillance and monitoring to ensure service delivery to vulnerable groups.

To provide MCH and nutrition services to vulnerable groups at their door steps

mobile services will be established with a mobile medical team consisting of MO,

staff nurse and a nutrition counselor along with necessary drugs.

128. Situational analysis and critical gap analysis: Scope of vulnerability in the state cannot be assessed at present as no mapping exercise was carried out by the health

service providers.

129. The following vulnerable groups neither given sufficient attention nor policy were

made to address their health needs:

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People living in hard to reach areas

Areas which are predominantly populated by SC/ST.

Groups with low standard of living and literacy rates.

Large migrant floating population with no constant source of

income/employment. eg: migrants, temporary settlers, nomadic communities, destitute & beggars.

Street children, orphans, children forced in to hard labour.

Homeless single women without family or social support or employment,

Fisherman communities along the costal belt and either side of rivers, islands.

MCH and nutrition services are not reaching to vulnerable groups, IEC activities

what are being done are also not reaching in an effective way.

Key strategies:

Identifying the pockets of vulnerability

Improving Quality of Care

Strengthening MIS

Strengthening Facilities

Community Engagement

Mobile MCH services will be provided.

Nutritional services will be provided.

Program components:

Identification and registration of vulnerable groups in sub center PHC CHNC

areas.

Incentives for the ASHAs MPHA (f)

Community sensitization in association with Rural development department.

Additional inputs to PHCs and sub-centers for service delivery to these identified

groups.

Strengthening of MIS for monitoring the program.

Provision of MCH and nutritional services.

Implementation methodology

(i) Identifying the pockets of vulnerability: A mapping exercise will be carried out by the Public health service provider institutions and consolidated at CHNCs to

define the scope of vulnerability in the state. This will ensure adequate and

authentic information for planning inputs and activities.

The following will be the criteria for identification of vulnerable groups:

o People living in hard to reach areas o Areas which are predominantly populated by SC/ST.

o Low service utilization pattern and health outcomes.

o Low standard of living and literacy rates.

o Low availability of health providers. o Large migrant floating population with no constant source of

income/employment. Eg:migrants, temporary settlers, nomadic

communities, destitute & beggars.

94

o Street children, orphans, children forced in to hard labour.

o Homeless single women without family or social support or employment,

o Fisherman communities along the costal belt and either side of

rivers , islands.

o MCH and Nutritional services will be provided by mobile MCH services

(ii) Improving Quality of Care: Special focus will be placed on providing quality of care to these groups by the primary health system. The entire health machinery

will be sensitised and organised to respond to the specific needs of these groups. Measures will be taken to address the needs of these groups by local

PHCs/CHNC. The Addl. DM&HO (NRHM/RCH) at the district level will be

nominated a District Nodal Officer to maintain these services.

(iii) Strengthening MIS: The ANM collects disaggregated data on several components of health care, for the vulnerable group , becomes aggregated by the

time it reaches the districts. Mo at PHC and SPHO atCHNCs will pay incentives

to the performers and necessary records will be maintained at these levels.

(iv) Strengthening Facilities: The identified health facilities (PHCs and CHCs) will receive additional focus and resources to strengthen health facilities through infrastructure support, drugs, manpower, and mobility support and close

monitoring.

(v) Community Engagement: A comprehensive behavior change communication strategy will be implemented for the vulnerable groups in coordination with rural

development department.

130. Monitoring and reporting systems: A monitoring and reporting system will be designed to be an integral part of the regular reporting system which measures the

performance in various components institution wise, CHNC & district wise.

131. Risk analysis: As the service delivery to the target group is a challenge to the public health care system, meticulous and accurate methods are to be adopted to assess

the physical and financial progress of the program implementation.

Expected outcomes:

vulnerable groups will be identified by the concerned public health staff of PHCs /UHCs/Sub centers, register and provide health services.

Special packages and targeted interventions for these groups will improve access

to health services and can provide specific health care needs

Senior public health officers of the CHNCs may be identified as nodal officers and funds may be release to them to support the PHCs to maintain effective

surveillance and monitoring to ensure service delivery to vulnerable groups.

District wise beneficiary list will be available at Addl DM&HO (RCH).

It will give a better focus on these groups for better future planning.

Mobile services and referral linkages can be developed and can reduce IMR and

MMR.

95

Special features of 2011-12

Certain level of clarity is attained in identifying these vulnerable groups, and

proposed probable roles at various levels to provide health care services.

Service delivary will be ensured to those who are at risk and not supported by any

other schemes.

MOs can take a decisive role to handle such needy cases.

Institutional deliveries and full immunization to children can be improved.

Incentive for hospital stay can facilitate ANCs for admission in hospital.

Community can encourage vulnerable groups to get admitted in the hospital for

services.

State as protector will do the best through this scheme.

Mobile health services to these vulnerable groups regularly.

Develop linkages with referral centers and ICDS.

Special IEC activities will be done.

Budget for Vulnerable Groups activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 1 Temporary Settlers / migrants

(payment for beneficiaries)

a) Pregnancy Registration to follow-up

the Institutional Deliveries


b) Mobile RCH services in 100 CHNC clusters in exclusivly remote unreachble areas

2 Hiring of Vehicle Vehicles 20000 100 240.00

3 Medical Officer on Contract Basis Salary 30000 100 360.00

4 Staff Nurse on Contract Basis Salary 12000 100 144.00

5 Drugs Drugs 50000 100 600.00

6 IEC on MCH services in those areas IEC/BCC 5000 100 60.00

7 Nutrition Councellor Salary 8000 100 96.00

Vulnerable Group Total 1527.60

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A10: HIGH FOCUSED DISTRICTS

132. Considering the fact that the overall health outcomes of the state are unlikely to

improve without targeted attention to the service delivery activities in high focus

districts:

to ensure improved access to health services through special packages and targeted

interventions;

to secure equity in provision of services and health outcomes among the most vulnerable populations in the state; and

to improve monitoring of targeted groups by revising and strengthening MIS;

regular evaluations and mapping exercises.

The following 6 districts are identified as high focus districts by GOI Adilabad, Mahabubnagar, Warangal, Khammam, Ananthapur & Nellore.

Strategies

i) Identifying the pockets of most difficult and hard to reach areas:

133. A mapping exercise will be carried out to define the scope of vulnerability in the

state. This will ensure adequate and authentic information for planning inputs and activities. Without awaiting the mapping exercise results, the following will be the

criteria for identification of vulnerable geographical locations:

Hard to reach areas

Areas which are predominantly populated by SC/ST/ and vulnerable groups

Low service utilization pattern and health outcomes

Low standard of living and literacy rates

Low availability of health providers

134. There are currently 184 such PHCs areas in the four high focus districts and 300 in the other districts of AP. In addition, the AP-SERP has identified 4,100 habitations for

intensive coverage of all SC and ST population with economic development and health-

nutrition interventions.

(ii) Improving Quality of Care

135. Special focus will be placed on providing quality of care to these groups by the primary health system. The entire health machinery will be sensitized and organized to

respond to the specific needs of these groups. The performance of the health

functionaries will be judged by their ability to address the health needs of these groups.

136. A special task force for monitoring health care service delivery in high focus

districts will be established at state level with one Maternal Health consultant and

Nutritional consultant. At district level a monitoring unit with DM&HO / Addl. DM&HO, PD, ICDS, PD, DRDA & Programme Officers & SPHOs of CHNCs will be

established to monitor MCH service delivery activities and nutrition component.

97

(iii) Strengthening Facilities

137. The identified health facilities (PHCs and CHCs) will receive additional focus and

resources to strengthen health facilities through infrastructure support, drugs, manpower, and mobility support and close monitoring. Further actions include:

Expedited recruitments and contracts will be undertaken to fill vacancies in the identified facilities.

To address the issue of absenteeism a biometric attendance system will be

introduced in the identified remote inaccessible and far to reach areas of AP for

maintaining discipline and promoting positive work culture.

The identified facilities will be the focus of infrastructure development and

upgradation.

Additional allocation for improving the mobility of the MO is also proposed.

Monitoring of PHC performance through key performance indicators. This has

been piloted in the state and will be scaled up to cover all vulnerable areas. The

indicators pertain to service provision – OPD and in patient, outreach activities

and management of PHC.

Based on performance a package of incentives is being proposed as well.

(iv) Community Engagement

138. A comprehensive behavior change communication strategy will be implemented

for the vulnerable groups. A special package of incentives is also proposed for enhancing

community participation.

Implementation Plan:

i) Service coverage: By providing comprehensive Family Health Package

Name based tracking of all registered pregnant women and 0-5 years children.

Distribution of comprehensive Mother & Child health card to each mother.

Reduction of home deliveries by making availability of SBA trained attendant in

habitations.

Providing diet to each pregnant woman and one attendant for 3 days at the time

of delivery at 24x7 hrs MCH centres.

To operationalize more functional FRUs in high focus districts along with

provision of specialists and blood component facilities.

To increase free transport facilities through 108 ambulances for all normal and complicated deliveries to nearest FRUs.

To organize birth planning for safe Institutional delivery for each pregnant

woman through VHNDs.

In addition to ensure the availability of SBAs in tribal and remote areas to encourage safe deliveries.

Providing maternal nutrition through identified nutritional centres.

98

ii) Suggested Approaches

Strengthening of identified 50 PHCs, 10 CHCs by Ensuring Patient Friendly

functional facilities by giving fixed incentives to service providers based on

performance bench marks. Rs.50,000/- to each PHC and Rs.75,000/- to each

CHC in a year.

Mobility Support to MOs in identified 50 PHCs for monitoring.

Provision of CUG mobile phones to ANMs in identified areas to have

effective communication:

To facilitate the ANM to intimate the name based ANC particulars for

registrations at SC level

To intimate maternal and infant deaths

To intimate adverse conditions of pregnancy of an ANC to MOs

To assure better monitoring at all levels

Transportation of ANC to delivery through 108

To inform nearby FRU for immediate medical / surgical attendance

Special Nutrition support to pregnant and lactating women through NDCCs

Strengthening of HMIS and TALLY ERP 9.0 in identified areas

Ensuring presence of staff by introducing Bio Metric attendance system

Budget for High Focused Districts activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Mobility for MOs in interior and

remote areas

Vehicles 18000 50 108.00

2 Special out reach camps for pregnant women

Camps 6000 100 6.00

3 Assured referral transport to 108 uncovered villages / habitations with drop back transport facility

Transport 25000 250 62.50

4 Incentives for MCH services beyond benchmarks

a) PHCs in High Focus Districts Incentives 2000 279 66.96

b) CHCs in High Focus Districts Incentives 5000 57 34.20

c) Area Hospitals in High Focus Districts


Total 292.96

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A11: TRAININGS:

139. The National Training Strategy aims to ensure integrated training programs to

encompass the vast training needs and expanded training universe, address issues pertaining to training in synchrony with planning and operationalization of health

facilities. The strategy will clearly define the role of each of the stakeholders involved in

training like State Program Managers; Director, IIHFW; Director of Public Health &

Family Welfare; Commissioner of Health & Family Welfare; Commissioner. APVVP; Director of Medical Education; Project Director, APSACS; Principals of Medical

Colleges; Nursing Colleges & Schools, Para-medical Training Centers; NGOs involved

in healthcare; Commissioner, AYUSH; Director IPM; DG, Drug Control Administration; Director, HMHMIDC; Principals of Regional Training Centers,

District Medical & health Officer, Project Officer – District Training Team in preparing a

Comprehensive Training Plan and Training Calendar for the State as well as the

Districts, so that the health facilities at sub-district and primary level could be operationalised with improved quality of care by the providers.

Situation Analysis

140. Under NRHM, the GoAP is undertaking Induction Training, In-service Training and Refresher Training for various categories of health functionaries – Doctors/Medical

Officers; Paramedics – Community Health Officers, Multipurpose Health Extension

Officers, Multipurpose Health Supervisors, Auxiliary Nurse Midwives, Pharmacists, Lab Technicians, etc. In addition, District officials like the DM&HOs, Addl. DM&HOs,

Program Officers, Statistical Officers & Asst. Statistical Officers, District Education

Media Officers, etc, NGO representatives; private providers are also being trained.

141. The State has a database of healthcare training institutions to enable optimal

utilization of all available facilities for training. The Commissioner, Health & Family

Welfare is playing an active role in steering ToTs and other trainings and is making funds available for training under different components of NRHM. She is ensuring that

training is an agenda item in all meetings with State as well as District officials. Sincere

attempts are on to build a system for monitoring and evaluation of in-service training

using available training infrastructure available at the State, Regional and District level and develop a District wise database of trained manpower to prevent duplication and

gaps in training of personnel and facilitate their posting in appropriate health facilities.

Comprehensive Training Plan 142. Efforts are being made to prepare a comprehensive annual training calendar for

the State at IIHFW. It is also envisaged to bring RTCs & DTCs under the purview of

IIHFW to strengthen the quality of trainings. To further strengthen the available training

infrastructure it is also contemplated to have a single pool of trainers/faculty for all the facilities and relocate the RTCs at other District headquarters for equity and accessibility

of training facilities. It is envisaged that this type of arrangement will facilitate

implementation of capacity building programs not only for the State but also at the District & sub-district level.

100

143. The IIHFW will also be responsible for induction trainings for all professionals

prior to assuming charge in administrative posts at State as well as District level. The trainings shall also incorporate skill up gradation in managerial (administrative &

financial) as well as technical aspects (public health, disease control, maternal health,

child health, etc).

144. Like the apex training institute, the RTCs under the guidance of IIHFW should

prepare an annual calendar for all trainings in consultation with DTCs. The RTCs

should train MOs, SNs, ANMs & other para-medical personnel as per the guidelines of GoI.

145. At the District level the DM & HO may nominate PO DTT as the District

Training Coordinator who will be responsible for all trainings conducted at the District level. The District Training Coordinator shall plan, conduct and coordinate integrated

training programs of all related schemes and ensure coordination with the RTCs, other

training institutes and IIHFW. S/he shall establish liaison between health and other related/allied departments in the District. The District Training Coordinator and his

team shall be responsible for undertaking Training Needs Assessment for all health

personnel working in his/her District to assess extent of skill up gradation and plan for

periodic in-service training. The District Training Coordinator shall monitor and evaluate the trainees‟ performance periodically as per the guidelines of the government.

Need for Strengthening IIHFW, RHFWTCs (RTCs) and DTCs 146. The Indian Institute of Health and Family welfare (IIH&FW), the State level

apex training institute is the collaborating centre for all the trainings in the State. It

undertakes clinical as well as management related trainings. For the clinical trainings,

the institute coordinates its activities with the medical colleges.

147. In addition to the apex training institute, there are 8 Regional Health and Family

Welfare Training Centers (RHFWTC), 22 DTTs, 16 ANM Training Centers, 4 LHV

promotional training centers. Each RHFWTC is responsible for the training activities in the Districts allotted to them. There is one District Training Team at each district

headquarters with field practice and demonstration areas (FPDAs) to impart practical

training to the trainers at PHC, and sub-centre level. In addition, to the above government institutions, there are six training schools (Srikakulam, Cuddapah,

Khammam, W. Godavari, Nizamabad & Karimnagar) for Health Assistants (M) which

used to offer a one-year foundation course along with the RTCs (M) and are in the

process of being revived. The 16 ANM training schools offer the eighteen months foundation course for the Health Assistants (F).

148. Apart from these institutions there are grant-in-aid institutes and more 250 private institutes which offer trainings to Health Assistants (F).

149. Although AP has a good network of training institutes set up under IPP VI (1992)

and RCH I (1997- 2003) which provided in-service training to a large contingent of health functionaries working in PHCs. However, the gaps with regard to staffing,

physical infrastructure, quality of faculty, and management of training programs need to

be addressed on a war footing. The existing training institutions need strengthening not only in terms of physical infrastructure but also the trainers who hold the key to success

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of any training program. Building capacity of the existing trainers needs to be given top

priority. Funds required for strengthening of infrastructure facilities will be provided by NRHM.

150. Presently, the existing training infrastructure (IIHFW, RTCs, and DTTs) is

grossly underutilized for various reasons. These training institutions are meant for use by all sub-departments and not just the Department of Public Health and Family Welfare

alone.

Training in 2010-11

151. Most of the trainings planned in 2010-11 have been initiated. However their initiation was delayed. Details of total numbers trained are attached in the training plan.

Since these issues have been addressed, trainings are being conducted and will continue

in 2011-12.

Implementation plan for 2011-12

152. For the year 2010-11 IIH&FW has been identified as a nodal body to coordinate

with other trainings institutions and other agencies for design and implementation of trainings allover the state. The training programmes planned for year 2010-11 are

included in the section below

153. Indian Institute of Health and Family Welfare (IIHFW) has conducted 2-day

workshop on Capacity Development of Medical, Health and Family Welfare dept. on 3rd

& 4th August, 2010 for all Principals of, RTCs and PODTTs of all the districts and

IIHFW faculty to develop training action plan and assess infrastructure and facilities requirement for the respective institutions. From the inputs provided by the participants

it has been inferred that budget required for strengthening the training institutes in the

state as follows

Maternal Health Trainings:

Key Objectives

To upgrade the skills and knowledge and to empower health workers for some Basic Em.O.C interventions such as using of emergency drugs to prevent PPH

and before referral, to plot partographs and to assist vaginal dlivery.

To upgrade the skills and knowledge of the health care providers in early

detection and complete treatment for the clients with RTI/STD.

Expected outcome

154. Functionalizing all the identified PHC and CHC in providing 24x7 services, thus

facilitating the districts to increase the institutional delivery to 90% by the end of 2011-

2012, which further facilitates in reducing the maternal morbidity and mortality.

102

1. Skill Birth Attendance (SBA) Training:

155. In view of implementation of SBA training the sufficient number of trainers was trained to provide training at district level. The state has identified 86 training facilities as

per the norms of GOI. A total of 4 ANMs/SNs will undergo training in each identified

training facility at a time. During the year 2010-11 the state could provide training to

SNs (1000) working in 24 x 7 hospitals / PHCs. The preference was given to SNs who conduct delivery in their working area. During 2010-11 three rounds of SBA training

could complete in the state. Till now the State has given training for 2203 health

functionaries.

156. The state is proposing to conduct SBA training to remaining SNs (600) and

ANMs working in 24 x 7 PHCs and who are conducting deliveries (1000) during the

year 2011-12. The duration of training programme will be 21 days as per the GOI norms.

2. BEMOC Training for Medical Officers:

157. In order to enhance the skills of Medical Officers for conducting deliveries as well

as timely referral 10 days training programme is proposed as per the norms of GoI.

Initially the training will be imparted to Medical Officers working in 24x7 PHCs of remote areas (Tribal & High Focused Districts)

3. Emergency Maternal Obstetric Care (EmOC) training:

158. The high MMR is a major concern in the country. To reduce MMR & IMR

provision of timely EmOC & LSAS has been recognized globally as a most important intervention of saving lives.

159. The MBBS doctors from the needy district will be given EMOC training for 16

weeks in coordination with AVNI EmOC and FOGSI, followed by posting and placing them at identified FRU & Govt. Hospitals where the specialist service for Obstetrics is

not available.

160. Preference shall be given to the Medical Officers from High focus districts and

Tribal areas for the year 2011-12.

4. Life Saving Anaesthesia Skills (LSAS) Training :

161. The high MMR is a major concern in the country. To reduce MMR & IMR

provision of timely EMOC & LSAS has been recognized globally as a most important intervention of saving lives.

162. The Govt. of India has communicated guidelines for conducting Training Programme in Medical Colleges having sufficient case load and perform sufficient

number of cesarian sections and recognized by MCI & DNB were identified by Govt. of

Andhra Pradesh are:

1. Osmania Medical College, Hyderabad,

2. Kakatiya Medical College, Warangal,

3. Andhra Medical College, Visakhapatnam,

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4. Guntur Medical College, Guntur,

5. Kurnool Medical College, Kurnool.

163. Orientation of Master trainers for LSAS was given to 24 Anesthetists from Five

Medical Colleges at IIH&FW, Hyderabad by National Level Trainers in March 2010

164. Further, the Master Trainers shall provide 18 weeks training in Anesthesiology,

14 weeks in identified teaching hospitals & 4 weeks in concern district hospitals to the

MBBS Doctors working in FRUs&CHCs where Anesthetists are not available. Preference shall be given to the Medical Officers from High focus districts and Tribal

areas for the year 2011-12.

5. Training in MTP by using MVA: to provide safe abortion services at CHC and FRU‟s, Medical Officers from these institutions will be trained and they will be provided with required equipment after the training.

6. RTI and STI training to MO, Lab technician, Staff nurses and field ANM will be under taken with the help of APSACS and as per the NACO guidelines. Trainings are

being conducted by APSACS for Medical Officers, Staff Nurses and Lab – Technicians

working in District/ Area Hospitals & CHCs. For the year 2011-12 trainings are proposed to be conducted for Medical Officers, Staff Nurses & Lab- Technicians from

PHCs. Preferably for high focused and ITDA districts.

7. IMEP training: Medical and paramedical personal working at Sub-centre, PHC,

CHC and FRU‟s and also other major institution will be trained under Infection Management and environment pollution so as to manage the biomedical waste safely.

(Trainings are proposed to be conducted along with RTI and STI trainings)

OTHER TRAININGS

8. Midwifery Skills Training:

165. CAMT is established on 5th May 2007to improve the Midwifery services through pre services & in services trainings under Sida Project in collaboration between Govt. of

A.P and ANSWERS through IIM, Ahmedabad as nodal agent along with other

partners. After completion of the project on November2009, CAMT was taken up by

Govt., budget was allotted under PIP 2010-2011.with the aim of improving midwifery services both in ANM/GNM Schools and labour rooms of the hospitals as per the

proposed objectives and functions of CAMT.

The objectives of the CAMT are:

Review the foundation of midwifery practice.

Strengthen knowledge and skills in midwifery through a review of maternal and

newborn health care in the home and hospitals.

Enhance personal and professional capacities of teachers.

Update knowledge and skills in midwifery practice in terms of latest changes in

policies national and international programmes and research training.

Develop proficiency in theory and practical teaching including clinical guidance

of students in midwifery.

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166. One of the main functions of CAMT is to provide technical inputs on midwifery and maternal and newborn care to training institutions, hospitals and health centers

Action plan for 2011 – 2012

167. Three Types of activities are planned for the academic year 2011 to 2012, namely

A. Follow up of labour rooms and staff nurses in CHC/Area Hospitals under

commissioner APVP and Teaching Hospitals under the control of DME and

Medak District until they are handed over to proposed District Change

Teams.

B. Seminar/ Workshop

1. Strengthening safe motherhood - One day seminar; 2. Improving the labour rooms & MCH services in the state through District

change team (DCT) – 2days

C. Trainings for various levels of Midwifery personnel

9. REFRESHER TRAINING FOR ACCREDITED SOCIAL HEALTH ACTIVISTS

(ASHAS) IN AP

168. To improve the health situation especially among poor and vulnerable sections of

population, Government of Andhra Pradesh has also opted for ASHA intervention and

included in its first Program Implementation Plan (2005-06). At present there are 70,700 ASHAs placed in rural areas appointed at the rate of 1 per 1000 population.

Training of ASHAs

169. MoHFW has come out with ASHA Moudles 6th and 7th focusing on skills that

save lives. These modules cover areas whose content is already familiar to the ASHA. In addition, these modules include the development of specific competencies in healthcare

for mothers and children. A companion communication kit for the ASHA to use when

she conducts home visits and village meetings has also been developed.

170. As per the national guidelines IIHFW has drawn 10 day ToT for district level

trainers and 5 day skill development training for 19,806 ASHAs located in 6 high

focused districts in the 1st phase: Anathapur, Mahabubnagar, Adilabad, Warangal, Nellore and Khammam.

171. In the second Phase ITDA districts i.e. Srikakulam ( Seetampet), Vizianagarm ( Parvathipuram), Vishakapatnam( Paderu), East Godavari (Rampachodavaram), West

Godavari (K.R. Puram) and Kurnool ( Srisailam) the total of 5037 ASHAs shall be

covered.

Monitoring and Evaluation 172. Formative and summative evaluation of training will be carried out, using pre-

tested tools to measure the outcome of the inputs given in the training. In addition,

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IIHFW faculty will undertake monitoring of district level trainings and submit the report

regularly.

Child Health Trainings:

1. Navjaat Shishu Suraksha Karyakram (NSSK)

173. Neonatal deaths contribute to nearly 45% of the under five mortality. Birth

asphyxia and severe infections together contribute to nearly 70% of the deaths. With

more & more deliveries occurring at health institutions it becomes important that the large number of health professionals attending to births, are trained in neonatal

resuscitation & new born care at birth. This will help in making a significant dent in the

IMR by saving new born lives. The Ministry of Health and Family Welfare, Govt. of India has therefore launched the NSSK – Navjaat Shishu Suraksha Karyakram a new

programme on Basic New Born Care and Resuscitation.

174. This program addresses important interventions of care at birth i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast Feeding and Basic

Newborn Resuscitation. The NSSK is two day skill based training. As per the

programme implementation guidelines, each district would require four trainers – two pediatricians and two gynecologists.

IMNCI and F-IMNCI:

175. IMNCI strategy is the centre piece for Child Health in NRHM. Till the 2nd

quarter of 2010 297 districts from 14 states have rolled out IMNCI. This involves the capacity building of grass root level health and nutrition workers in skills to identify signs

of illness in neonates and infants and provide treatment and early referral. Facility based

IMNCI (F- IMNCI) is an integration of the existing IMNCI package and the Facility

Based Care package in to one package. The integrated approach of IMNCI and Facility based care; (F-IMNCI) therefore provides a continuum of quality care for severely ill

newborns and children from the community and to the facility.

176. Majority of the health facilities (24x7 PHCs, FRUs, CHCs and District hospitals)

do not have trained pediatricians to provide specialized care to the referred sick

newborns and children, the F-IMNCI training will therefore help in skill building of the

medical officers and staff nurses posted in these health facilities to provide quality health care to the sick neonates and children. The revised strategy which integrates both the

facility based care and the IMNCI to provide the optimum skills needed at the facilities

by the medical officers.

177. The introduction of F- IMNCI will help to bridge the shortage of pediatricians.

Progress and Achievements in 2010-11:

178. NSSK: The Indian Institute of Health and Family welfare, Hyderabad rolled out NSSK in the state with support of the Indian Academy of Pediatrics (IAP) and

UNICEF. Four TOTs were conducted and 111 trainers (Pediatricians and obstetricians)

were trained.

106

179. Following the TOTs 18 batches have been conducted in the state and two more

batches per district have been planned to be taken up in March and April 2011.

180. Till date 550 health staff has been trained in NSSK in the state and till end of

March/April 2011- 1380 health workers will be trained.

181. IMNCI: Govt. of Andhra Pradesh initiated IMNCI in Medak and Warangal districts which support from UNICEF in 2006 and 2007 respectively.

DISTRICTS MO MPHS MPHA SNs ICDS AWWs Others Total

Warangal 85 209 1012 52 126 3353 36 4873

Medak 47 270 604 16 27 2227 3 3194

Other Districts 1381 63 1444

Total 1513 479 1616 131 153 5580 39 9511

182. Till the end of March 2010 the state had trained 9511 workers with grass root

level workers trained only in two districts. The state had proposed to start IMNCI in 15

districts in 2010-11 however the IMNCI basic trainings were conducted only in Warangal and Medak.

183. Warangal completed 11 batches of IMNCI basic training (i.e. 251 workers) and

two batches of follow up training (48 workers) from April 2010 till Dec 2010. IMNCI trainings were restarted in Medak after a gap of two years. Medak could complete three

batches of basic IMNCI trainings (87 participants), three IMNCI Follow up training for

supervisors (73 participants) and two batches of facilitation technique training (42 participants trained).

184. Thus till date the state has trained 9849 workers in IMNCI basic training and 360

supervisors in the IMNCI follow up training.

F-IMNCI: Facility Based IMNCI:

185. IIHFW with support from UNICEF conducted four batches of the five days F-

IMNCI TOT in Hyderabad. Pediatricians, faculty from the PSM department and Regional Training centers were involved. 64 participants were trained in these four

batches. The DME AP deputed 16 participants from various government medical

colleges form the department of Pediatrics and PSM to New Delhi for the eleven days F-

IMNCI training. This was supported by UNICEF Hyderabad. The state thus has 80 state level trainers in F-IMNCI. UNICEF will be supplying the required training kits for F-

IMNCI to the identified nine medical colleges.

State action plan for 2011-12:

186. NSSK: Training Load: With the training load of 8520 (2176 Medical Officers, 896 Staff Nurses and 4608 ANMs in 24X7 PHCs) and @32 trainees per batch there will

be 240 batches.

107

First Quarter

Sl.

No.

Category Load

(for the

Qtr)

Total

Batches

Batch Duratio

n

Unit Cost

in Lakhs

Total Cost

per quarter

1 MOs 544 17 32 2 1.08 18.45

2 Staff Nurse 224 7 32 2 1.08 7.60

3 ANMs 1152 36 32 2 1.08 39.06

Total 1920 59 65.11

Second Quarter

Sl.

No.

Category Load (for

the Qtr)

Total

Batches

Batch Duratio

n

Unit Cost

in Lakhs

Total Cost

per quarter

1 MOs 544 17 32 2 1.08 18.45

2 Staff Nurse 224 7 32 2 1.08 7.60

3 ANMs 1152 36 32 2 1.08 39.06

Total 1920 59 65.11

Third Quarter

Sl.

No.

Category Load (for

the Qtr)

Total

Batches

Batch Duratio

n

Unit Cost

in Lakhs

Total Cost

per quarter

1 MOs 544 17 32 2 1.08 18.45

2 Staff Nurse 224 7 32 2 1.08 7.60

3 ANMs 1152 36 32 2 1.08 39.06

Total 1920 59 65.11

Fourth Quarter

Sl.

No.

Category Load (for

the Qtr)

Total

Batches

Batch Duratio

n

Unit Cost

in Lakhs

Total Cost

per quarter

1 MOs 544 17 32 2 1.08 18.45

2 Staff Nurse 224 7 32 2 1.08 7.60

3 ANMs 1152 36 32 2 1.08 39.06

Total 1920 59 65.11

Note: Each District is expected to conduct 2-3 batches per quarter.

187. Monitoring Plan: The Department will involve IIH&FW along with professional associations like IAP & NNF for monitoring of the trainings &

implementation in all the districts. A team will be constituted at the state level, which

will visit the training sites every month. The team will visit 2 centers every month thus covering all the districts. The estimated budget for the monitoring of NSSK trainings

would be Rs. 16.56 Lakhs (@Rs. 3000 per visiting 2 centers every month in 23 districts).

188. F-IMNCI Training: The state has identified nine Government Medical Colleges who will conduct the F-IMNCI training for the medical officers and staff nurses from the

108

districts. The regional training centers will assist the medical colleges in conducting these

trainings.

189. Resource Persons: The State has a pool of 80 facilitators for F-IMNCI. These

facilitators will be utilized to train the District Level Medical Officers. UNICEF has supplied mannequins required for F-IMNCI training to IIH&FW Hyderabad. UNICEF

will also be procuring training kits for the identified nine Medical Colleges.

190. The list of medical colleges along with the timelines for F-IMNCI trainings is given below.

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Sr.

No

Medical College

for F-IMNCI

Training

Regional

Training

center

DISTRICT

Medical Officers Staff Nurses Total

batches

per

center

1st qtr

Apr-

Jun

11

2nd

quarter

July-

Sep 11

3rd

quarter

Oct-

Dec 11

4th

quarter

Jan-

Mar 12

Total

to be

trained

in

2011-

12

Training

Load

Batches Training

Load

Batches

1 Osmania Medical college and

Niloufer Hospital

RTC Hyderabad

Male

Hyderabad 108 7 180 12 19

Medak 202 13 207 13 26

Adilabad 185 12 100 7 19

64 6 3 3 3 15

2 Gandhi Medical College and Hospital

RTC Hyderabad Female

Nalgonda 203 13 225 14 27

Nizamabad 121 8 166 11 19

Rangareddy 106 7 127 8 15

61 5 3 3 3 14

3 Kakatiya Medical College and MGM Hospital Warangal

RCH Training Center GMH Hanamkonda

Warangal 168 11 104 7 18

Khammam 182 12 141 9 21

Karimnagar 213 14 180 12 26

65 6 3 3 3 15

4 Government

Medical College and GGH Kurnool

RTC Male Kurnool 214 14 99 7 21

Mehboobnagar 237 15 190 12 27

RTC Female Ananthpur 232 15 145 9 24

72 5 3 3 3 14

5 Government Medical College and GGH Guntur

RTC Male Guntur 197 13 128 8 21

RTC Female Prakasam 202 13 100 7 20

41 5 3 3 3 14

6 Siddhartha Medical College Vijaywada

Krishna 201 13 166 11 24

W. Godavari 204 13 191 12 25

49 5 3 3 3 14

7 Andhra Medical college and KGH Vizag

RTC Male Vishakhapatnam 203 13 95 6 19

RTC Female Srikakulam 175 11 114 8 19

Vijayanagaram 278 18 113 8 26

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Sr.

No

Medical College

for F-IMNCI

Training

Regional

Training

center

DISTRICT

Medical Officers Staff Nurses Total

batches

per

center

1st qtr

Apr-

Jun

11

2nd

quarter

July-

Sep 11

3rd

quarter

Oct-

Dec 11

4th

quarter

Jan-

Mar 12

Total

to be

trained

in

2011-

12

Training

Load

Batches Training

Load

Batches

64 6 3 3 3 15

8 Rangaraya Medical College & GGH Kakinada

East Godavari 165 11 202 13 24

24 6 3 3 2 14

9 SVRR Medical college and Ruia Hospital Thirupati

RCH Training Center GMH Thirupati

Chitoor 256 16 257 16 32

Nellore 199 13 154 10 23

Kadappa 196 13 138 9 22

77 6 3 3 3 15

TOTAL 4447 288 229 517 50 27 27 26 130

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Resource Persons:

191. The Medical Officers mainly Pediatricians, Community Medicine experts, and faculty of Regional Training Centres are trained at State level by the National level

Master trainers in F-IMNCI. 4 batches of state level TOTs are conducted at IIH&FW,

Hyderabad during 2010-11 and one batch of 16 participants trained in F-IMNCI at New

Delhi through UNICEF support. The State has a pool of 80 facilitators for F-IMNCI. The State level trainers in turn would train the District Level Medical Officers.

192. UNICEF has supplied mannequins required for F-IMNCI training to IIH&FW. UNICEF will also be procuring training kits for e identified Medical College.

3. IMNCI Training

193. IMNCl for Health Workers and Anganwadi Workers at district level

The State of Andhra Pradesh has decided to train Health Workers and

Anganwadi Workers in basic IMNCI to release budget to the IIHFW for conduct

of TOTs in the six regional hubs for the five high focus districts followed by in the

all the districts.

The Districts trainers will train ANMs/AWW in 3 to 4 training centres in each

district.

Status of IMNCI in Andhra Pradesh

194. Govt. of Andhra Pradesh initiated IMNCI in Medak and Warangal districts

which support from UNICEF in 2006 and 2007 respectively. IIH&FW, Hyderabad also

trained basic IMNCI for Medical Officers, Staff Nurses and Faculties from various districts and Medical College in 2007 and 2008 total 1381 Medical Officers and 63 Staff

Nurses are trained. UNICEF have conducted 2 workshops at Warangal on MN-CHN

activities by involving all heads of the districts PODTTs and CDPOs and prepared

Action plan to roll out IMNCI trainings for ANMs/AWWs all over state. Total 84 Trainings centres are identified in 23 districts.

Cadre wise IMNCI Basic Training completed DISTRICTS MO Health

Supervisor

MPHA Staff

Nurse

CDPO/

Supervisor

AWW Others Total

Medak 45 840 12 1541 120 2568

Warangal 83 205 1023 51 126 3252 36 4776

Other districts 1381 63 1444

Total 1509 205 1863 114 138 4793 156 8788

Hyderabad 111 46 157

Action Plan for Andhra Pradesh;

195. The Health and Medical department Government of Andhra Pradesh has

included the following strategies under NRHM to address the issue of infant morbidity

and mortality.

1. Formation of IMNCI cell in every district manned by a CAS as the IMNCI

Facilitator and supported by a paediatrician from the DH/ Medical College

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Hospital as the IMNCI coordinator. The IMNCI cell would be responsible for the

capacity building in IMNCI of all the health and ICDS workers and to ensure effective implementation, monitoring and supervision. The cell would also be

involved in capacity building of all medical officers and staff nurses in F-IMNCI

and NSSK. Being skill based trainings the teaching hospitals and medical colleges

would be involved in the training program.

2. The state is focussing on facility based new born care and will be establishing

SCNUs (Special care New Born Units), Neonatal stabilization units and New born care corners in various health facilities including teaching hospitals.

Capacity Building of Staff Nurses, Pediatricians in these centres would undergo in

house SCNU training and the Govt. plans to involve NNF and UNICEF to

support this activity.

3. Pre Service IMNCI is an important component of the state PIP.

S N District Training

Load

Batches 1st quarter

April -

June 11

2nd

quarter

July-

Sep 11

3rd quarter

Oct-Dec 11

4th quarter

Jan-Mar

12

Total No.

batches in

2011-12

1 Hyderabad 961 40 12 12 16 40

2 Medak 3340 139 Complete

3 Nalgonda 4819 201 18 18 42

17 Nizamabad 3189 133 18 18 18 54

18 Rangareddy 2582 108 18 18 36

4 Warangal 5196 217 Complete

5 Adilabad 4415 184 18 18 18 18 72

6 Khammam 4430 185 18 18 18 18 72

19 Karimnagar 4564 190 18 18 36

7 Kurnool 4238 177 18 18 18 54

8 Mehbubnagar 5632 235 18 18 18 18 72

20 Ananthpur 4708 196 18 18 18 18 72

9 Guntur 5556 232 18 18 18 54

10 Prakasham 4826 201 18 18 18 54

11 West Godavari 4635 193 18 18 36

21 Krishna 4637 194 18 18 36

12 Vishakptnam 4290 179 18 18 36

13 Srikakulum 4189 175 18 18 18 54

14 East Godavari 6106 255 18 18 18 54

22 Vizianagaram 3654 152 18 18 36

15 Chitoor 4406 184 18 18 18 54

16 Nellore 4104 171 18 18 18 18 72

23 Kadapa 3948 165 18 18 36

Total 98425 4106 90 228 372 376 1066

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Five Districts (Adialabad, Khammam, Mahabubnagar, Anathapur and Nellore)

to start IMNCI Trainings in the first quarter.

Eight Districts (Chittoor, East Godavari, Srikakulam, Prakasam, Guntur,

Kurnool, Nizamabad and Hyderabad ) in the second quarter.

Eight Districts (Kadapa, Vizianagaram,Vishakhapatnam, Krishna, West

Godavari, Karimnagar, Rangareddy and Nalgonda) in the third quarter.

By the end of March 2012 - All districts will have rolled out IMNCI.

Each districts will identify three training centers and are expected to complete two

batches in each center every month i.e. 6 batches per month in one quarter.

The districts can thus complete 18 batches in every quarter.

Each district will complete 54 batches in one year i.e. 1296 participants will be

trained in one year in a district.

Innovations in Implementation of IMNCI:

1) Tracking of every new born baby with the help of IMNCI Tracking Chart distributed

to all the Anganwadi Workers trained in IMNCI.

2) Parallel reporting of IMNCI implementation by the DWD&CW & the Health

Department.

3) Development of IMNCI software with support of NIT Warangal with scope for

scalability throughout the state. This will help minimize the human error in reporting of No. of babies visited with in 24 hrs, No. of babies visited 3 times in 10 days and

the No. of babies assessed. It will also have an online component which will help real

time entry of the visits by the frontline workers and the status of the baby in future. Plan to give unique ID Number to every new born baby and also the health and

nutrition workers and Medical Officers.

4. Pre service IMNCI: 196. AP has the distinction of being one of the states with the largest number of

medical and nursing colleges. The state has 33 Allopathy Medical Colleges (13

government and 20 Private) and 191 BSc Nursing colleges (6 Government and 185 Private) admitting 4850 students for MBBS and 10372 students for BSc Nursing

respectively every year. Approximately 10000-15000 of these students graduate every

year, and join the public or private health services. Building the capacities of these

students in the skills required for saving neonatal and infant lives would help the state in bringing down the IMR and NMR. The students are receptive and ready to learn new

skills and IMNCI can be taught by including it in the MBBS and BSc Nursing

curriculum. The paediatrics department and the PSM department can share the responsibility of teaching IMNCI to the students in their sixth semester.

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197. UNICEF supported the piloting of pre service IMNCI in Andhra Medical College

Vishakhapatnam and shared the details with Dr NTR University of Health Sciences. The NTR UHS has decided to include IMNCI in the undergraduate teaching curriculum and

UNICEF Hyderabad and WHO India country office will support the state in rolling out

Pre Service IMNCI.

198. The NTR University of Health Sciences has formed the steering committee. The

steering committee prepare the Pre service IMNCI operational guidelines which will be

issued by the NTRUHS to all the Medical and Nursing Colleges in the state.

199. WHO India Country office and UNICEF Hyderabad have committed to support

the orientation workshop and the first two TOTs for the state. Gandhi Medical College

which has been identified as the nodal center for Pre service IMNCI will conduct the training of faculty members of all medical colleges and nursing colleges.

Budget details for Pre service IMNCI:

Sl.

No.

Activity Batch

size

Batches

/ Units

Rate Total

Load

Total

cost

1 State level Workshop (Supported

by UNICEF and WHO)

1 2.00 2.00

2 TOT for faculty from select

medical colleges (UNICEF)

16 2 2.00 32 4.00

3 Training of Faculty from medical

& Nursing Colleges

20 20 2.40 400 48.00

Budget required for Pre service IMNCI is 48.00 Lakhs. Budget of Six Lakhs for activity one and two will be supported by UNICEF and WHO.

5. Management of Severe Acute Malnutrition Training:

200. The state will be setting up NRCs in all district headquarter hospitals to manage

children with severe acute malnutrition. The state has committed to set up 23 NRCs –

one in each district through the funds available under NRHM PIP 2010-11. CHAI (Clinton Health Access Initiative) is supporting the state in setting up the first five NRCs

in teaching hospitals and in designing the remaining 18 NRCs in the State. CHAI will

also support the supply of F75 and F-100 to all the 23 centers till March 2012. The

doctors, staff nurses and nutritionists recruited in these NRCs will be trained in the management of SAM children using the Kalawati Saran Children‟s Hospital (KSCH)

adaptation of the WHO module on SAM.

Sl

No

Training Units /

Batches

Unit cost Training

load

Total

Cost 1 State level TOT for Pediatricians ( 20

participants for 3 days)x(1 batch) 1 4.94 20 4.94*

2 Training of medical officers/

Pediatricians from Phase 1& 2 NRCs ( 20 participants for 3 days)x (5 batches)

5 3.09 100 15.45

3 Training of staff nurses and nutritionists from Phase 1 and Phase 2

8 1.63 80 13.04

115

NRCs ( 20 participants for 3 days)x(8 batches)

4 One day sensitizations of PGs at Phase 1 facilities

6 0.25 120 1.50

*UNICEF supported

Family Planning Training:

1. Repositioning of IUD in Family Welfare Program: An Alternative Methodology of

Training for IUCD Services & Postpartum IUCD

Key Objective

To promote spacing method

To orient health care providers with the knowledge, attitudes and skills associated

with the competent delivery of IUCD (380-A) services

By the end of orientation programme the participants will be able to

1. Explain how copper bearing IUCDs prevent pregnancy, health benefits, risk and

common misconceptions about IUCD. 2. Counsel a client interested in using CuT 380 A (IUCD).

3. Insert the IUCD gently and safely using no touch technique

4. Provide appropriate client education counseling following IUCD insertion

5. Remove the IUCD gently and safely using no touch technique 6. Provide routine follow-up services to IUCD users and appropriate management

of side effects and potential problems

Outcome

To provide IUCD services at PHCs, CHCs & FRUs safely by the end of 2011-12 and

to encourage spacing methods.

Strategy

201. The Commissionerate of Health & Family Welfare, Govt. of AP is taking the responsibility to train the service providers for 6 days as per the norms laid down by John

Hopkins University & GoI. In order to cover health functionaries in the state for this

year it is proposed to conduct the following category of trainings ion the state of Andhra

Pradesh.

1. Training of Trainers Workshop on Alternative Methodology of Training for

IUCD Services for Health personnel working at AHs & DHs 2. Training of Trainers Workshop on Alternative Methodology of Training for

IUCD Services Program Officers & OBG specialists.

3. Training Workshop on Alternative Methodology of Training for IUCD Services

for Health functionaries 4. Trainings in IUCD Immediate Postpartum Intrauterine Contraceptive Device

(PPIUCD)

116

Other Trainings

1. ARSH Training

202. ARSH strategy has been approved as a part of the National RCH – II program

implementation Plan. This strategy focuses on Adolescent Reproductive and Sexual

Health. In order to meet the reproductive and sexual health needs of adolescents, the strategy focuses on reorganizing the exiting Public Health System at various levels. To

provide these services, steps are to be taken to ensure improved service delivery for

adolescents during routine checkups at different levels on Fixed Days and Timings. This

is to be in tune with the Outreach Activities. These activities include promotive, preventive, curative and referral services. Inorder to provide these services selected

facilities in the district must be in a position to provide prescribed package of services

under ARSH strategy.

Training implementation cascade method State level master trainer

(Faculty MOHFW)

District level Trainer

(PODTT, Paediatrician, Gynecologist, Psychologist and Faculty IIHFW)

Mandal level Training to Medical Officers, ANMs and LHVs

Establishment of Clinics and Service Provider

The programme would be implemented in the districts where age at marriage is low.

2. MENSTRUAL HYGIENE:

203. The Scheme on Menstrual hygiene is part of Adolescent Reproductive and Sexual

Health. The Scheme aimed at promotion of menstrual hygiene among adolescent girls by

creating awareness and a form for discussion on age at marriage, nutrition, gender issues, contraceptives, self esteem and negotiation skills. In view of lack of safe sanitary

facilities the girls face several problems during menstruation. In order to increase

availability of sanitary facilities at affordable cost the GOI has initiate the present scheme with the following objectives.

204. The programme will be focused in rural areas with the following objectives:

To increase awareness among adolescent girls on menstrual hygiene, build self-

esteem, and empower girls for greater socialization

To increase access to and use of high quality sanitary napkins by adolescent girls in rural areas.

To ensure safe disposal of sanitary napkins in an environment friendly manner

205. In order to achieve the objective the state is proposed to conduct trainings at different levels which will be monitored by the programme officers

117

3. Training Workshop on HMIS & Reports

206. Given the understanding of the role of statistics and the statisticians in planning

and overall developmental process, the objectives of the training are

1. To orient the Sate, District and sub-district level persons dealing with data on

their job role and responsibilities in Health and Family Welfare

2. To brief on Health Management Information System under NRHM 3. To Monitor and Validate data at each level

4. To support district and state level authorities in supplementing information

related to District and Sub-District Planning.

4. Reorientation workshops for Sub-district Appropriate authorities on Effective

Implementation of the PC&PNDT Act

Participants: The District and sub-district appropriate authorities and district level legal

advisories.

Objectives of the training a. Sensitize the Private Medical practitioners on provisions of the Act

b. Enhance their knowledge on Registration of centres under PC&PNDT act

Maintenance of Records

Violations under the Act and Penalties.

Administrative measures in implementing the Act.

5. Sensitization Workshop on Gender, Health and Development for State and

District Level Officers

207. Understanding the existing gender disparities in health, one of the main focused in NRHM is the promotion of gender equity in health care. While the Government is

taking utmost care in providing health services with gender sensitivity with respect to

timings, ailments etc., equally it is essential to sensitize the health providers on differential gender needs to achieve the over all health goals of NRHM. The present

workshop is a beginning in this direction.

Objectives Deconstruct the knowledge on gender and construct the meaning and importance

of gender in Health Differentiate the differences between sex & gender; its impact of health goals

under NRHM

Elaborate the role of gender as an impediment in achieving the specific health

programmes. To sensitize and enhance the knowledge of health personnel for operationalizing

Gender Approach in the health system

118

6. Induction Training for PHC Medical Officers in Andhra Pradesh

Sensitize PHC Medical Officers to the National Rural Health Mission (NRHM),

its vision, goals and strategies,

Orient the Medical Officers to their roles and responsibilities they have to perform at the Primary Health Center, Sub-center and at the level of the

community.

Provide training in office administration and management for effective delivery of primary health care in the community.

208. A total of 929 Medical Officers from all Districts were trained in 2008 out of 1367

deputed at various training centers (IIHFW, RTCs & FPAI). After the initial recruitment, a second round of recruitment took place recently, and it has been decided

to conduct induction training for the new recruits including those who were recruited in

the first round but did not undergo training.

7. Program on Management Training for District Coordinators of Hospital Services

& Hospital Superintendents of APVVP 209. The main of purpose of the training is to orient & sensitize the DCHS and

Superintendents of Secondary Hospitals to various management aspects in order to

strengthen capacity and institution building.

Sensitize the officials to the National Rural Health Mission (NRHM), its vision,

goals and strategies

Orient them to their roles and responsibilities in the light of the present Health Sector Reforms under way in the State.

Provide training in office administration and management for efficient &

effective delivery of quality services at the District level.

Budget Proposed under Training Strategy for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Skill Birth Attendance

a) Skill Birth Attendance district level Training to Staff Nurses

Batches 111000 150 166.50

b) Skill Birth Attendance district level Training to ANMs

Batches 111000 250 277.50

Total 444.00

2 BEMOC a) BEMOC to Medical Officers Batches 190000 30 57.00

Total 57.00

3 EmOC a) Training of MOs in Emergency

Obstetric Care Batches 150000 40 60.00

b) Training of MOs in Life saving Skills Batches 600000 5 30.00

119


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 in Anesthesia

Total 90.00

4 NSSK Training

a) District level to 2176 Medical officers Batches 108000 68 73.44

b) District level to 896 Staff Nurses Batches 108000 28 30.24

c) District level to 4608 ANM Batches 108000 144 155.52

Total 259.20

5 F-IMNCI Training

a) District level to Medical Officers (5 days)

Batches 180000 50 90.00

b) District level to Medical Officers (11

days)

Batches 250000 40 100.00

c) Training for Staff Nurses (11 days) Batches 200000 40 80.00

d) Modules Printing, Chart & Photo booklets

Printing 750 2000 15.00

Total 285.00

6 IMNCI Training

a) Trainign of Trainers (528) Batches 200000 22 44.00

b) Basic Training for 25584 Health and Nutrition workers

Batches 109000 1066 1161.94

c) Follow up Training for 3840 Supervisors (Health& ICDS)

Batches 60000 160 96.00

d) Monthly Implementation Meetings at CHNCs

Meeting 1000 360 3.60

e) IMNCI Training Material & IMNCI Implementation Logistics

i) Log books for AWWs and ANMs Printing 30 30000 9.00

ii) Log books for Medical officers Printing 30 2000 0.60

iii) AWC Reporting books ( 100 sheets perforated)

Printing 30 25000 7.50

iv) Sub center Reporting books ( 100

sheets perforated)

Printing 30 4500 1.35

v) PHC Reporting books ( 100 sheets perforated)

Printing 30 1000 0.30

vi) Supervisors formats for Follow up Supervision

Printing 30 4000 1.20

vii) Tracking Charts 6 X 4 feet Charts 200 25000 50.00

viii) Modules, Chart & Photo-booklets, etc. Others 200 30000 60.00

Total 1435.49

7 Pre Service IMNCI

a) Training of Faculty from medical & Nursing Colleges

Batches 240000 20 48.00

Total 48.00

8 Capacity Development FBNC a) Capacity Development of Doctors

(160 MOs) Batches

144000 10

14.40

b) Capacity Development of Staff Nurses (480 SNs)

Batches 106000 30 31.80

120


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 c) Honorarium for Resource Hospitals Batches 48000 106 50.88

Total 97.08

9 Training in Management of SAM

Training of 140 MOs / Pediatricians from Phase 1 & 2 NRCs

Batches 309000 5 15.45

Training of 160 Staff Nurses and Nutritionists from Phase 1 & 2 NRCs

Batches 163000 8 13.04

One day sensitizations of PGs at Phase 1 facilities

Batches 25000 6 1.50

Total 29.99

10 IUCD

a) Orientation Workshop Training to APVVP Doctors (Specialists

Batches 184000 2 3.68

b) TOT for Medical Officers Batches 210000 8 16.80

c) District trainings to Mos/ SNs/LHVs Batches 175000 138 241.50

d) PPIUCD Batches 69000 12 8.28

Total 270.26

11 ARSH Trainings

a) ARSH ToT Batches 356000 1 3.56

b) ARSH District level Trainings to Mos Batches 90000 40 36.00

c) ARSH District level Trainings to ANMs, AWWs & LHVs

Batches 135000 260 351.00

d) Printing of Modules for ARSH Trainings

10.00

Total 400.56

12 Menstrual Hygiene Trainings a) ToT to DPHNO, Supervisors of

ICDS, APO (DRDA) and PHN Batches 140000 3 4.20

b) District Level Trainings to ASHAs, AWWs & ANMs

Batches 40000 46 18.40

c) Printing District Level Trainings

Menstrual Hygiene

Printing 3.00

Total 25.60 13 Induction Trg. for PHC MOs Batches 450000 32 144.00 14 Capacity Building Trainings & BCC

Workshop

a) State Level officers on communication

skills, BCC and Media Management

Batches 140000 1 1.40

b) DM&HOs training on communication skills, BCC and Media Management

Batches 120000 1 1.20

c) Workshop on BCC strategies and material development in association with National and International Agencies

Batches 124000 6 7.44

d) Sensitiszation of journalists on health issues in collaboration with AP Press Academy

Batches 124000 3 3.72

e) TOT for RTC faculty Batches 128000 2 2.56

121


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 g) DEMOs/Dy.DEMOs training on

capacity enhancement on BCC under NRHM

Batches 227000 3 6.81

h) Capacity Enhancement on BCC for HEOs to be posted in CHNCs under

NRHM

Batches 108000 12 12.96

i) Capacity Enhancement on BCC for MPHEOs under NRHM

Batches 110000 20 22.00

Total 58.09

15 Orientation Training to Cluster / District / State level Management Units SPMU/DPMU Trainings

50.00

Training Total 3694.27

122

A11: PROGRAMME MANAGEMENT

210. In addition to SPMU and DPMU have been established under NRHM at the

state, the district levels and block level units i.e. 360 Community Health & Nutrition

Clusters also established respectively for the management of NRHM activities.

211. While the external and internal technical/programmatic assistance under

APHSRP and HIV program has brought velocity to overall reforms under the NRHM

umbrella, the assistance has been limited to either identified diseases or a few priorities of the department so far. The assistance has not encompassed the range of inputs the health

sector may require in ensuring that basic services reach the remotest corners and to the

most marginalized.

212. The state therefore proposes the following strategies to ensure the momentum

gathered under the reforms program is sustained and that all initiatives that are at

different stages of implementation are fully integrated under the unified umbrella of NRHM.

213. The Regional Directors (RD) – six of them across the state in the rank of

Additional Director of Health – who hitherto performed administrative functions are

being assigned programme coordination responsibilities over three to five districts. Regional Data Managers (Bio-Statisticians) will support the RD in overall coordination

and monitoring of NRHM activities in the region.

214. The DPMUs is headed by a Public Health Officer who have completed their

DPH course from PHFI (IIPH) will support the DMHOs with their responsibilities. The

institution of DMHO is being strengthened with two additional DMHOs and physical as

well as functional integration of all programme officers under one umbrella.

215. To ensure effective monitoring and sustained backstopping at the cluster hospital

level, 360 CHNCs have been established and with a community PMU to support the Community Health Officer. A Deputy Civil Surgeon who is hereby designated as the

„Senior Public Health Officer‟ (SPHO), supported by the following staff, who shall be

positioned through redeployment: a) Community Health Officer; b) Deputy Para-

Medical Officer (DPMO - Leprosy); c) Public Health Nurse (PHN); d) Health Educator; e) MPHEO / Sub unit officer (Malaria); f) Ophthalmic Officer; g) LD Computer; and h)

one Senior Assistant.

Budgetary Requirement

Project Management Unit:

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

1 Mission Director Deputation 1

2 Chief Programme Officer (CPO)

Deputation 1

3 Chief Administrative Deputation 1

123

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

Officer (CAO)

4 Chief Finance Officer (CFO)

Deputation 1

State Health System Resource Centre (SHSRC)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs) 1 Public Health

Specialist / Epidemiologist

Contractual 1 50,000 6.00

2 Health Economist Contractual 1 50,000 6.00

3 HMIS Specialist Contractual 1 50,000 6.00

4 HR Specialist Contractual 1 50,000 6.00

5 Technical Advisor (Emergency Medical Services)


6 Supporting Staff Contractual 6 8,400 6.05

Sub-Total 36.05

State Project Management Unit (SPMU)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

1 Consultant (MH) Contractual 1 50,000 6.00

2 Consultant (CH&I) Contractual 1 50,000 6.00

3 Consultant (Population Stabilization)


4 Consultant (School Health)


5 Consultant (Public Health & Epidemiologist)


6 Consultant (HMIS) Contractual 1 50,000 6.00

7 Consultant (SDS / BCC/ IEC)


8 Consultant (PPP) Contractual 1 50,000 6.00

9 Consultant (Trainings / Capacity Building)


10 Consultant (HR) Contractual 1 50,000 6.00

11 Consultant (Nutrition) Contractual 1 50,000 6.00

12 Consultant

(Convergence)


Sub-Total 72.00

124

Human Resource Management Unit (HRMU)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

1 Consultant (HR) Contractual 1 50,000 6.00

2 Consultant (Organization Development)


Sub-Total 12.00

Project Management Unit for ITDA Areas

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

1 Consultant (Tribal Health)


2 ITDA Program Manager


3 Supporting Staff Contractual 2 10,000 2.40

4 Hiring of vehicles 1 20,000 2.40

5 Administrative

Overheads

2500000 25.00

Sub-Total 71.80

State Finance Management Unit (SFMU)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs) 1 State Finance Officer Deputation /


2 Accounts Manager Contractual 1 45,000 5.40

3 Assistant Accounts Managers


4 Accountants Contractual 4 18,000 8.64

5 Audit Fees 10,00,000 10.00

6 Concurrent Audit (State)

1 25,000 3.00

7 Concurrent Audit (Districts)

23 6,000 16.56

Sub-Total 55.60

Information System Unit (ISU)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs) 1 IT Specialist Contractual 1 50,000 6.00

2 System Administrator Contractual 2 30,000 7.20

3 Sr. Software Engineers


125

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

4 Jr. Software Engineers Contractual 2 20,000 4.80

Sub-Total 24.00

Project Management Unit Supporting Staff

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs)

1 Personal Secretary to Mission Director


2 Personal Assistants Contractual 3 15,000 5.40

3 Superintendents Contractual 2 20,000 4.80

4 Computer Project Assistants


5 Computer Operators Contractual 8 12,000 11.52

6 Computer Assistants Contractual 8 10,000 9.60

7 Projectionist Contractual 1 10,000 1.20

8 Refrigeration Mechanics


9 Junior Assistants Contractual 10 9,000 10.80

10 Office Subordinate Contractual 18 7,500 16.20

11 Drivers Contractual 10 8,500 10.20

12 Hiring of Vehicle to Mission Director

1 40,000 4.80


14 Administrative

Overheads

2000000 20.00

Sub-Total 123.92

District Programme Management Unit

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs) 1 District Project

Officer Deputation 23

2 District School Health Coordinator

Deputation / Contractual

23 40,000 110.40

3 IMNCI Coordinator Deputation /

Contractual

23 40,000 110.40

4 Asst. District Project Officer


5 Accountant Contractual 23 20,000 55.20

6 MIS Assistant Contractual 23 15,000 41.40

7 Computer Assistant Contractual 23 10,000 27.60

8 Office Subordinate Contractual 46 6,700 36.98


Sub-Total 384.74

126

Community Health & Nutrition Clusters (CHNC)

Sl.

No.

Cadre Mode of

Appointment

Proposed

Strength

Remuneration

Per month

Cost per

annum

(in lakhs) 1 Cluster Health Officer Deputation 360

2 MIS Assistant Contractual 360 8,000 345.60

3 Accounts Assistant Contractual 360 8,000 345.60

4 Hiring of vehicle 360 18,000 777.60

Sub-Total 1468.80

BUDGET ABSTRACT

S N Activity Budget

proposed

1 Strategy Planning & Innovation Unit (SPIU) / State Health System Resource Centre (SHSRC)

36.05

2 State Project Management Unit (SPMU) 72.00

3 Human Resource Management Unit (HRMU) 12.00

4 State Finance Management Unit (SFMU) 55.60

5 Project Management Unit for ITDA Areas 71.80

6 Information System Unit (ISU) 24.00

7 Project Management Unit Supporting Staff 123.92

8 District Programme Management Unit 384.74

9 Community Health & Nutrition Clusters (CHNC) 1468.80

Total 2248.91

127

A10: BEHAVIOUR CHANGE COMMUNICATION

216. The Government have established an integrated IEC/BCC Unit directly under

the Commissioner of Health & Family Welfare to prepare and launch a Comprehensive

Behavior Change Communication strategy, by merging the MEM Unit of Commissioner of Health & Family Welfare and the State Health Education Bureau

(SHEB) of the Director of Public Health & Family Welfare. District IEC/BCC Bureau„s

in 23 O/o District Medical & Health Officers and 360 Cluster IEC-BCC Bureau‟s in 360

Community Health & Nutrition Clusters (CHNC‟s) have also been established. The Government is committed to strengthen the infrastructure in this direction. The

Government vide.GO.Ms.No.276 HM & FW(B1)dept dt.06-10-2010 redesignated the

post of Joint Director SHEB as the Joint Director IEC-BCC Bureau to carry out all IEC-BCC activities related to NRHM, Family Welfare, Public Health and HIV/AIDS

through the IEC –BCC bureau only.

217. The IEC-BCC bureau will make efforts to improve access quality health care through newly formed CHNC systems. Through IEC –BCC strategy the department will

ensure convergence of all stake holders in achieving the state health goals. There will be

special focus on tribal areas, high focus districts and efforts will be made to promote social and gender equality in health services. The Health Melas will be organized in

urban slums, peri urban areas, tribal areas and high focus districts. Efforts will be made

through IEC-BCC to decrease gender ratio in coordination with Education,Women and

Child Welfare, Panchayat Raj and Tribal Welfare departments and medical organizations like IMA,FOGSI, APNA.

218. Additional activities on health promotion and prevention like awareness & counseling through mobile exhibits at public gatherings like Rajiv Arogyasri screening

camps will be undertaken . School health (JBAR) a new programme Class I to X will be

supported by IEC-BCC activities for it sustained and successful implementation. Pilot

programmes like well Hyderabad on NCD‟s will be studied and scaled up in all urban slums and other areas. The bureau is also planning to publish in house journal to be

distributed amongst health facilities and Panchayat including ASHA‟s. Receiving only

Terminals(ROT) of Mana TV(AP Govt satellite channel) will be established at all health facilities for conferencing with staff, PR leaders and for telecast of health programmes to

the public)

Key Objectives 219. Behavioral Change Communication (BCC) is envisaged to be integral component

of the State and District PIP and has a critical role in achieving the objectives of National

Rural Heal Mission (NRHM).Keeping in view of the above situation and the paradigm

shift in Communication strategy is focusing on Behavioral Change Communication (BCC)

Make the leap from” Awareness to Behavioral Change”

From being “instructive” to being empowering and

from taking the “Genetic approach” to “individualized approach”.

128

Situation analysis, critical gap identification

220. The various IEC and BCC cells in the different departments are making efforts in isolation and thus loosing the opportunity of synergy through concentric efforts. IEC

wings of Health and Family Welfare like SHEB under the DPH & FW and MEM wing

under the CH & FW,APVVP and JD – IEC APSACS, are carrying the IEC activities

independently with out knowing each other on the IEC materials producing by each wing under the each HOD.

221. Resources were underutilized and not shared leading to lack of efficiency. Programme Officers under the Director of Public Health and Family Welfare producing

the IEC materials by themselves without involving the media experts available in State

Health Education Bureau which is established to carry out the IEC activities on Health

programmes.

222. The IEC material produced by the State Programme officers of Director of Public

Health and Family Welfare is directly sent to the respective District programme officers at the district level. The Lack of coordination due to absence of a common strategy of the

state for IEC/BCC, DEMO‟s are not aware of the IEC materials produced on various

Health Programmes and supplied to the districts.

223. Lack of supervision and monitoring and evaluation of the activities under IEC

and BCC bureau. No coordination at the State level with other media agencies like

department of Field Publicity, Song and Dram Division of Department of Audio Visual Publicity of Govt of India.

Key strategies of the programme

224. State level BCC bureau will be the focal point for conceptualizing, integrating,

developing communication strategy implementing, monitory and evaluation of BCC activities.

225. The State level Communication Strategy, developed in consultation with various

stake holders, will focus on awareness generation using Mass Media Channels like Radio, Print, TV and films. The strategy will consider using new emerging media like

Radio, Print, TV and films. The strategy will consider using new emerging media like

satellite communication, internet, mobile, for effective, dissemination of messages etc. The communication strategy will involve building up a conducive environment for

particular health issues through campaign and program mode. The state communication

strategy involves designing Mass media Campaigns on critical health intervention. It will

also develop media Strategies during the out breaks and epidemics and list out steps to handle emergency and crisis situations .More emphasis will be given for inter personal

communication (IPC) through individual / group approach.

Programme components

To establish the IEC bureau at the State level merging SHEB, MEM, and the IEC wings of APVVP and APSACS for comprehensive planning and implementation

of IEC activities in an effective manner by implementing the orders issued vide

Go.Ms.No.186 HM & FW (D1) Dept.

129

Constitute an expert/advisory committee consisting of media experts, subject

specialist‟s academicians to guide the BCC bureau.

To assess the BCC needs and requirements –both soft ware and hard ware of all

twelve wings of H&FW and to pool up the budget allocations meant for carrying

out IEC/BCC activities for these wings. To utilizing the services of all IEC

personnel available under various heads of the department in IEC bureau.

To workout a detailed BCC action plan along with the budget for incorporating

the same in the 2011-12 state PIP plan.

To strengthen the infrastructure and equipment facilities at district and cluster

level for effectively carrying out IEC/BCC activities. To construct a new building for establishment of IEC bureau in the space available in the campus of

Commissioner of Health and Family Welfare on par with other states with

adequate for storing of IEC material and Library .The building of IEC bureau in Maharashtra located in Pune was funded by UNFPA similarly the Government

of A.P can have a separate building for IEC bureau. Allocation of exclusive audio

visual vans with all the facilities for carrying out field level BCC activities for each

institute.

To provide guidance and leadership to district and clusters IEC units

Designing of area specific, programmes specific, and issue specific BCC strategies

linked with the delivery system

Strengthening of documentation process to learn lessons from best practices and

as well as failure stories.

Develop a sound monitoring and evaluation mechanism to study the media wise

impact of BCC interventions among the community members. Hold regular by monthly review meetings with Demo‟s. To develop IEC-BCC monitoring tools at

all levels.

To set up Learning Resource Centers (Ware House) bringing all the IEC material

produced by different agencies and develop programme specific and Media specific IEC/BCC kits. To developing area specific IEC materials keeping in view

the local beliefs and socio cultural practices.

Enhance capacities of BCC personnel and other programme officers from time to time so as to update them with current disease patterns and media trends and

technologies.

Ensure timely and adequate release of budget and IEC material to District and

Cluster units in order to carry out BCC activities effectively. To make provision for transportation of IEC material to the Cluster/PHC /SC level. The Key

functionaries under IEC bureau are not to be entrusted with other activities which

are likely to affect the effective implementation of IEC activities

To interface with Media agencies – both Private and Government-to strengthen

health promotional activities by organizing sensitization work shop from time to

time.

To appoint a media advisory committee at the State level involving the IEC Officers concerned of different HOD‟s, department of Field Publicity Song and

Drama division, Govt of India, Information & Public Relation Dept, Private

Media agencies and active NGO‟s working on Health & Family Welfare like

UNICEF etc..

To carry out internal and external evaluation studies impact of IEC/BCC

interventions.

To redefine the Job chart of all IEC functionaries right from state to PHC level.

130

To ensure effective coordination with all the line departments to avoid

duplication of

IEC /BCC activities.

Document best BCC practices /Success stories in Health and Family Welfare.

Letters of appreciation, awards etc. for the best performing district IEC staff.


The Health Educators possessing PG diploma in Health Education now working

at few PHC‟s level are deployed to CHNC‟s .The Health Educators are made

responsible to plan, implement and monitor IEC/BCC activities in the CHNC area with the involvement of local Health personnel.

KAP studies will be carried out on the existing the health problems in the CHNC

area and the BCC activities will be planned and implemented accordingly

The implementation methodology of the IEC /BCC activities will be area specific language specific and problem specific.

The Dy.DEMO‟s and DEMO‟s of the district IEC bureau will guide the Health

Educators of CHNC‟s and provide leadership to the Health Educators for effective implementation of IEC/BCC activities in the district.

Monitoring & Reporting Systems

226. The monitoring and reporting system on IEC/BCC will be at the CHNC, District and State level

The IEC/BCC activities carried out by the CHNC‟s, District and State level.

CHNC‟s: The IEC/BCC activities carried out by the health personnel such as MPHA,MPHS,MPHEO/CHO will be monitored by the Health Educators of the

CHNC‟s and the monitoring report will be submitted to the district bureau.

District level: The DEMO and Dy. DEMO‟s of the IEC bureau will monitor the IEC activities carried out by the Health Educators and submit the evaluation

report to the State IEC bureau State level.

The Technical Officers, HEEO and DD MEM will monitor the IEC/BCC

activities by the District and provide feed back.

Risk Analysis

227. Behavior Change is a complex process. Study of the individual, group, community on behavioral pattern towards the particular health behavior is very

important so as to plan suitable and appropriate communication interventions. KAP

studies will be carried out for different population groups to inform the IEC/BCC activities

Expected Outcomes

Community involvement in implementation of H & FW programmes

Reduction of disease burden through behavioral change.

Optimum utilization of H & FW services provided by the government.

131

QUARTERLY BUDGET ALLOCATIONS PROPOSED FOR 2010-11

S N Detailed activities Quarterly budget allocations

Q1 Q2 Q3 Q4 Total

1 Setting up and development of IEC/BCC unit at the state level/ district level

-- 50.00 -- -- 50.00

2 Develop IEC/ BCC strategy Streamline objectives/ identify communication tools/identify media mix as per target audience/ frame monitoring evaluation

indicators

Identify external agency / Advertising agency for the task ( if needed)

-- 50.00 -- -- 50.00

3 Media Mix

Develop a strategic media mix as per the

target population and issues ( Child Health,

Maternal Health/ Family Planning)

a) Interpersonal communications

Counselling at FRUs,PHCs etc

One to one interaction by ASHAs/ANMs/AWWs

Group discussions at village/ block/Panchayat level

Community meetings

Workshops at Panchayath/ block/ district level

-- -- -- -- --

12.50 12.50 12.50 12.50 12.50

-- -- -- -- --

12.50 12.50 12.50 12.50 12.50

25.00 25.00 25.00 25.00 25.00

b) Community media

Folk arts

Street plays

Health melas

Rallies

Social mobilization programmes

-- --

-- -- --

12.50 12.50

-- 12.50 12.50

-- --

-- -- --

12.50 12.50

-- 12.50 12.50

25.00 25.00

-- 25.00 25.00

c) Outdoor media

Banners

Bus boards

Bulletin boards

Sign ages / hoardings

12.50 12.50

12.50 12.50

12.50 12.50

12.50 12.50

12.50 12.50

12.50 12.50

12.50 12.50

12.50 12.50

50.00 50.00

50.00 50.00

d) Television spots 12.50 12.50 12.50 12.50 50.00

e) Radio programmes 7.50 7.50 7.50 7.50 30.00

f) Newspaper advertisements 12.50 12.50 12.50 12.50 50.00

g )Print materials

Pamphlets

Posters

Flip charts

Flash cards

Calendars and danglers

12.50 12.50 12.50 12.50

-

12.50 12.50 12.50 12.50

-

12.50 12.50 12.50 12.50

-

12.50 12.50 12.50 12.50 20.00

50.00 50.00 50.00 50.00 20.00

Total 875.00

132

BUDGET ABSTRACT FOR RCH FLEXIBLE POOL

(Rupees in lakhs) S N Activity Budget

proposed

2011-12

I Maternal Health

1 Referral Hospital Strenthening 2147.87

2 24-hours MCH Centres 4767.84

3 Janani Suraksha Yojana 4282.94

4 Maternal Death Review(MDR): 159.00

5 Mother & Child Tracking 100.00

6 MTP Services (Trainings) 10.60

7 RTI/STI Services (Trainings proposed) 233.40

8 Midwifery Training for ANMs, Staff Nurse & MOs 100.00

9 Blood Bank & Blood Storage Centres 239.80

Maternal Health Total 12041.45

II Child Health

1 New Born Care Corners 2418.35

2 New Born Stabilization Units (NBSU) 1247.10

3 Sick New Born Care Units (SNCU) 281.00

4 Nutritional Rehabilitation Centers 515.73


III Family Planning Strategy

1 Family Planning Management 9.01

2 Terminal / Limiting Methods

a) Plan for facilities providing FEMALE sterilisation services on fixed days at health facilities in districts

65.64

b) Compensation for sterilisation (Female) 2250.00

c) Compensation for sterilisation NSV (male) 600.00

d) Accreditation of NGOs / Voluntory Organizations for sterilization services

250.00

3 SPACING METHOD (Providing of IUD services by districts)

a) IUD services at health facilities in districts 94.00

b) Compensation to ASHA for 100% retention of IUD by clients 200.00

4 Workshop on Population Stabilization 28.00

5 BCC/IEC activities/campaigns/melas for family planning 36.00


8 Spacing Methods


IV Adolescent Health

1 Establishment of Health Clubs 99.20

2 Fixed Day Health Clubs with Specialist Services & Consellers 18.72

3 Printing of Booklets & IEC activities 21.75

Adolescent & School Health Total 139.67

V School Health Programme

1 School Health Programme 1560.50


VI Urban Health Strategy

1 Urban Health centres 706.08

2 Other initiatives 147.44


133

S N Activity Budget

proposed

2011-12

VII Tribal Health Strategy

1 Tribal RCH 2244.71

2 Special Package to the identified Institutions

3 Maintenance of Birth Waiting Rooms


VIII Vulnerable Groups

1 Special Package to the identified Institutions 1527.60

Vulnerable Groups Total 1527.60

IX High Focused Districts

1 High Focused Districts 292.96


X Training Strategy

1 Skill Birth Attendance Training to Staff Nurses and ANMs 444.00

2 BEMONC 57.00

3 Training of MOs in Emergency Obstetric Care 60.00

4 Training of MOs in Life saving Skills in Anesthesia 30.00

5 NSSK Training 259.20

6 F-IMNCI Training 285.00

7 IMNCI Training 1435.49

8 Pre Services IMNCI 48.00

9 Capacity Development FBNC 97.08

10 Training in Management of SAM 29.99

11 IUCD Training 270.26

12 ARSH training 400.56

13 Menstrual Hygiene 25.60

14 Induction Training for PHC Medical Officers 144.00

15 Capacity enhancement on BCC 58.09

16 Orientation Training to Cluster / District / State level Management Units

50.00

Training Strategy Total 3694.27 XI Programme Management Unit 2248.91

XII Behaviour Change Communication (BCC) 875.00

Total RCH Flexible Pool 33496.43

134

B: NRHM FLEXI POOL

B.1 CORE ACTIVITIES

181. The National Rural Health Mission (NRHM) seeks to achieve well-defined health

outcomes by 2012. The programme‟s objective is to establish an effective primary health care system that caters to the health needs of the entire rural population. The NRHM

supports a female health activist in every village; ownership of the village community in

effective management of its health and sanitation needs; strengthened primary health and the referral systems; integration of all vertical health and family welfare programme

activities; and efficient utilisation of funds and infrastructure to strengthen health

delivery system.

B.1.2 ASHA:

182. ASHA Incentives: The rural Andhra Pradesh consists of 22,912 Gram

Panchayats, 26,586 revenue villages, and 67,561 habitations. 70,700 ASHAs have been positioned during the first three years of the Mission as Health Resource Persons, who

constitute the first call of the community for all maternal and child health services,

disease prevention and health promotion activities. Of the 70,700 ASHAs, 55,400 are in

the rural areas, 10,000 in the tribal areas and 5,300 in the peri-urban / urban areas of the state.

183. The ASHA is the principal link between the community and the formal health system. She is a voluntary worker who is rewarded for her contribution to the

furtherance of well being of the community. Her focus however will be on women and

children and those affected by communicable diseases. The revised ASHA incentives is

as follows:

S N Incentive item 2010-11

1 Registration during the first trimester of pregnancy 30

2 Completion of 4 antenatal checkups, 2 TT immunization and 120

days of IFA tablets to pregnant woman

120

3 Pregnant woman having institutional delivery in government health institution

150

4 Pregnant woman having institutional delivery in private health

institution

75

5 Postnatal Care and Newborn Care for mother and neonate (each visit Rs 25)

150

6 Referral of Post-Partum Complication to a CEMONC Centre 50

7 Referral of Sick New Born baby to a SNCU 50

8 Complete Immunisation - All doses of immunization for BCG, DPT, OPV, Measles, and Hepatitis-B and Vitamin A Supplementation

150

9 Reporting of new born child with birth weight of less than 2,000

grams to the sub-centre and PHC (Rs 25); and follow-up progress on

weekly basis in coordination with Anganwadi until the weight-for-age stabilizes.

100

135

S N Incentive item 2010-11

10 Providing health and nutrition counseling to the parents and family

members in close coordination with the Anganwadi worker and

ensuring the child completes 12 months of age in a health state.

50

11 Referral of Severely Acute Malnutrition cases to Nutrition

Rehabilitation Centres and follow-up

50

12 Maternal Death Reporting to Sub-centre and PHC 50

13 Infant Death Reporting to Sub-centre and PHC 50

14 Organization of Monthly Village Health & Nutrition Day 50

15 Counseling and motivation of men for Vasectomy/NSV operation

and follow up visit.

100

16 Counseling and motivation of women for Tubectomy /DPL surgery

and follow up visit of the cases.

50

17 Motivation and Counseling for successful IUCD insertion and

retention for at least one year and intake of contraceptive Pills for one

year.

100

18 Pulse Polio Campaign (Rs 75 per day) 225

ITDA Project Areas

19 Ensuring Skilled Birth Attendance at delivery and for 48 hours after delivery in ITDA areas

100

20 Referral of pregnant mother to Birth Waiting Homes a week before

EDD; and ensuring safe institutional delivery in ITDA areas

100

21 Referral and admission of Severely Acute Malnourished (SAM) Child in Nutrition Rehabilitation Centre (NRC) and monthly follow-up

50 for admission

in NRC;

and 25 / month for

follow-up

22 Compensatory Incentive for ASHA / Community Health Worker in

the ITDA areas, considering the small population and widely scattered habitations, if the incentive package falls below Rs.400 per

month.

Communicable Disease Control Programmes

23 Identification of Malaria case, successful treatment and follow-up of

the patient for 3 months in ITDA areas

10 / case

20 Leprosy: PB – after confirmation and completion of course of treatment

MB – after confirmation and completion of course of treatment

300

500

21 Identification and successful completion of DOTS for Tuberculosis 300

184. ASHA will be rewarded for good performance on the maternal and child health

and disease prevention front. The best ASHA will be identified for each PHC,

Community Health and Nutrition Cluster, district and state levels and will be rewarded with cash grant at the annual Health Day. Any ASHA failing to ensure cent per cent

ANCs, PNCs, Immunisation, and failure to take measures to prevent and report any

case of IMR / MMR will be censured, including removal if the failure is gross or wilful.

136

185. The details of budget requirement for the payment of incentives under Maternal

Health to ASHAs are as follows:

Expected No. of Pregnant women to be registered … 17,24,000

Expected No. of live births … 15,67,000

Expected No. of Institutional deliveries … 14,99,800

Expected No. of Inst. deliveries in Govt. hospitals … 8,99,880

Expected No. of Private accredited hospitals … 5,99,920

Expected No. of Home Deliveries … 67,200

Expected No. of PNC cases … 15,67,000

Expected no.of BPL cases

Expected No. of BPL Pregnant women to be registered … 6,48,045

Expected No. of BPL ANC cases … 6,48,045

Expected No. of BPL Inst. deliveries in Govt. hospitals … 3,53,417

Expected No. of BPL Private accredited hospitals … 2,94,628

Expected No. of BPL PNC cases … 6,48,045

Review and Monitoring

186. Village Organisations: The effectiveness of ASHA‟s performance as a link worker between the community and the health delivery system – and not as the last

functionary of the health care system – will be reviewed every week by the VOs. The

ASHA along with the Anganwadi Worker and the ANM will attend the review meeting

of the village organizations. The PHC Medical Officer will join as many such meetings as possible depending on the fixed-day schedule for the PHCs. The feedback from the Nirupeda VOs will be critical in determining the effectiveness of ASHA‟s role. The

services to be provided by the health system will be publicized amongst all residents of the village through the VOs and also by writings on the wall. As mentioned above, VOs

will receive and disburse ASHA incentives from hereafter.

187. Primary Health Centre: The capacity building of ASHA is a continuous process. For this purpose, ASHA meetings are conducted on the last Tuesday of the

month in all PHCs across the state. This ASHA-DAY, which is a review-cum-capacity

building intervention, brings together all PHC functionaries for a monthly review and feedback of their work. This is also an opportunity to decide the work plan for the

following month. ASHA day will not be used for incentive disbursement for but

monitoring the VOs role in incentive administration. At the CHNC level, the Senior

Health Officer will periodically review the work of PHCs every month. Once a quarter, all functionaries of the health department will brought together at the cluster level for

information sharing and for disseminating best practices.

188. District Level: The DMHO has the overall responsibility for monitoring

and coordination of all NRHM activities in the district under the leadership and

guidance of the district collector. The District Public Health Nursing Officer (DPHNO),

who has formerly worked as the District Training Manager (DTM) in the ASHA training programme, is the Nodal Officer for facilitating and supporting the entire mid-

wifery team, including the ASHA, ANM and the Staff Nurses. The DPHNO will be

137

provided mobility to undertake field visits and galvanizes the functionaries responsible

for safe motherhood and child survival.

Budget for ASHA activities 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 ASHA Performance Based

Incentives

a) Registration of early pregnancy Incentives 30 648045 194.41

b) Completion of 4 ANCs and ensuring TT & IFA tablets

Incentives 120 648045 777.65

c) Postnatal Care & Newborn care for

mother and neonate

Incentives 150 648045 972.07

d) Referral of Post-Partum Complication to a CEMONC centre


e) Providing health and nutrition counseling to the parents and family members in close coordination with the Anganwadi worker and ensuring

the child completes 12 months of age in a health state

Incentives 50 583240 291.62

f) Referral of Severely Acute Malnutrition cases to Nutrition Rehabilitation Centres and follow-up


g) Maternal Death Reporting to Sub

centre & PHC


h) Infant Death Reporting to Sub Centre and PHC


i) Organization of Monthly Village Health & Nutrition Day

Incentives 50 70700 424.20

j) Incentives to the ASHA for promoting Institutional delivery in

tribal areas

Incentives 600 13121 78.73

k) Reporting of new born child with birth weight of less than 2,000 grams to the sub-centre and PHC (Rs 25); and follow-up progress on weekly basis in coordination with Anganwadi

until the weight-for-age stabilizes

Incentives 100 51844 51.84

Total 2890.98

2 Best ASHA Awards

a) PHC Level Best Performer Awards 1000 1624 16.24

b) Cluster Level Best Performer Awards 2000 360 7.20

c) District Level Best Performer Awards 5000 23 1.15

d) State Level Best Performer Awards 10000 1 0.10

Total 24.69

3 ASHA Day review & others

a) ASHA Conventions Conventions 100 70700 848.40

b) Providing Saree to ASHAs (2 sarees) Saree 200 70700 282.80

138


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 Total 1131.20

4 Ashas Training TOT (6&7 Modules) Training 9434 60 5.66

5 Training for ASHAs Training 97000 497 482.09

6 Translation and Printing of ASHAs modules

Printing 2000000 20.00

ASHA Total 4554.62

B.1.3 Village Health and Sanitation Committee:

189. Under NRHM, a village health and sanitation committee has been established in

every gram panchayat of the state to: (i) ensure optimal use of health service in the

village; (ii) improve participation of village health and sanitation committees in maintaining quality health and sanitation services; and (iii) prevent occurrence of

epidemics in the villages.

190. The VHSC grant would be released in two installments based on the performance

of the VHSC duly ensuring that not less than 30% of the VHSC grant is spent in

improving sanitation in the SC and ST habitations. Closer and stronger links will be

forged with the rural water supply and sanitation department (RWS &S) to ensure more effective solid waste management, potable water supply and sewage disposal. Training

would be conducted for Panchayat Secretaries in sanitation and health linkage. In

addition, IEC/BCC campaigns would be conducted in every village using popular folk media to improve sanitation, prevent water and food-borne diseases, ensure quality of

drinking water, and eliminate vector breeding sources. The best performing Panchayat in

each Cluster would be awarded a cash grant of Rs 10,000.

Activity Cumulative

Achievements so far

No. of Revenue Villages 28,123

Number of Village Health & Sanitation committees constituted 21,916

No. of Joint Account opened 21,916

Budget for VHSC Strengthening 2010-11


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

4 Village Health Sanitation Committees

a) Cash Grant of Rs 10,000 for each GP 1 10000 21916 2191.60

b) Awards for best performance 1 10000 360 36.00

Total 2227.60

139

B.1.4 Untied Funds:

191. Sub-Centre Strengthening: Every sub-centre is given Rs 10,000 annually under NRHM for undertaking activities that would contribute to NRHM objectives. This grant

would be utilised for improving effectiveness of sub-centres through improved patient

care infrastructure for maternal and child care; organising village health and nutrition

days; provision of essential services that would prevent and help manage epidemics; increased effectiveness of ASHAs through supportive supervision; and monitoring of

village health and sanitation committees; etc. These funds will be utilised essentially for

strengthening the maternal and child health services at the sub-centre level and for organising IEC / BCC campaigns for preventive and promotive health.

Total Budget required for 12,338 Sub-centers is Rs. 1233.80 lakhs.

192. PHC Strengthening: Under NRHM, every PHC is provided an amount of

Rs.25,000 per annum for improving the responsiveness and the effectiveness of the health system.

Total Budget required for 1,624 PHCs is 406.00 lakhs.

193. Each CHC is provided Rs 50,000 under NRHM every year for strengthening the

responsiveness and efficiency of the health system at the CHC level. These funds will be used for the common needs, including referral and transportation of patients in

emergency situations.

Total Budget required for 309 CHCs is Rs 154.50 lakhs.

(Rs in lakh)

Facility level Number of

facilities

Total amount

released so far

Total amount

utilized

Unspent

balance

Untied Fund for SCs 12338 1239.37 206.03 1033.34

Untied Fund for PHCs 1624 245.91 76.17 169.74

Untied Fund for CHCs 309

Untied Fund for DH 16 -- -- --

Budget for Untied Funds - 2010-11

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 1 Sub Centres 10000 12338 1233.80

2 Primary Health Centres 25000 1624 406.00

3 Community Health Centers 50000 309 154.50

Total 1794.30

140

B.1.5 Annual Maintenance Grants:

194. Maintenance Grant for SHC, PHC, CHCs: In addition to the above

provisions, every sub-centre, PHC and CHC is provided an annual maintenance grant of

Rs.10,000, Rs.50,000, and Rs.1,00,000 respectively, for improvement and maintenance of physical infrastructure. These grants are utilised through the HDS for undertaking

minor repairs, provision of water supply, toilets, sanitation and maintenance.

(Rs in lakh)

Facility level Number of

facilities

Total amount

released so far

Total amount

utilized

Unspent

balance

AMG for SCs 12338 -- -- --

AMG for PHCs 1624 290.31 127.43 162.88

AMG for CHCs 309 -- -- --

AMG for DH 16 -- -- --

Budget for Annual Maintenance Grants - 2010-11

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Sub Centres 10000 3387 338.70

2 Primary Health Centres 50000 1230 615.00

3 Community Health Officeer 100000 284 284.00

Total 1237.70

B.1.6 Rogi Kalyan Samitis:

195. The NRHM provides one time corpus grant, the RKSs of 1,624 PHCs in the state

would require about Rs 1,624 lakhs during the current financial year. Similarly, one lakh

rupees is provided to each RKS of the CHCs and Area Hospitals.

Budget for HDS - 2010-11

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Primary Health Centres 1 100000 1624 1624.00

2 Community Health Officeer 1 100000 309 309.00

3 Area Hospitals 1 100000 54 54.00

4 District Headquarters Hospitals 1 500000 17 85.00

Total 2072.00

141

B.2 HEALTH CARE INFRASTRUCTURE:

B.2.1 Civil Constructions

Budget for the Construction of Health Facility buildings - 2010-11

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 1 Sub Centres (including Tribal

SCs) Construction 900000 500 4500.00

2 Primary Health Centres Construction 4000000 100 4000.00

3 Community Health Centres Construction 7500000 25 1875.00

4 Developing the Project hospital

at Srisailam ITDA in to a multi specialty hospital for Primitive tribal Chenchu citizens.

Construction 20000000 1 200.00

5 Rennovation of SCNUs (18 SCNUs)

a) Strengthening of existing SCNUs


b) New SCNUs ( 20 bedded) Construction 3800000 5 190.00

c) New SCNUs ( 12 bedded) ( Tribal)


6 New Born Stabilization Units

a) Refurbishment Refurbishment 500000 264 1320.00

Total 12515.00

B.2.2 Strengthening of Community Health and Nutrition Clusters (CHNCs)

196. The rural Andhra Pradesh is being carved into Community Health and Nutrition

Clusters (CHNCs), with each cluster providing integrated primary health services to about one to two lakh population. At the centre of the CHNC is the first referral unit

(FRU) – a Community Health Centre (CHC) or an Area Hospital (AH) – that will

support four to ten Primary Health Centres (PHCs). The cluster hospital will also house a Senior Public Health Officer (SPHO) who will facilitate, support, co-ordinate and

monitor the functioning of all primary health institutions – PHCs and Sub-centres –

within the cluster. It is expected to integrate the ICDS institutions with the CHNC over a

period of time to integrate the much needed nutrition component with the health.

197. NRHM will support efforts to strengthen the CHNCs, which are expected to

make dramatic impact on the quality of public health in the rural areas of the state. In the coming years, the CHNC is likely to become the fulcrum for organising primary health

services in the state. In this direction, it is proposed to construct an extension to the CHC

/ Area Hospital that would house the office of the Senior Public Health Officer (SPHO)

in charge of all health and nutrition activities in the CHNC and who would be the principal officer responsible for NRHM implementation in the cluster. The SPHO will be

assisted by a number of functionaries, including a Public Health Nurse, Sub-Unit Officer

142

(Leprosy), Assistant Malaria Officer (AMO), Ophthalmic Officer, a Senior Assistant and

an HMIS unit with a MIS officer, Data Entry Officer, and an Accountant. During the current year, it is proposed to strengthen offices of one hundred SPHOs with an outlay of

Rs 5 Crores.

Budget for the Construction of Health Facility buildings - 2010-11

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Strengthening of Community

Health and Nutrition Clusters

500000 100 500.00

B.3 MANPOWER

Salaries of Additional Auxiliary Nurse Mid-wife (ANM) & MPHA(M) 198. In January 2011, the Pay Revision Commission is enhanced the salaries of

regular ANMs, accordingly, contract 2nd ANM salary have also been enhanced from

Rs.5200 pm to Rs.100,20 therefore, Of the 12,338 sub-centres currently functioning in

the state, 10,384 are financed by the central government, and the remaining 1,954 are funded by the AP government. Therefore, 10,600 sub-centres require the services of the

second ANM.

199. Action has been initiated to divide the service area of operation between the two

ANM, so that each can provide focused attention to the people under her jurisdiction.

Moreover, the mid-wifery skills of both ANMs would be upgraded within a period of

eighteen months. Both ANMs will actively move around the area of their operation and provide an effective link between the PHC and the community in providing

comprehensive preventive, promotive and curative health services.

200. As per the Govt. of India guidelines, it is proposed to recruit 2067 MPHA(Male)

and will be placed at Sub-centres.

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6 1 Salaries of Second ANM Salary 10020 10600 12745.44

2 Salaries for MPHA (Male) Salary 10020 2067 2485.36

B4. Nutrition Support Interventions:

B4.1 Village Health and Nutrition Day:

143

201. It is proposed to conduct VHNDs in 20,144 Villages in the state in 2011-12 is

provide comprehensive MCH services in the community to increase awareness on age at marriage, registration of all pregnant women at 12 weeks, 3 times check up by MPHA

(F), one time by M.O, Birth planning at 5th month of pregnancy, promotion of

institutional deliveries, Post-natal care services to be delivered women & new born child,

breast feeding practices, immunization services, promotion of spacing methods, sterilizations, vasectomies. Awareness on availability of services for communicable &

non-communicable diseases, Adolescent health, school health services etc.,

202. It is proposed to conduct in the following number of villages based on their

population.

1. For 500 – 2000 population villages once in a month at Anganwadi centre / Sub centre as per availability of good accommodation.

2. For 2000 – 5000 population – VHNDs will be organized twice in a month.

3. For 5000 to 10000 population – VHNDs will be organized thrice in a month.

a. Total no. of villages with a population between 500 – 2000 10,949 b. Total no. of villages with a population between 2000 – 5000 6,915

c. Total no. of villages with a population between 5000–10000 and above 2,286

Total 20,144 Budget required:

1) Incentives to Anganwadi teacher – Rs.50 per VHND

50 x 20144 x 12 … Rs.120.86 laklhs

2) Incentives to ICDS Supervisor – Rs.75 x 20144x12 … Rs.181.30 lakhs 3) Incentives to Anganwadi helper Rs.25x20144x12 for

mobilization of community … Rs.60.43 lakhs

Budget for Logistics: 1) Banner for each VHNDs Place – 200 x 20144 … Rs.40.29 lakhs

2) Drinking Water facilities – 500 x 20144 … Rs.100.72 lakhs

3) Examination table, four fibre chairs 1500 x 20144 … Rs.302.16 lakhs 4) Registers & Reporting formats 100 x 20144 … Rs.20.14 lakhs

5) Other investigation logistics (Uristics, Haemoglobinometer,

B.P. Apparatus) - to be arranged from untied funds to sub

centres of Rs.10,000/- component 6) Community growth monitoring charts 300 x 20144 … Rs.60.43 lakhs.

Total … Rs.886.33 lakhs

B4.2 Nutrition Rehabilitation Centers:

203. To improve the nutritional status of the children under five and reduce the Infant

Mortality Rate and under five mortality rate

144

Objectives:

1. To bring down the incidence of SAM and MAM through quality facility based

management of malnourished children in the Nutritional Rehabilitation Centers.

2. To develop a self sustainable model of community based management of malnourished children for providing a continuum of care from the NRCs to the

community with interdepartmental coordination.

Facility Based Management of SAM - Setting up of Nutritional Rehabilitation

Centers

204. The progress on under-nutrition amongst women and children is relatively slow in the state of Andhra Pradesh in spite of several schemes and programmes implemented

through the Departments of Health and Family Welfare, Women Development and

Child Welfare (WDCW), and Rural Development. The NFHS-3 (2006) revealed that 30 percent of women (15-49 Years) have a BMI below normal, 62.7 percent of women are

anemic and 79.6 percent of children between 6 to 59 months are anemic. Similarly,

among children under three years – 38.4 percent are stunted, 14.9 percent are wasted,

and 29.8 percent are underweight.

205. To address the problem of under-nutrition, the Government of Andhra Pradesh is

working at two levels – (a) at the community level through ICDS, Village Health and Nutrition Days (VHND), IMNCI, IKP etc; and (b) at the facility level through Facility

Based IMNCI (F-IMNCI) and Nutrition Rehabilitation Centers (NRCs).

206. The facility level interventions are specifically aimed at treating severe acute malnutrition (SAM) cases amongst children. All these interventions except NRCs are

described in detail at other sections of the PIP – only the NRC component is explained

here in detail.

Severe Acute Malnutrition (SAM) 207. India carries the highest burden of Severe Acute Malnutrition (SAM) worldwide.

Of all Indian children under 5 years of age, 6.8%1 are severely wasted according to the

NFHS -3, equating to more than 8 million children. The number of Indian children with SAM comprises over 40% of the total global prevalence. Andhra Pradesh is the fifth

most populated state in India with more than 76 million people. With a statewide SAM

prevalence of 3.8%2, an estimated 297,000 children in AP are suffering from SAM.

208. Government of India has approved the national guidelines for F-IMNCI which

includes specific protocols for facility based treatment of SAM. However,

implementation of the treatment protocols has not yet been fully rolled out in any states.

209. The majority of children with SAM in AP silently suffer without access to

appropriate treatment that can prevent mortality. Currently, some facilities provide

children with SAM food, such as eggs or fresh milk. While well-intended, the

1 http://www.who.int/nutgrowthdb/database/countries/who_standards/ind.pdf

2 http://www.who.int/nutgrowthdb/database/countries/who_standards/ind.pdf

http://www.who.int/nutgrowthdb/database/countries/who_standards/ind.pdf

145

unregulated amounts of nutrients in these foods, such as sodium, iron, and protein, can

increase the risk of mortality in these children and are contrary to both national and international standard of care. The F-IMNCI and Indian Academy of Pediatrics (IAP)

recommendation for therapeutic feeding of SAM children is Formula 75 (F75) for

stabilization and then Formula 100 (F100) for transition and rehabilitation. F75 and

F100 is also inpatient standard of care for SAM indicated by the WHO. These therapeutic milks have all of the nutrients needed for a child with SAM to achieve a

recommended weight gain of 10 g/kg/day during rehabilitation. Currently, however,

these therapies are not available at any facilities in AP.

Government of AP Initiatives

210. In light of these facts, the Department of Health, Medical and Family Welfare,

Government of Andhra Pradesh has issued guidelines to establish 23 Nutrition Rehabilitation Centers (NRCs) throughout AP, enabling this life saving treatment to

become a part of the state health system and has released funds and begun renovations

on the same.

211. The ultimate goal of this initiative is to ensure that children with SAM in AP

have access to treatment as defined in F-IMNCI and the WHO Guidelines for inpatient

treatment through a sustainable and scalable system. There is currently a gap between what SAM treatment protocols recommend in the aforementioned guidelines and the

current management of SAM in AP. It is envisaged that the improved provision of

treatment according to these standards will decrease the mortality rates of children due to SAM.

Progress to Date

212. A task force was formed and an Operational Plan developed to supplement the initial proposal for SAM treatment. The Operational Plan describes the organizational

structure for the project and gives a framework for development and implementation by

outlining processes for staffing, refurbishment, protocol finalization and training, supply

chain, M&E development, and SAM referral systems. Roles and responsibilities of various departments have been outlined and progress is being made. Site review and

identification have been conducted at Medical College Hospitals across AP to assess sites

for treatment capacity. The GoAP has released funds for establishment of these centers and started the renovation and equipment procurement for 23 centers across the state.

Methodology

213. Technical staff from Clinton Health Access Initiative, along with officials from CHFW, DME, APVVP, APHMHIDC, UNICEF, and Task Force members have been

visiting government medical college hospitals and district hospitals to identify

appropriate space close to pediatric units for the NRCs, in consultation with the Hospital Superintendent and Head of Department (HOD) Pediatrics of respective facilities. A list

of Phase 1 facilities was finalized, with 5 Government Medical College Hospitals in

Thirupati, Kakinada, Warangal, Vizag, and Hyderabad being selected; Hyderabad has

been chosen as the Nodal Center for the program and will serve as a training hub for future NRCs. It is expected that the first five NRCs shall be operational by April 2011

and the renovation and operationalization of the remaining 18 centers will be completed

146

shortly thereafter, creating one NRC per district and a total of 23 NRCs. Priority is

being given to the remaining focus districts under NRHM (Adilabad, Khammam, Mehaboobnagar, Ananthapur, Srikakulam, Nellore and Prakasam) that have high under-

nutrition rates amongst children, depending on infrastructure capacity noted during site

assessments.

214. Renovation of the NRCs includes refurbishment of a separate 15-30 bedded ward

isolated from non-SAM children treated at the hospital, creation of SAM treatment

specific kitchen facilities for meal preparation and storage space for food. Several other items like medical equipments and materials are being procured to make the space

functional (e.g. measuring equipment, kitchen materials, etc).

Proposed Plan 215. The Government of Andhra Pradesh has committed the expenditure for setting-

up the NRCs involving renovation work, equipment procurement etc from the funds

available under NRHM PIP 2010-2011. The work will start and is expected to be complete by July 2011.The funds required for operationalization of these NRCs,

recruitment of human resources, capacity building, incentives, food supplements and

maintenance are being requested in this year‟s PIP 2011-12. CHAI i.e. Clinton Health

Access Initiative along with UNICEF will be providing technical assistance for the program. The Clinton Health Access Initiative has committed to funding the SAM

treatment food (F75 and F-100) till March 2012. The Government would take an

informed decision regarding funding of the therapeutic food in the NRCs after March 2012 following discussions with the concerned departments and development partners.

Further details on all aspects of the proposed operational costs are included below.

Staffing of NRC Following is the proposed staffing for a 15-30 bedded NRC.

1) Pediatric Specialists cum In-charge (2)

2) Nutritionist cum-data-entry operator (1)

3) Social Worker (1) 4) Staff Nurses (6)

5) Cook cum- caretaker (2)

216. Except for the pediatrician (who will be given an honorarium) all other staff for

the NRC will be hired on a full time contract basis under NRHM.

217. In places where the NRC is located in a teaching hospital, the Medical Superintendent and HOD of Pediatrics will make sure that the NRC is mainstreamed

into the existing pediatric department. All pediatric units shall admit SAM patients to

the NRC and follow them on a unit by unit basis. The state will support the required staff for the NRC, except the pediatrician who will be drawn from existing cadre of

DME for teaching hospitals or APVVP for district hospitals. Food

218. As per treatment timelines, the stabilization phase of SAM treatment where

complications are resolved and F75 is administered takes approximately 3-7 days.

147

Rehabilitation with F100 can take anywhere from 15-25 days on average. As per

UNICEF consumption data, average consumption for a 7 kg child over the course of treatment is 2 sachets of F75 and 8 sachets of F100. Clinton Health Access Initiative

(CHAI) will support the cost of this ready to use food for the NRCs until March 2012.

After that time, GoAP will decide regarding the funding of the therapeutic food given in

NRCs.

Training

219. The health care staff recruited in the NRCs will be trained on the stabilization and

treatment of SAM children and the administration of F75/F100. WHO has prepared a 5

day training module on the Inpatient Treatment of SAM, which has been condensed into a 3 day version by Kalawati Saran Children‟s Hospital (KSCH), New Delhi. The

doctors, staff nurses and nutritionists who will be working to stabilize and treat SAM

patients in the NRC will undergo the SAM training.

220. A Training of Trainers (TOT) would first be held in Hyderabad at Niloufer

Hospital over a period of three days and conducted by national resource trainers. This

will be followed by training the remaining pediatricians, staff nurses and nutritionist from all chosen sites at Niloufer Hospital, so that first-hand exposure to an existing NRC

can be experienced. The post graduates of the pediatric departments where the NRCs

will be established will undergo a one day sensitization on SAM management at their

respective hospitals. Further details for these trainings are given in the Child Health Training section.

Incentives 1) Caregiver Incentives

221. An incentive of Rs 100 per day for wage loss, Rs 25 per day for food, and Rs 200 for transportation compensation will be provided to caregivers, who accompany and stay

with the children during the period (approximately 21 days) of treatment. In addition

similar wage, food and transportation reimbursements for patients and caregivers will be given for 4 follow up visits.

2) Community Worker (AWW / ASHA/ any other) Incentives

222. In order to strengthen linkages from the community to the SAM treatment

facility, an incentive of 100 INR will be given to the community worker who brings the

mother-child duo for admission to the NRC and whose child gets admitted. 3.) Physician Incentives

223. Teaching Hospital: The budget for the NRC including the honorarium for

pediatricians (Rs 10000/- per month @Rs 5000/- per pediatrician) will be transferred to

the HOD of Pediatrics. The HOD of pediatrics will be responsible for the smooth functioning of the NRC.

224. District Hospital: The Superintendent of the hospital will identify two

pediatricians who will be responsible for the day to day rounds, admissions and discharge of the SAM children. Each of these pediatricians will be paid an honorarium

148

of Rs 5000/- per month. The budget for the NRC will be transferred to the

superintendent of the concerned hospital.

Monitoring

225. CHAI and UNICEF will provide technical assistance to develop tools for

monitoring cases admitted to NRCs as well as overall programmatic assistance. The data collected from NRCs will be collated at state level and reviewed on a quarterly basis.

Budget

226. The following is a list of the budget requirements needed to maintain the 23 NRCs over the course of the next fiscal year.

A. Operational Cost

1) Food Cost: Costs of F75/F100 used for in-patient SAM treatment and associated transport costs of product

2) Human Resources: Salaries for all staff members of the NRC

3) Training: Training of NRC staff on stabilization and treatment of SAM patients

4) Incentives: Wage and transport reimbursements to parents of SAM patients and frontline health functionaries assisting SAM patient –AWW and ASHA; an

additional monthly stipend for physicians who volunteer to be In-charge and

maintain the NRC.

5) Contingency: A small monthly sum to each facility to replace small

items/equipment that may become damaged or missing from the NRCs.

227. NGO partners at the Clinton Health Access Initiative and Balasahyoga will be

supporting Food costs of F75/F100 for the centers until March 2012. The GoAP has released funds for Renovations and Equipment, and will bear operational costs viz.

Human Resources, Training, Incentives, and Contingency costs for the 23 centers.

Summary of the Operational budget requirement for one year for 23 NRCs ( until March 2012)

Line Item CHAI

(Cost in Lakhs)

GoAP

(Cost in Lakhs)

(A) Operational Cost

1) Food cost 92.05

2) Human Resources 301.94

3) Training *Included in Child

Health Training Section

4) Incentives 201.48

5) Contingency 13.80

GRAND TOTALS CHAI: 92.05 NRHM: 517.12

*Details in Annexure

Annexure:

OPERATIONAL COSTS FOR NRCs (RE-CURRING)

149

A.) HUMAN RESOURCES

A Cost for Human Resources

Sl

No Human Resources Quantity

Unit Cost

per

Month

(INR)

Cost per

Facility per

Month (INR)

Number of

Facilities

Number of

Months

Total Cost

( Lakhs)

1 Social Worker 1 8,000 8,000 23 12 22.08

2 Nurse 6 13,000 78,000 23 12 215.28

3 Nutritionist/Data Entry Operator 1 10,000 10,000 23 12 27.60

4 Cook/Caretaker 2 6,700 13,400 23 12 36.98

Total Human Resources Cost (Lakhs) 1.09 301.94

B.) INCENTIVES

B Cost for Incentives

BI Caregiver Incentives

Sl

No

Incentives-Caregivers and Patients Units Unit Cost

(INR)

Cost per

Facility per

Month(INR)

Number of

Facilities

Number of

Months

Total Cost

( Lakhs)

1 Wage loss compensation + Food for

each mother during inpatient care( 15 beds for 20 days)

300 150 45,000 23 12 124.20

2 # of days Wage loss compensation for

follow-up visit

20 100 2,000 23 12 5.52

3 Cost of food for caregiver and child at follow-up visit

40 50 2,000 23 12 5.52

4 Cost of Transportation for inpatient treatment ( to and fro)

40 200 8,000 23 12 22.08

5 Cost of Transportation for follow-up

after discharge

20 200 4,000 23 12 11.04

Total Caregiver Incentives Cost ( Lakhs) 0.61 168.36

BII Physician Incentives

Sl

No Incentives-Physicians Units

Unit Cost

(INR)

Cost per

Facility per

Month (INR)

Number of

Facilities

Number of

Months

Total

(Lakhs)

1 Incentive for the Pediatricians 2 5,000 10,000 23 12 27.60

Total Physician Incentives Cost (Lakhs) 0.10 27.60

BIII Community Incentives

Sl

No Incentives-Community Workers

Quantity

(per

month)

Unit Cost

(INR)

Cost per

Facility per

Month (INR)

Number of

Facilities

Number of

Months

Total

(Lakhs)

1 Incentive to Community worker to bring mother and child who qualifies to the NRC for admission and follow up

20 100 2,000 23 12 5.52

Total Community Incentives Cost (Lakhs) 0.02 5.52

Total Annual Incentive Costs for 12 facilities (Lakhs) 201.48

C.) CONTINGENCY FUND

C Maintenance/Contingency Fund

Sl

No Maintenance/Contingency Fund

Quantity

(per

month)

Unit Cost

(INR)

Cost per

Facility per

Month (INR)

Number of

Facilities

Number of

Months

Total Cost

( Lakhs)

1 Monthly fund for miscellaneous items 1 5,000 5,000 23 12 13.80

Total Maintenance/Contingency Costs (Lakhs) 0.05 13.80

D.) FOOD COSTS *paid for by CHAI

D Cost for Food Supplementation ( F75/F100)

150

Sl

No Description

Quantity

(per month)

Unit Cost

/ Facility/

Month

Number of

Facilities

Number of

Months

Total Cost

( Lakhs)

1 Cost for Food Supplementation (F75/F100) 1 33,350 23 12 92.046

*Estimated Total for Food Supplementation (F75/F100)*Supported by CHAI (Lakhs) 92.05

E.) TRAINING ON SAM TREATMENT *included in Child Health Training section

Total Supported by CHAI (Lakhs) 92.05

*Total Requested Support by NRHM (Lakhs) 517.22

GRAND TOTAL (crore) 609.27

Budget required for this scheme is Rs.609.27 lakhs

B.5 ADDITIONAL FUNDS FOR COMMUNICABLE DISEASES:

Sl.

No.

Activity Proposed

Budget

(Rs/lakhs)

1 2 3

1 RNTCP 143.00

B.6 Quality Assurance Cell for monitoring MCH activities & Trainings 228. A quality assurance cell for monitoring MCH & nutrition activities will be

established comprising of JD (MHN), JD (M&E), JD (CHI) and State Consultants

(Maternal Health, Child Health & Nutrition). For this a sum of Rs.18.00 lakhs budget is

proposed (3 JD‟s x Rs.50,000/- per month x 12). The 3 consultants will be funded by UNICEF under SPIU. These funds will be utilized for extensive MCH monitoring to the

field.

229. In the similar way district Quality Assurance Cell will be formed comprising of

Addl. DM&HO, S.O, PO DTT & DIO. These team will closely monitor MCH services

and VHNDs at village level and review this services at Sub-centre and PHC level, for this

a sum of Rs.8,000/- per person in normal districts and Rs.12,000/- in high focus / Tribal districts per district (3 x Rs.8,000/- x 9 months = Rs.2.16 lakhs & 3 x Rs.12,000/- 3

months = Rs.1.08 lakhs)

1) State Quality Assurance Cell monitoring Rs.18.00 lakhs

2) District Quality Assurance Cell monitoring Rs.3.24 lakhs

Total Rs.21.24 lakhs

B.7 MAINSTREAMING OF AYUSH

230. Recognizing the importance of Health in the process of economic and social

development and for improving the quality of life of our citizens, the Government of

India has resolved to launch the National Rural Health Mission (N.R.H.M) improving

the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and to carry out necessary

architectural correction in the basic health care delivery system. The Mission adopts a

151

synergistic approach by relating health to determinants of good health viz. segments of

nutrition, sanitation, hygiene and safe drinking water. The NRHM aim to revitalize local health traditions and mainstream AYUSH (including manpower and drugs) to

strengthen the Public Health System at all levels.

231. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of

organizational structures, optimization of health manpower, decentralization and district

management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district health system, and

operationalizing community health centers into functional hospitals meeting Indian

Public Health Standards in each Block of the Country.

232. With respect to AYUSH Department, the important goals of National Rural

Health Mission (NRHM) is „Co-location of AYUSH at PHCs/CHCs‟ and

„Mainstreaming of AYUSH‟. N.R.H.M envisages creation of AYUSH facilities in all the PHCs/CHCs in the State. The framework for implementation of NRHM is 2005-2012.

The approvals for NRHM are through Programme Implementation Plan (P.I.Ps) and

N.R.H.M promotes decentralized planning and the States are free to prioritize within the

resource envelope provided to them. The intent of co-location and mainstreaming of AYUSH is to increase the choice to patients in health care.

233. In A.P. state, it is proposed to provide AYUSH Facilities in all the PHCs and CHCs. Before the NRHM Scheme came into existence, AYUSH facilities have been

created in (253) PHCs and (39) CHCs. Therefore it is proposed to cover the remaining

PHCs/CHCs in a phased manner over a period of (3) years i.e., 2007-08, 2008-09 and

during 2009-10. Accordingly, notifications for recruitment of (491) Medical Officers, Compounders and Sweeper cum Nursing Orderlies have been issued for the years 2007-

08 and 2008-09 and staff recruited.

234. As on today the following is the status of AYUSH Dispensaries established under

NRHM Scheme in the state:

Phase-I (2007-08)

Zone

Ayur. Unani Homoeo. Naturo. Total

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

I 34 23 5 0 20 16 7 4 66 43

II 35 21 5 1 20 15 7 5 67 42

III 32 23 6 3 21 14 7 4 66 44

IV 44 34 9 4 29 26 8 3 90 67

V 47 37 12 7 23 18 8 4 90 66

VI 54 47 12 7 35 31 11 7 112 92

Total 246 185 49 22 148 120 48 27 491 354

Phase-II (2008-09)

Zone Ayur. Unani Homoeo. Naturo. Total

152

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

San

ctio

ned

Wo

rkin

g

I 34 23 13 2 18 15 3 2 68 42

II 33 20 13 2 17 12 4 2 67 36

III 34 32 14 6 16 16 4 2 68 56

IV 45 37 17 9 23 17 4 4 89 67

V 45 37 18 10 22 16 4 4 89 67

VI 54 48 23 13 27 24 6 5 110 90

Total 245 197 98 42 123 100 25 19 491 358

Grand Total

491 382 147 64 271 220 73 46 982 712

235. Each AYUSH facility is provided with the following staff on contract basis with a consolidated pay as shown against the post:

236. In this connection it is since a long time, the contractual staff are requesting to

enhance their pay w.r.t the recent Pay Revision Commission (PRC) recommendations. It

is proposed to enhance their consolidated pay to the minimum of the pay scale for the corresponding post as per P.R.C 2010. Accordingly, in this office letter

No.3793/NRHM/2009, dt.14/12/2010, the Commissioner & Mission Director

(NRHM), Hyderabad has been requested to recommend the Govt. of India for

enhancement of the pay as shown below:

Sl.

No. Designation Present pay

Enhanced

pay proposed

No. of

persons

working as on today

1. Medical Officer 9300 18030 712

2. Compounder 4800 9200 678

3. Sweeper cum Nursing Orderly 3900 6700 834

The present P.I.P for the year 2011-12 has been prepared taking into

consideration the enhanced pay.

The other components for each PHC/CHC are:

Medicines (recurring) Rs.40,000/- per year

Contingency (recurring) Rs.24,000/- per year

Equipment & Furniture (non-recurring) Rs.30,000/- per year

Sl.

No.

Name of the contract post Consolidated

pay

per month

1. Medical Officer Rs.9300/-

2. Compounder Rs.4800/-

3. Sweeper cum Nursing

Orderly Rs.3900/-

153

237. The notification for recruitment of (491) Doctors for the year 2009-10 i.e., 3rd

phase has been issued during December 2009, applications received and scrutiny over. In this connection, it is submitted that, the P.I.P for the year 2010-11 was submitted by this

Department for Rs.3297.96 taking into account the staff to be recruited under NRHM

Phase-III (2009-10) and filling up of all the vacant posts of Phase-I and Phase-II i.e., for

(1473) AYUSH Facilities. However, as per record of proceedings of NRHM Programme Implementation Plan for the year 2010-11, an amount of Rs.2074.00 lakhs only has been

approved under Mainstreaming of AYUSH.

238. Further, during the brain storming session on preparation of State PIP 2011-12 on

28/11/2010, the Principal Secretary, HM&FW Department has instructed that no

further expansion of AYUSH Department. Therefore, the present P.I.P for the year

2011-12 does not take into consideration the staff to be recruited under the 3rd phase and

the vacant posts existing presently.

Coordination issues between AYUSH and Allopathic staff – G.O issued:

239. After establishment of AYUSH Facilities in PHCs/CHCs, certain coordination issues arose between the AYUSH and Allopathic staff. On this Govt. vide

G.O.Ms.No.202, HM&FW (R.2) Department, dt.17/09/2009 have issued certain

instructions for streamlining the working of newly crated AYUSH units in PHCs/CHCs.

Among other points, according to the G.O the Incharge PHC/CHC should provide leadership and supervision to the AYUSH Unit.

Compounder Training programme:

240. By the end of Jan. 2010, (548) Compounders recruited under NRHM Scheme (Phase I & II) have been provided (2) weeks training programme in the AYUSH

Colleges. Steps are being taken to provide training to the Compounders who have not

yet trained.

Doctors Training programme:

241. All the AYUSH Doctors recruited under NRHM scheme are being provided (4)

days training programme at Indian Institute of Health and Family Welfare Department,

Vengalrao Nagar, Hyderabad in batches of (35) Doctors, system-wise. The approximate

expenditure towards training of each batch is Rs.1.00 lakh. So far (13) batches of the training programmes are over and (403) Doctors have been trained (215-Ayurveda, 62-

Unani, 92-Homoeo., 34-Naturo.) on “Mainstreaming of AYUSH”. The remaining

Doctors will be trained during 2011.

242. A summary of budget as per the broad functional head is given below. This

proposal is only for the activities which are to be taken up with the assistance from

NRHM Flexi-pool to be sanctioned by Dept. of Health, Ministry of Health and Family Welfare, Govt. of India. The other components ex. Medicines, equipment, furniture, contingency

etc. will be projected to Dept. of AYUSH, Ministry of Health and Family Welfare, Govt. of India.:

S. No.

Main Heads Components Budget Amount

(Rs in lakh)

154

1. Human

Resource

Payment of AYUSH Medical Officers (712

Doctors x Rs.18030/- x 12 months)

1540.48

Payment to other AYUSH staff:

Payment to AYUSH Compounders (678 Compounders x Rs.9200/- x 12 months)

748.51

Payment to AYUSH S.N.Os (834 SNOs x

Rs.6700/- x 12 months)

670.54

2. Other Mission activities

Nil -

Total 2959.53

OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11

Activity Financial Physical

2009-10 2010-11

(upto 30/09/2010)

2009-10 2010-11

Amount

Approve

d

Exp Amount

Approve

d

Exp Expecte

d

Output

Achiev

ements

Expect

ed

Output

Achieve

ments

Mainstreaming of AYUSH

1722.10 1168.67 2074.00 561.01 - 22.21 lakhs avg.

- 11.10 lakhs avg.

POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS:

HR policies for Doctors, Nurses paramedical staff and programme management staff:

243. As mentioned earlier, each AYUSH Dispensary is provided with one Medical

Officer, one Compounder and one Sweeper cum Nursing Orderly (S.N.O).

244. Before the NRHM scheme was implemented, the post of Nursing Orderly and

Sweeper cum Scavanger were existing as two different posts. However as it was proposed to allot only (3) category of personnel for each AYUSH Dispensary, the post of

Sweeper cum Nursing Orderly was created.

245. While filling of all the posts, the Presidential Orders on zone-wise reservations and roster points were followed. The recruitment of Medical Officers was done in the

Commissionerate office itself and the (6) Regional Deputy Directors who are the

appointing authorities for the posts of Compounders and Sweeper cum Nursing Orderlies completed the recruitment process.

246. All the appointments were made on contract basis and their contract is being

renewed every year for another.

Accountability and Performance appraisal:

247. The AYUSH staff are working in the PHCs/CHCs. With a view to solve the

coordination issues that arose between the AYUSH staff and allopathic staff, the Govt. vide G.O.Ms.No.202, HM&FW (R.2) Department, dt.17/09/2009 have issued certain

instructions for streamlining the working of newly crated AYUSH units in PHCs/CHCs.

155

Among other points, the Incharge PHC/CHC should provide leadership and supervision

to the AYUSH Unit. The attendance certificates to the AYUSH staff is also being issued by the concerned I/c. PHC/CHC.

Policies on drugs, procurement system and Logistics management

248. It is proposed to provide medicines worth Rs.40,000/- to each AYUSH Dispensary established under NRHM scheme. Further there are (3) Pharmacies one each

in Ayurveda, Unani and Homoeopathy functioning under the control of this

Department.

249. A Committee was constituted for making recommendations for purchase of

medicines, furniture and equipments to be supplied to the newly established units under

the NRHM scheme. As per the recommendations of the Committee and after obtaining permission from Govt. orders were placed for supply of Ayurvedic medicines on

IMPCOPS, Chennai and for supply of Unani medicines on Indian Medicines

Pharmaceutical Corporation Ltd (IMPCL), Almora, Uttaranchal as the Govt. Indian Medicine Pharmacies Ayurveda and Unani expressed their inability to manufacture and

supply the medicines required for the NRHM Dispensaries. However, Homoeo.

Medicines are being supplied through the Govt. Homoeopathy Pharmacy,

Ramanthapur, Hyderabad.

Equipments:

250. A Committee was constituted for making recommendations for purchase of

furniture and equipments to be supplied to the newly established units under the NRHM scheme. The Committee proposed to procure the furniture and equipments from

A.P.Health Medical Housing Infrastructure Development Corporation (APHMHIDC),

Hyderabad. Accordingly the essential functional equipments were supplied through the APHMHIDC.

Ambulance Services and Referral Transport

251. Ambulance services and referral transport facilities are not provided by this

Department.

Maintenance of buildings, Sanitation, Water, Electricity, laundry, kitchen

252. The AYUSH Dispensaries are established in the premises of the existing

PHCs/CHCs. The Govt. have ordered the Incharge of the PHC/CHC to provide space around 800 Sq. ft. to the AYUSH Dispensaries. The maintenance, sanitation, water,

electricity etc., is being looked after the PHC/CHC only.

Diagnostics:

253. The AYUSH Doctors practice their own systems of medicine, and if required and

the situation warrants may prescribe diagnostic tests.

156

Patient’s feedback and grievance redressal

254. Govt. in G.O.Ms.No.202, HM&FW (R.2) Dept., dt.17/09/2009 while addressing the coordination issues among other things have made the I/c of the

PHC/CHC as the overall Supervisor and also to provide the leadership to the AYUSH

units. The grievances will be received by the I/c. of the PHC/CHC. However the

Regional Deputy Directors are the immediate controlling Officers for the Dispensaries. If any grievance is received by them it is promptly attended to.

IEC

255. In all the P.I.Ps for the three phases 2007-08, 2008-09 and 2009-10 the component „Preparation and distribution of IEC material on AYUSH‟ has been approved for

Rs.15.00 lakhs. However funds were not released therefore the IEC activities have not

been taken so far. However the same is proposed to be taken up shortly.

Monitoring and Review

256. Regular meetings are held at regional levels by the Regional Deputy Directors of

this Department.

AYUSH Manpower

Manpower Component Continuing

from previous

year

(2010-11)

New proposed

during 2011-12

Cumulative for

2011-12

Institution Number Amount (Rs

in Lakhs)

Number Financial

(Rs in Lakhs)

AYUSH Doctors PHCs 639 - - 639 1382.54

CHCs 73 - - 73 157.94

DHs - - - - -

Paramedical Staff (AYUSH)

PHCs Comp. 608 - - 608 671.23

SNO. 746 - - 746 599.78

CHCs Comp. 70 - - 70 77.28

SNO. 88 - - 88 70.75

DHs - - - -

Training of AYUSH Manpower

Name of Training

Category Trained till date

Year 2010-11

No. of Batches

Duration Training Load Financial (in Lakhs)

Mainstreaming of AYUSH

Medical Officers

403 13 4-days 35 Doctors per batch Rs.1248517/-

Compounder Training Programme

Compounders 548 33 2-weeks Approx. 16 Compounders per

batch

Rs.1395749/-

Total 951 46 Rs.2644266/-

157

Support from Department of AYUSH for PIP 2011-12:

Co-location under NRHM:

S. No.

Centre One time assistance Recurring assistance Total Amount No. of

Units Amount New

Units Old

Units Cumulative

Amount

1. PHC 117 Rs.12.60

crores

Rs.12.60

crores 2. CHC 11

3. DH -

Total 128

Note: An amount of Rs.12.60 crores is released by Govt. of India for relocation of (128)

AYUSH units established under NRHM scheme. The amount has been deposited in the

P.D account of the APHMHIDC and construction work of the buildings is under progress.

Upgradation of AYUSH Hospitals:

S.

No. Centre

One time assistance Recurring assistance Total

Amount No. of

Units Amount

New

Units

Old

Units

Cumulative

Amount

1 - 17 Rs.706.00 lakhs

- - - Rs.706.00 lakhs

Note: In this office letter No.2430/Bg.IV/2010-2, dt.06/09/2010 proposals have been sent to the Govt. of India for release of grant-in-aid towards upgradation of AYUSH

Hospitals. The release of funds is awaited.

Up gradation of AYUSH Dispensaries: (Rs. in lakhs)

S.

No. Centre

One time assistance Recurring assistance Total

Amount No. of

Units Amount

New

Units

Old

Units

Cumulative

Amount

1. 1039 10390.00 - 103.90 103.90 10493.90

Note: In this office letter No.2430/Bg.IV/2010-2, dt.06/09/2010 proposals have been

sent to the Govt. of India for release of grant-in-aid towards upgradation of AYUSH

Dispensaries. The release of funds is awaited.

i) Establishment of Programme Management Unit (AYUSH)/HMIS

S.

No.

State One time assistance Recurring assistance Total Amount

1 A.P. 2009-10 – GOI

share – Rs.1.25

- Rs.1.25

2010-11 – GOI

share – Rs.5.00

- Rs.5.00

Total Rs.6.25

Note: Govt. of India have sanctioned 2.50 lakhs and 10.00 lakhs as grant-in-aid under

the C.S.S for Mainstreaming of AYUSH under NRHM for the setting up of P.M.U for

158

(12) months for the years 2009-10 and 2010-11 and released an amount of Rs.1.25 lakhs

and 5.00 lakhs respectively as 50% central Govt. share for implementation of the scheme towards setting up of Programme Management Unit (PMU). The Commissioner, Family

Welfare has been requested to release this amount to this Department. The State Govt.

has also been requested to release its share

ii) Procurement of Essential Drugs for AYUSH Hospitals and Dispensaries

S. No.

Unit Stream Recurring assistance

Total Amount

1. 990 Ayurveda - 465.25

2. 517 Homoeo. -

3. 354 Unani -

Budget proposed under AYUSH program for 2011-12

S N Main Heads Components Budget

Amount

(Rs in lakh)

1. Human

Resource

Payment of AYUSH Medical Officers (712

Doctors x Rs.18030/- x 12 months)

1540.48

Payment to other AYUSH staff:

Payment to AYUSH Compounders (678

Compounders x Rs.9200/- x 12 months)

748.51

Payment to AYUSH S.N.Os (834 SNOs x Rs.6700/- x 12 months)

670.54

2. Other Mission

activities

Nil -

Total 2959.53

B.8 CUG Mobile connection to Tribal areas ANMs

S

N

Activity Unit Rate

(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 CUG Mobile connection to Tribal areas ANMs

500 2050 123.00

159

B.9 NACP (APSACS)

Expansion of ICTC and PPTCT services to all 24 X 7 health facilities:

257. AP has a total number of 1624 PHCs, of which 266 already have the Nurse practitioner model ICTC and 295 have Facility Integrated ICTC. The remaining 1063 24

PHCs don‟t have any services of ICTC. Below table indicates the situation analysis of

PHCs with ICTC facility.

Expansion of ICTC & PPTCT services to all PHCs-Situational

Analysis

S.No PHCs Number of facilities

1 Total PHCs in the state 1624

2 PHCs covered by Nurse Practitioners 260

3 PHCs covered by Facility integrated

ICTC 295

4 PHCs not covered by any kind of ICTCs 1063

Need of Standalone ICTCs in 429 priority mandals: Currently there are three categories of ICTCs in the State:

a. Standalone ICTCs where a Full time Counsellor and Lab technician is placed. There are 411 Standalone ICTCs in the state of AP

b. Facility Integrated ICTC (Government & Private) Sites (where an existing lab technician is trained in HIV testing and existing Staff nurse is trained in

counseling). There are 225 in private and 295 in Govt FICICT ICTCs in the state

of AP

c. Mobile ICTC: Where a full time counselor cum lab technician is placed in the mobile van to provide ICTC services. There are 23 Mobile ICTCs in the state of

AP

Nurse Practitioners Model project of APSACS:

o NPs and Standalone ICTCs: This was taken up as PHC enhancement project in 10 high prevalent districts where the Nurse practitioners

(NPs) were placed in 266 PHCs, providing comprehensive HIV/AIDS

services which include HIV/AIDS counselling, testing, PPTCT and

outreach services. PPTCT services include HIV Counselling and testing of pregnant women and administration of prophylactic

Nevirapine to HIV +ve pregnant women and their babies in order to

prevent the peri-natal transmission of HIV along with outreach activities in the periphery. All the 266 PHCs were standalone ICTC

where uniquely the nurse does HIV testing, counseling and provide

PPTCT services and outreach. o NPs Standalone ICTCs converted to FI-ICTCs: NPs model transitioned into

Integrated with NRHM as :In view of the overall policy to integrate

HIV/AIDS into the general health system, services of all the 266 Nurse

Practitioners were taken up by NRHM and placed at different PHCs and CHCs in the state. All the 266 standalone ICTCs were converted to FI-ICTCs where

NPs were given the role of HIV counseling and doing more regular PHC taks.

o FIICTC model is not functioning effectively compared to standalone

ICTC:

160

Based on the data in the year 2010 it was evident that the

FICICT model (facility integrated) is not functioning as effective as standalone ICTCs, which is reflecting adversely on

the overall performance of testing and counseling services in the

state.

The data of HIV testing at PHCs manned by NPs (Now as staff nurse) is studied for the last one year and observed that the

performance has reduced drastically (the number of testing

reduced by 90 %). In Nov and December 2009, the average 35457 tests have been conducted when the NPs managed

facility were functioning as standalone ICTC and average of

3360 HIV tests conducted during the corresponding period

(Nov-December of 2010) when the services converted to facility integrated ICTCs.

There is a decrease in non ANC testing to the extent of 25,000

per month from 1 lakh and ANC testing dropped from 85,000 to 65,000 test per month. As the Nurse Practitioners were engaged

only in HIV counseling and they were assigned many other regular

and general tasks at the PHCs.The data presented below is

captured for the corresponding period during Nov 2009 (Standalone model existing) VS Nov 2010 (Facility integrated

model existing).

o At this rate of HIV testing it will be difficult to achieve the annual

target for testing and keeping in view the crucial juncture where state is showing the down trend in the HIV prevalence it is important to

sustain the response for at least next 2 years so that the program

achievements can be consolidated.

Convergence Plan 2011-12:

Selection of 429 Standalone ICTCs: The criteria for selection of high

priority mandals for standalone ICTC and list of mandals o Mandals which are not having standalone ICTC currently and meeting

at least one of the following mentioned criteria:-

1) ANC positivity 1% or more (with minimum 200 pregnant women tested in reference period)

161

2) Pre-ART registration of 100 or more

Above mentioned criteria suggest us the mandals with established epidemic and hence would be a priority for testing

facilities scale up.

o Overall 429 mandals were identified based on need for ICTCs scale up

which is supported by CMIS data (National MIS). Table summarizes district wise scale up while mandals details are in Annexure II. More

detail planning will be done by identification of the health facility for

scaling up of testing and counseling services.

Table 1:- District wise Priority Mandals

S N District Priority

Mandals

S N District Priority

Mandals

1 Adilabad 3 13 Nalgonda 29

2 Anantapur 15 14 Nellore 19

3 Chitoor 12 15 Nizamabad 20

4 East Godavari 34 16 Prakasam 38

5 Guntur 40 17 Ranga Reddy 14

6 Kadapa 14 18 Srikakulam 12

7 Karimnagar 25 19 Vijayanagaram 1

8 Khammam 19 20 Visakhapatnam 20

9 Krishna 37 21 Warangal 9

10 Kurnool 13 22 West Godavari 35

11 Mahabubnagar 5 Grand Total 429

12 Medak 15

258. The detail analysis of the village and mandal wise data indicates that the

existence of key villages in priority and low-priority mandals varies but important to

control the epidemic. However, in view facility availability and controlling the epidemic

the expansion of the facility is important. The figures below indicates the distribution of key villages in the priority and low-priority mandals which is evident to show the spread

of HIV infected.

Priority mandals with key villages Low-Priority mandals with key villages

259. Proposal for 2011-12 is to Establish 429 stand alone ICTCs : Out of the total 429 ICTCs proposed, the existing 266 NPs would continued under NRHM funds where

they provide HIV counseling, testing and outreach alone and have limited interface in

162

the day to day duties of a staff nurse and appoint NPs in the remaining 163 ICTCs. (

429= existing NPs 266+ New 163 NPs).

Budget

260. The detail budget for both the models is presented below. The budget only includes the cost of human resource and the basic maintenance of the center. Till the

time of overall convergence with NRHM APSACS will continue to provide the testing

kits and the necessary training.

Budget

Component/Activity Units Amount in lakhs

i. Salaries of NPs 429 x 12,000 per head per month x 12 months (continue 266 existing NPs

+163 new NPs to be recruited)

61,776,000

B.10 Strengthening of RCH services through CHNC

261. Each CHNC will be provided a lumpsum of one lakh for addressing local needs and emergencies. An additional of four lakhs to be provided to each CHNCs where IMR

and MMR is high. 100 such CHNCs with more number of poor performing mandals will

be provided with this additional budget. These were identified based on the list of poor

performing and mandal with high mortality rates as provided as by planning department, Govt of AP.

B.11 PHC mobile for strengthening RCH services

262. To strengthen RCH services and to generate demand for deliveries at public health facilities, PHC mobile is being operationalised. This Mobile PHC will visit every

village at least once a month to provide MCH services, Review MCH team performance

at village level, tracking of pregnant women and children, supportive supervision to the

services provided by MCH team at Village level. This Mobile PHC will comprise of MO, CHO (F)/PHN, ANM & LT. For this Rs 220 per Village (Rs 70 for doctor and 50 for

other staff) is budgeted.

B.12 PG Diploma Course in Public Health

263. The government is in the process of amending its service rules to make it

mandatory for any member of the AP Health Service to possess PG diploma / degree for appointment as DMHO/ Additional Director / Director of Health Services. In this

direction, it is proposed to train doctors in one year PG Diploma in Public Health

Management course at IIPH, Hyderabad in two batches. The cost of training is expected

to be about Rs 150 lakhs, of which 50% will be financed from NRHM.

163

BUDGET ABSTRACT FOR RCH FLEXIBLE POOL

(Rupees in lakhs) S N Activity Budget

proposed

2011-12

1 Strengthening the Role of ASHA

a) ASHA Performance Based Incentives 2890.98

b) Best ASHA Awards 24.69

c) ASHA Conventions 848.40

d) Providing Saree to ASHAs (2 sarees) 282.80

e) Ashas Training TOT (6&7 Modules) 5.66

f) Training for ASHAs 482.09

f) Translation and Printing of ASHAs modules 20.00

2 Village Health Sanitation Committees 2227.60

3 Untied funds

a) Sub Centres 1233.80

b) Primary Health Centres 406.00

c) Community Health Officeer 154.50

4 Annual Maintenance Grants




5 Hospital Development Societies (HDS)

a) Primary Health Centres 1624.00

b) Community Health Officeer 309.00

c) Area Hospitals 54.00

d) District Headquarters Hospitals 85.00

6 Construction of Health Facility Buildings



c) Community Health Centres 1875.00

e) Developing the Project hospital at Srisailam ITDA in to a multi specialty

hospital for Primitive tribal Chenchu citizens.

200.00

f) Strengthening of existing SCNUs 190.00

g) New SCNUs ( 20 bedded) 190.00

h) New SCNUs ( 12 bedded) ( Tribal) 240.00

i) Refurbishment of New Born Stabilization Units 1320.00

7 Strengthening of Community Health and Nutrition Clusters 500.00

8 Salaries of Second ANM 12745.44

9 Salaries for MPHA (Male) 2485.36

10 Procurement of Equipment & Medicines 4022.25

11 Nutrition Support Intervention

a) Village Health & Nutrition Day 886.33

b) Establishment of Nutrition rehabilitation centers (SAM) 609.27

12 RNTCP 143.00

13 Quality Assurance Cell for monitoring MCH activities & Trainings 21.24

14 Mainstreaming of AYUSH 2959.53

15 CUG Mobile connection to Tribal areas ANMs 123.00

16 Salaries of NPs (Nurse Practioners) 617.76

17 Strengthening of RCH services through CHNC 760.00

18 PHC mobile for strengthening RCH services 686.40

19 PG Diploma Course in Public Health 75.00

Total NRHM Flexible Pool 51035.80

164

C. IMMUNISATION

Executive Summary

264. To bring down IMR from 49 to 30 we are proposing in Child Health Component Rs.74.26 crores to provide new born care to cut short neonatal deaths by implementing

NBCCs, NSUs and SCNUs in Subcentres, PHCs, CHCs, district hospitals, area hospitals

and medical colleges in a phased manner.

265. To strengthen the routine immunization in the state we are proposing Rs.32.93

crores for vaccine delivery, proper cold chain maintenance, and for programme

implementation.

Key objectives defined in specific measurable units

IMR (SRS 2010) - 49 per thousand live births

Goal Overall NRHM 2012 - 30 per thousand live births

Goal Annual 2011-2012 - 44 per thousand live births

266. To cover all the children especially focusing on vulnerable groups who are

missing routine immunization such as beggars community, fishermen community, nomadic tribes, migratory families, construction labour, urban slum dwellers, residents

of peri urban areas, overlapping surrounding Panchayats, new colonies out side the

towns, tourist groups, families with working hours that do not coincide with the team visits, agricultural families living/working in the fields

Situational analysis of the State Immunization Programme:

267. Andhra Pradesh follows the 7-vaccine schedule. The prescribed Immunization schedule is to be completed before the child completes one year. In A.P. State the

Immunization is implemented as a part of Routine Immunization. The Immunization is

being provided to the children through 1624 PHCs / 12522 Sub Centers under the

supervision of Medical Officers. At the secondary level through hospitals i.e. area hospitals and district hospitals which are functioning under the control of A.P. Vaidya

Vidhana Parishad and specialized treatment is being provided through teaching

hospitals. The ANMs conducts a large percentage of the Immunization in rural areas on designated days i.e. Wednesday (SC headquarters sessions) and Saturday (outreach

sessions) every week. Every ANM is supposed to cover 5000 population. The expected

pregnant women (1737000) and infants (1493000) are going to be benefited by

immunization programme.

268. The performance on the Immunization front has been showing a steady

improvement due to the activities undertaken under NRHM. The ASHAs are also playing vital role in mobilization of children to the Immunization sites to ensure timely

immunization and to sustain high coverage of immunization by contributing their share.

165

Current scenario of implementation of Immunization Programme:

a) State-level coverage as per District-Level Household Survey DLHS-3, Coverage

Evaluation Survey 2009, and reported coverage for 2009-10, 2010-11 upto

December 2010.

S N Coverage Fully immunization 1. DLHS-3 67.1%

2. CES (UNICEF-2009) 68.0%

3. Reported coverage (2009-10) 100.16%

4. Reported coverage (2010-11) upto December 96.09%

b) District-wise coverage level of all antigens for 2009-10, 2010-11 up to December

(including Hep-B and J.E.).

S N Antigen 2009-10 2010-11 up to

December

No. % No. % 1. BCG 1524311 102.83 1049376 99.16

2. OPV 3rd dose 1496934 100.98 1021658 96.54

3. DPT 3rd dose 15009199 101.25 1023007 96.67

4. Hep-B 1496838 100.97 999462 94.44

c) Reasons for shortfall

269. Though the achievement is 100% over target in the districts as per the reports

received from the districts, there are some PHCs and SCs where the performance is low due to various reasons such as vacancy of posts, irregular supplies of vaccines, natural

calamities, and sudden absence of field staff for various reasons. However, the sessions

are being conduct by hired ANMs in the areas where the posts are vacant to improve immunization coverage. The matter is being reviewed in the meetings of DIOs and

through video conferences for improvement of immunization coverage in the low

performing units.

d) Reporting and incidents of VPDs:

270. There were no outbreak of Diphtheria, Pertusis, and Tetanus. The incidents of Diphtheria, Pertusis, Tetanus and Measles have come down due to successful and

effective implementation of routine immunization activities.

e) Reporting and Response to outbreaks and AEFIs:

271. The state-level and district-level committees have been formed under AEFI.

Instructions were issued to convene district-level AEFI committees once in three months. During the year 2008 eleven number of AEFI cases have been reported from

different districts. In every case the Expert Committees from medical colleges formed as

per the G.O.Ms.No.596 dt.14.12.2007 have been requested to investigate the cause of

death. Line Listing Formats on AEFI for the 2008-09 (up to August) are furnished in the enclosed statements. In respect of the cases for which investigation was made the cause

of death was declared not due to immunization.

166

1) Strategy for further improving routine immunization:

a) The target of immunization coverage for this year is 14,94,000.

b) Districts identified for poor access in the A.P. state are – Adilabad, Khammam,

Mahabubnagar, Warangal, Anantapur and Nellore. The districts are covered hard

to reach, scattered, remote areas and the migratory population from neighbour

districts also more. Special focus is being given to the above districts for improving routine immunization by covering migratory population.

c) One of the reasons for drop outs reflected by DPT3 coverage is migration, in

addition to deaths occurred if any. However the DMHOs have been requested to instruct the field staff to record the status of providing DPT3 in their records who

got DPT3 vaccination in other places. In case of permanent migration, the details

of DPT3 administration will not be available.

d) The awareness among community regarding immunization is being given to all the parents through the ANMs, AWWs, ASHAs and ITDA staff. In addition to

that emphasizing the importance of immunization through IEC.

e) The following steps have been taken for effective implementation of immunization programme.

Reviewing immunization activities frequently with DMHOs / DIOs and also

visiting the allotted districts by state officers for monitoring the immunization

activities in the districts.

Conducting village health day in the villages once in a month for providing

immunization and treatment for minor ailments.

Organizing immunization catch-up campaigns in tribal districts.

Organizing Measles and AFP surveillance campaigns.

PPI campaigns etc.,

By publicizing through IEC activities to bring awareness in all sections of

public about the immunization particularly in the SC/ ST and weaker section

areas, habitations and outreach areas.

In addition to the Health staff 70,700 ASHA workers are also actively

involved in mobilization of children and pregnant women to the

immunization sites.

Hiring the services of retired / pvt. ANMs for conducting Immunization

sessions wherever the regular ANM post is vacant in sub-centres.

Hiring the services of retired / pvt. ANMs for conducting Immunization

sessions in slum and underserved in urban areas.

167

Japanese Encephalitis vaccination is introduced in routine immunization in

the districts where campaign is over.

Hiring the services of Refrigeration Mechanics in the vacancies caused due to

death / promotion / removal of services etc.

3. Micro plans have been updated in all the districts in the state for the year 2010-11.

4. Roles and responsibilities of ANMs.

Wherever 2nd ANM posts are filled up the area has been demarcated among both

the ANMs and the services to be provided are one and same. The responsibilities

of ANMs are

To register pregnant women and to be given ANC and track the drop out pregnant women to provide ANC.

List of all eligible children below 1 year to be prepared and given

immunization services including drop out children.

To update the service register and immunization card.

To administer Vitamin-A along with Measles.

Every child is to be weighed and suggest the parents of the baby who is under

weight about nutrition, post-natal care, breastfeeding / complimentary feeding, diarrhea and home management, ARI, safe drinking water, sanitation

etc.

5. Mechanism of coordination between AWW and ASHA.

272. The immunization sessions will be conducted mostly in AWW centres where the

ANM, AWW and ASHA will participate. The ASHA worker always coordinates with ANM and motivate the parents to get their children to immunization sessions for

vaccination. ASHA will be made available the list of children to be brought to the

session on par with ANM. The ASHA and ANM performs door to door visit to update

the list of children with newborns. Name based registry is in practice in the state to track all the children for immunization.

6. Alternative vaccine delivery system.

273. The ANM or Health Worker will carry the vaccines to immunization sites by

local means such as cycle, motorbike, boats, etc. by paying Rs.50/- per session.

274. It is observed that immunization coverage is low in the areas where the

vulnerable groups like beggers, fishermen community, nomadic tribes, migratory families

are living. To improve coverage in the above areas, it is proposed to engage two vehicles

per PHC per month to conduct immunization sessions.

168

2) Status of RIMS implementation:

275. The RIMS data from the districts and state hqrs. could not be uploaded due to

technical problems in the software. This has been brought to the notice of GOI by the

district / state hqrs. authorities for rectification. The problem still exists.

276. The RIMS training was provided to all the DIOs, SOs (UIP), Computer

Assistants of all districts during the year 2006. Many posts of DIOs and SOs (UIP) are

filled up by promotion and they are required training on RIMS. If orientation training to the newly posted DIOs, SOs (UIP) and Computer Assistants and reorientation training

to other staff is provided that would be helpful in uploading data of RIMS.

3) Partner agencies:

277. The immunization activities are being implemented in the state with the support of

following partner agencies.

i) National Polio Surveillance Project (WHO)

ii) PATH India

iii) UNICEF.

iv) Rotary International v) Care, etc.

Supervision and Monitoring:

The Joint Director (Child Health & Immunization) and State EIP Officer is the state programme officer for implementing and monitoring immunization activities under

the head of Commissioner of Health & Family Welfare.

All the Program Officers of this office have been allotted certain districts to supervise and monitoring the Immunization Programs.

In all Health Campaigns such as PPI, Measles, Vitamin – A, the monitoring cells are

being established in the districts. All Program Officers of this office including RDs,

SMOs, will be monitoring the Health Campaigns.

At district level the District Immunization Officer is implementing and monitoring

immunization activities in addition to the other programme officers such as Addl.

DMHOs, District Leprosy Officers, District Malaria Officers, etc.

The DIOs review meetings are being conducted almost every month and reviewed the progress of Immunization.

Regional review meetings with DIOs are also being conducted as and when it was

felt necessary.

Reviewed in Video Conferences fortnightly along with other NRHM activities.

169

Medical Officers are implementing and monitoring immunization activities at PHCs

and sub-centre level by field visits and reviewing the progress in weekly meetings of supervisors, ANMs, etc.

The District Collectors and DMHOs will review the progress of immunization in the

monthly medical officers meeting.

The ANMs are maintaining survey registers duly updating the information of new cohorts for all vaccines and stock registers and conduct the immunization sessions by

carrying the vaccines and AD syringes as per the beneficiaries available in survey

registers.

The ASHAs and Anganwadi Workers also prepare a list of beneficiaries to be mobilized for immunization sessions.

o Every Wednesday and Saturday the state hqs. contacts the DIOs regarding the

sessions conducted at the grass root level on the fixed days.

o The name-based tracking system will be strengthened to enable effective monitoring

of all immunization activities.

o It is also proposed to establish a State Monitoring Cell at state hqs. To track and

monitor all immunization activities.

Risk analysis

Vaccine vans in almost all districts are in condemned stage as they were supplied to districts long back and chain of letters addressed to Govt. of India to supply new

vaccine vans.

The vehicles of DIOs are frequently going out of order and need major repairs. Some

vehicles are beyond repairs and need replacement or the DIOs are to be permitted to hire the vehicles. However certain amount has been projected in the PIP for the

repairs of DIO vehicles.

Generators supplied to district and regional stores long back and requires frequent

repairs and also budget to be released for procurement of fuel particularly in summer. The spare parts are not available in the local market and needs replacement of

generators in the districts.

The Vaccine carriers along with spare Ice packs are also supplied to the districts three years back and there is demand from districts for supply of new vaccine carriers. As

per GOI norms the shelf life of vaccine carriers is only three years. Hence new

vaccine carriers in large quantity is required for the state. The vaccine carriers are to

be supplied either by Govt. of India or to permit the state to procure vaccine carriers through rate contract firms of GOI with the financial support of GOI.

The vaccines such as Measles, Hep-B and some times OPV are not being supplied by

Govt. of India regularly inspite of several letters addressed to GOI due to which the full immunization is not up to mark.

170

AEFI - Certain deaths are being reported from the districts about which the parents

are alleging that the deaths are occurred due to vaccination of various vaccines and the AEFI Expert Committee committees constituted in govt. medical colleges are

proceeding to the scene of occurrence and investigating the cause of death. The

paediatricians are requesting to make arrangements for payment of DA and engaging

vehicle for their travel to avoid delay in investigation. Therefore the budget is projected in PIP.

Expected outcomes

The state remained polio free from 2008.

Neonatal Tetanus has been eliminated and Certified by WHO.

Measles cases being reported but much less than what it used to be.

A.P. is the first state to include Hep-B (in RI), AD Syringes, Disposable Syringes,

Waste Management Systems - sustaining it with the support of GOI.

IMR - reduced from 59/1000 (2003 SRS) live births to 49 / 1000 live births as per SRS (2010). By 2012 it is proposed to reduce IMR to 30 / 1000 live births.

However, the state is not content still and is on path to achieve total coverage and

NRHM objectives with the financial support of Govt. of India.

Special features

278. Certain new interventions are proposed in the PIP to fill up the gaps noticed

earlier and also budget proposals prepared by giving special focus to high focus districts.

Budget analysis

279. The NRHM activities are introduced in the middle of 2005 and the expenditure

was very less. From 2006 onwards the expenditure went on increasing. Though all the activities are being implemented in the districts the reporting of expenditure was poor

due to non collection of expenditure particulars from periphery levels. However, the

expenditure particulars are available with NRHM monitoring section.

Basic information of the State/UT related to Immunization Programme

Position Name & Designation Contact No./Email

State Immunization Officer Dr. T. Neerada Joint Director (CH&I)

9849902229 040-24606378

[email protected]

State Cold Chain Officer Sri M.M. Jaya Rao Cold Chain Officer

9849902227 040-24734579

[email protected]

State Level Data Assistant Sri P.A.R. Kumar Computer Program Assistant

9849807900 040-24606378

District Immunization Officers (DIO)

23 23

Systems of ensuring stability of tenure for these key officers should be elaborated

171

Beneficiaries details of pregnant women and children

S N Beneficiaries Target

2009-10 2010-11 2011-12

1 Pregnant women 1739100 1737000 1724000

2 0 to 1 yr infants 1482400 1494000 1486000

3 1-2 yr 1294900 1307000 1365000

4 5 yr 1894700 1912000 1380000

5 10 yr 2364000 2406000 1447000

6 16 yr 1722900 1739000 1640000

C.4 Details of Routine Immunization Sessions

State Abstract

S N Routine Immunization Sessions 2009-10 2010-11 2011-12 1. Total Sessions planned 613397 523531 571082

2. Total Sessions Held 600003 886383 308267

3. No. of Outreach Sessions 299588 262367 270434

4. No. of Fixed site sessions 306437 281756 286040

5. No. of Sessions in Urban Areas 80726 72493 84470

6. No. of Sessions in Rural Areas 560988 479183 514953

7. No. of sessions in hard to reach areas 10555 9830 5769

8. No. of session with hired vaccinators* 7857 5837 7473

9. No. of hired vaccinators* 283 271 648

10. No. of villages where sessions are held monthly

66046 61920 23227

11. No. of villages (smaller) where sessions are held on alternate months

354 387 415

12. No. of villages where sessions are held

quarterly

64 70 78

Existing Support to the States

Sl

No

Item Stock

(functional)

as on 31st

Dec'10

Requirement Remarks

2009-10 2010-11 2011-12

1 Cold Chain Equipments -

a

Walk-in-Coolers -32 Cu.M.

CFC 1 0 0 0

NCFC 1 0 1 0

Walk-in-Coolers - 16.5 Cu.M

CFC 6 0 0 0

NCFC 6 0 1 0

b

Walk-in-Freezers - 32 Cu.M.

CFC 0 0 0 0

NCFC 1 0 0 0

Walk-in-Freezer - 16.5 Cu.M.

CFC 0 0 0 0

NCFC 1 0 3 2

c

Ice-Lined Refrigerator (Large)

172

Sl

No

Item Stock

(functional)

as on 31st

Dec'10

Requirement Remarks

2009-10 2010-11 2011-12

CFC 24 0 0 0

NCFC 135 0 5 5

Ice-Lined Refrigerator (Small)

CFC 1081 0 0 0

NCFC 1470 0 500 434

d

Deep Freezers (Large)

CFC 18 0 0 0

NCFC 102 0 13 5

Deep Freezers (Small)

CFC 289 0 0 0

NCFC 1707 0 350 284

e

Cold Boxes (Large) 2591 100 100 100

Cold Boxes (Small) 742 50 50 50

f Vaccine carriers 51120 12646 6400 6400

g Ice Pcks 217700 50000 25000 25000

h

Vaccine Vans (Large) 2 1 1 0

Vaccine Vans (Medium) 6 3 2 1

Vaccine Vans (Small) 7 16 4 3

2 Vaccine stock and requirement (including 25% wastage and 25% buffer)

a) TT 126.07 126.67 108.65

b) BCG 77.4 77.04

c) OPV 95.3 96.24 96.81

d) DPT 126.79 128.02 119.75

e) MEASLES 24.65 24.84 24.71

f) Hep B 73.93 74.51 74.12

g) JE (Routine)

3 Syringes including wastage of 10% and 25 % buffer

a) 0.1 ml 20.38 20.54 20.44

b) 0.5 ml 290.55 292.82 270.63

c) Reconstitution Syringes 12.67 12.67

4 Hub Cutters

*Note: DPT is to be given instead of DT at 5 yrs once the current stock of DT Vaccine is exhausted

173

District –wise Coverage reports (in numbers)

S.

No Name of District

Yearly Target

(2010-11) BCG Coverage

OPV - 1st Dose

Coverage

OPV - 3rd Dose

Coverage

DPT - 1st Dose

Coverage

DPT - 3rd Dose

Coverage

Infants Pregnant

Women 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*

1 Srikakulam 48118 56289 28630 48414 28540 48414 28858 48414 28762 48414 28854 48414

2 Vizianagaram 43763 47723 25405 44013 40679 44013 40679 44013 40679 44013 40679 44013

3 Visakhapatnam 70371 81822 54556 70375 53837 70375 54583 70375 53837 70375 54583 70375

4 East Godavari 74758 86450 54966 74356 54751 74356 52390 74356 54751 74356 52390 74356

5 West Godavari 57691 66395 52605 57106 48108 57106 48252 57106 48108 57106 48252 57106

6 Krishna 73330 84220 55784 72438 58105 72438 55381 72438 58105 72438 55381 72438

7 Guntur 72785 84134 55818 72364 54732 72364 53250 72364 54732 72364 53250 72364

8 Prakasam 55234 64189 45817 55209 45621 55209 44480 55209 4562 55209 44480 55209

9 Nellore 48506 56340 36462 48459 36218 48459 35911 48459 36218 48459 35911 48459

10 Chittoor 80180 93083 55612 80061 56651 80061 55623 80061 56651 80061 55623 80061

11 Kadapa 58095 67514 38797 58069 38879 58069 40547 58069 38879 58069 40547 58069

12 Anantapur 72833 85077 57625 72831 58468 72831 58752 72831 58468 72831 58752 72831

13 Kurnool 77461 90533 56533 77867 55822 77867 49368 77867 55822 77867 49368 77867

14 Mahabubnagar 73675 86367 52901 74284 53984 74284 53451 74284 53984 74284 53451 74284

15 Rangareddy 103120 113439 71830 97569 69740 97569 70704 97569 69740 97569 70704 97569

16 Hyderabad 87246 95976 59820 82549 60705 82549 59300 82549 60705 82549 59300 82549

17 Medak 60036 70280 41027 60448 40752 60448 40729 60448 40752 60448 40729 60448

18 Nizamabad 46065 53902 35358 46362 34438 46362 32704 46362 34438 46362 32704 46362

19 Adilabad 57941 67808 41273 58322 31242 58322 41227 58322 31242 58322 41227 58322

20 Karimnagar 81325 80107 45286 68901 45527 68901 45283 68901 45286 68901 45286 68901

21 Warangal 71433 82877 47143 64795 47143 64795 43358 64795 47143 64795 43358 64795

22 Khammam 45191 52846 33331 45453 34052 45453 33304 45453 34052 45453 33304 45453

23 Nalgonda 63352 74125 45320 63755 43413 63755 45126 63755 43413 63755 45126 63755

TOTAL 1522509 1741496 1091899 1494000 1091407 1494000 1083260 1494000 1050329 1494000 1083259 1494000

174

District-wise coverage reports (in numbers)

S N Name of District Measles Coverage

TT2+Booster

Coverage

Hep B - Birth Dose

Coverage (Wherever

applicable)

Hep B - 1st Dose

Coverage (Wherever

applicable)

Hep B - 3rd Dose

Coverage (Wherever

applicable)

JE-routine

(Wherever

applicable)

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 1 Srikakulam 28752 48414 33332 77968 15391 48414 15363 48414 28218 48414

2 Vizianagaram 26044 44013 27757 70881 12510 44013 23124 44013 23307 44013

3 Visakhapatnam 53411 70375 58790 113334 23900 70375 53837 70375 54583 70375

4 East Godavari 52582 74356 58955 119746 17497 74356 45588 74356 44124 74356

5 West Godavari 46971 57106 50846 91966 17003 57106 48108 57106 48252 57106

6 Krishna 53130 72438 61604 116657 14726 72438 50985 72438 50213 72438 63371

7 Guntur 53002 72364 59468 116538 12733 72364 53484 72364 52126 72364

8 Prakasam 43380 55209 45532 88911 2990 55209 45621 55209 44480 55209

9 Nellore 34655 48459 40641 78040 36412 48459 36218 48459 35911 48459 42393

10 Chittoor 55517 80061 65071 128934 36515 80061 56651 80061 55623 80061

11 Kadapa 39177 58069 41345 93516 17183 58069 38879 58069 40547 58069

12 Anantapur 57685 72831 60394 117289 50532 72831 58468 72831 58752 72831

13 Kurnool 47396 77867 56373 125401 49738 77867 55822 77867 49368 77867 11050 12155

14 Mahabubnagar 51999 74284 56152 119631 18372 74284 53651 74284 53003 74284 64955

15 Rangareddy 69700 97569 77500 157129 22214 97569 69142 97569 62490 97569

16 Hyderabad 59184 82549 65840 132941 38237 82549 60705 82549 59300 82549

17 Medak 40542 60448 47579 97348 14107 60448 40752 60448 40729 60448 52882

18 Nizamabad 32376 46362 37299 74663 35358 46362 34438 46362 32704 46362 40559

19 Adilabad 40662 58322 48952 93924 31242 58322 31562 58322 41227 58322 51022

20 Karimnagar 44955 68901 50590 110961 46783 68901 45527 68901 45527 68901

21 Warangal 43266 64795 43770 104349 47143 64795 40695 64795 43350 64795 12105 126700

22 Khammam 33141 45453 37669 73199 14109 45453 34052 45453 33304 45453 87000

23 Nalgonda 44117 63755 51242 102674 34961 63755 43413 63755 45126 63755 55775

TOTAL 1051644 1494000 1176701 2406000 609656 1494000 1036085 1494000 1042264 1494000 23155 596812 # Coverage for 2010-11 till Dec‟10

175

Budget for Routine Immunization activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Mobility support for DIOs for supervision

a) High Focused Districts 1 10400 6 7.49

b) Other Districts 1 8000 17 16.32

c) State level 1 25000 1 3.00

2 Review meetings for the DIOs 1 59600 6 3.58

3 Alternative Vaccine Delivery 1 50 50088 300.53

4 Vaccine transport

a) High Focused Districts 1 19500 6 14.04

b) Other Districts 1 15000 25 45.00

5 Support for Computer Assistants to DIOs 1 10000 23 27.60

6 Support for two Computer Assts. to JD(CH&I)

1 12000 2 2.88

7 Repairs and maintenance of cold chain equipment

a) Central Vaccine Store 1 80000 1 0.80

b) Regional Vaccine Stores 1 220000 6 2.20

c) District Vaccine Stores 1 460000 23 4.60

d) Cold Chain points 1 1000 2556 25.56

8 Printing of immunization cards and

registers

1 5 3000000 150.00

9 Focus on slum & underserved areas in

urban areas

1 350 9696 33.94

10 Mobilization of children by ASHAs 1 150 70700 1272.60

11 Cold Chain electricity charges

a) Central Vaccine Store 1 70000 1 8.40

b) Regional Vaccine Stores 1 11000 6 7.92

12 Hiring services of MPHA(F) in vacant places of SCs

1 350 28800 100.80

13 Minor repairs of Vaccine Delivery Vans 1 10000 39 15.60

14 Loading and unloading Charges of

vaccines / injection safety / other CC items etc

1 500000 5.00

15 Training to Health Workers on Immunization

1 770 47380 364.83

New interventions proposed

16 Maintenance of Data Loggers to WICs/WIF at state headquarters

1 5000 12 0.60

17 Adverse Events Following Immunization 312500 3.13

18 Supportive supervision from state-level 1 50000 46 23.00

19 Providing fuel to Generators at CVS, RVS & Districts

1 25000 34 8.50

20 Procurement of Spare Parts 1 150000 23 34.50

21 Procurement of Vaccine Carriers 1 372.27 2500 9.31

22 Procurement of Spare ice packs 1 10 12500 1.25

Total 2492.96

176

D. DISEASE CONTROL PROGRAMS

D.1 National Vector Borne Disease Control Program (NVBDCP) 280. Andhra Pradesh is a known high risk and vulnerable State for Malaria,

particularly the areas like tribal areas located in Eastern Ghats are highly endemic

for the disease. However the disease was kept under control by adopting various strategies by the state. Dengue which was sporadic up to 2002 has started in

reporting cases in considerable and alarming numbers in most of the districts of

the state. The Incidence reached its peak in the year 2010 is appearing high

numbers in certain Districts like Krishna, Guntur, Prakasham, Karimnagar, Warangal, Khammam, MahabubNagar, Hyderabad and Rangareddy districts.

The reasons for increase in the incidence may be due to virulence of virus,

vectorial capacity of the Aedes Aegypti and availability of the susceptible population, increased surveillance and diagnostic facilities are the another

contributing factor for recording more number of cases during the year 2010.

281. Similarly Chikungunya has suddenly appeared in the year late 2005 and in 2006. However the disease is now limited to certain pockets of the districts of

Mahaboobnagar, Nizamabad, and Khammam. AES Surveillance has been

intensified in the state a total 143 AES screened for JE virus out of them only 7 are found to be confirmed JE cases. On screening the samples from districts of

Karimnagar, Warangal and Nalgonda by NIV Pune, 8 Chandipura virus cases

detected. However the incidence is limited only to the above 3 districts.

Objectives:

Major objectives Sub Objective Assumptions

Malaria 1. To reduce the Annual

Parasitic Incidence in 2010 is 0.39 (33218 cases) to 0.31 (26404) by 2011-12.

Strengthening of surveillance

further by increasing the ABER by 1% of 2010 (10.60) and sustaining the ABER above 10% across all the high endemic districts.

The Objectives can possibly

achieved if the logistics like budget, materials (insecticides, Larvicides, RDT, ACT etc.) are provided by the 1st week of April 2011. Additional Tribal Malaria Surveillance Workers from local tribal youth to strengthen surveillance with

performance based incentives from April to Nov.

Increase in the capacity building activity related to EDCT by providing training to ASHAs (6000 in 2011-12 as against 4100 could be trained in 2010) and

Medical officers (375, as against 300 in 2010) in 2011-12 especially in 6 high endemic districts.

The Objectives can possibly achieve if the logistics like budget, are positively approved in PIP of 2011-12.

2. To totally prevent Malaria mortality

Sentinel hospitals of the high risk areas will be made fully functional.

Support for strengthening the sentinel hospitals from GOI by providing logistics and Capacity building (Training the sentinel sites

MOs and additional LTs in high

177

risk areas) Dengue 1. Compared to 2006 dengue related mortality, we could already achieve

the target of less than 50% in 2009& 2010, and we would like to sustain and continue the reduction of mortality further.

1) Strengthening of the reporting system from all the sentinel site hospital for taking up prompt and

effective containment measures to interrupt the transmission

If additional support in the form of Kits and maintenance budget is released by NVBDCP to all existing

10 and additional 13 centres proposed

2) Strengthening the active surveillance for early detection and referral to functional sentinel hospital.

3) Capacity building of the Human resource of the SS hospital for strengthening the case

management to avert mortality.

Support for strengthening the sentinel sites from GOI (Training the sentinel sites MOs and LTs)

4) Enhancing the social mobilization activity through the appropriate IEC/BCC.

IEC/BCC budget provided on time by GOI.

Chikungunya 1)50% Reduction of morbidity caused due to

Chikungunya

1) Strengthening of the Chikungunya reporting system

further in 2011-12.

2) Morbidity reduction by effective case management.

3) Enhancing the social mobilization activity through the appropriate IEC/BCC.

IEC/BCC budget provided on time by GOI.

JE

1. Compared to 2006 JE related mortality, we could already achieve the target of less than 50% in 2009&2010, and we would like to sustain and continue the reduction of

mortality further.

1) Providing all support to the Sentinel hospitals for effective case management.

2) Making JE vaccination as a part of routine immunization.

3) Strengthening the surveillance activity for early case detection and prompt treatment.

4) Enhancing the social

mobilization activity through the appropriate IEC/BCC.

Filaria 1) With MDA we are able to achieve < 1% of Mf rate for last 4 years, the reduction of Mf rate

will be maintained

1) Accurate Line listing of LF for home based morbidity management and surgical treatment of Hydrocele cases is

planned for 2011-12.

178

further.

2) In East Godavari, Nellore, Chittore, Mahabubnagar and Nizamabad districts, 200

Hydrocele cases are planned for surgery in 2011-12

3) Home based morbidity management training camps will be taken up extensively in all endemic districts.

Disease Situation in the State in Year 2009-2010

Year Malaria

Cases

Malaria

Deaths

Dengue

Cases

Dengu

Deaths

Chikungunya

cases

AES/

JE

Cases

AES/JE

Deaths

Microfilaria

Positive

cases 2009 25152 3 1190 11 117 56 /

35 11 / 0 492

2010 33218 20 776 3 41 143/7 5/0 374

List of Districts having vector borne diseases as major public health problem.

Malaria is endemic in (7 No.) districts viz; Srikakulam, Vizianagaram,

Vishakapatnam, East Godavari, Adilabad, Khammam and Prakasham

Dengue is endemic in (4 No.) districts viz; Warangal, Prakasham, Guntur,

Krishna,

Chikungunya is endemic in (4 No.) districts viz; Mahaboobnagar,

Adilabad, Khammam, Nizamabad

AES including JE is endemic in (8 No AES / 3 No JE .) districts viz;

Mahaboobnagar, Medak, Nalgonda, Hyderabad, Rangareddy, Nizambad, Karimnagar and Warangal .

Filaria is endemic in (16 No.) districts viz; Srikakulam ,Vizianagaram,

Vishakapatnam, East Godavari, West Godavari, Krishna, Guntur, Prakasham , Nellore, Chitoor, Mahaboobnagar, Medak, Nalgonda,

RangaReddy, Khammam, Nizambad and Karimnagar

Kala azar is endemic in --- AP state is declared as Kala azar endemic state

Budget Expenditure Details for 2010-11 (In Lakhs)

Disease Balance

from

previous

years as on

31.03.2010

Committed

expenditure

2009-10

Cash

assistance

from

NVBDCP

2010-11 as

per PIP

Cash assistance

from NRHM flexi

fund 2010-11 as

per PIP

State

resources as

per

BE 2010-11

Proposal for

2011-12

NVBDCP

a. Domestic Budget Support

0 0.14 121.9 22 567.8 286.6

b. World Bank fund for project states (HR, Mobility, Training and M&E)

28.42 1.35 126.1 0 0 197.204

179

Malaria

a. Goal: To reduce the Annual Parasitic Incidence 0.327 of 2009 (2010 value of API is

0.35) to 0.31 by 2011-12.

b. Demographic Profile and Infrastructure of the state:

Population of the State: 84161186

Infrastructure Number

Districts 23

World Bank Districts 5

Tribal Districts 10

Entomological Zones 6

CHCs 309

PHCs 1624 (1709*)

HSCs 12092 (12167*)

Villages 48276 (48512*)

FTDs 1655

* Figure includes Urban Units and Sections of Hyderabad

c. State and Zone-wise status of Manpower (sanctioned & vacant)

Regular Posts Sanctioned In

Position

Vacant

District Malaria Officer 22 14 8

Assistant Malaria Officer 41 11 30

Medical Officer 3760 3003 757

Lab. Tech. 1980 1420 560

Zonal Office

Zonal Officer (Malaria) 6 5 1

Assistant Director (Ent.) 6 4 2

Others

Sr. Entomologist/Biologist 28 7 21

SUO 258 237 21

d. District Wise Human Resources Details

Dengue / Chikungunya

0 1 45 0 0 80.04

JE 0 0 5 0 0 41.55

Filaria 0 0 282 0 1.77 468.3

Decentralized Procurement

3.49 0 83 0 0 624. 376

c. GFATM fund for project states

0 0 0 0 0 0

Kala-azar 0 0 0 0 0 0

Kala-azar World Bank Project

assistance

0 0 0 0 0 0

Total 31.91 2.49 663.00 22.00 569.57 1698. 104

180

Sl No District DMO (Full Time)

Sanctioned In Place Vacant

1 Srikakulam 1 1 0

2 Vizianagaram 1 0 1

3 Visakhapatnam 1 0 1

4 East Godavari 1 1 0

5 West Godavari 1 0 1

6 Krishna 1 1 0

7 Guntur 1 1 0

8 Prakasham 1 0 1

9 Nellore 1 0 1

10 Chittoor 1 0 1

11 Cuddapah 1 1 0

12 Ananathapur 1 0 1

13 Kurnool 1 0 1

14 Mahboobnagar 1 1 0

15 Medak 1 1 0

16 Nalgonda 1 1 0

17 Hyderabad 0 0 0

18 Rangareddy 1 1 0

19 Nizamabad 1 1 0

20 Adilabad 1 1 0

21 Karimnagar 1 1 0

22 Warangal 1 1 0

23 Khammam 1 1 0

Grand Total 22 14 8

Sl No District Assistant Malaria Officer


1 Srikakulam 1 0 1





6 Krishna 2 1 1

7 Guntur 3 1 2

8 Prakasham 2 0 2

9 Nellore 1 0 1

10 Chittoor 2 0 2

11 Cuddapah 2 0 2


13 Kurnool 2 1 1


15 Medak 1 0 1

16 Nalgonda 1 0 1

17 Hyderabad 0 0 0

18 Rangareddy 2 0 2

19 Nizamabad 1 0 1

20 Adilabad 2 0 2

21 Karimnagar 1 0 1

181

22 Warangal 1 0 1

23 Khammam 2 0 2

Grand Total 41 11 30

Sl. No District Medical Officer

Sanctioned In Place Vacant 1 Srikakulam 178 118 60





6 Krishna 167 120 47

7 Guntur 161 152 9

8 Prakasham 257 180 77

9 Nellore 188 146 42

10 Chittoor 173 155 18

11 Cuddapah 162 124 38


13 Kurnool 207 156 51


15 Medak 117 113 4

16 Nalgonda 136 129 7

17 Hyderabad 49 49 0

18 Rangareddy 86 77 9

19 Nizamabad 90 77 13

20 Adilabad 166 94 72

21 Karimnagar 166 163 3

22 Warangal 177 170 7

23 Khammam 169 162 7


Sl No District Lab Technician

Sanctioned In

Place

Vacant

1 Srikakulam 81 71 10





6 Krishna 69 57 12

7 Guntur 120 65 55

8 Prakasham 75 70 5

9 Nellore 88 26 62

10 Chittoor 109 72 37

11 Cuddapah 75 53 22


13 Kurnool 75 70 5


15 Medak 94 83 11

16 Nalgonda 108 72 36

182

17 Hyderabad 17 1 16

18 Rangareddy 57 42 15

19 Nizamabad 37 10 27

20 Adilabad 77 57 20


22 Warangal 111 60 51

23 Khammam 84 70 14


183

Zone

Name of the Zonal

Office(Malaria)

Zonal Officer

Sanctioned /

Required

In

Place Vacant

I Visakhapatnam 1 0 1

II Rajahmundry (E.G.Dist) 1 1 0

III Guntur 1 1 0

IV Kadapa 1 0 1

V Warangal 1 1 0

VI Hyderabad 1 1 0

Total 6 4 2

Zone

Name of the Zonal

Office(Malaria)

Asst.Dir (Ent)

Sanctioned /

Required

In

Place Vacant

I Visakhapatnam 1 1 0

II Rajahmundry(E.G.Dist) 1 0 1

III Guntur 1 0 1

IV Kadapa 1 1 0

V Warangal 1 1 0

VI Hyderabad 2 2 0

Total 7 5 2

Sl No District Sr. Entomologist


1 Srikakulam 1 0 1





6 Krishna 1 0 1

7 Guntur 4 1 3

8 Prakasham 0 0 0

9 Nellore 1 0 1

10 Chittoor 1 0 1

11 Cuddapah 0 0 0


13 Kurnool 3 3 0


15 Medak 1 0 1

16 Nalgonda 5 3 2

17 Hyderabad 0 0 0

18 Rangareddy 1 0 1

19 Nizamabad 0 0 0

20 Adilabad 1 0 1

21 Karimnagar 0 0 0

22 Warangal 3 1 2

23 Khammam 1 0 1


184

Sl No District Sub Unit Officer (SUO)


1 Srikakulam 10 9 1





6 Krishna 14 14 0

7 Guntur 16 16 0

8 Prakasham 12 10 2

9 Nellore 11 10 1

10 Chittoor 11 11 0

11 Cuddapah 10 10 0


13 Kurnool 13 13 0


15 Medak 9 9 0

16 Nalgonda 6 6 0

17 Hyderabad 6 6 0

18 Rangareddy 4 4 0

19 Nizamabad 5 4 1

20 Adilabad 14 12 2


22 Warangal 13 11 2

23 Khammam 12 11 1


e. Contractual Staff

Post Number

Sanctioned/In Position

Remarks (Supported by)

State Level

Consultants 6/4 World Bank

GIS Operator 1/1 World Bank

Accountant 1/1 World Bank

Secretarial Assistant 1/1 World Bank

Insect Collector 2/1 World Bank

District level

DVBD consultant 5/5 NVBDCP

District level support staff

Data Entry Operator 5/5 World Bank

Financial and logistic assistant 5/5 World Bank

MPW 1053 Financed by State or

NRHM

MPW 55/47 NVBDCP

Lab.Tech. 15/13 World Bank

Malaria Technical Supervisors 30/30 World Bank

Project monitoring unit staff both at state and district level ( indicate

positions )

Nil

185

f. District Wise WB Supported Contractual Staff Details

District

DVBD

Consultant DEO FLA MTS MPW LTs

S P S P S P S P S P S P

Srikakulam 1 1 1 1 1 1 5 5 2 2

Vizianagaram 1 1 1 1 1 1 5 4 28 28 2 2

Visakapatnam 1 1 1 1 1 1 8 8 4 4

East

Godavari 1 1 1 1 1 1 6 6 27 18 4 0

Khammam 1 1 1 1 1 1 6 4 3 2

Total 5 5 5 5 5 5 30 27 55 46 15 10

186

g.Epidemiological Data for Malaria upto December 2010

Sl

No District Population

Persons Examined Tot

BSE+RDT

Positive

Positive Pf No. of

deaths

ABER API Pf% SPR SFR

BSE RDT

positive

1 Srikakulam 2417598 385455 533 385988 1283 1176 3 15.97 0.53 91.66 0.33 0.31

2 Vizianagaram 2192267 355030 250 355280 2351 2131 2 16.21 1.07 90.64 0.66 0.60

3 Visakhapatnam 4489923 812132 4018 816150 12815 9861 11 18.18 2.85 76.95 1.58 1.21

4 East Godavari 4895579 571485 292 571777 2258 2053 0 11.68 0.46 90.92 0.40 0.36

5 West Godavari 4425242 528834 8 528842 402 308 0 11.95 0.09 76.62 0.08 0.06

6 Krishna 4458675 523019 265 523284 2751 176 0 11.74 0.62 6.40 0.53 0.03

7 Guntur 4851712 612572 45 612617 429 24 0 12.63 0.09 5.59 0.07 0.00

8 Prakasham 3282247 433377 1189 434566 1639 700 1 13.24 0.50 42.71 0.38 0.16

9 Nellore 2675895 231411 229 231640 118 61 0 8.66 0.04 51.69 0.05 0.03

10 Chittoor 4258424 399460 8 399468 241 78 0 9.38 0.06 32.37 0.06 0.02

11 Cuddapah 2800395 404559 28 404587 1607 222 0 14.45 0.57 13.81 0.40 0.05

12 Ananathapur 4113814 477369 49 477418 368 161 0 11.61 0.09 43.75 0.08 0.03

13 Kurnool 3990534 448730 0 448730 279 89 0 11.24 0.07 31.90 0.06 0.02

14 Mahboobnagar 3936246 421524 93 421617 239 122 0 10.71 0.06 51.05 0.06 0.03

15 Medak 3029938 217187 43 217230 154 90 0 7.17 0.05 58.44 0.07 0.04

16 Nalgonda 3895019 266593 0 266593 40 5 0 6.84 0.01 12.50 0.02 0.00

17 Hyderabad 4707007 264377 0 264377 274 37 0 5.62 0.06 13.50 0.10 0.01

18 Rangareddy 4266541 185408 9 185417 195 63 0 4.35 0.05 32.31 0.11 0.03

19 Nizamabad 2708997 224357 1 224358 30 13 0 8.28 0.01 43.33 0.01 0.01

20 Adilabad 2955352 224267 185 224452 612 412 0 7.59 0.21 67.32 0.27 0.18

21 Karimnagar 3784302 230480 127 230607 166 87 0 6.09 0.04 52.41 0.07 0.04

22 Warangal 3446552 239617 78 239695 156 114 0 6.95 0.05 73.08 0.07 0.05

23 Khammam 2578927 440966 2951 443917 4811 4731 3 17.21 1.87 98.34 1.09 1.07

AP Total 84161186 8898209 10401 8908610 33218 22714 20 10.59 0.39 68.38 0.37 0.26

187

h.Map showing Prioritized districts for Malaria based on epidemiological situation in 2010

188

I. API wise list of prioritized PHCs, Sub Centres and Villages

j.Strategy proposed for 2011-12:

Strengthening of surveillance further by increasing the ABER by 1% of 2010(11.2 projected value) and sustaining the ABER above

10% across all the high endemic units.

The Objectives can possibly achieved if the logistics like budget, materials (insecticides, Larvicides, RDT, ACT etc.) are

provided by the 1st week of April 2011. Additional MSWs from local tribal youth to strengthen surveillance with performance based incentives from April to Nov.

Asha of the 5 WB districts to be provided with performance incentives for Blood slide collection, Performing RDT and

providing complete treatment for malaria Positives. Increase in the capacity building activity related to EDCT by providing training to ASHAs (6000 in 2011-12 as against 4100 could

be trained in 2010) and Medical officers (375, as against 300 in 2010) in 2011-12 especially in 6 high endemic districts.

The Objectives can possibly achieve if the logistics like budget, are positively approved in PIP of 2011-12 on time.

Sentinel hospitals of the high risk areas will be made fully functional.

S. No. API PHCs

(No.)

Sub

centre

(No.)

Villages

(No.)

Population

@ Village

(No.)

%

Population

@ villages

1 <1 1158 10689 39739 79057665 93.94

2 1 – 2 180 567 2255 2240663 2.66

3 2 – 5 82 342 1719 1067275 1.27

4 5 – 10 68 274 2161 1102427 1.31

5 > 10 55 220 2402 693156 0.82

Total 1543 12092 48276 84161186 100

189

k. Planning for Deployment of Drugs, testing kits for epidemic Preparedness for the year 2011-12 (All are in Numbers)

District Chloroqui

ne

Primaqui

ne 2.5

Primaquine

7.5

ACT

(Artesu

nate+S

P)

Blister

Quinine

Injection

Quinine

Sulphate

Arteether

Inj RDK

Lancets

for BS

collection

Micro Slides

Srikakulam 952811.75 3494.4 10203 1680 486 1458 218.7 285335 382038 393308

Vizianagaram 1349833.8 7224 21954 3180 1060 3180 403.875 140991 378824 204100

Visakhapatnam 66,00,000 90081.6 92380.8 14370 5100 15300 715.95 336077 982499 400000

East Godavari 1824799.5 0 638000 5752.5 1917.5 5752.5 862.875 347152 688506 300000

West Godavari 1892100 913.5 5965.75 943.5 304.5 913.5 137.025 19980 528740 119500

Krishna 1662840 0 42880.25 207 35.5 106.5 15.975 250 444431 166000

Guntur 2441542.5 13.5 8426.25 27 4.5 13.5 2.025 1250 668538 654300

Prakasham 0 0 16058 213 71 213 31.95 30218 459119 30217.5

Nellore 457628.75 2016 0 0 8.5 25.5 3.825 0 191119 0

Chittoor 1887603.8 5510.4 4476 80 27 80 9.9 76481 531120 276848.55

Cuddapah 1746746.3 0 48453.6 1119.3 0 309 46.35 2000 486524 200000

Ananathapur 1758786.5 0 12904.8 267 89 267 40.05 36000 474451 208468

Kurnool 1820238.8 11121.6 0 27 0 126 18.9 0 504936 266968.35

Mahboobnagar 1689033.8 0 4375 785 245 736 12.825 0 470169 247724.95

Medak 479697.25 2116.8 102.4 126 33 99 14.85 816 263506 127549.95

Nalgonda 1072071 1612.8 0 43.5 3.5 10.5 1.575 0 302505 0

Hyderabad 1007471.3 57 0 33 19 57 8.55 0 281699 347000

Rangareddy 604027.5 0 0 132 43 129 19.35 0 167686 74300

Nizamabad 894337.5 0 0 0 0.5 1.5 0.225 0 244396 241500

Adilabad 0 11558.4 23465.4 2844 194.5 583.5 87.525 0 198524 105170

Karimnagar 127151.5 0 1896.6 159 0 88.5 13.275 0 252336 35952

Warangal 0 806.4 0 365 0 261 39.15 17427 515846 152670.65

Khammam 1562737.3 0 24607.2 5070 1411 4233 634.95 477352 431859 229057.95

State (25% Buffer) 0 0 0 9549 0 0 0 442832 0 0

25231459 136526.4 956149.05 46972.8 11053 33943.5 3339.675 2214160 9849370 4780635.9

190

l.Planning for Bednet (LLIN) Distribution for the Year 2011-12

Sl. No. District Name Eligible

Sub centre

Eligible

villages

Eligible

Population

Tribal

population

Total Bednet Number of bed nets

available in

community based on

household survey

Required in

the Current

Year

Total Planned to be

distributed in the year

as per allocation Required

ITNs LLINs

A B C D = A-(B+C) ITNs LLINs

E F

1 Srikakulam 102 544 252549 135467 84466 0 0 84466 0 84466

2 Vizianagaram 145 1455 480450 480450 95350 0 0 95350 0 95350

3 Visahakapatnam 195 3490 600740 600740 230776 0 0 230776 0 230776

4 East Godavari 74 551 329603 329603 142630 80000 0 62630 0 62630

5 West Godavari 66 206 64646 68406 30914 611 0 30303 0 30303

6 Krishna 15 46 164000 0 5000 49500 0 0 0 0

7 Guntur 0 0 0 0 6188 0 0 6188 0 6188

8 Prakasham 29 101 52596 19436 34554 11708 0 22846 0 22846

9 Nellore 18 24 21861 0 8352 0 0 8352 0 8352

10 Chittoor 85 850 450000 0 32000 0 0 32000 0 32000

11 Cuddapah 16 67 30904 0 65643 0 0 65643 0 65643

12 Ananathapur 41 71 48660 0 26864 0 0 26864 0 26864

13 Karimnagar 8 16 32673 0 30000 0 0 30000 0 30000

14 Kurnool 7 18 13304 5203 13304 0 0 13304 0 13304

15 Medak 16 32 0 0 19456 0 0 19456 0 19456

16 Nalgonda 18 46 75800 0 0 0 0 0 0 0

17 MBNR 15 20 52350 10200 20940 0 0 20940 0 20940

18 Hyderabad 0 0 0 0 0 0 0 0 0 0

19 RangaReddy 0 0 0 0 0 0 0 0 0 0

20 Adilabad 111 656 186929 120347 111095 0 0 111095 0 111095

21 Nizambad 0 0 0 0 0 0 0 0 0 0

22 Warangal 27 84 61807 61807 31416 0 0 31416 0 31416

23 Khammam 122 510 230518 161417 169341 0 0 169341 0 169341

Total 1110 8787 3149390 1993076 1158289 141819 0 1060970 0 1060970

Grand Total (with 25% Extra for Buffer at State Level) 1326212.5 1326213

191

m. District-wise Planning for utilization of Insecticides for the year 2011-12

Sl no Districts SP 10%(MTS) DDT

50%(MTS)

Malathion

Technical

(MTS) Temephose (Liters)

BTI

(MTS)

Pyrethrum

Extract (Liters)

1 Sirkakulam 5.46 0 0.5 0 0.8 200

2 Vizayanagaram 0 0 0.5 0 0.8 200

3 Visakhapatnam 13.56 0 1 1500 2.5 400

4 East godavari 4.78 0 0.5 0 0.8 100

5 West godavari 0 0 0 0 0.5 200

6 Krishna 0 0 0.5 4000 2.5 500

7 Guntur 0 0 0.5 1408 2.5 400

8 Prakasham 0 27.89 0 0 0.5 200

9 Nellore 0 0 0 0 0.5 200

10 Chittore 0 0 0 0 0.5 200

11 Kadapa 0 0.607 0 0 0.5 200

12 Anantapur 0 0 0 0 0.5 200

13 Karnool 0 7.095 0.5 434 1.5 200

14 Adilabad 8.83 0 0 0 1 200

15 Karimnagar 0.33 0 0 0 1 200

16 Warangal 0.27 0 0.5 179 1.5 200

17 Khammam 13.22 0 0.5 329 1 100

18 Mehboobnagar 0 1.64 0 0 0.5 150

19 Medak 0 0.075 0 0 0.5 100

20 Nalgonda 0 0 0 150 1 150

21 Hyderabad 0 13.15 1 5000 2.5 400

22 Rangareddy 0 0 0 0 0.5 150

23 Nizamabad 0 1.15 0 0 0.5 150

State 0 0 0 0 5.6 0

Total 46.45 51.607 6 13000 30 5000

192

n. Planning for Performance Incentives for Ashas for the Year 2011-12

Districts

Cost of Preparation of

Slide Cost for Treating RDT Cost for Treating Slide +ve Total

Srikakulam 357300 100044 107190 564534

Vijayanagaram 310050 86814 93015 489879

Vishakapatnam 568050 159054 170415 897519

E.Godavari 592650 165942 177795 936387

Kammam 349350 97818 104805 551973

Total: 2177400 609672 653220 3440292

193

2. Dengue and Chikungunya

a. Goal:

Dengue: Compared to 2006 dengue related mortality, we could already achieve the target of less than 50% in 2009& 2010, and we would like to sustain and continue the reduction of mortality further. Chikungunya: 50% Reduction of morbidity caused due to Chikungunya b. Disease Situation:

The District disease situation for Year 2010 may be given district-wise as per following table

Sl.

No

.

Name of district/ Dengue 2010 Chikungunya 2010

Corporation Suspected

cases

Blood

samples

tested

Positive

cases

Deaths Suspected

cases

Blood

samples

tested

Posit

ive

cases

Deaths

1 SRIKAKULAM 36 36 0 0 0 0 0 0

2 VIZIANAGARAM 0 0 0 0 0 0 0 0

3 VISAKHAPATNAM 1 1 1 0 0 0 0 0

4 EAST GODAVARI 1 1 3 0 0 0 0 0

5 WEST GODAVARI 26 26 5 0 25 25 1 0

6 KRISHNA 584 584 201 3 0 0 0 0

7 GUNTUR 387 387 133 0 0 0 0 0

8 PRAKASHAM 289 289 100 0 0 0 0 0

9 NELLORE 74 74 41 0 0 0 0 0

10 CHITTOOR 4 4 4 0 0 0 0 0

11 KADAPA 19 19 0 0 0 0 0 0

12 ANANTHAPUR 5 5 5 0 0 0 0 0

13 KURNOOL 1 1 4 0 0 0 0 0

14 ADILABAD 1 1 1 0 10 10 5 0

15 KARIMNAGAR 46 46 15 0 0 0 0 0

16 WARANGAL 270 270 195 0 0 0 0 0

17 KHAMMAM 46 46 12 0 16 16 5 0

18 MB'NAGAR 34 34 5 0 27 27 18 0

19 MEDAK 25 25 6 0 9 9 3 0

20 NALGONDA 14 14 6 0 8 8 2 0

21 HYDERABAD 38 38 19 0 4 0 0 0

22 RANGAREDDY 46 46 16 0 2 2 1 0

23 NIZAMABAD 17 17 4 0 10 10 6 0

Total 1964 1964 776 3 107 107 41 0

194

c. Map showing Prioritized districts for Dengue and Chikungunya based on

Epidemiological situation in 2010

d. Strategy proposed for 2011-12:

Strengthening of the reporting system from all the sentinel site hospital for taking

up prompt and effective containment measures to interrupt the transmission.

More sentinel diagnostic centres need to be approved by NVBDCP , in

addition to 10 existing centres to cover 7 uncovered larger districts.

Strengthening the active surveillance for early detection and referral to functional

sentinel hospital.

Support for strengthening the sentinel sites from GOI (Training the

sentinel sites MOs and LTs)

Capacity building of the Human resource of the SS hospital for strengthening the case management to avert mortality.

3. Acute Encephalitis Syndrome including Japanese Encephalitis

a. Goal: Compared to 2006 JE related mortality, we could already achieve the target of less than

50% in 2009&2010, and we would like to sustain and continue the reduction of mortality

further.

195

b. Disease Situation: The number of cases and deaths of the preceding year may be given in the following

table .

Sl. No Name of the

District

No. of AES

cases

No. of

Deaths

No. of

Sera/CSF

Sample tested

No. Confirmed

for JE

1 Srikakulam 0 0 0 0

2 Vizianagaram 0 0 0 0

3 Visakhapatnam 0 0 0 0

4 East Godavari 1 0 1 0

5 West Godavari 0 0 0 0

6 Krishna 0 0 0 0

7 Guntur 2 0 2 0

8 Prakasam 0 0 0 0

9 Nellore 0 0 0 0

10 Chittoor 0 0 0 0

11 Kadapa 0 0 0 0

12 Ananthapur 1 0 1 0

13 Kurnool 3 0 3 0

14 Mahaboobnagar 15 0 12 0

15 Medak 17 0 15 0

16 Nalgonda 20 0 21 2

17 Hyderabad 28 0 25 0

18 Rangareddy 16 0 12 2

19 Nizamabad 11 4 11 2

20 Adilabad 2 0 2 0

21 Karimnagar 7 1 6 0

22 Warangal 8 0 7 0

23 Khammam 2 0 2 1

24 Out of State's 10 0 10 0

Total: 143 5 130 7

196

c. Map showing Prioritized districts for AES/JE based on epidemiological situation

in 2010

d. Strategy Proposed for 2011-12

Providing all support to the Sentinel hospitals for effective case management.

Making JE vaccination as a part of routine immunization.

Strengthening the surveillance activity for early case detection and prompt treatment.

Enhancing the social mobilization activity through the appropriate IEC/BCC.

197

e. Monitoring of functioning of Sentinel surveillance Hospital separately for

Japanese Encephalitis.

Sl. No Name of the

District

Total No. of

Sentinel Sites

identified

No. of

functional

Reasons for non

functional status

Suggested solutions

1 Hyderabad 1 1 Not Applicable Not Applicable

2 Warangal 1 1 Not Applicable Not Applicable

3 Kurnool 1 1 Not Applicable Not Applicable

4 Ananthapur 1 1 Not Applicable Not Applicable

5 Guntur 1 1 Not Applicable Not Applicable

Total 5 5

4. Lymphatic Filariasis

a. Goal: With MDA we are able to achieve < 1% of Mf rate for last 4 years, the reduction of Mf rate will be maintained further.

b. The status of LF in endemic districts of AP for 2009

SI.

No.

Name of Districts Population at

risk

Coverage of

eligible

population

under MDA

Microfilaria

rate

No. of line

listed total

Lymphoedema

cases

No. of line

listed total

Hydrocele

cases

No. of

Hydroce

le

operatio

ns

1 SRIKAKULAM 2660921 2413664 0.21 3160 483 0

2 VIZIANAGARAM 2398387 2206516 1.39 405 15 0

3 VISAKHAPATNAM 4373277 4026542 0.06 2451 69 25

4 EAST GODAVARI 5510458 4915329 0.45 15480 128 26

5 WEST

GODAVARI 3953014 3513911

0.21 4796 126 0

6 KRISHNA 4299487 3869538 0.17 0 0 0

7 GUNTUR 4786584 4307928 0.81 3856 37 22

8 PRAKASHAM 3276233 2948614 0 440 13 0

9 NELLORE 2746411 2452153 1.73 3472 1300 45

10 CHITTOOR 4251583 3996488 0.15 2232 249 0

11 MB'NAGAR 3805058 3390625 0.06 649 25 0

12 MEDAK 2692487 2481969 0.29 8445 0 0

13 NALGONDA 3856454 3505867 0.68 140 350 105

14 RANGAREDDY 4113545 3677522 0.02 1208 0 0

15 NIZAMABAD 2579174 2417610 0 1538 0 0

16 KARIMNAGAR 3810463 3390944 0.08 9431 0 0

Total 55303073 50124276 0.45 57703 2795 223

* Note The Activity of Line Listing of LF & Hydrocele Cases and MDA Evaluation for 2010 still continues at the

field level.

198

c. Map showing Prioritized districts for Filaria based on epidemiological situation in

2010

d. Strategy Proposed for 2011-12 Accurate Line listing of LF for home based morbidity management and surgical

treatment of Hydrocele cases is planned for 2011-12. In East Godavari, Nellore, Chittore 200 Hydrocele cases are planned for surgery

in 2011-12

Home based morbidity management will be taken up.

e. The requirement of drugs for the districts to be covered under MDA

2011 should be given as per the format indicated below:

Sl

No

Name of District Total

Population

Eligible

Population

DEC 100 mg. Albendazole 400

mg tabs.

(population x

2.5)

(Population

x 1)

1 SRIKAKULAM 2660921 2352842 5882105 2352842

2 VIZIANAGARAM 2398387 2206516 5516290 2206516

3 VISAKHAPATNAM 4489923 4130725 10326812 4130725

4 EAST GODAVARI 5542482 4943894 12359735 4943894

5 WEST GODAVARI 4425242 3982778 9956945 3982778

Adilabad

Karimnagar Nizamabad

Medak Warangal

Rangareddy HYD Nalgonda

Mahaboobnaga

r

Kurnool Prakasam

Guntur

Khammam

W.Godavari

Krishna

E.Godavari

Visakhapatnam

Srikakulam V’Nagaram

Anantapur

r

Kadapa Nellore

Chittoor

Filaria Endemic districts

199

6 KRISHNA 4452874 4007586 10018965 4007586

7 GUNTUR 4851712 4366544 10916360 4366544

8 PRAKASHAM 3282247 3118135 8205618 3118135

9 NELLORE 2783720 2449675 6124187 2449675

10 CHITTOOR 4186275 3996488 9991220 3996488

11 MB'NAGAR 392068 3448462 8621155 3448462

12 MEDAK 4266541 3839886 9599715 3839886

13 NALGONDA 3029935 2726944 6870360 2726944

14 RANGAREDDY 3895019 3505586 8763965 3505586

15 NIZAMABAD 2708997 2458799 6772493 2458799

16 KARIMNAGAR 3810462 3390944 8477360 3390944

Total 57176805 54925804 138403285 54925804

5. SWOT Analysis of NVBDCP in Andhra Pradesh

SWOT Status Actions to be Taken to match the

requirements

Strengths 1. Known problem. 2. Availability of Officers with

adequate Knowledge to face the problem. 3. Problem is seasonal.

1. Further studies are required to know the Vector dynamics and parasite

behaviour. 2. The present regular officers in different caders may be trained at national level in transmission dynamics and control of VBDs for a period of 10 days. 2. Qualified officers are to be recruited

through service commission 3. During the season the ITDAs may have to be requested to appoint persons on incentive payment basis for weekly surveillance, diagnosis and Treatment

Weakness 1. Illiteratacy among the Ashas 2. Vacancies in basic health

functionaries. 3.Constrains in Finance & Logistics 4.Vast area of TSP with difficult terrain 5. Congenial ecosystem for perennial transmission of Malaria. 6.Lack of awareness of Vector borne diseases in the community 7. Untimely supply of logistics

1. Refresher training to Ashas at regular intervals of 6 months

2. Sanction of additional man power to meet the vacancy problem of basic health functionaries in high risk areas to be met by the project. Similar to Asha scheme male tribal surveillance teams for vector borne diseases may be provided during the transmission season. 3. The important components like lab equipments, reagents, and spray wages is to be borne by the Project at least during the project period which will have impact on the incidence 4.Release of funds for social

mobilization for creating awareness among the community pertaining to diseases to be affected in difficult terrains and congenial ecosystem and their prevention and control.

200

Opportunities 1. Utilization ASHA‟s for surveillance, diagnosis & treatment.

2. Availability of NRHM funds

for prevention and control of VBDs3.NGO Partnership large scale introduction of RDT ACT LLIN in endemic districts4.Possibility of introduction of specific RDT‟s for PV & PF5.Weekly monitoring of

Epidemiological Situation through Special Officers / Programme Officers.

1.Trainings to all Ashas in the district irrespective of criteria of high risk or low risk 2.Funds allotment may be increased for control of outbreaks and epidemics

3.Funds from the project may have to be considered for release for PPP 4. The Project may consider supply of RDTs to detect both PV. And PF in the field at least in inaccessible areas 5. Involvement of District Collectors, P.O., and I.T.D.A.for close monitoring

and financial support directly from tribal funds.

Threats 1.Unexpected change in climate by global warming

2.Resistance of mosquitoes to insecticides and parasites to the drugs

1. Sensitization of state level administrators and political heads by the NVBDCP at New Delhi or State Head quarters

2. Imparting training to the dist. Level and state level officers of the Programme in forecasting and facing the climatologically changes, impact VBDs effectively.

3.Regular Field level studies to detect the resistance is the present day need for which arrangements are to be made by the national body .Vector sensitivity and parasite sensitivity study may be carried out by establishing field stations.

10.Out Come Analysis of PIP of 2010-11

Activity

Financial (Rs in Lakhs) Physical

2009-10

2010-11 (As on

31.12.2010) 2009-10 2010-11

Amt.

approved Expd. Amt. approved Expd.

Expected

Output Achievements

Expected

Output Achievements

Malaria 293.76 252.32 248 148.55 88,79,304 9189256 8945542 8945542

Filaria 293 293 282 277.29 196208 255485 215870 220387

*Dengue/Chikungunya 55.5 70.88 45 0 313 / 5 1190 / 117

1190 /

117 776 / 41

J.E 10 6.63 5 2.99 16 34 34 6

Cash assistance for

decentralized

commodities 470.3 466.8 83 0 - - - -

*Commodity support by

GOI 1165.81 1165.81 689.32 817.79 - - - -

11.Policy and Systemic Reforms In Strategic Areas

Sl. No Strategic Areas Issues that need to be addressed

1 Human Resources All the Key posts in the Department are being filled

201

Wherever the filling is not possible the staff are redeployed from silent areas to the high risk areas at the time of need Most of the posts sanctioned under project on outsourcing / contract basis are filled up, trained and positioned on work.

For remaining filling up is under process.

2 Accountability and performance appraisal

From time to time the performance of Individuals at different levels is being evaluated by conducting weekly, monthly reviews starting from PHC level to the state level. Basing on the performance gap need of training is identified and the persons are trained in the identified fileld to improve there performance.

Particularly in the Village level ASHAs are being paid performance based incentives. MPWs are given commendation certificates for best performance Punitive measures are also implemented to punish the chronic defaulters

3 Policies on drugs, procurement system and Logistics managements

Required insecticides, Larvicides and Drugs if any are being procured through a state level Government procurement agency i.e., APHHMIDC.

The items are supplied in time to the fieid for utilization to the patients.

4. Equipments Regular assessments of essential funcitional equipments needs are being done before commencement of transmission season wel in advance. Timely indent is placed to the GOI, APHHMIDC for supply of the required equipments. Due attention is given for repairs of the available equipment

5. Diagnostics Sentinel Hospital are identified for diagnosis of Dengune / Chikgunyana and JE in entire state. A list has been forwarded to the Director NVBDCP for supply of Test kits as per requirement.

6 Private Public Partnership

Efforts are being made to involve the NGOs and other service organization in to the programme. A state consultant has been appointed for this specific purpose. Proposal for release of Budget under PPP during 2011-12 is also putup.

7 Capacity building Trainings are planned and being implemented for all categories like ASHAs, Lab Technicians , MPWs, MPHS, SUOs and others involved in the programme

12. Conditionalities

Mandatory

1. As per the Mandate regular and detected district programme officers posted in all the districts

2. All the contractual positions under NVBDCP are being filled 100%

202

3. The grant in Aid under NVBDCP from State Health Society to the district society will be released with in 30 days after receipt of Grant – Aid from GOI.

Desirable:

1. The Annual Blood Examination will be maintained more than 10% of the Population

under Surveillance. Both state and district.

2. Minimum of the 30% of the Pf cases will be detected through Raid Diagnostic Test in

endemic areas.

3. The coverage under Indoor Residual Spray will be achieved more than 80% of the

targeted population projected in PIP.

4. More than 80% of the allotted SSH for Dengue, Chikungunya and JE will made

functional.

NVBDCP Andhra Pradesh

Abstract of Budget Requirement in PIP 2011-12 for VBDs

DBS /

NRHM

External

Assistance

NRHM

Additionality State G.Total

1801.04 197.20 1130.35 1179.74 4308.33

203

Districtwise Budget Requirement and Allocation for 2011-12 (In lakhs) Under NRHM Additionality

Sl no Name of the district

Malaria Other VBDs Others

Total NGO/PPP

(To meet asha

Incentives in Non

Project areas

Procurement of Bed

Net / LLIN for Non

Project Area

RDT for Non

Project Area

Dengue and

chikungunya

(Operational Cost)

AMC of Computer and

Cost of Internet + GIS

Software

1 2 3 4 5 6 7 8 9

1 Sirkakulam 4 0.06 0 0.00 0 1 5.06

2 Vizayanagaram 4 0.11 0 0.00 0 1 5.11

3 Visakhapatnam 7.58 0.62 0 0.00 0 1 9.20

4 East godavari 4 0.11 0 0.00 0 1 5.11

5 West godavari 0 0.02 45.0 2.39 0 1 48.41

6 Krishna 3 0.13 0.0 0.03 1.5 1 5.66

7 Guntur 3 0.02 9.6 0.15 1.5 1 15.27

8 Prakasham 3 0.08 50.0 3.60 1.5 1 59.18

9 Nellore 0 0.01 15.1 0.00 0 1 16.11

10 Chittore 0 0.01 78.1 9.17 0 1 88.28

11 Kadapa 0 0.08 100.9 0.24 0 1 102.22

12 Anantapur 0 0.02 65.1 4.32 0 1 70.44

13 Karnool 0 0.01 20.9 0.00 0 1 21.91

14 Adilabad 5 0.01 33.3 0.00 0 1 39.33

15 Karimnagar 0 0.01 45.0 0.00 1 1 47.01

16 Warangal 0 0.00 80.0 2.04 1.5 1 84.54

17 Khammam 6 0.01 0.0 0.00 0 1 7.01

18 Mehboobnagar 0 0.01 50.8 0.00 0.5 1 52.31

19 Medak 0 0.00 39.2 0.10 0 1 40.28

20 Nalgonda 0 0.03 0.0 0.00 0 1 1.03

21 Hyderabad 0 0.01 0.0 0.00 0 1 1.01

22 Rangareddy 0 0.01 0.0 0.00 0 1 1.01

23 Nizamabad 0 0.23 0.0 0.00 0 1 1.23

ZMO units(6) 0 0 0.0 0.00 0 0 0.00

State 0 0 345.0 51.64 0 7 403.64

Total 39.58 1.59 978.00 73.68 7.50 30.00 1130.35

204

Malaria Other VBDs

Kala-

azar

Decentralized

commodities

Total

domestic

support

(3-12)

World bank

Total

Budget

from

NVBDCP

(13+21)

State fund

Sl

no

Name of the

district

Contractual

MPWs

Incentive

for

ASHAs

for

identified

districts IEC Training

Epidemic

Preparedness

and M&E

Dengue and

chikungunya AES/JE ELF

Human

Resources(*) Trainnig

mobility

support

Total

(WB+GFATM)

(14-20)

Allocation

from

NRHM

Flexi

Fund

G.Total

(22+23)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 21 22 23 24 25

1 Sirkakulam 7.2 5.65 5 0 3 1.5 0.75 24.79 0 30.2241 78.11 13.94 10.8 4 28.74 106.848 5.1 112 32.9

2 Vizayanagaram 7.2 4.90 3.75 0 3 1.5 0.75 27.54 0 31.2659 79.90 13.94 7.8 4 25.74 105.644 5.1 111 321.267

3 Visakhapatnam 20.16 8.98 6.5 0 3 1.5 1.6 31.09 0 96.8928 169.72 17.9 11.8 4 33.7 203.417 9.2 213 105.13

4 East godavari 19.44 9.36 1 0 3 1.5 0.75 35.79 0 51.9462 122.79 15.26 8.06 4 27.32 150.109 5.1 155 44.06

5 West godavari 0 0.00 1 4.55 0 2.5 0 31.49 0 40.7546 80.29 0 0 0 0 80.2946 48.4 129 79.8179

6 Krishna 0 0.00 0.96 4.34 2 6.54 0.75 28.99 0 92.5104 136.09 0 0 0 0 136.09 5.7 142 57.103

7 Guntur 0 0.00 0.5 5.5 2 6 1.65 29.89 0 73.8972 119.44 0 0 0 0 119.437 15.3 135 107.158

8 Prakasham 0 0.00 1 6 0 4.25 0 26.09 0 27.3521 64.69 0 0 0 0 64.6921 59.2 124 31.48

9 Nellore 0 0.00 0.5 4.29 0 2.5 0 26.29 0 25.5418 59.12 0 0 0 0 59.1218 16.1 75 12.0629

10 Chittore 0 0.00 0.5 4.75 0 2 0 30.99 0 30.9044 69.14 0 0 0 0 69.1444 88.3 157 35.8531

11 Kadapa 0 0.00 1.5 4.1 2 2 0 0 0 15.5592 25.16 0 0 0 0 25.1592 102.2 127 21.98

12 Anantapur 0 0.00 1.5 5 0 2 0.45 0 0 15.4511 24.40 0 0 0 0 24.4011 70.4 95 48.1794

13 Karnool 0 0.00 0.5 5.3 0 2 2.4 0 0 29.4246 39.62 0 0 0 0 39.6246 21.9 62 18.71

14 Adilabad 0 0.00 3.5 7.9 2 3.25 1.75 0 0 13.4525 31.85 0 0 0 0 31.8525 39.3 71 60.84

15 Karimnagar 0 0.00 0.5 2.7 0 3.75 2.25 24.59 0 28.5067 62.30 0 0 0 0 62.2967 47.0 109 12.32

16 Warangal 0 0.00 1.5 4.75 0 6.25 2.9 0 0 19.9102 35.31 0 0 0 0 35.3102 84.5 120 37.8862

17 Khammam 7.2 5.52 5 0 3 1.75 2.25 0 0 25.7735 50.49 15.26 9.74 4 29 79.4924 7.0 87 60.138

18 Mehboobnagar 0 0 0.5 4.5 0 3.25 2 23.59 0 31.1844 65.02 0 0 0 0 65.0244 52.3 117 19.166

19 Medak 0 0 0.5 2.89 0 2.25 1.75 24.89 0 26.6361 58.92 0 0 0 0 58.9161 40.3 99 12.178

20 Nalgonda 0 0 0.5 2.5 0 2.25 1.75 30.09 0 32.9032 69.99 0 0 0 0 69.9932 1.0 71 14.6193

21 Hyderabad 0 0 1 4.97 0 5 4 0 0 66.6851 81.66 0 0 0 0 81.6551 1.0 83 24.758

22 Rangareddy 0 0 0.5 5.37 0 2.25 2.75 29.44 0 28.3689 68.68 0 0 0 0 68.6789 1.0 70 8.341

23 Nizamabad 0 0 0.5 5.4 0 2.75 3.5 26.79 0 24.7381 63.68 0 0 0 0 63.6781 1.2 65 13.296

ZMO units(6) 0 0 0 0 0 0 0 0 0.00 0 0 14.4 14.4 14.4 0.0 14 0.5

State 0 0 25 20 0 11.5 10.55 16 0 61.6 144.65 33.31 0 5 38.31 182.959 403.6 587 0

Total 61.200 34.403 63.210 104.810 23.000 80.040 44.550 468.340 0.00 921.483 1801.04 109.60 48.20 39.40 197.20 1998.24 1130.35 3128.59 1179.744

1. In Human Resource under WB, 10% increase per year for contractual staff has been taken into consideration for calculation 2. The Colum number 17 to 20 which are not

applicable are placed in hide

205

Annexure-I

13. Financial Proposal for Vector Borne Diseases

Component (Sub- Component) Financial

requirement

(in lakhs.)

To be placed in

functional head as

per NRHM

Malaria

Domestic Budget Support (DBS)

MPW 61.20 Human Resource

ASHA Honorarium 34.40 Honorarium and Incentive

Monitoring , Evaluation & Supervision & Epidemic Preparedness including mobility

23.00 Operating Cost

IEC/BCC 63.21 IEC & BCC

Training / Capacity Building 104.81 Training

Subtotal Malaria DBS 286.62

Additional support under World Bank States

Human Resource 109.60 Human Resource

Training /Capacity building 48.20 Training

Mobility support for Monitoring Supervision & Evaluation & review meetings, Reporting format( for printing formats)


Subtotal Malaria WB Project 197.20

Total for malaria (DBS+EAC) 483.82

Total financial requirement as per NRHM functional heads

Human Resource 170.80

Honorarium and Incentive 34.40

Operating cost 62.40

IEC/BCC 63.21

PPP/NGO 0

Training 153.01

Procurement

Infrastructure

Total Malaria (DBS + EAC) 483.82

Activities for Dengue & Chikungunya

Strengthening surveillance (As per GOI approval) Financial aid/grant to institutions Apex Referral Labs recurrent @ Rs.1.00 lakh per lab. 1.00

Sentinel surveillance Hospital recurrent @ Rs. 0.50 lakhs per lab.

11.50

Test kits (Nos.) to be supplied by GoI (kindly indicate numbers of ELISA based NS1 kit and Mac ELISA Kits required

separately)

0 GOI Supply

Monitoring/Supervision and Rapid Response 2.00 Operating cost

Epidemic Preparedness 8.50 Operating cost

IEC/BCC/Social Mobilization 51.54 IEC

Training/Workshop 5.50 Training

Total (Dengue and Chikungunya) 80.04


Human Resource 0

Honorarium and Incentive 0


IEC/BCC 51.54

206

PPP/NGO 0

Training 5.50

Procurement 0

Infrastructure

Financial aid/grant to institutions 12.50

Total Dengue/Chikungunya (Headwise) 80.04

Activities for AES/JE

Sentinel Sites which will include diagnostics and management as well as supply of Elisa kits

4.00 Procurement

IEC/BCC specific to J.E. in endemic areas 27.00 IEC

Training specific for J.E. prevention and management 7.55 Training

Monitoring 3.00 Operating cost

Procurement of insecticides (Technical Malathion) 3.00 Procurement

Total AES/JE 44.55


Procurement 7.00

IEC 27.00

Training 7.55

Operating cost 3.00

Total AES/JE (Headwise) 44.55

Activities for ELF

State level meeting viz. State Task Force meeting, State

Technical Advisory Committee (TAC) meeting

1.00 Operating Cost

Training/sensitization of district level officers on ELF 16.00 Training

IEC/BCC for ELF at state level 15.00 IEC

Printing of forms for line listing, MDA reports & registers for drug distributors etc.


Mobility support for M&E 8.00 Operating Cost

Dist. Coordination committee meeting in each district 4.00 Operating Cost

Sensitization of Media and other voluntary organizations 4.00 Operating Cost

IEC/BCC for ELF at district level, CHC, PHC, Sub-centre, Village including VHSC/GKS for community mobilization efforts to realize the desired drug compliance of 85% during MDA

27.75 IEC

Capacity building of peripheral health workers and drug distributors for MDA

139.00 Training

Demonstration of home based morbidity management for lymphoedema cases


Hydrocelectomy for lymphoedema cases 6.10 Operating Cost

Microfilaria survey in the night in identified sentinel and random villages and wards in urban areas before MDA in each filaria endemic districts

8.00 Operating Cost

Honorarium to drug distributors including ASHA involved in MDA

177.00 Honorarium & Incentives

Honorarium to supervisor to Drug distributors 18.05 Honorarium & incentives

Monitoring and supervision by district, block, PHC and health

supervisors including mobility support and support for rapid response team

9.00 Operating Cost

Post MDA assessment by medical colleges (Govt. & private)/ ICMR institutions.

1.44 Operating Cost

207

Total filaria elimination (Headwise) 468.34


Sub Total Filaria elimination 468.34

Operating Cost 75.54

Training 155.00

IEC 42.75

Honorarium & Incentives 195.05

Total filaria elimination (Headwise) 468.34

Commodities (Cash Grant form GOI )

Drugs

Chloroquine phosphate tablets 124.143 Procurement

Primaquine tablets 5.081 Procurement

Quinine sulphate tablets 0.509 Procurement

Quinine Injections 2.900 Procurement

DEC 100 mg (1200 lakhs) 300.000 Procurement

Insecticides DDT 50% wdp (51.6 MTs ) 0.000 Supplied by GOI

Synthetic Pyrethroid 10% WP - for WB Dist (46.43 MTs ) 0.000 Supplied by GOI

Malathion 25% wdp (600 MTs) 0.000 State Resources

UMS – Larvicides

Temephos (13000 liters) 83.850 Procurement

Bti (WP/AS) (15 MTs Bti WP , 1500 liters Bti AS ) 330.000 Procurement

Pyrethrum extract 2% (5000 liters) 75.000 Procurement

Subtotal for Decentralised commodities 921.483

Cash assistance from GOI for Malaria , Dengue chikungunya,

AES/JE and filaria

1076.75

Cash assistance from GOI for Decentralized commodities 921.483

Grand Total Cash assistance 1998.233

Total financial requirement under DBS as per NRHM

functional heads


Honorarium and Incentive 229.450


IEC/BCC 184.500

PPP/NGO 0.000

Training 272.860

Procurement 928.483


Total (DBS ) 1801.033

Total financial requirement under EAC as per NRHM

functional heads



Training 48.20

Total ( EAC) 197.20

Grand total (DBS+EAS) 1998.23

208

NRHM Flexibility

Asha Incentives 1.59 Incentives for non project areas

AMC, Computer, GIS 30 operational cost

(NRHM)

Dengue chikungunya (spray, transportation and OIL for spray) 7.5 operational cost (NRHM)

PPP / NGO activities 39.58 PPP/NGO

Procurement of Bednet / LLIN (LLIN: Total requirment for

18 districts is 13 lakh nets . 10 lakhs nets expected from GOI

for project districts . Hence 3.26 lakhs nets proposed)

978 Procurement

RDT Malaria (For Non Project Areas)- Out of total

requirment of 22.14 lakhs RDTs, 15.86 lakhs is expected from

GOI , Hence 6.27 lakhs @ 12.Rs per test is projected )

73.68 Procurement

NRHM Flexibility 1130.35

Total (WB+DBS+Decentralised commodity + NRHM Flexi) 3128.58

Total Functional head-wise breakup (NVBDCP)


Training 321.06

Infrastructure 0

Procurement 928.48

IEC 184.50

Untied funds 1130.35

Honorarium & incentives 229.45

RKS 0

Other Mission 0

PPP/NGO (asked NRHM untied fund ) 0

Operating Cost 151.44


Grand Total 3128.58

State Fund

Component (Sub- Component) Financial

requirement

(in lakhs.)

To be placed in

functional head as per

NRHM

Wages for IRS 314.606 operational cost

Maintainance of hatcharies (@ Rs 50,00 per district, and one

at the state level)

12 operational cost

Malathion 25% WDP( 594 MT @70000 per MT) 416.198 Procurement

Knap sack sprayer (130 sprayer @2000Rs per sprayer ) 2.78 Procurement

Hand fogging (80 machines @50000Rs per machine) 40 Procurement

Vehicle mounted (3 machines @ 10 lakh per machine) 30 Procurement

Medium fogging (8 machines @5.5 lakh per machine) 44 Procurement

Power Spray (15 machines @6930 Rs per spray) 1.04 Procurement

Stir Pump (1120 @2470 Rs per pump) 42.98 Procurement

Slide box (10 capacity slide box per ASHA costing 15 Rs each,

25 capacity slide box per MPW cost 22 Rs each ,total MPWs

25993 and Ashas 70252))

16.22 Procurement

Lab Reagent ( 1860 labs , @10000 per lab) 186 Procurement

209

Slides (4780636 slides @0.52 Rs per slide) 24.77 Procurement

Lancets (9849370 lancets @ 0.5 Rs per lancet) 49.15 Procurement

Subtotal (State fund) 1179.744

Total financial requirement from state fund as per functional

head

Human Resource 0

Honorarium and Incentive 0


IEC/BCC 0

PPP/NGO 0

NRHM additionalities 0

Training 0

Procurement 853.138

Infrastructure 0

Total VBD budger for state fund 1179.744

GRANDTOTAL BUDGET FOR VBD FOR ANDHRA

PRADESH (Including DBS, ECS , NRHM and State fund)

4308.33

In-kind Contribution

Items Quantity

ACT (For5 Project districts) Adequate Quanatity of Act available for the year 2011-12

RDT (For5 Project districts) 15.86 lakh

tests

LLIN (For5 Project districts) 10 lakh nets

DDT 50% wdp Adequate Quantity available

Synthetic Pyrethroid - for WB Dist

46.27 MTs

Arteether 3340 injections

Albendazole (Tablets) 54925804

Proposal for Epidemic Preparedness:

Andhra Pradesh State though is able to keep the API of Malaria lower than 1 %

for last few years there are sporadic outbreaks observed through out the year in different

parts of the states specifically tribal areas located in Eastern Ghats. To deal with such incidence, specific budget (Epidemic preparedness) has been allocated for high endemic

districts. However it is essential that in the situation of emergency, provision should be

made under the NRHM flexi fund to provide immediate budgetary allocation to specific

districts in case any vector borne disease related outbreaks or epidemic occurs.

210

D.2 REVISED NATIONAL TB CONTROL PROGRAM

282. The Revised National TB Control Programme (RNTCP), based on the

internationally recommended Directly Observed Treatment Short-course (DOTS)

strategy, was launched in India in the year 1997 expanded across the country in a phased manner with support from the World Bank and other development partners. The entire

state of Andhra Pradesh is covered under RNTCP since February, 2004. Presently the

state has 178 TB Units (One each for five lakh population) and 919 Designated

Microscopy Centers (one each for one lakh population). The state under RNTCP is providing the following services,

Diagnostic and treatment services for the control of TB ,which is not drug

resistant.

Multi TB drug resistant (MDR TB ) diagnostic and treatment services in eight

districts, and the entire state to be covered by the end of 2011.

Co-trimoxozole preventive therapy and linking up of TB/HIV co-infected patients to the ART center.

Operational research activities support for the medical colleges on priority areas.

Key Objectives: The objectives of the programme are to:

Detection of at least 90% of all incident TB cases

Successfully treat at least 90% of New Smear Positive cases

Situational Analysis, Critical gaps Identification:

S N Priority areas Activity planned under each priority area 1 To Improve Case Detection

among all types of TB patients

1 Strengthen the involvement of other public sector hospitals like military hospitals, coal hospitals etc.

2 Involvement of PPs through IMA

3 Strengthen the TB HIV coordination and implement

“Intensive case finding” across the state

2 To Improve Quality of DOTS

1 Vacant posts be filled at all levels including contractual posts and ensure supervision and monitoring

2 To involve General Health staffs effectively in implementing RNTCP

3 Involvement of Community volunteers

4 Involve all ASHAs across the state in DOT Provision

3 To Improve Supervision and monitoring at all levels

1 Implement Supervision & Monitoring Strategy To implement supervisory registers in all PHIs

2 Regular monthly review of key staff at District level

3 Regular Internal Evaluation from State Level.

4 Bi annual DM&HO review meeting to enhance the involvement

4 Regular Training/Re-training/Sensitization

1 Training of all untrained staffs

2 Retraining of low performing key staffs at the state level

3 Regular sensitization of General health staffs and Private practitioners

211

5 EQA implementation in all the districts

1 Regular Monitoring by STDC and prompt feedback

2 On site evaluation of all the districts of AP by IRL

3 Analysis of Annexures submitted by the DMCs, identify constraints on the priority areas and seek implementation of

the recommendations on a quarterly basis.

6 Implementation DOTS Plus in all districts

1 Accreditation of laboratory at Kurnool medical college and 2nd lab at IRL

2 Training of all staff under DOTS Plus and implementation of DOTS Plus

3 Prompt air borne infection Control in DOTS Plus site

7 TB-HIV Collaborative activities

1 Strengthen intensified case finding at ICTCs, Care & Support centres and ART centres.

2 Expand Co-trimoxazole, Prophylaxis therapy for HIV-TB patients in all the districts

3 Strengthen the linkage between TBHIV patients with CPT and ART linkage

Key Strategies of the Program:

PURSUE HIGH-QUALITY DOTS EXPANSION AND ENHANCEMENT

Secure political commitment, with adequate and sustained financing

Ensure early case detection, and diagnosis through quality-assured

bacteriology

Provide standardized treatment with supervision, and patient support

Ensure effective drug supply and management

Monitor and evaluate performance and impact

ADDRESS TB/HIV, MDR-TB, AND THE NEEDS OF POOR AND

VULNERABLE POPULATIONS

Scale–up collaborative TB/HIV activities

Scale-up prevention and management of multidrug-resistant TB (MDR-TB)

Address the needs of TB contacts, and poor and vulnerable populations

CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING BASED ON PRIMARY HEALTH CARE

Help improve health policies, human resources development, financing,

supplies, service delivery and information

Strengthen infection control in health services, other congregate settings and

households

Upgrade laboratory networks, and implement the Practical Approach to Lung

Health (PAL)

Adapt successful approaches from other fields and sectors, and foster action

on the social determinants of health

ENGAGE ALL CARE PROVIDERS

Involve all public, voluntary, corporate and private providers through Public-Private Mix (PPM) approaches

Promote use of the International Standards for Tuberculosis Care (ISTC)

EMPOWER PEOPLE WITH TB, AND COMMUNITIES THROUGH

PARTNERSHIP

Pursue advocacy, communication and social mobilization

Foster community participation in TB care, prevention and health promotion

Promote use of the Patients' Charter for Tuberculosis Care

212

ENABLE AND PROMOTE RESEARCH

Conduct programme-based operational research

Advocate for and participate in research to develop new diagnostics, drugs

and vaccines

Programme Components: 283. Political and Administrative Commitment: The Government of India has given

TB control programme top priority. The government‟s continuous financial

commitment, human resources and administrative support speak of its commitment to

control and eliminate TB and the success of the programme, to date, bears testimony to this commitment.

284. Good Quality Diagnosis through sputum Microscopy: Sputum microscopy continues to be the primary tool for detection of infectious cases. Apart from sputum

microscopy, RNTCP also uses standardised diagnostic algorithms to diagnose and treat

all forms of TB wherein X-ray plays a supporting role. However in line with the stop TB

strategy the programme is exploring all possible avenues with newer and innovative technologies for early detection of TB including use of LED fluorescent microscopes,

liquid culture and line probe assay for diagnosis drug resistant TB etc.

285. Uninterrupted supply of Good Quality Drugs: RNTCP uses intermittent short-

course chemotherapy (SCC) regimens to facilitate the direct observation of treatment.

RNTCP ensures that there is no interruption in treatment due to shortage of drugs, once

a person is diagnosed with TB. Suffi cient anti-TB drugs in patient wise boxes are made available at all the appropriate levels (Peripheral Health Institution/TB

unit/District/State/National). The uninterrupted supply of drugs to each patient is made

possible through the “patientwise box.”

286. Directly observed treatment: Directly observed treatment (DOT) is one of the key

elements of the DOTS strategy. In DOT, an observer (health worker or trained

community volunteer who is not a family member) watches and supports the patient in taking drugs. The DOT provider ensures that the patient takes the right drugs, in the

right doses, at the right intervals, for the right duration.

287. Systematic Monitoring and Accountability: :RNTCP has a systematic monitoring

mechanism which accounts for/tracks the outcome of every patient put on treatment.

There is a standardised recording and reporting structure in place. The cure rate and

other key indicators are monitored regularly at every level of the health system and regular supervision ensures quality of the programme. RNTCP shifts the responsibility

for cure from the patient to the health system.

Implementation Methodology:

288. Structure Of The Revised National Tuberculosis Control Programme: The

RNTCP has a central division, state, district and sub-district levels and health units. As

noted above, a major organizational change is the creation of a sub-district level. Creation of a sub-district level allows for the systematic monitoring of the outcome of

every patient. An additional structure of the RNTCP is the District Tuberculosis Control

Society. This society functions with the District Collector as the Chairman, the District

213

Tuberculosis Officer (DTO) as Member Secretary, and has governmental and non-

governmental representatives. It is responsible for monitoring the programme implementation, arranging necessary logistics such as transport and procuring materials

such as laboratory consumables.

289. State level : At this level, a State Tuberculosis Officer (STO) is responsible for

planning, training, supervising and monitoring the programme in the state. He is responsible administratively to the State Director of Health Services and technically

follows instructions of the Central TB Division. There should be a full-time STO trained

in the RNTCP for each state.

Main responsibilities at the state level are to:

work closely with the Central TB Division for performing the duties mentioned

above;

plan, supervise, monitor and evaluate anti-tuberculosis activities throughout the

state;

ensure adequate supply of drugs, laboratory equipment and documents needed in

the state;

organize training programmes in the state in collaboration with the Central TB

Division, the State TB Training and Demonstration Centre (STDC) and the

District Chief Medical Officers, and to give on-the-job training to the district and peripheral workers;

214

ensure that the required reports on case-finding, results of treatment and

programme management are completed in each district and sent to the Central TB Division in time;

review the reports on case-finding, results of treatment and programme

management from the districts and take necessary action for their improvement;

and ensure close cooperation between the staff in case-finding and treatment of tuberculosis and the microscopy services.

290. District level: The district is the key level for the management of primary health care. The district level (or municipal corporation level in large metropolitan areas)

performs functions similar to those of the state level in its area. The District Medical

Health Officer or his equivalent is the principal health functionary in the district and is

responsible for all medical and public health activities including control of TB. The District Tuberculosis Centre (DTC) is the nodal point for TB control activities in the

district and also functions as a specialized referral centre. The DTO at the DTC has the

overall responsibility of the Programme at the district level and is assisted by an MO, Statistical Assistant and other paramedical staff. For each district, there should be a full-

time DTO who is trained in the RNTCP.

Main responsibilities at the district level are to:

implement the RNTCP through the district health staff;

maintain a map of the area detailing all health facilities, government

organizations and NGOs which specifically carry out TB activities, including the

staff responsible for these activities (name, position and location);

train and re-train the medical and paramedical staff;

maintain a regular supply of drugs, treatment-related materials, sputum

containers and slides, laboratory-related materials, forms and registers for the district;

supervise and ensure proper treatment of tuberculosis throughout the district, and

particularly ensure that:

o the correct treatment is prescribed in all health facilities o patients are receiving the appropriate drugs under direct observation of

health workers during the intensive phase of treatment and at least one

dose per week in the continuation phase is directly observed

o regimens are given for the required period, and cured patients are discharged from treatment

o sputum is examined for acid-fast bacilli (AFB) at the stipulated time

intervals o patients are individually advised about their disease

o patients are referred or transferred as appropriate

o treatment outcomes of patients are determined and recorded in the

Tuberculosis Register;

organize health education and establish liaison with private practitioners and

NGOs who provide TB services to promote compliance with national norms and

facilitate referral;

assist staff in the diagnosis of TB in all health facilities in the district;

ensure that the sub-district staff visit all microscopy centres for supervision at least

once a month;

215

make sure, by reviewing quarterly reports and randomly spot-checking, that MOs

and health workers properly identify symptomatic patients, collect and transport sputum specimens and refer patients for diagnosis;

visit all sub-district Tuberculosis Units, hospitals, Community Health Centres

(CHCs) and Block Primary Health Centres (Block PHCs) at least once a quarter;

and complete quarterly reports on notified New and retreatment cases of tuberculosis, sputum conversion and on the results of treatment.

291. Sub-district level: A team comprising a specifically designated MO-TC, STLS and STS is based in a CHC or Taluk Hospital (TH) or Block PHC. The team constitutes the

TU, and the STS and STLS are under the administrative supervision of the DTO. The

staff from the DTC (laboratory technician and treatment organizer) will carry out the

functions of the sub-district supervisory team in its respective sub-district in addition to their functions as a microscopy and treatment centre. The sub-district covers a

population of approximately 5,00,000. The sub-district is reponsible for accurate

maintenance of the Tuberculosis Register and timely submission of quarterly reports.

Functions of the TU are to:

maintain a map of the area detailing all health facilities, and government

organizations and NGOs which specifically carry out TB activities, including the staff responsible for these activities (name, position and location);

maintain a regular supply of drugs and other logistics and ensure their

uninterrupted availability in all designated centres in the sub-district. Retrieve

unfinished medicine boxes of patients who have defaulted (i.e. stopped treatment for two months or more continuously);

establish liaison with private practitioners and NGOs providing TB services to

promote compliance with national norms, facilitate referral and ensure registration and notification;

organize sputum smear examination at the microscopy centres of the

sub-district;

carry out categorization of treatment services and DOT;

organize regular training and continuing education;

supervise the microscopy centres and PHCs at least once a month, and

perform quality control of slides as per the Laboratory Manual;

prepare and distribute reagents, and ensure regular and sufficient

supply of reagents and sputum containers in each health facility;

keep the Tuberculosis Register up-to-date and accurate;

prepare quarterly reports on case detection, sputum conversion, treatment

outcome and programme management;

make sure MOs and health workers correctly identify symptomatic patients and

refer patients for diagnosis;

diagnose smear-negative patients who require X-ray examination (if facilities

exist);

act as a referral point, for example, for patients who:

o present diagnostic problems

o have drug reactions o refuse to take drugs

o are failure cases requiring further investigation

216

o do not convert to smear-negative status at the end of the intensive phase

and identify the reasons for the same o require evaluation of treatment outcome, i.e. cured, treatment completed,

defaulted, died, transferred out, failure; and

Monitor the maintenance of the Laboratory Register and the documentation

related to microscopy examinations.

Health units: At this level are the rural and other hospitals, health centres, dispensaries

and health facilities within a district.

Main responsibilities at the health units are to:

send tuberculosis suspects or their sputum specimens to designated microscopy

centres for examination;

carry out categorization of treatment services and DOT;

trace patients who do not collect their drugs and bring them back under

treatment;

keep Tuberculosis Treatment Cards and records and make them available for the STLS, STS, MO-TC, DTO and other supervisory staff when they visit the health

unit;

facilitate follow-up sputum smear examinations;

trace and investigate contacts; and

discharge patients who have come to the end of their treatment regimen in

coordination with the designated MO-TC of the sub-district

Monitoring & Reporting System:

217

Risk Analysis

o TB primarily affects people in their most productive years of life with important

socio-economic consequences for the household and the disease is even more

common among the poorest and marginalized sections of the community.

o 70% of TB patients are aged between the ages of 15 and 54 years of age. While

two thirds of the cases are male, TB takes a disproportionately larger toll among young females, with more than 50% of female cases occurring before 34 years of

age.

o The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually. Studies suggest that on an average 3 to 4 months of work time is lost as

result of TB, resulting in an average lost potential earning of 20-30% of the annual

household income.

o Tuberculosis is one of the earliest opportunistic diseases to develop amongst

persons infected with HIV. HIV infection is the most powerful risk factor for the

progression of TB infection to TB disease. An HIV positive person has many times higher risk of developing TB disease in those infected with TB bacilli, as

compared to an HIV negative person.

Expected Outcomes:

S.No

.

Priority areas Expected Outcome

1 To Improve Case

Detection among all types of TB patients

Total CDR from 136/lac to 150/lac

NSP CDR Increase from 50107 (80%) to 56370(90%)

NSN CDR Increase from 28529 cases to 50107

cases

2 To Improve Quality of

DOTS Reduce initial defaulters from 762 cases (4.2%)

to less then 150 cases (1%)

Percentage of patients started DOTS within

seven days of diagnosis increase from 90 to 100%

3 To Improve Supervision

and monitoring at all

levels

Improvement in program indicators

Submission of ATPs and Tour Diaries of MOs

and other key staff

Regular review meetings both at state, district

and sub district level

4 Regular Training/Re-

training/Sensitization

Training of all untrained staffs

Retraining of low performing key staffs at the state level

Regular sensitization of General health staffs

and Private practitioners

218

5 EQA implementation in

all the districts

Regular Monitoring by STDC and prompt

feedback

On site evaluation of all the districts of AP by IRL

Analysis of Annexures submitted by the

DMCs, identify constraints on the priority areas and seek implementation of the

recommendations on a quarterly basis.

6 Implementation DOTS

Plus in all districts Accreditation of laboratory at DFIT, Nellore

and 2nd lab at IRL

Training of all staff under DOTS Plus and implementation of DOTS Plus

Prompt air borne infection Control in DOTS

Plus site

7 TB-HIV Collaborative activities

The proportion of TB patients knowing their HIV status improvement from 76% to 100%

The proportion of co-infected cases to be

started on CPT to be 100%


292. Andhra Pradesh in one of the very few states in the country implanting all the

components of RNTCP, DOTS, DOTS Plus, Intensified TB HIV Package, Airborne

Infection Control, PPM Initiatives

1. Culture & DST Lab scale up plan

2. Culture & DST Lab at DFIT Nellore 3. Culture & DST Lab at SVIMS, Tirupati

4. Culture & DST Lab (II Lab) at IRL, STDC, Hyderabad, all labs to have liquid

Culture and DST and LPA diagnostics for MDR TB diagnosis.

293. LPA drastically reduces the diagnostic time from three to four months to three

days. This helps an early detection and initiation of treatment thus cutting the threat of

infection. o Extension of DOTS Plus services

219

New DOTS Plus sites at Chest Hospital, Vizag, Chest Hospital, Warangal & DFIT

Nellore.

The state in collaboration with TBAlert has launched Axshya Project in seven

districts of Andhra Pradesh. The goal of the Axshya project is to decrease

morbidity and mortality due to TB in India and improve access to quality TB care and control services through enhanced civil society participation.

Piloted referral mechanism of TB symptomatic from medical outlets in Ongole

TU, Prakasam district.

Airborne Infection Control – Guidelines were piloted in 13 selected health

facilities.

The state is now moving towards the Universal Access concept of providing early

and better diagnosis and treatment i.e., affordable and convenient in time, place and person.

Budget Analysis:

Statement of Budget release vs Expenditure for FY 2009-10

S.N Heads Budget

approved for

the f.y.2009-

10

Budget

released

during 2009-

10

Expenditure

for the

f.y.2009-10 (

Rs.in lakhs)

Difference

1 2 3 4 5 6(4-5)

1 Civil Works 12.66 10.42 1.52 8.90

2 Laboratory Materials 135.60 240.56 235.00 5.56

3 Honorarium 92.54 50.00 33.00 17.00

4 Publicity 77.80 81.99 64.75 17.24

5 Equipment Maintenance

26.14 57.54 48.07 9.47

6 Training 52.22 34.58 24.45 10.13

7 Vehicle Maintenance 46.25 60.08 46.79 13.29

8 Vehicle Hiring Charges

154.48 146.56 113.35 33.21

9 NGO Support 236.10 47.68 32.83 14.85

220

10 Medical Colleges 77.44 20.89 15.19 5.70

11 Miscellaneous 275.27 132.51 105.24 27.27

12 Contractual Service. 708.64 891.98 777.96 114.02

13 Printing 127.00 25.36 24.13 1.23

14 Research and Studies 100.00 2.20 2.20 0.00

15 Salary for Regular Staff

0.00 0.00 0.00 0.00

16 Procurement of Drugs 0.00 0.26 0.00 0.26

17 Procurement of Vehicles

33.00 49.66 29.62 20.04

18 Procurement of Equipment

0.00 3.01 1.64 1.37

19 Additionalties 300.00 0.00 0.00

TOTAL 2455.14 1855.28 1555.74 299.54

Statement of budget proposals in the f.y.2010-11 & 2011-12.

Sr.No Expenditure Annual Budget

proposal for the

f.y.2010-11

Annual Budget

proposal for the

f.y.2011-12

Diff

a b c=b-a 1 Civil Works 62.04 72.04 10.00

2 Laboratory Materials 136.95 149.46 12.51

3 Honorarium 75.00 115.00 40.00

4 Publicity 77.00 79.50 2.50

5 Equipment Maintenance 30.00 60.13 30.13

6 Training 52.00 100.03 48.03

7 Vehicle Maintenance 50.00 47.75 -2.25

8 Vehicle Hiring Charges 154.35 166.14 11.79

9 NGO Support 150.00 200.08 50.08

10 Medical Colleges 50.00 130.31 80.31

11 Miscellaneous 131.50 136.95 5.45

12 Contractual Service. 1443.70 1056.04 -387.66

13 Printing 125.00 125.00 0.00

14 Research and Studies 70.00 70.00 0.00

15 Salary for Regular Staff 0.00 0.00 0.00

16 Procurement of Drugs 0.00 0.00 0.00

17 Procurement of Vehicles 45.00 0.00 -45.00

18 Procurement of Equipment 18.00 24.60 6.60

Sub-total 2670.54 2523.03 -147.51

19 Additionalties 193.00 97.80 -95.20

TOTAL 2863.54 2688.03 -175.51

ANNEXURE 1

Civil Works (Rs.in Lakhs)

Activity No.

required

as per

the

norms in

the state

No.

already

upgraded/

present in

the state

No.

planned

to be

upgraded

during

next

Pl provide

justification if an

increase is

planned in excess

of norms (use

separate sheet if

Estimated

Expenditure

on the

activity

Quarter in

which the

planned

activity

expected to

be completed

221

financial

year

required)

(a) (b) (c) (d) (e) (f)

STDC/ IRL 1 Upgraded

SDS 1 Upgraded 1.50

DOTS Plus Site

5 5

Upgradation of DOTS Plus site at Hyd, Guntur, Vizag , Warangal

and Thirupati

50.00

DTCs 24 Upgraded

Up gradation of DTC drug stores.

7.20

TUs 178 Upgraded

DMCs 920 Upgraded

Civil works – maintenance

13.34

TOTAL 72.04

ANNEXURE 2

Laboratory Materials

Activity Amount

permissible

as per the

norms in the

state

Amount

actually

spent in

the last 4

quarters

Procurement

planned

during the

current

financial year

(in Rupees)

Estimated

Expenditure

for the next

financial year

for which

plan is being

submitted

(Rs.)

Justification/

Remarks for

(d)

(a) (b) (c) (d) (e)

Purchase of Lab Materials by Districts 124.80

172.96

111.99 124.50

Lab mate rials for EQA activity at STDC (eg. Lab consumables for

trainings, preparation of Panel slides etc)

12.48 12.48 12.48

Lab materials & consumables for Culture/DST activity at IRL and other Accredited Culture & DST labs in Govt. sector including Medical Colleges

12.48 12.48

12.48

Total 136.95 149.46

ANNEXURE 3

Honorarium

Activity Amount

permissible

as per the

norms in the

state

Amount

actually

spent in

the last 4

quarters

Expenditure

(in Rs)

planned for

current

financial

Estimated

Expenditure for

the next financial

year for which

plan is being

Justification/

Remarks for

(d)

222

year submitted

(Rs.)

(a) (b) (c) (d) (e)

Honorarium for DOT providers (both tribal and non tribal districts)

120.00 31.44 68.40 90.00

Honorarium for DOT providers of Cat IV patients

6.60 6.60 25.00

Total 126.60 31.44 75.00 115.00

* These community volunteers are other

than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc.

ANNEXURE 4 Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP 1) Information on previous year‟s Annual Action Plan

a) Budget proposed in last Annual Action Plan : Rs. 77 lakhs b) Amount released by the state : Rs.19.88 lakhs c) Amount Spent by the district- : Rs.3.46 lakhs (12 months)

2) Permissible budget as per norm : 78,50,000/- 3) Budget for next financial year for the district as per action plan detailed below

: 79,50,000 Lakhs

Program

Challenges to

be tackled by

ACSM during

the Year

20010-11

WHY

ACSM

Objective

For

WHOM

Target

Audience

WHAT

ACSM Activities

When

Time Frame

By

WHOM

Monitoring

and

Evaluation

Budget

Based on existing TB indicators and

analysis of communication challenges (Maximum 3

Challenges )

Desired behavior or action

(make SMART: specific, measurable,

achievable, realistic & time bound

objectives)

Activities Media/ Mater

ial Required

Q1

Q2

Q3

Q4

Key implementer

and RNTCP officer 20000re

sponsible for supervis

ion

Outputs;

Evidence that the

activities have

been done

Outcomes:

Evidence that

it has been effect

ive

Total expenditure for the

activity during the financial year

Challenge 1. Maintain & Sustain Case Detection

Advocacy Activities

Maintain & Sustain Case

Detection in the state and increase Case Detection in

ADB,APR,CHT,KRN,KMR,MBR,MDK

To gain administrati

ve support, increase referrals, involve

community and other partners like

Opinion leaders

Community School & colleges students

Govt. & Prvt. Employees

World TB Day

Rallies/Mee

tings/ Sensitization/

Quiz

Y STO/D

TO

Photos,

Paper clippings, Repor

t, Letter

Media

Reports

1000000

No. presently

involved in

RNTCP

Additional enrolment

proposed for the next

fin. Year

Community volunteers in all the

districts* 48000 10000

223

,NGD, NZD districts

To gain administrative support and involve

partners

NGOs,SHGs etc

Annual Performance

Report & to gain administrati

ve support

Annual Book

STO/DTO

STO

Annual

Report

Release on Worl

d TB Day/Usag

e during revie

ws

Key decision

makers/ Officials

Y

250000

Communication Activities

Display of IEC material at all the

health facilities, govt. & non-govt. organisations

Posters

Y 1. Displ

ay of material at

health

facilities,

DOT Centers,G

ovt. &

non Govt.

Offices

500000

Maintain and sustain

NSP CDR >70%

Opinion leaders

Community School & colleges students

Govt. & Prvt. Employees

Pamphlets

Y Increase in

Case Detection

450000

Tin plates Y 1200000

Radio

Flip Books Miking

Cinema Slides

Annual Diary

Y Y

Y Y

Y

Y

Y 600000

300000

200000

200000

600000

Social Mobilization activities

Increase

involvement of community, local

opinion leaders

Increase involvement of

school & college students

NSP CDR of >70% in

6 districts (NZB,CHT, RGY,KRN,KRM,CDP)

Opinion leaders/SH

G Members/ Teachers/ School &

college students

Community

Meetings

School/College Activity

Flip Books

/Pamphlets

Y

Y

Y

Y

Y

Y

Y

Y

Docum entaion/

Photog raphs

Docum entaion/ Photographs

DTO 1200000

250000

Challenge 2: Low Pediatric Case Registration

Advocacy Activities

Low

involvement of IMA &

To motivate

members to refer pediatric

2. STO

/DTO

224

Pediatrics Asso.

cases

Communication Activities

Increased referrals

from MOs, Pediatricians

Increased referrals

from MOs, Pediatricians

MOs/Pediatricians

MOs/Pediatricians

Pvt. Prac. Kits Table Top Kit with

Pen stand, Table Tops

900000

Social Mobilization

Challenge 3:- Defaults and low adherence

Advocacy activities

Communication activities

Increase Interactive

meetings/Counseling of family

members/Sharing of experiences by cured

patients

DOT Providers Sensitization/TB

Care Clubs/IPC

Motivate patients &

DOT Providers For

completion of treatment

Patients/DOT

Providers/Immediate family

members of patients

Pat. Provider

meetings

Flip materi

al/Charts

Documenta

tion of event

/Photos/

Reduction

in defaults

300000

Sensitization Meetings

DOT Providers

training materi

al

DTO

Social Mobilization Activities

TOTAL BUDGET 7950000

ANNEXURE 5

Equipment Maintenance Item No.

actually present in the state

Amount

actually spent in the last 4 quarters

Amount

Proposed for Maintenance during current financial yr.

Estimated

Expenditure for the next financial

year for which plan is being

submitted (Rs.)

Justification/

Remarks for (d)

(a) (b) (c) (d) (e)

Computer (Maintenance includes AMC, software and hardware upgrades,

Printer Cartridges and Internet expenses)

26 44.00 8.10 8.10

Binocular Microscopes (RNTCP)

1069 8.00 16.03

STDC/ IRL Equipment 7.90 30.00

15% of the equipment cost

AMC to be given

225

for IRL equipment.

Any Other (pl. specify) Generator at STDC

1 6.00 6.00

Maintenance of generator at

STDC,

Hyderabad.

TOTAL 30.00 60.13

ANNEXURE 6

Training

Activity No.

in the

state

No.

already

trained

in

RNTCP

No. planned to be trained

in RNTCP during each

quarter of next FY (c)

Expenditure

(in Rs)

planned for

current

financial

year

Estimated

Expenditure

for the next

financial

year

(Rs.)

Justification/

remarks

Q1 Q2 Q3 Q4

(a) (b) (d) (e) (f)

Training of DTOs (at National level)

24 10

National DOTS Plus trainings

40 120 80 40 40 40 30.00

Training of MO-TCs

178 161 17 4.00 4.00

Training of MOs (Govt + Non-Govt)

4107 2762 400 400 300 245 7.00 5.58

Training of LTs of DMCs- Govt + Non Govt

918 849 40 28 4.00 0.38

Training of MPWs

Training of

MPHS, pharmacists, nursing staff, BEO etc

24 +

581

489 2000 2000 1500 4.00 10.12

Training of Comm Volunteers

60658 51744 15000

15000 15000 3.00 10.00

Training of Pvt Practitioners

200 200 200 200 6.00 17.40

Other trainings

Re- training of MOs

25 25 25 40 2.00 0.19

Re- Training of LTs of DMCs

30 20 15 15 2.00 0.20

226

Re- Training of MPWs

120 130 120 130 2.00 0.07

Re- Training of MPHS,

pharmacists, nursing staff, BEO

10 20 30 10 2.00 0.10

Re- Training of CVs

500 500 500 500 10.00 3.10

Re-training of Pvt Practitioners

10 20 10 15 5.00 0.08

TB/HIV

Training of MO-TCs and MOs

4285 1125 1000 1000 500 500 3.00 4.65

TB/HIV Training of STLS, LTs , MPWs, MPHS, Nursing Staff, Community Volunteers etc

1200 1200 1200 1200 2.00 12.84

TB/HIV Training of STS

60 60 60 3.00 0.78

Training of MOs and Para medicals in DOTS Plus for management of MDR TB

500 500 500 500 3.00 0.54

Provision for Update Training at Various Levels #

Review Meetings at State

Level

1.00

Any other activity

Total 52.00 100.03

ANNEXURE 7

Vehicle Maintenance

Type of Vehicle Number

permissible

as per the

norms in

the state

Number

actually

present

Amount

spent on

POL and

Maintenance

in the

previous 4

quarters

Expenditure

(in Rs)

planned for

current

financial

year

Estimated

Expenditure for the

next financial year

for which plan is

being submitted

(Rs.)

Justification/

remarks

(a) (b) (c) (d) (e) (f)

Four Wheelers 3 3 2.00 3.25

Two Wheelers 178 178 40.14 48.00 44.50

TOTAL 50.00 47.75

ANNEXURE 8

227

Vehicle Hiring*

Hiring of

Four

Wheeler

Number

permissible

as per the

norms in the

state

Number

actually

requiring

hired

vehicles

Amount

spent in

the prev.

4 qtrs

Expenditure

(in Rs)

planned for

current

financial year

Estimated

Expenditure for the

next financial year

for which plan is

being submitted (Rs.)

Justification/

remarks

(a) (b) (c) (d) (e) (f)

For STC/ STDC

Nil Nil

For DTO 24 24 97.85 41.25 54.00

For MO-TC 178 178 113.10 112.14

TOTAL 154.35 166.14

* Vehicle Hiring permissible only where RNTCP vehicles have not been provided

ANNEXURE 9

NGO/ PP Support: NGO/ PP Support: (New schemes w.e.f. 01-10-2008)

Activity No. of currently involved in RNTCP

Additional enrolment planned for this year

Amount spent in the previous 4

quarters

Expenditure (in Rs) planned for current financial

year

Estimated Expenditure for the next financial year for

which plan is being submitted (Rs.)

(a) (b) (c) (d) (e)

ACSM Scheme: TB advocacy, communication, and social mobilization

15 28 37.06 5.00 22.50

SC Scheme: Sputum Collection Centre/s

8 41 9.41 5.60

Transport Scheme: Sputum Pick-Up and Transport Service

8 34 9.80 9.80

DMC Scheme: Designated Microscopy cum Treatment Centre (A & B)

20 13 31.90 30.00

LT Scheme: Strengthening

RNTCP diagnostic services 4 18 15.89 4.28

Culture and DST Scheme: Providing Quality Assured Culture and Drug Susceptibility Testing Services

1 0 28.80 28.80

Adherence scheme: Promoting treatment adherence

12 508 10.00 24.00

Slum Scheme: Improving TB

control in Urban Slums 3 17 7.10 7.50

Tuberculosis Unit Model 8 1 20.00 42.40

TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk groups (HRGs)

7 5 12.10 25.20

TOTAL 150.00 200.08

228

ANNEXURE 10

Miscellaneous

Activity* e.g. TA/DA, Stationary,

etc

Amount permissible as per the norms in the state

Amount spent in the previous 4 quarters

Expenditure (in Rs)

planned for current

financial year

Estimated Expenditure for the next

financial year (Rs.)

Justification/ remarks

(a) (b) (c) (d) (e)

Miscellaneous (ta/da) 131.95

98.00 126.50 131.95

Miscellaneous (Stationery)

Miscellaneous (furniture)

Miscellaneous (transport)

Miscellaneous (insurance)

Miscellaneous (telephone charges)

Miscellaneous (electricity)

Miscellaneous (water charges)

Miscellaneous (cell phone charges)

Miscellaneous (conveyance)

Miscellaneous (Dots plus)

Miscellaneous - CFs (TA/DA)

5.00 5.00 5.00

TOTAL 136.95

Please mention the main activities proposed to be met out through this head

Note: Dots plus implementing districts Hyderabad, Rangareddy, Medak, Nalgonda, Guntur, East Godavari, West Godavari, Krishna, Vizianagaram, Srikakulam and Visakhapatnam.

229

ANNEXURE 11

Contractual Services

Category of Staff No.

permissible

as per the

norms in

the state

No.

actuall

y

presen

t in the

state

No.

planned to

be

additional

ly hired

during

this year

Amount

spent in

the

previou

s 4

quarters

Expendi

ture (in

Rs)

planned

for

current

fin. Yr

Estimated

Expenditu

re for the

next

financial

year (Rs.)

Justificati

on/

remarks

(a) (b) ©

746.76

(d) (e)

Asst. Program Officer / Epidemiologist

1 1 5.04 4.8

Medical Officer(STC) 1 1 3.78 3.6

TB/HIV Coord. 1 4.41

Urban TB Coord. 1 2.52

DOTS plus site Sr. Medical Officer

1 5 3.78 18.00

DOTS plus site Statistical Assistant

1 5 1.89 9.00

Microbiologist (IRL) 1 1 6.72 4.41

Sr.LT (IRL) 1 1 1.89 2.87

IEC Officer 1 1 2.84 2.27

Accounts officer/State Accountant

1 1 2.84 2.27

Addl. Accountant 1 1 1.62 1.51

Secretarial Asst 1 1 1.35 1.07

Pharmacist / Storekeeper 1 1 1 2.08 1.5

Store Assistant (SDS) 1 1 1.01 0.96

DEO- (State TB Cell) 1 1 1.74 1.26

DEO- (IRL) 1 1 1.74 1.26

Driver- State 2 2 2.53 1.76

Medical Officer (District) 4 2 4 15.46 20.49

Sr.DOT Plus & TB –HIV

Supervisor

20 24 DEO 24

+,ZTF Chairm

an DEO= total 25

41.40 43.20

STS 178 81 215.39 122.47

STLS 178 141 313.06 213.19

Contractual LT 144 333 472.10 356.64

TBHV 223 204 288.27 205.63

DEO 25 24 36.53 25.70

Accountant – part time 24 14 8.72 5.29

Driver 26 1 0.00 0.88

CFs 5 5 5.00 6.00

Any other contractual

TOTAL 812 1443.71 1056.04

230

ANNEXURE 12

Printing

ANNEXURE 13

Research and Studies (excluding OR in Medical Colleges) Any Operational Research projects planned (Yes/No) __Yes Estimated Total Budget:

Sr. No. Details of protocol Amount in lakhs

01 Study prevalence of TB among indigenous community across AP

50.00

02 Multi centric study to study the outcome of referred and transferred out patients in AP

20.00

Total 70.00

ANNEXURE 14

Medical Colleges

Activity Amount

permissible

as per norms

Estimated

Expenditure for the

next financial

year(Rs.)

Justification/

remarks

Contractual Staff: MO-Medical College (Total approved in state:

11) STLS in Medical Colleges (Total no in state :

0) LT for Medical College (Total no in state: 35) TBHV for Medical College (Total no in state:

35)

111.56

111.56

Research and Studies: Thesis of PG Students Operations Research*

8.75

8.75

Travel Expenses for attending STF/ZTF/NTF meetings

8.00 8.00

IEC: Meetings and CME planned 2.00 2.00

Equipment Maintenance at Nodal Centres

Total 130.31

Activity Amount

permissible as

per the norms in the state

Amount

spent in

the previous 4

quarters

Expenditure

(in Rs)

planned for current

financial year

Estimated Expenditure

for the next financial

year for which plan is being submitted (Rs.)

Justificati

on/

remarks

(a) (b) © (d) (e)

Printing-State level:*

Printing- Distt. Level:*

125.00 15.78 125.00 125.00

Total 125.00 125.00

231

ANNEXURE 15

Procurement of Vehicles

Equipment No.

actually

present in

the state

No. planned for

procurement this year

(only if permissible as

per norms)

Estimated Expenditure for

the next financial year for

which plan is being

submitted (Rs.)

Justification/

remarks

(a) (b) © (d)

4-wheeler ** 3

2-wheeler 178 45.00 0.00

Total

** Only if authorized in writing by the Central TB Division

ANNEXURE 16

Procurement of Equipment

Equipment No. actually

present in the

state

No. planned for

this year (only

as per norms)

Estimated Expenditure

for the next financial

year for which plan is

being submitted (Rs.)

Justification/

remarks

(a) (b) © (d)

Office Equipment (Computer, modem, scanner, printer, UPS etc.)

26 9.00 15.60 Replacement of

computer systems at state & districts.

Any Other – Xerox machines 26 10 9.00 Replacement - most of the Xerox machines in the state are beyond

repairs.

Total 24.60

ANNEXURE 17

Additionality funds from NRHM

S.no Proposed plan / activity Number

planned

for the

financial

year

Amount (Rs

in lakh)

Justification

1 Up gradation and extension of STDC Hostel Building

1 45.00 The existing hotel building is not sufficient to accommodate the trainees. Hence we proposed to extent the Hostel building.

2 Transport Charges 18 .00 Sputum transportation charges for DOTs Plus Culture & DST Lab

for one year.

3 LCD Projectors 24 4.80 To install at DTCOs offices.

4 Extension of State Drug Stores

1 20.00 To Accommodate CAT-IV Drugs, racks, fittings and ACs.

5 Walk in cold room 01 5.00 Purchase of walk in cold room

6 Walk in Incubator for C & DST Lab at Visakhapatnam

01 5.00 Purchase of walk in incubator.

Total 97.80

232

ANNEXURE 18

Consolidated Budget Summary of proposed under RNTCP

S N Category of Expenditure Budget estimate

for the coming FY

2011 – 2012(To be

based on the

planned activities

and expenditure in

Section C)

1 Civil works 72.04

2 Laboratory materials 149.46

3 Honorarium 115.00

4 IEC / Publicity 79.50

5 Equipment maintenance 60.13

6 Training 100.03

7 Vehicle maintenance 47.75

8 Vehicle hiring charges 166.14

9 NGO/PP support 200.08

10 Miscellaneous 136.95

11 Contractual services 1056.04

12 Printing 125.00

13 Research and studies 70.00

14 Medical Colleges 130.31

15 Procurement –vehicles 0.00

16 Procurement – equipment 24.60

Total 2533.03

17 Additonalities funds from NRHM 97.80

Grand Total 2630.83

233

D.3 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

294. Blindness is a major socio economic problem in developing countries realizing this problem the Government of India has established National Programme for control

of Blindness in the year 1976 as a 100% centrally sponsored scheme with the goal of

reducing the prevalence of blindness from1.4% to 0.3% by 2020 with participation of

NGO‟s and PMP‟s.

295. Pertaining to Andhra Pradesh State, the programme is implemented by

reaching goals every year by achieving 100% targets. At present the Cataract Surgery Rate for the year 2009-10 is 662 per lakh population against Government of India

allotted 644 per lakh population . Present prevalence of avoidable blindness is 1% as

per National Survey 2007.

Key Objectives

To provide high quality eye care to the effected population by reducing the

prevalence of the avoidable blindness from 1% to 0.9% such as Cataract,

Refractive Errors , Glaucoma, Diabetic Retinopathy and Corneal Blindness

To expand coverage of eye care services to the under served areas i.e, in Tribal

PHCs 100 posts of PMOAs may be accommodated to achieve more

performance in under served areas.

To reduce the backlog of blindness i.e., Eye Ball Collection from 65% to 100% by strengthening and Establishment of Eye Donation Centers and Eye Banks.

Screening and Treatment of Diabetic Retinopathy, Glaucoma.

To develop institutional capacity for Eye care services by establishing Fixed

Service Centers in (40)-Area Hospitals.

Situational analysis , Critical Gap Identification

Specialty Eye Care Activities are available in Medical Colleges, 4- Regional eye

Hospitals , District Head Quarters Hospitals.

Screening of Eye Ailments available at old PHCs level .

All the Areas Hospitals to be provided with Ophthalmic Equipment and trained

Ophthalmic Personnel

Annual Maintenance Contract for Equipment is required

Timely release of budget in phased manner

Key Strategies of the Programme

Reduction in the backlog of blind persons by active screening of population above 50 years, organizing screening eye camps and transporting operable cases to eye

care facilities;

Involvement of voluntary organization in various eye care activities;

Participation of community and Panchayats, ANMs, Asha and Aganwadi in

organizing services in rural areas

234

Development of eye care services and improvement in quality of eye care by

training of personnel, supply of high-tech ophthalmic equipments, strengthening follow up services and regular monitoring of services

Screening of school age group children for identification and treatment of

Refractive Errors, with special attention in under-served areas

Public awareness about prevention and timely treatment of eye ailments

Special focus on illiterate women in rural areas. For this purpose, there should be

convergence with various ongoing schemes for development of women and

children

To make eye care comprehensive, besides cataract surgery, provision of assistance for other eye diseases like Diabetic Retinopathy, Glaucoma Management, Laser

Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of

Childhood Blindness etc.;

·Construction of dedicated Eye Wards and Eye OTs in all Area Hospitals as per

need

Development of Mobile Ophthalmic Units and linked with Tele-Ophthalmic

Network and few fixed models

Involvement of Private Practitioners in sub-district, blocks and village levels.

The prevention and treatment of blindness may be categorized under the public

health sector (i.e., prevention) and the ophthalmologic sector (i.e., treatment

solutions)

Programme Components

Cataract Surgeries

Refractive Errors

School Children eye Screening

Eye Ball Collection

Diabetic Retinopathy

Glaucoma

Squint

Trachoma

Training

IEC


As it is possible as well as efficient to manage most eye diseases in the

communities where they arise, emphasis should be places on the development of

primary eye care and a good referral system.

Conducting Screening Camps in under served areas i.e., Rural, Tribal and urban areas which aids in motivating and referring cases to secondary level

for intervention.

The State Red Cross Society has been requested to associate with NPCB activities for which they have agreed.

As State Government introduced JAWAHAR BALA AROGYA RAKSHA

SCHEME for School going children , All schools are to be covered under

NPCB and Spectacles are to be issued to needy children.

235

A Proposal was submitted to the Government of India for establishing (3)-eye

Banks at (3)-Regional Eye Hospitals i.e, Viskhapatnam, Kurnool, Warangal for improvement of Eye Ball Collection and Utilization

A Proposal was submitted to the Government of A.P for permission to obtain eye

balls from bodies which are sent for postmortem to the hospitals. If the Govt.

issue permission the eye ball collection will be improved.

At tertiary level treatment is provided for Diabetic Retinopathy ,Glaucoma and

Squint .

Monitoring and Reporting Systems :

The DPM is Monitoring the eye Care activities in the District and submitting

Monthly and Quarterly (including Physical and financial) reports to State

Programme Officer.

The District collector and Chairmen of DBCS will review the performance

quarterly and provide suggestions for improvement of performance .

The State Programme Officer(NPCB) under the control of Director of Public

Health will monitor and review the progress of the activities monthly and inturn the reports submitted to Mission Director (NRHM) and Director

General of Health Services, New Delhi.

Quarterly review meeting will be convened under the chairman ship of the Prl.

Secretary to Government ,HM&FW Department ,Hyderabad for strict implementation of the NPCB activities.

Risk Analysis

All Service Centers are not provided with required infrastructure and Manpower.

All Areas hospitals to be provided with staff trained in Ophthalmic services

Since the vehicles provided 15years back at present they are not road worthy

due to which performance is effected .

Expected Out Comes

Cataract surgeries 6.00 Lakhs

School children Eye Screening 20.00 Lakhs

Refractive errors 1.00 Lakhs

Free Spectacles Distribution 0.40 Lakhs

Eye Ball collection 0.06 Lakhs

Other eye Diseases 0.05 Lakhs

Special Features for 2011-12

Establishment of 100-Vision centers in Tribal Areas and underserved areas.

Fixed Service centers(40) to be provided with Infrastructure and Manpower.

Strengthening and Establishment of (3)-eye Banks at (3)-Regional Eye Hospitals i.e, Viskhapatnam, Kurnool, Warangal for improvement of Eye Ball

Collection and Utilization

To Provide Argon laser for Diabetic Retinopathy Treatment in seven Teaching hospitals.

236

Training of Ophthalmic surgeons and Other Staff

To develop a software by NIC for on line submission of reports to avoid delay reporting and take immediate decisions.

Budget Analysis

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

FUNCTIONAL HEAD WISE CLASSIFICATION OF THE BUDGET

Sl.No. Activity Unit cost Physical

Target

Required fund

under NRHM

Human Resource

F National Programme for Control of Blindness

a Ophthalmic Surgeon 25000 15Surgeons X

12 Months 45.00

b Ophthalmic Assistant 8000 50 PMOOs X12months

48.00

c Eye Donation Counselor 10,000 12EDCs

X12months 14.40

5 Training

5.1

Training /Capacity

building for health personnel‟s

- - -

Training of Teachers and

others - 11000 -

F Procurements-Drugs and Supplies

a Procurement of Drugs

and Supplies and

Per case:

Drugs& consumbles-

200 Sutures-50 IOLs-200 Spects-125

1lakhGovt.Sector cases

575.00

F. Procurements-Equipment

Procurement of Equipment- ARGON

Green Laser equipment for DBR

20,00,000 07 Nos for 7-

Medical Colleges 140.00

New Ophth. Microscopes Each Rs.2.50

Lakhs

25 Nos Dist.Hospitals-

16,A.H- 7 & CHC-2

Rs.62.50

Other Ophthalmic Surgical Equipment for

Operation Theatres

Rs.25000 for each

Ophthalmic Unit

for 50 Nos for establishment of New Ophthalmic

Centers& O.T.s in AH

Rs.12.50

A-Scan Each Rs.3

Lakhs

for 10 Nos in 4-District Hospitals

and 3- Area Hospitals and 3- in

Rs.30.00

237

CHCs.

Keratometer Each

Rs.40,000 for 10 –District

Hospitals . Rs.4.00

Phaco Machines eachRs.35

lakhs

for 3 Nos Medial

Colleges and 3- Dist. Hospitals

Rs.105.00

Yag leasers Each Rs.15

Lakhs for 4 District

Hospitals Rs.60.00

Electro Vitrectromy Each Rs.3

Lakhs

for 20 District Hospitals & 3 Area

Hospitals Rs.70.00

Slit Lamps Each

Rs.40,000/-

for 20 Nos 10- in Dist. Hosp, AHs-

03,CHCs-02 and 5-for Medl. colleges.

Rs.8.00

F. ICC/BCC Works

IEC-BCC Activities

a Cataract Operations 75/case 1lakhGovt.Sect

or cases 75.00

b Eye Donation

c Other Activities

World Sight Day 10,00,000 1 10.00

Eye Donation Fortnight 10,00,000 1 10.00

F ASHA’s

a ASHA Incentives (covered under package)

Referral Transport

1.6 Referral Transport Transport/

POL-

100/case

1lakhGovt.Sector cases

100.00

Other Mission Flexible Pool Activities

B

15.3.3

Other M&W Development of Soft ware

for online reporting system from Districts

20,00,000 1 20.00

B 23.1 Support Strengthening of NPCB

School Children Eye

Screening 5,00,000 23 Districts 115.00

Eye Ball Collection 1,000 2000 20.00

DBR & Glaucoma etc., 1,000 5000 50.00

INNOVATIONS/PPP/NGO

E Cataract Performance

Ngo Sector 750/- 2,80,000 2100.00

Private Sector (PMPs)

(not Claiming) 1,85,000 -

G OPERATIONAL COST

a Mobility Support

14,00,000 SBCS 14.00 c Review meetings

d Field visits / T.A

e Office expenditure Formats &Reports

b Lab consumables and 50,000 23 districts 11.50

238

salaries at DBCS

Financial Aid/Grant to institutions

a Medical Colleges 40,00,000 1 40.00

b Vision Centers 50,000 50 25.00

c Eye Donation Centers 1,00,000 2 2.00

d Eye Banks 15,00,000 3 45.00

e NGOs 30,00,000 2 60.00

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

PROGRAMME IMPLEMENTATION PLAN (PIP) BUDGET 2011-2012

S N Activity 2010-11

Approved

as per PIP

(Rs/Lakhs)

2011-12

(Proposed)

(Rs/lakhs)

Remarks/ Justification

Recurring Grant -in- Aid

1 Cataract Operations 1674.00 2850.00 Rs.750 per case X3,80,000 Cataract Operations

2 IEC: for other than Cataract operations

20.00 World Sight Day &Eye Donation fortnight each @Rs.10lakhs

3 SES Programme 46.00 115.00 @5.00 Lakh each DBCS

4 Grant-in-Aid for Eye Ball Collection 15.00 20.00 @Rs.1000eachpair for 2000

5 Maintenance of State Blindness Control Society

10.00

14.00 Salaries,T.A&D.A,POL and purchage of consumbles etc., as per guidelines of NPCB

6 Maintenance of Ophthalmic Equipment in 23 DBCSs and DBCS Salaries

5.00 11.50 For 23-Districts @ Rs.50000/- each

7 New initiative Diabetic Retinopathy

and Glaucoma management etc., 50.00 50.00

For laser treatment eachRs.1000/-

for 5000cases

Manpower

1 Ophthalmic Surgeons in District Hospitals in 42- FSCs

45.00 45.00 @25000/-PM for 15 X12months

2 Ophthalmic Assistants in District Hospitals, PHC and Vision centers

48.00 48.00 @8000/-PM for 50 X12 months

3 Eye Donation Counselors in Eye Banks

14.40 14.40 @Rs.10,000/-PMfor 12 X12 Months

Non- recurring Grant -in- Aid 1 Medical Colleges 40.00 40.00 For procurement of equipment

2 GIA for Vision Centre 25.00 25.00 For 50-VCs @ Rs.50,000/- each

3 Eye Donation Centre 1.00 02.00 2-Units for up-gradation/ Strengthening

4 Eye Banks 0.00 75.00 For 3-Unit establishment (3-REHS)

5 Non- Recurring GIA for NGOs

30.00 60.00 For 2-Unit for Strengthening/Up gradation

6 New Ophth. Microscopes

Rs.62.50 Each Rs.2.50 Lakhs X25 Nos Dist.Hospitals-16,A.H- 7 & CHC-2

7 Other Ophthalmic Surgical Equipment for Operation Theatres

Rs.12.50

Rs.25000 for each Ophthalmic Unit for 50 Nos for establishment of New Ophthalmic Centers& O.T.s in AH

239

8 A-Scan

Rs.30.00 Each Rs.3 Lakhs for 10 Nos in 4-District Hospitals and 3- Area Hospitals and 3- in CHCs.

9 Keratometer

Rs.4.00 Each Rs.40,000/- for 10 –District

Hospitals .

10 Phaco Machines

Rs.105.00 eachRs.35 lakhs for 3 Nos Medial Colleges and 3- Dist. Hospitals

11. Yagleasers

Rs.60.00 Each Rs.15 Lakhs for 4 District Hospitals

12. Electro Vitrectromy

Rs.70.00 Each Rs.3 Lakhs for 20 District Hospitals & 3 Area Hospitals

13. Slit Lamps

Rs.8.00 Each Rs.40,000/- for 20 Nos 10- in Dist. Hosp, AHs-03,CHCs-02 and 5-for Medl. colleges.

Total 3741.90

Particulars 2009-10 2010-11(up to Dec,2010)

Annual Target 550000 550000 (412500 P.T)

Achievement:

Govt. Sector 86248 54403

NGO Sector 274621 191740

PMP Sector 213313 178876

Total 574182 425019

Percentage 104.4% 103.03%

Performance :

1.The Cataract Operations performed 2009-10 and 2010-11(up to December 2010)

as follows:

2. Year wise Cataract Operations performance

Year Annual Target IOL Total % on A.T.

2008-09 5,50,000 576601 582318 105.9

2009-10 5,50,000 568288 574182 104.4%

2010-11

up to

Dec,2010

5,50,000 420502 425019 103.03%

3. School Children Eye Screening :

Activity

2008-09 2009-10 2010-11

(up to December,)

Annual

Target Achievement

Annual

Target Achievement

Annual

Target Achievement

No. of Teachers

Training

11000 10828 11000 10290 11000 9928

240

No. of School

Children

Screened

952381 1392412 1500000 1623223 1500000 1472607

No. of School

Children

detected with Reff. Errors

66667 69111 90000 73034 90000 69680

Distribution

Free Glass 20000 33118 27000 42619 30000 25394

Eye Ball Collection

5000 3570 5500 3005 6000 2943

4. Year wise Eye Ball Collection

Year Collection

2008 3570

2009 3005

2010 (up to Dec,2010) 2943

241

D.4 NATIONAL IODINE DEFICIENCY DISORDERS CONTROL

PROGRAMME

296. Every year nearly 2/3rd of the population is not protected from Iodine

Deficiency, which implies that every year nearly 1 million newborns may be at risk of suffering from preventable brain damage that can result from Iodine Deficiency in

mothers. Iodine is an essential micro nutrient required for human body with a view to

cover wide spectrum of iodine deficiency disorders such as mental and physical retardation, brain development, deaf mutism, still birth, abortions etc., The Govt. of

India launched 100% centrally assisted National Goiter Control Program (NGCP) in

August 1992, which was subsequently renamed as the National Iodine Deficiency

Disorder Control Program (NIDDCP).

297. In the State of Andhra Pradesh efforts were directed to overcome iodine

deficiency by setting up a IDD cell, established at the Directorate of Health Services in 2009 in Andhra Pradesh. Despite the fact that there is a national ban on sale of non

iodized salt for edible purposes and efforts have been made to ensure universal

consumption of iodized salt, the state of Andhra Pradesh is reported to have the lowest

consumption of adequately iodized salt in the country. Annual report for the year 2009-2010 indicates that in AP only 46.39% salt is adequately iodized (>15ppm iodine), which

implies that every year nearly 2/3rd of the population is not protected from iodine

deficiency, which implies that every year nearly 1 million newborns may be at risk of suffering from preventable brain damage that can result from iodine deficiency in

mothers.

KEY OBJECTIVES

Surveys to assess the magnitude of the Iodine Deficiency Disorders.

Supply of iodated salt in place of common salt.

Resurvey after every 5 years to asses the extent of Iodine Deficiency Disorders and the Impact of iodated salt.

Laboratory monitoring of iodated salt and urinary Iodine excretion.

Health education. & Publicity

SITUATION ANALYSIS

298. The Physical performance for the year 2009-2010 indicates that 46.39% of the salt

samples were Adequately Iodized and in the year 2010-to till October it is 46% of the salt samples were Adequately Iodized.

Physical Performance for the year 2009-10 and Apr 2010- Sep 2010

SN Year Total No. samples tested

Total No. of samples with

Nil Iodine

Total No. of Samples with

15 PPM or

more Iodine

% of the samples with 15 PPM or

More Iodine.

1 2009-10 774351 158301 359225 46.39

2 Apr to Sep 2010 411661 73755 191112 46

242

KEY STRATEGIES

Checking iodine levels of iodated salt with wholesalers and retailers within the

State and coordinating with the Food and civil Supplies Department.

The Distribution of iodated salt within the State through open market and public distribution system.

Creating demand for iodated salt.

Monitoring consumption of iodated salt. Conducting IDD surveys to identify the magnitude of IDD in various districts.

Conducting training.

Dissemination of information, education and communication.

To increase the awareness about the usage of Iodized salt.

PROGRAMME COMPONENTS

IDD Cell

IDD Monitoring Lab

Health Education And Publicity

IDD Surveys

Running School Health and awareness Programmers.

Creating effective collaboration with the Inter Ministerial Stake holders.

Conducting workshops.

IMPLEMENTATION METHODOLOGY

Conducting surveys in the District assess the magnitude of IDD.

Conducting awareness campaign in the District to create awareness about IDD

and using of Iodized salt.

Training of ASHA, ANMS and AWW for community awareness and monitoring.

Training of Health Inspectors and Food –Drug Inspectors, State, District,

Community, Salt

Production and Monitoring under the Programme. o Coordinating with the civil suppliers department to ensure apply of

Iodized salt through PDS.

o To Organize a State level Stake holders meeting. o IEC and campaigns.

o School awareness programmers and to include in school curriculum at

level of primary and higher education. For this purpose CBSC, NCERT,

State Boards and UGC may be requested to be include Iodine efficiency Disorders and Iodated salt in their Syllabi for various levels of education

including Medical Education.

Implementation of the transport of Iodized salt through railway mode, So that

this will help in the proper movement.

Radio/TV spots have been prepared and their broadcast/telecast is being carried

out.

A 10 minutes video film on IDD has been prepared and is being distributed to the States.

243

Pamphlets have been developed for distribution to States & UTs. Poster

depicting the various facets of IDD manifestation have also prepared.

Salt Testing Kits for the qualitative testing of iodated salt to show presence of

iodine are being used for creating awareness among people, including those living

in remote, rural areas and urban slums.

IEC activities have also been intensified in coordination with the Song & Drama Division,

Directorate of Field Publicity DAVP Doordarshan & AI with a view to promote

the consumption of iodated salt among the masses.

MONITORING & REPORTING SYSTEMS

Currently Ministry Health and Family Welfare has appointed State IDD Cell

Team.

Its very important that state DPH&FW has to take responsibility to sustain the

monitoring system and create a strong reporting system with in the state and MOHFW in future.

The State IDD Monitoring cell and Laboratory is responsible to assess the

estimation of Iodine in salt and Urine.

The State IDD cell team is conducted survey in these Districts.

o Nizamabad

o Nalgonda,

o Warangal, o Khammam Districts

o Consolidation of Monthly reports received from all the Districts.

RISK ANALYSIS

Fetus Abortions

Stillbirths

Congenital anomalies

Increased perinatal mortality

Endemic cretinism

Neonate Neonatal goiter

Neonatal hypothyroidism

Endemic mental retardation

Increased susceptibility of the thyroid gland

to nuclear radiation

Child and Goiter

adolescent (Subclinical) hypothyroidism

Impaired mental function

Retarded physical development



Adult Goiter with its complications

Hypothyroidism

Impaired mental function

Spontaneous hyperthyroidism in the elderly

Iodine-induced hyperthyroidism



244

Importance of the problem

EXPECTED OUTCOMES

Conducting surveys in the District assess the magnitude of IDD.

Conducting awareness campaign in the District to create awareness about

IDD and using of Iodized salt.

Training of ASHA, ANMS and AWW for community awareness and

monitoring.

Training of Health Inspectors and Food –Drug Inspectors.

Coordinating with the civil suppliers department to ensure apply of Iodized salt through PDS.

To Organize a State level Stake holders meeting.

SPECIAL FEATURES

299. For proper implementation of Programme in some Districts concerned

responsible persons should be appointed, so that the programme will run smoothly.

300. For proper analyzing of spot test method kits should supply to all the sub centers

and even to ASHA, ANM, Aganwadi works.

245

Budget for NIDDCP activities for 2011-12

SN Proposed Activity Amount

Required

Rs.In Lakhs

1 Posters on ill effects on using the non iodized salt 20.00

2 Book lets for Para medical staff & Anganwadi workers 20.00

3 State level workshop for Stake holders 5.00

4 Work shops at District level 5.75

5 Celebration of Global Iodine Deficiency Day at State and

District level

3.75

6 Salaries to the IDD Monitoring Lab Staff 12.00

7 Surveys in the Districts (field visits) 12.00

8 Lab Consumables 5.00

9 Mobility Support and Monitoring 5.00

10 Formats and reports 1.00

TOTAL 90.00

246

D.5 NATIONAL LEPROSY ERADICATION PROGRAMM 301. National Leprosy Eradication Programm in the state of Andhra Pradesh has been

started as National Leprosy Control Programme (NLCP) in 1954- 55, and adopted Survey, Education and Treatment (SET) Strategy. Dapsone has been the main stay of

treatment. In 1976 Dapsone resistance was reported from India. Further WHO has

advocated a new therapy called Multi Drug Therapy (MDT) for treatment of Leprosy in

1981. Since 1983 MDT has been used for treatment of Leprosy in National Programme, which has been renamed as National Leprosy Eradication Programme and the same has

been included in the Prime Minister‟s 20 Point‟ Economic Programme.

Before MDT

Before MDT total cases - 4.9 lakhs

Prevalence Rate - 124/10,000

Total cases on hand as on Jan 2011 - 4843 Prevalence rate - 0.57

Gr-II Deformity rate - 4.7

Child rate - 11.5

Brining the ANCDR to below 10/ one lakh population in all mandals of A.P so

as to reduce the burden of leprosy and disease deformity rate.

AS on 2010 March ANCDR is 10.74 / lakh population, Deformity rate among new cases are 4.5% .

Sensitization capacity building, orientation, training to NLEP staff Medical

Officers and DM&HO.

Effective IEC activities. Supervision and monitoring.

All the mandals with ANCDR more than 10/ one lakh house to house survey

should be conducted with the help of General Health Staff and ASHA‟s.

Delay in diagnosis may result in increasing transmission of diseases and Deformity rate.

Key Objectives:

Bringing the ANCDR to below 10 per 1 Lakh Population in all the Mandals of

Andhra Pradesh. So as to reduce the burden of leprosy both in Rural and Urban.

Sustaining of quality Leprosy services.

Reducing stigma and discrimination.

Involvement of General Health Care staff in early diagnosis, treatment and

disability limitation.

Improving referral system in the integrated setup.

Situational Analysis:

Before the start of Multidrug Therapy (1983) the PR is 124/10,000 Population.

Total Cases at 1983 (Start of MDT) : 4.91 Lakhs

The state has achieved the Goal of Elimination ie. Less than „1‟ case per 10,000 at the State Level by March,2005.

247

Total registered cases as on March 2005 : 6323

PR as on March 2005 : 0.79/10,000 Population

Total Registered cases as on December,2010 : 6032

PR as on December,2010 : 0.57/10,000 Population

Key Strategies of the Programme:

Sensitization, capacity building, orientation and reorientation trainings in NLEP to General Health staff from ASHA, ANM to Medical Officers and DM&HOs.

Special 2 days sensitization and orientation to all the District Collectors and

DM&HOs.

Effective supervision in monitoring at Sub-Center and PHC level.

Reducing the reservoir of infection by early Case Detection, prompt and complete

treatment.

Increased IEC campaign especially through TV and radio so that hidden cases

may come out due to self reporting.

Predinsolene tablets and Clofazamine tablets should be available in all the

Primary Health Centers.

All Lab Technicians in the designated Microscopic centers for the tuberculosis

should given training for taking slit skin smear test and punch biopsy.

Lab Reagents should made available at all the designated microscopic centers.

All the APMOs, DPMOs and District Nucleus Medical Team should be given reorientation training in Leprosy

Programme Components:

Early case detection and prompt complete treatment.

Disability limitation by DPMR activities.

Training to all General Health Care Staff

IEC campaign

Involvement of ASHA workers.

Implementation Methodology :-

Effective IEC activities at Sub centers, PHC and District Levels.

For every New MB case detected focal survey should be conducted in surrounding 50

houses.

All mandals with ANCDR more than 10 house to house survey should be

conducted

involving the General Health Care staff and incentive IEC campaign should be

undertaken.

School Health IEC activities and Healthy contact survey.

Utilisation of services of ASHA and Aganwadi.

All the deformed cases should be educated about self care and physiotherapy

should be

given and Reconstructive Surgeries should be undertaken for all the fit deformed cases.

248

Monitoring & Reporting Systems:

Effective monitoring by the PHC Medical Officers at every weekly meeting and

the

Medical Officer should see every Leprosy case once in two months.

The District Nucleus Medical Team should visit 1/4 of the PHCs in the district

every

month and review the programme in detail.

The ADM&HO (Lep & Aids) should visit 1/4 of the PHC in the district every

month

and review the programme in detail.

The DM&HO should compulsory review the NLEP programme. During the

monthly

Medical Officers review meeting.

Proper reporting duly following the simplified information system (LF1, LF2,LF3&

LF4) as per the NLEP guidelines.

8. Risk Analysis:

Delay in diagnosis may result in deformity.

In proper management of reactions may result in deformity.

Unable to control the reservoir infection will result in more number cases

especially children.

Lack of self care may result in more complication like secondary infection, absorption of fingers.

Deformed cases will be burden to the individual, family, community and hospital

services.

Delay in early diagnosis More MB cases Transmission of the disease in

the community – in proper treatment Type – I and Type- II reactions, disability

& deformities Burden to the individual – community –Nation.

Expected Outcomes:

Reduce the transmission of the disease in the community.

Reduction in the case load both in Rural and Urban by early case detection and prompt treatment.

Reduction in deformity rate.

Reduction in the child prevalence.

249


Budget allocation should be more from the previous year for better mobility of the

District Nucleus Team, ADM&HOs (Lep & Aids) and the Sample survey cum

Assessment Units.

IEC campaign through TV and radio (FM radio) so that self reporting of the cases

will be more.

Providing Medical and Social Rehabilitation to the deformed and disabled patients.

More involvement of the General Health Care staff.

Community participation in diagnosis and rehabilitation.

Budget for NLEP activities for 2011-12

Activity Amount

Proposed Rs.

In Lakhs

A. Contractual Staff (State & District)

1) BFO 1.80

2) Administrative Assistant 0.84

3) Surveillance Medical Officer at SLO 2.40

4) Drivers 4.86

5) D.E.O. 0.96

Total 10.86

B. Incentives for ASHA workers

1) Intensive payment for Expected new case to detected by ASHA

workers

3.50

2) Intensive payment for expected MB patients satisfactory

completing treatment :

5.00

3. Intensive payment for expected PB patients satisfactory

completing treatment :

3.00

Total 11.50

C. Drugs and Materials Supplies

1. Supportive drugs for leprosy patients @ 24000/ Dist including patients in Leprosy colonies

5.50

2. Lab reagents and equipments for dist. 2.50

3. Printing of formats etc 4.00

Total 12.00

4. Vehicle Operation and Hiring

1. State Health & Family Welfare Society (NLEP) 1.70

2. District Health Society (NLEP) 17.25

Total 18.95

D. IEC Plan

1) Wall paintings 6.90

2) Quiz 0.70

3) Posters 4.50

4) Banners 3.45

5)Rallies 0.60

250

6)Sensitization meetings with ZPs and Mahalial Mandals NGOs etc

5 Nos.per Dist.

1.15

7)School IEC activities 2.30

8)Hoardings 9.20

9)Special Campaigns In priority mandals with PR above 1 by taking

up suitable IEC activities

6.20

Total 35.00

E. Training & Capacity Building

1) 4 days training to newly appointed MO's 3.00

ii. 3 days training to newly appointed HS (M & F) 2.00

iii. 3 days training to newly appointed HW (M & F) 4.22

iv. Two days Reorientation Training. 5.01

v. 5 days training to Lab Technicians District Hospital / CHC 0.48

Vi. ASHA Training 7.95

Total 22.66

F. DPMR Plan

1. MCR footwear 120 Nos. 7.00

2. Aids & Appliances 3.00

3. Honorarium to Government Medical Colleges for under taking Reconstructive Surgeries

3.00

4. Honorarium to 400 patients of below BPL who have undertaken

Reconstructive Surgeries

20.00

Total 33.00

G. Urban Leprosy Control :

46 Identified Urban areas 20.15

Mega City Medium City Township

Total 20.15

H. NGOS Services – SET Scheme

1. GMLF, chilakalapally, Viziangaram Dist. 18.00

2. GRETNALTES, Morampudi, Guntur Dist.

3. SRDS, Vijayawada, Krishna District.

4. The Libra Society, Ramachandrapuram, E.G. Dist

Total 18.00

I. NLEP Supervision, Monitoring and Review

1. TA / DA of Contractual staff . 0.60

2. State level Review Meetings 1.00

Total 1.60

J. Office Operations and Maintenance

1. Rent, Telephone, Electricity, P & T Charges, Miscellaneous (State

and Districts)

4.52

2. Office equipments maintenance cost at state level 0.48

3. Consumables – Stationary Items (State and Districts) 3.50

Total 8.50

H. Cash Assistance 25.00

Grand Total 215.22

251

ABSTRACT

Sl.

No Name of the Activity

Estimated

Budget

Rs. In

Lakhs

1 State Leprosy Cell-Contractual Staff 10.86

2 Incentive for ASHA 11.50

3 Drugs Materials and Supplies 12.00

4 Vehicle Operation and Hiring 18.95

5 IEC Plan 35.00

6 Training & Capacity Building 20.44

7 DPMR Plan 33.00

8 Urban Leprosy Control 20.15

9 NGOS Services – SET Scheme 18.00

10 NLEP Supervision, Monitoring and Review 1.60

11 Office Operations and Maintenance 8.50

12. Cash Assistance 25.00

Total : 215.00

252

D.6 INTEGRATED DISEASES SURVEILLANCE PROGRAMME

Strengthening IDSP Reporting Infections Diseases Effectively (RIDE)

Executive Summary:

Strengthening the DSU and SSU and medical colleges units.

Timely reporting by sub-district level functionaries.

Real time monitoring and alerting using SMS,IVRS,GIS, systems with the NICs (Govt. of India) technical support.

Water quality Sampling and testing at sub-district level.

Estimated Expenditure Rs.1098.77 Lakhs.

No additional posts are erected

Involvement of all stake holders without creating field level infrastructure

Public private partnership with private medical colleges, Hospitals, and NGOs.

Setting up of 21 districts Laboratories with Rs.728 lakhs as directed by the

Officers IDSP, Delhi to includes in PIP.

Strengthening of information system by way of Broad band audio/video

conference that existed in the districts.

Project Identification:

1. Name of the Scheme: reporting Infectious Diseases Effectively (RIDE).

2. Location of Scheme: Health Sector Instructions in entire Andhra Pradesh.

3. Broad description of Scheme: to Monitor and control the diseases especially the communicable diseases effectively and efficiently.

4. Forecasting the Disease occurrence and to render feedback for preventive measures.

Objectives:

Creation of minimum infrastructure to maximize the benefits of other available

infrastructure

To strengthen State and District Surveillance Units and operationalise the

monitoring on 24X7 basis using state – of – the – art technology solutions

efficiently and effectively, to enable them to function as even epidemic control cells.

Map risk zones and facilitate differentiation of risk zones.

Forecasting epidemics.

Coordinating diseases and interventions over time.

Monitoring the activities of health infrastructure and personnel in field.

To develop state - of - the - art online early warning and alerting system.

To build a State – of – the – art technology based mobile computing solution to

ensure instantaneous flow of information even from locations which are devoid of any computer and electricity, example Tribal Thandas and Sub – PHCs in

remote, inaccessible areas.

To build a GIS based state wide spatial analysis system for monitoring the spread of diseases.

To facilitate sampling and preliminary testing of water in-situ.

253

To establish 21 district laboratories and to strengthen 2 districts priority

laboratory which are already existed. Inter-linkage with other existing programmes providing similar benefits: the

proposal facilities maximize the benefits of the infrastructure and being created

under the IDSP Project. The private health institutions partnership will also be

taken for effective surveillance.

Demand Analysis:

Need / Justification, Basis of Estimation of Quantifiable:

302. Under the IDSP Project, Infrastructure is created at district level only. However,

districts is not the source of information. The field level units and health workers are the

sources of information. So there is an urgent need to equip the field level workers with effective training and especially the newly recruited Medical Officers, 2nd ANMs and

other field functionaries. This facilities timely reporting of the Disease incidence

information. This needs also the mobility (Transport) in a big way so as the RRT staff

and other staff to reach the spots without loss of time and the immediate investigation of the epidemic can be done. Hence the train‟s component is included in the PIP for better

desirable levels of benefits in IDSP. Hence the training component is included in the PIP

for better desirable levels of benefits in IDSP.

At Present there are:

13,711 Female Health workers

1839 Pharmacists

CHCs – 50

PHCs 1791

Lab Assistants: 1713

APVVP Hospital and Teaching / General Hospitals approximately 200

303. All of them besides the private diagnostics centers, Hospitals, Nursing Homes,

Private Practitioners etc., are also going t involved in this reporting system.

Examinations of Alternatives

Alternatives considered indicating their physical and financial parameters:

The timely reporting is crucial.

Present System: At present through phone, fax, email and post, the information is

being sent; it is taking a lot of time. S-form, P-form & L Form.

Alternative: If Computers can be installed at all the locations and internet facility

can be provided and online internet based reporting is possible.

Second Alternative (RIDE): Mobile computing technology to be used to get the

information online without creating any additional infrastructure in the field.

Rapid Response Teams mobility is ensured for the quick epidemic investigation

and preventive and control measures.

304. Basis of alternatives selected whether it is least cost option (to achieve a given

object or based on maximization of end results.

254

305. The second alternative is preferable is preferable as the cost involvement is least. The field level workers who are mostly computer illiterates can also easily report the data

using mobile or POTs.

Physical parameters of the proposed programme/project/scheme

Duration : One year

Salient Features of the proposal.

306. To identify the potential areas infectious diseases occurrence and paths of their

spread Geographical in formations System can be used very effectively. The diseases

surveillance activities, The public health infrastructure and resources the Disease demographic information can be mapped together to monitor and manage the infectious

disease, so that timely control measures can be taken before reaching the epidemic

proportions. Thus the benefits of such spatial analysis include –

Physical Targets together with the basis/norms for fixing the targets – year wise physical targets along with the build up and output expected.

o Empowering other stake holders

o Provision of preliminary water quality testing kits to the PHCs (H2S Kits) and Cl estimation kits to Sub – Centers and ANMs.

o Establishing / Strengthening district laboratorie

Physical inputs and activities proposed – land, buildings, utilities, equipment, supplies etc. – Land provided free of cost or at a sub sized rate (i.e. capital cost)

Manpower requirements (category/post-wise-existing/proposed), their training

requirements and arrangements.

Transport of samples from the field to the laboratory for testing.

Purchasing the diagnostic kits etc.

For greater mobility and control measures

Impact /target Groups / Beneficiaries

Likely Impact of the Scheme:

Locating the geographical distribution and variation of diseases

Map risk zones and facilitate differentiation risk zones.

Forecasting epidemics, and feed back to the field functioning

Controlling epidemics and better training

Coordinating diseases and interventions over time and sustain the preventive

aspects

Manage patient care environments, materials, supplies and human resources

Monitoring the activities of health infrastructure and personnel in field.

Route health workers, equipment and supplies to needy locations

Identification of direct beneficiaries / specific target groups – criteria of the

selection of beneficiaries and mechanism built in the proposal for ensuring proper selection of beneficiaries

Beneficiary‟s involvement in the formulation of the scheme and consideration of

their needs.

Private institutions involvement

255

Budget for IDSP activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

Proposed

budget

(Rs/lakhs)

1 2 3 4 5 6 7

I Surveillance & Preparedness

a) Total cost for Training i. DM&HO(23) 2 1000 23 0.46

ii. DSO(23) 2 750 23 0.35

iii. DM/DEO 2 500 23 0.23

iv. Training toNewly posted doctors 1 1000 800 8.00

v. supervisor (Dist) 1 200 2500 5.00

vi. MPHA(F) (2nd ANM) 1 200 10000 20.00

vii. Newly Posted MPHA(F) 1 200 1700 3.40

viii. Pharmacist & Laboratries 1 200 3220 6.44

ix. Supervisor staff at Districts 1 250 250 0.63

x. ANM, CHC 1 200 350 0.70

xi. CHNC staff 1 200 1800 3.60

xii. Private Nursing Home Doctors (1 each)

1 300 1000 3.00

xiii. Ashas Training at PHC 1 100 34500 34.50

Total 86.30 86.30

b) Staff Remuneration

i. Remuneration of Epidemiologist 12 30000 24 86.40

ii. Remuneration of Microbiologist 12 30000 3 10.80

iii. Remuneration of Entomologist 12 15000 1 1.80

iv. Cosultant -Finanace 12 14000 1 1.68

v. Cosultant - Training 12 28000 1 3.36

vi. Data Manager

vii. Head Quarter 12 14000 1 1.68

viii. Data Managers 12 13500 23 37.26

ix. Data Entry Operators

a. Ssu 12 8500 1 1.02

b. DSU 12 8500 23 23.46

x. Medical colleges . Other Instt 12 8500 13 13.26

Total 180.72 180.72

c) Transport (Mobility Support)

i. At District

a. DSO/DM/DEO/ DE 20 300 3 0.18

b. Meetings at State Head Quarter 4 300 23 0.28

c. Hire of Vechile Mobolity 10 750 23 1.73

d. State Head Quarters 4.50

Total 6.68 6.68

II Office Expenses

a. SSU

b. Statinery 12 2000 1 0.24

c. Computer peripherals etc 13 2000 1 0.26

d. Computer Repairs other Misc 1.00

e. Statinery,Computer peripherals etc, Computer Repairs other Misc

12 1500 23 4.14

256


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

Proposed

budget

(Rs/lakhs)

1 2 3 4 5 6 7

Total 5.64 5.64

III. Telephone & Broadband

a. Tephone & BB 12 4000 1 0.48

b. Data cards & and others 12 2500 1 0.30

c. Telephone & BB 12 1700 23 4.69

d. Medical colleges 12 1700 13 2.65

Total 8.12 8.12

IV. For strenghthning of district Labs

a) Basic Equipment 1 1790000 21 375.90

i. Staff salary 1 1188000 21 249.48

ii. Consumables and general Lab ware 1 100000 21 21.00

iii. Cost of kits, media, reagents 1 347500 21 72.98

iv. Contingency amoutn Annum 1 45000 21 9.45

Total 728.81 728.81

V. Collection and Transportation of

samples 650000

6.50 6.50

VI. Other Misc Expenses

a. Computer Rentals for trainings 100000 1.00

b. Software development charges for NIC

300000 3.00

c.

Procurement of new computers, updation of RAMS, Updations HDD, Procurement of Mass storage devices for backup,

2000000

20.00

e. Printing of Formats and Reports ( S, P, L, W Forms and their registers)

3000000 30.00

f. Innovations / PPP / NGO coordinations with IDSP

750000 7.50

g. IEC and BCC activities towards Outbreak Response and prevention

1050000 10.50

Total 72.00 72.00 VII. Outbreak Investigation and Response

a. Consumables for and kits for Identified distrit prioroty labs

1 200000 2 4.00

4.00

Grand Total 1098.77 1098.77

257

Abstract of National Disease Control Programme

S N Activity Proposed

during Sub-

group

Proposed

after Sub-

group

1 2 3 4

1 National Vector Borne Diseases Control Programme 1801.04 1801.04

2 Revised National T.B. Control Programme 2533.03 1978.24

3 National Programme for Control of Blindness 3741.90 2500.00

4 National Iodine Deficiency Disorders Control Programme 90.00 26.00

5 National Leprosy Eradication Programme 215.00 215.00

6 Integrated Disease Surveillance Programme 1098.87 272.92

NDCP Total 9479.84 6793.20

258

CHAPTER-5

MONITORING AND EVALUATION

307. Public health systems are essential systems and always remained the priority

subjects of the state and central government. Policies are made by the GoAP to ensure

equitable, easily accessible, good quality services to all the citizens, focusing on un-reached and the tribal areas.

308. The planning and the service delivery & utilization of resources mainly depend on the availability of timely and accurate data, its analysis & feed back. The real time MIS

data is an „essential decision support tool‟.

Executive summary: 309. The state has undertaken many reforms to strengthen the health care delivery

system in Andhra Pradesh. One amongst them is strengthening of monitoring and

evaluation system. A post of joint director (Monitoring and evaluation) is created for the management of collection and compilation of data from all the primary secondary &

tertiary health care systems and private hospitals. Government has strengthening District

Project Monitoring Units in the districts, SPMU in the state.

310. To build effective MIS and system for real time data collection & analysis and

feed back, Nodal MIS personnel at all levels from PHC to state were identified and

instructions were issued.

311. As a part of organization strengthening reforms “Community Health Nutrition

Clusters” were created by the GoAP to extend supportive supervision, and to monitor 5

to6 PHCs by a senior Public Health Officer with senior experienced team members to support him. To ensure consistency and quick response from peripheral grass root

institution and the analysis of such data , it is decided by the GoAP to design develop

and adopt suitable IT systems. It is also envisioned that all the levels of administrators and nodal persons to be trained in utilizing these systems. The IT infrastructure is to be

provided for this purpose.

312. GOI has introduced HMIS web portal to effectively monitor NRHM activities (physical and financial) and strengthen the program implementation. The HMIS enables

data collection from the level of sub centers, PHCs, CHCs, Area hospital, District

hospital and reports are collected from PHCs, and districts and up loaded from state to the GOI.

Key objectives:

Collection of accurate and quality data from sub centers and to upload from

PHC.

Collection of data from private sector through existing PHCs, CHNCs, and other

assigned government health institution.

259

For Compilation and evaluation of data and communication of feedback

information at all levels to take corrective actions immediately to achieve the objectives set by the GoAP.

To have regular monitoring system at all levels.

Situation Analysis:

At present data is collected from sub centers and compiled at PHC and is being

handed over to district manually. No IT enabled systems exist at this level. This

often results in delay, default, and submission of in accurate data, no accounting software packages are used for the purpose.

Districts compile the data that is available as on the date of reporting upload it in

to HMIS portal. The cadres involved in data collection and compilation are not trained. Hence there are many gaps inaccuracies in the reports generated.

There is no on line data feeding facility at PHCs.

Critical analysis of data is not being done in all levels especially at the PHCs and

feed back is not generated and used.

Mid term analysis of on going programs are not done.

Intra departmental coordination in collection and compilation of data is a matter

of concern.

There is no policy for training the personnel who are posted /assigned the responsibility of handling the data as a result of transfers, new recruitments,

promotions etc. There is a need for periodic trainings in this regard to all the

cadres involved.

There is no regular supervision for ensuring the quality reliability at all levels.

Registers and report formats are not supplied regularly to the field staff to collect

the data that is useful for the field staff in their day to day health program

implementation activities. Registers and formats are not user friendly.

The PHC , CHC , and all the other staff are not trained to enable them for

understanding their rolls clearly.

There are no regular fixed day reviews and support for improvisation of staff

performance.

Mobility (vehicles) for the monitoring officers is not provided.

Key strategies:

Online data collection; Provision of on line facility to all PHCs, CHNCs and

districts so as to enable them to have the information, and to disseminate the

information and implementation of the web based computerized Accounting System („Tally Accounting System - software package‟).

Nodal MIS person is kept responsible at all levels and data will be shared with all

program officers for effective utilization of data and to take corrective measures.

Effective supervision; Supervision by SPHOs along with his/her team in their jurisdiction. Utilization of Services of all Nodal officers who were kept in charge

for each district to support SPHO and supervisors at district and at PHC as

district task force teams. All these teams will give supportive supervision to the field level functionaries.

260

Registers and report formats are to be supplied regularly to the field staff to collect

the data that is useful for the field staff in their day to day health program implementation activities. Registers and formats are to be user friendly and

relevant to their function and easy to understand. Printed preferably in telugu

language.

To have regular fixed day reviews and support for improvisation of staff performance.

Program Components:

To have Regular review at all levels to monitor the program

Training / sensitization on HMIS data up loading.

Training / sensitization on filling up of all user friendly registers and reporting.

Provision of registers and reporting formats.

Mobility to monitoring officer.


IT enabling of the PHCs CHNCs and other health institutions.

o Procurement of computers, printers, internet facility through APHMHIDC/ APTS or any authorized government agency as decided by the GoAP.

Printing of registers and formats as per established government procedures for

production and supply of printed material for the department.

To recruit data entry operators through Rogi Kalyan Samithis or Hospital

development societies as 3rd party for a period of one year by the end of the year

institution must develop competence.

Trainings and capacity building: o Training of trainers – to be done by the joint director – trainings.

o State level workshop for all HODs regarding HMIS – convened by JD M&E.

o Training of all Nodal persons of PHCs , CHNCs and DM&HOs, Statistical officers – to be done by the District Training team.

o Funding by NRHM.

o Training the concerned staff in usage of „Tally Accounting System software

package‟

Provision of laptops and data card for internet connectivity to all the joint

directors for real time data exchange collective decision making.

Possibilty of creating state owned M&E portal to meet the needs of RTI is to be

explored.

A vehicle is to be provided under NRHM to the monitoring officer.

Provision of strengthening of Finance wing in the district and state level under

NRHM by providing Tally System.

Monitoring and reporting system for assessment the performance M&E wing :

Number of institutions reporting in time.

Number of program specific analysis reports generated moth wise, quarterly.

Consolidated performance reposts for the state district wise – submitted to the

GoAP for decision support and state health planning.

261

Periodic conference / evaluation meeting conducted for reporting officers of

different levels of administration

Number of tours made by the state M&E team and the individual officers with

outcomes achieved month wise quarter wise.

Risk analysis :

313. The implementation of the proposed interventions enabling is essential as failure to implement may result in ineffective performance.

To sustain the M&E system and improve the functionality following are essential.

Ensuring trained staff availability.

Ensuring the availability of computers and technical support to maintain them.

Minimizing the administrative delay in release of funds.

Timely supply of registers and formats.

Expected out comes:

Real time reliable quality ensured institution wise district wise report generation.

Well maintained periodicity of reporting to assist the decision support at state

level.

Improvement in accuracy and reliability of the reports as result of real time

collection submission and consolidation of the reports,

Timely analysis of the reports and rapid communication of analyzed reports and

suggested interventions to the concerned HODs and controlling/program officers

for necessary corrective action.

Provision of accurate program management data and analysis reports for state health planning.

Inputs under RTI act implementation, to support in preparation of answers to

LAQs.

Online Accounting will be available.

Real-time automated financial report generation through „Tally Accounting

System software package‟

Special features in 2010 -11 proposals:

Refinement and rationalization of reporting formats.

IT enabling of M&E systems.

Capacity building in identified target group in a mission mode.

Mobility to monitoring officers.

Budget Analysis (summaries budget utilization since inception of NRHM, with

specific reference to 2010-11 and analyze the proposal for 2011-12)

An amount of Rs.10.00 lakhs are released for M&E under NRHM on Health Statistics and Demography & HMIS Portal.

The Reorientation training are being conducted to the Deputy Director (Stat.),

Statistical Officers, Lecturer and Statistics & Demography, Deputy Statistical

Officers, Assistant Statistical Officers and LD Computers at State, District, and PHC Level.

262

The following surveys are being conducted and planned during 2010-11 with in 3

months. o Evaluation Study on Role and Responsibilities of 2nd ANMs in Andhra

Pradesh.

Study on Utilization of Rogi Kalyani Samithi Funds.

Evaluation of 108 and 104 partner Public Health facility survey of PHCs and CHCs in the districts in tribal

area

Sample Survey of Health practices for adolescent girls in tribal welfare schools in Andhra Pradesh

Trainings to Statistical Personnel on Health Statistics, Demography & HMIS Portal

a) Rs.3,93,969/- was released to the Director, Indian Institute of Health and Family

Welfare, Vengalraonager, Hyderabad for conducting the HMIS Re-Orientation

Training Programme to the Deputy Directors (Stat.), Statistical Officers and Lectures in Statistics & Demography. For 3 batches @Rs.1,31,323/- 1st batch is

planned from 19.01.2011 to 22.01.2011 (4days)

b) An amount of Rs.1,48,199/- was released to the Director, IIH&FW,

Vengalraonagar, Hyderabad for 2 batches @Rs.74,050/- for each batch for conducting training on Health Statistics, Demography & HMIS Portal to LD

Computers, ASOs and Dy. SOs.

c) Rs.4,46,100/- was released to the Principals of RTC, Kurnool, Guntur and Visakhapatnam for 6 batches @Rs.74350/- for each batch for conducting training

on Health Statistics, Demography & HMIS portal to LD Computers, ASOs and

Dy. SOs for 2 batches at each centre.

Sl

No

Place of Training No.of

Batches

Participants Date of

Training

No.of

participants

attended 1 RTC Kurnool 1 LD Computers, ASOs

and Dy. SOs 09.11.2010 to 12.11.2010

25 Members

2 RTC Kurnool 1 LD Computers, ASOs and Dy. SOs

07.12.2010 to 12.12.2010

25 Members

3 RTC Guntur 1 LD Computers, ASOs and Dy. SOs

09.11.2010 to 12.11.2010

23 Members

4 RTC Visakhapatnam

1 LD Computers, ASOs and Dy. SOs

27.12.2010 to 30.12.2010

17 Members

5 IIH&FW, Hyderabad


15.09.2010 to 18.09.2010

28 Members

Total 5 118 Members

Proposed to be conducted in January 2011

S N Place of

Training

No.of

Batches

Participants Date of

Training

No.of

participants

attended

1 IIH&FW, Hyderabad

1 Dy. Directors, SOs and Lec. In Stat. & Demo.

19.01.2011 to 22.01.2011

25 Members

2 IIH&FW, Proposed 2 Dy. Directors, SOs and 50 Members

263

Hyderabad Batches Lec. In Stat. & Demo.

3 RTC Guntur 1 LD Computers, ASOs and Dy. SOs

03.01.2011 to 06.01.2011

25 Members

4 RTC Visakhapatnam


03.01.2011 to 06.01.2011

25 Members

5 IIH&FW, Hyderabad

Proposed 1 Batch

LD Computers, ASOs and Dy. SOs

25 Members

Total 6 150 Members

Abstract of Trainings Conducted so far on Health Statistics, Demography & HMIS Portal

Sl.

No.

Released to Training to No.of

Batches

Amount

released 1 Director, IIH&FW, Vengalraonagar,

Hyderabad (for 3 batches @Rs.1,31,323/- for each

batch)

DD (Stat.), SOs & Lecs. in Stat. & Demography

3 Rs.3,93,969/-

2 Director, IIH&FW, Vengalraonagar, Hyderabad (for 2 batches @Rs.74,050/- for each batch)

LD Computers, ASOs and Dy. SOs

2 Rs.1,48,199/-

3 Principals of RTC, Kurnool, Guntur and

Visakhapatnam (for 6 batches @Rs.74350/- for each batch)

LD Computers,

ASOs and Dy. SOs

6 Rs.4,46,100/-

Total 11 Rs.9,88,268/-

264

Budget for Monitoring and Evaluation activities for 2011-12


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

1 Strengthening of

M&E/HMIS/MCH Tracking

a) Mobility Support

i) State level M&E Officer Mobility 20000 1 2.40

ii) State level District Nodal Officers for

fields visits

Mobility 2600 1320 411.84

b) State level convention for all HODs Conventions 100000 2 2.00

c) Quarterly review meetings of

DMHOs

Meeting 500 660 3.30

d) SPHOs monthly review meetings Meeting 300 360 12.96

Quarterly Review meetings to all Medical Officers at District level

Meeting 200 8800 17.60

c) Workshops / Training on M&E

i) State Level workshop to all HODs 1 5000 1 0.05

ii) District Level workshop to all District 1 3000 22 0.66

iii) Monthly Review meetings to Statistical Officers

1 10000 12 1.20

d) M&E Studies

i) NRHM important interventions

survey

1 5000000 1 50.00

e) Others

i) Medical Officers review meetings to all PP Units, UFWCs, UHCs an

UHPs

1 200 464 0.93

Sub Total 502.94

2 Operationalising HMIS at Sub-

District Level

a) Review of existing registers to make them compatible with National HMIS

i) NRHM Reports consisting 8 pages per 2800 Institutions 2 sets per month

1 5 5600 3.36

ii) FWP Performance formats 12 Sets per each Institute in duplicate for 12

months

1 55 5600 36.96

b) Printing of New Registers/ Forms

c) Training of Staff 1 21750 42 9.14

Sub Total 49.46

3 Operationalising MCH Tracking

a) Towards Printing and Reproducing

Registers / Forms (Field Survey Registers MPHA (M&F), Field

Supervisory Register (M&F), House Hold Registers)

1 30000000 1 300.00

b) Capacity Building of Teams

i PHC 1 5000 1624 81.20

ii PP Unit & UFWCs 1 500 227 1.14

c) On going review of MCH tracking

activities

265


(Rs/Unit)

No.of

posts /

units /

quantity

Annual

total

(Rs/lakhs)

1 2 3 4 5 6

i On going review of MCH tracking Cluster Level

1 5000 360 216.00

ii On going review of MCH tracking District Level

1 8000 22 21.12

iii On going review of MCH tracking State Level

1 18000 12 2.16

d) Monitoring data collection and data quality

i Monitoring data collection at district level

1 50000 22 11.00

e) Administrative overheads to 22

districts & Headquarters

1 50000 23 11.50

Sub Total 644.12

M&E Total 1196.51

266

CHAPTER-6

FIANANCIAL MANAGEMENT

1. Budgeting for Various Activities:

314. The State of Andhra Pradesh has impressive Tertiary Health infrastructure,

especially in the private sector. In this back ground the Government of Andhra Pradesh has demonstrated its commitment to achieve sustainable improvement in the health

status of its population with strong focus on improvement in the health outcomes for all

sections of people, especially women, children, vulnerable group of population such as

SC‟s and ST‟s etc.

315. The budgeting for various Programmes/activities under NRHM is proposed

strictly in accordance with Financial Monitoring Report (FMR) Format so as to facilitate proper analysis of the progressive utilization of funds and taking remedial measures.

316. The Fiduciary Risk Assessment (FRA) which was carried out as a precursor to

the APHSRP pertains to enhancing financial accountability in societies key functions need to be established within society‟s to ensure processes which improve accountability

including internal controls; periodic reports; submission of statutory requirements;

liaison with audit/public Accounts committee (PAC); and follow – up of external and internal reports.

317. Financial Management is one of the Key Performances Indicators (KPI) allocate,

monitor and to appraise the degree of proper utilization of funds under different health interventions by different plan Implementing Officers at both State and District level and

achieving the ultimate objective of ensuring financial propriety.

318. To implement and monitor the activities during the year, each implementing

agency in the state and district DCHS prepare a plan of action indicating inter-alia, the

physical targets and budgetary estimates in accordance with approved pattern of

assistance under the scheme, covering all aspects of the program activities for the period from April to March each year, and send it to Department of Family Welfare for

approval well before the start of the financial year.

319. The monitoring by the GoI will be at the program level. However, to evaluate

performance, progress under each activity as proposed by the state in the Annual Work

Plan (AWP) and agreed by the GoI, will be monitored. Any changes in the approved

AWP will be discussed during the quarterly and annual reviews and implemented by mutual consent. Activity wise performance evaluation will then be synchronized with

the revised work plan. In all such cases FMG, GoI will necessarily be informed of this

revision.

267

2. Financial Management Staff:

320. Chief Finance Officer (SPMU) was appointed at state level and recently two Assistant Accounts Officers have also been appointed to assist the Chief Finance Officer

(SPMU) in the Financial Management

321. Accountants & Data Assistants are in position at State / District level. At State level one Senior Assistant (Regular), one project Assistant, four Account Clerks and one

Junior Accountant one personal Assist, two Contract Junior Assistants are working. At

District level One DPO, AO (NRHM), MIS & DEO are working at District Level, and remuneration of the PMU staff including NDCPs is under process.

322. The powers to accord financial approvals/sanctions are vest at the level where the

funds have been devolved.

For the funds to be spent at the State Health Society level for any activity

included in the approved State PIP the office bearers of the SHS should have full

powers to sanction the expenditure in accordance with norms and no separate

approvals of any State Government Department should be necessary.

For the funds to be spent at the District Health Society level for any approved

activity the office bearers of the District Society have full powers to sanction the

expenditure in accordance with norms and no approval of the SHS or State Government is necessary.

For the funds to be spent by BMOs, CHCs/PHCs, Sub – Centers, VHSCs, etc,

for approved activities, the functionaries concerned are fully empowered to incur

expenditure in accordance with the norms laid down in the approved plans. The functionaries concerned refrain from seeking unnecessary administrative /

financial approvals of the higher authorities.

The delegated powers for the office – bearers and authorities of the State Health Society and District Health Society are same across all Programmes and the

framework of delegation of these powers also apply to the State‟s Share

contributed to the State Health Society under NRHM. However procurement

procedures (including Civil Works) for any programme should be in accordance with specific agreements entered into with funding agencies or donors, as the case

my be.

Key Tasks:

323. The Chief Financial Officer‟s key tasks included but not be limited to the

following:

Develop an operational manual of management of funds in state society, district society and facility level societies (eg Rogi Kalyan Samiti); obtain

necessary approvals.

Manage society funds including flexi pool funds by:

Overseeing disbursement of funds to implementing agencies. Ensuring that the accounting procedures laid down in the

operational manual are followed.

Preparation of statement of expenditure and collection of utilization certificates.

Ensuring conduct of financial counting / management audits and

compliance with findings.

268

Ensure conduct of training needs assessment of state and district

accounting staff and conduct of training programmes for them (Such as double entry book keeping, using accounting software, etc.)

Budget analysis of the state, district and facility level societies and

developing proposlas for improving financial management systems at

these levels.

324. Accounting Policies: In order to ensure uniformity and consistency in the

method of accounting for program funds and financial reporting, the periodic financial reporting and the annual financial statements are guided by the accounting policies and

principles. In some cases there are some deviations from the accounting standards

prescribed by the institute of Chartered Accountants of India, e.g. Depreciation policy.

Some key accounting policies are:

Maintenance of Accounts: The accounts of the society are maintained on double entry book keeping principles, on cash basis of accounting. Standard books of accounts (cash book,

journal, ledger, etc.) are maintained in accordance with the accounting policies

being given bellow. The financial statement has been prepared on the cash basis of accounting and the

applicable accounting standards issued by the Institute of Chartered Accountants

of India subject to certain exceptions which are listed below.

Fixed Assets: Fixed assets are stated at cost of acquisition and subsequent improvements thereto including taxes, duties, freight and other incidental expenses relating to

acquisition. Capital fund, equivalent to cost of fixed assets purchased during the

year, is created. For the purpose of fixed assets only those assets are counted which are directly

purchased for the use in the premises of the state and district society officers and

the vehicles purchased for the use of society.

Investment: Investment in FDRs or any other instruments are current investments and are stated at cost.

Depreciation: Depreciation of fixed assets is not provided as assets are generated out of Grants-

in-Aid (GIA). However assets are disposed of / condemned as per the provisions

under General Financial Rules (GFR) of state/UT governments or GoI.

Recognition of Income / Expenditure: The Grant-in-Aid (GIA) is accounted on cash basis.

The Grant-in-Aid (GIA) is reflected in the Income & Expenditure

accounts as income to the extent of fund utilization against it.

The Grant-in-Aid (GIA) to the extent it remains utilized at the end of the financial year is shown as liability in the balance sheet.

„Other Income‟ – interest income, income from investments are accounted

on cash basis. Commodity grants received from the Government of India relating to the

RCH program are not reflected in the financial statements of the society.

Maintenance of Accounts Records:

269

325. A record of all program transactions is maintained with appropriate supporting

documentation for the transactions. These supporting documents should be cross – referenced so as to link them to each item of expenditure with budget heads, project

components, expenditure categories (summary and detailed) compatible with

classification of expenditure and sources of funds indicated in the project

implementation plan and project cost budget sheets. These books of accounts together with supporting documents and project management reports are maintained for at least

three years after the completion of audit of the entire program expenditure, i.e., at least

three years after the completion of RCH Phase II program.

Heads of Accounts:

326. In order to keep proper financial information on the program activities, the standard ledger heads for each component and sub-ledger heads for all the categories

under these components are maintained. All expenditure incurred by a society is booked

under the account heads maintained in respect of various items of expenditure relating to these components.

Submission of Financial Reports:

327. All the districts send a monthly financial report to the state by the 10th of the

following month in respect of expenditure incurred. In case the information is not

received from the districts by 10th, the state immediately contacts the district RCH Society/CMO to get the information expeditiously.

Utilization Certificate:

328. In respect to the grants-in-Aid received from the Government of India, the

Society shall furnish a “Utilization Certificate” (UC) in Form No. GFR 19A duly signed

by the ED/ Project Director to Department of Family Welfare, GoI along with the

audited annual financial statements. The UC is required to be submitted by 31st July every year along with the audited statement of expenditure.

Basis for assessment of Performance: Timely disbursement of funds to the district societies and, collection of

SoEs and consolidation of financial data each district wise and for the state

as a whole. Budget analysis of the state, districts and facility level societies.

Timely conduct of financial management / accounting audits.

Number of suggestions for improved utilization of funds implemented and quantum of financial impact.

3. Statutory Audit:

329. Statutory Audit for the year 2009-10 is completed and submitted to GOI by 27th

January 2011, some clarification regarding the expenditure split under RCH Flexible

Pool for this we are working out, soon we will forward the information desired by the GOI-NRHM.

270

330. Selection of Statutory Audit for the year 2010-11 is under process by this month

we will inform the Status of the Statutory Auditor for the Year 2010-11.

331. The Government of Indian Ministry of Health and Family Welfare has

communicated the Guidelines for the appointment of Statutory Auditor through Open

Tender System to Conduct Audit of State and District Health Societies for the year 2010-11. Therefore a tender notification for hiring the services of Charted Accountant firms

for Statutory Audit of State Health and Family Welfare Society and District Health and

Family Welfare Society for the Financial Year 2010-11 under the (NRHM) has been issued vide Rc.No 018/NRHM/Fin./2011, dated 07.02.2011 in Times of India. Last

date for submission of tender proposals is 25.02.2011.

4. Concurrent Audit:

332. For the Financial year 2009-10 instructions are given to DHS to appoint Concurrent Auditors to conduct Concurrent Audit, in some of the DHS they are failed to

appoint but in some DHS appointment of Concurrent Auditor was delayed so this was

the reasons, we couldn‟t submit the Executive summery Report, But for the Financial

Year 2010-11 we have taken necessary steps for appointment of Concurrent Auditors at DHS by Open Tender System and appointing single Auditor for 6-7 DHS ,

333. The Financial Management unit of NRHM is considerably strengthened to provide sustained oversight and capacity development of the financial management units

from the state to the PHC level.

334. Systems are being strengthened to ensure streamlined and transparent management of NRHM finances. Concurrent audit was ordered in all the 23 districts by

4 audit parties. The names of the audit parties and districts where they conduct

Concurrent Audit are shown bellow.

Sl.

No Name of the firm District allotted

1 Sayanarayana Raju &

Co

East Godavari, West Godavari, Guntur, Prakasam,

SPSR Nellore, Chittoor

2 A V Ratnam & Co Hyderabad, Medak, Nalgonda, Visakhapatnam,

Vizianagarm and Srikakulam and Head Quarters.

3 V Suneeth Krishna, Ananthapur, Nizamabad, Khammam,

Karimnagar and Kadapa

4 K Suseela & Co Mahabbonagar, Warangal, Adilabad, Rangareddy

and Kurnool.

5. Implementation of Tally:

335. Tally has been procured and installed in 23 district & Head Office, In 9 districts

and Head Office Tally version is updated as per the new TCP developed by the GOI

NRHM. In the remaining 14 districts updating of Tally version is under process, Training will be imparted to all the staff concerned in districts as well as in Head Office.

271

6. Mode of Fund Transfer:

336. Fund Transfer from SHS to DHS by e-transfer and fund transfer from PHCs by e-Transfer (There are no Blocks in this State).

7. Financial Reporting under NRHM:

337. FMR (excluding NDCPs) up to 28.02.2011 & Statement of Fund Position as on 28.02.2011 had sent to GOI/FMG in a prescribed time frame, integration of NDCPs is

under Process.

338. FMRs are sent timely (excluding NDCPs). Consolidated FMR up to 31.12.2010 has already been submitted to Government of India.

339. All the districts send a monthly financial report to the state by the 10th of the following month in respect of expenditure incurred. In case the information is not

received from the districts by 10th, the state immediately contacts the district RCH

Society/CMO to get the information expeditiously. In some cases concerned district

officials are asked to personally bring the information to ensure compliance. In case districts neither furnish the information nor bring the information personally, the state

officials are deputed to look into the problems of the district in giving the information

and set it right for future.

340. A format of financial report is to be furnished quarterly within 30 days from the

close of each quarter by the state to the center. As stated in the above para, the state

ensure receipt of information from all the districts, compilation, and furnishing of the same to the MoH&FW, GoI within the stipulated date without fail and no excuse is

acceptable on this count.

341. The state evaluates the performance of the contractual Finance and Accounts

staff by suitably devising a performance appraisal format/sheet which will inter-alia

include her/his performance vis-à-vis Financial Performance related indicators. A copy

of this performance appraisal sheet is forwarded to the Financial Management Group (FMG) , GoI for getting concurrence for the yearly extension of tenure of the Finance

and Accounts personnel. Pending feedback from the central FMG, the state is

empowered to extend the tenure up to six months.

342. A similar procedure is followed by the state/UT to evaluate and monitor the

performance of accounts and finance staff of the district RCH societies.

9. MIS: The timely submission of monthly MIS/FSP and quarterly MIS is in place, But

with head wise and age wise details of advances up to 31.12.2010 will be initiated

10. RCH – I Unspent Balance:

There were no Unspent Balances under RCH – I Project.

272

11. Key Areas for Priority during 2011-12:

The following six district have been identified as high focus districts / backward areas on the basis of left wing affected, minority, tribal, SC/ST, Gender etc., grounds

1. Adilabad

2. Mahabubnagar

3. Warangal 4. Ananthapur

5. Khammam

6. Nellore

The para-medicos working in above districts are being paid special pay and allowances.

273

BUDGET ABSTRACT OF NRHM PIP – 2011-12

(Rupees in lakhs)

S N Activity Budget

proposed

2011-12

RCH Flexible Pool

I Maternal Health

1 Referral Hospital Strenthening 2147.87

2 24-hours MCH Centres 4767.84

3 Janani Suraksha Yojana 4282.94

4 Maternal Death Review(MDR) 159.00

5 Mother & Child Tracking 100.00

6 MTP Services (Trainings) 10.60

7 RTI/STI Services (Trainings proposed) 233.40

8 Midwifery Training for ANMs, Staff Nurse & MOs 100.00

10 Blood Bank & Blood Storage Centres 239.80

Maternal Health Total 12041.45

II Child Health

1 New Born Care Corners 2418.35

2 New Born Stabilization Units (NBSU) 1247.10

3 Sick New Born Care Units (SNCU) 281.00

4 Nutritional Rehabilitation Centers 515.73


III Family Planning Strategy

1 Family Planning Management 9.01

2 Terminal / Limiting Methods

a) Plan for facilities providing FEMALE sterilisation services on fixed days

at health facilities in districts

65.64

b) Compensation for sterilisation (Female) 2250.00

c) Compensation for sterilisation NSV (male) 600.00

d) Accreditation of NGOs / Voluntory Organizations for sterilization services

250.00

3 SPACING METHOD (Providing of IUD services by districts)

a) IUD services at health facilities in districts 94.00

b) Compensation to ASHA for 100% retention of IUD by clients 200.00

4 Workshop on Population Stabilization 28.00

5 BCC/IEC activities/campaigns/melas for family planning 36.00



IV Adolescent Health

1 Establishment of Health Clubs 99.20

Fixed Day Health Clubs with Specialist Services & Consellers 18.72

Printing of Booklets & IEC activities 21.75


V School Health Programme

1 School Health Programme 1560.50


VI Urban Health Strategy

1 Urban Health centres 706.08

2 Other initiatives 147.44

274

S N Activity Budget

proposed

2011-12


VII Tribal Health Strategy

1 Tribal RCH 2244.71


VIII Vulnerable Groups

1 Special Package to the identified Institutions 1527.60


IX High Focused Districts

1 High Focused Districts 292.96


X Training Strategy

1 Skill Birth Attendance Training to Staff Nurses and ANMs 444.00

2 BEMONC 57.00

3 Training of MOs in Emergency Obstetric Care 60.00

4 Training of MOs in Life saving Skills in Anesthesia 30.00

5 NSSK Training 259.20

6 F-IMNCI Training 285.00

7 IMNCI Training 1435.49

8 Pre Services IMNCI 48.00

9 Capacity Development FBNC 97.08

10 Training in Management of SAM 29.99

11 IUCD Training 270.26

12 ARSH training 400.56

13 Menstrual Hygiene 25.60

14 Induction Training for PHC Medical Officers 144.00

15 Capacity enhancement on BCC 58.09

16 Orientation Training to Cluster / District / State level Management Units

50.00

Training Strategy Total 3694.27 XI Programme Management Unit 2248.91

XII Behaviour Change Communication (BCC) 875.00

Total RCH Flexible Pool 33496.43

II) Mission Flexible Pool

1 Strengthening the Role of ASHA

a) ASHA Performance Based Incentives 2890.98

b) Best ASHA Awards 24.69

c) ASHA Conventions 848.40

d) Providing Saree to ASHAs (2 sarees) 282.80

e) Ashas Training TOT (6&7 Modules) 5.66

f) Training for ASHAs 482.09

f) Translation and Printing of ASHAs modules 20.00

2 Village Health Sanitation Committees 2227.60

3 Untied funds




4 Annual Maintenance Grants



275

S N Activity Budget

proposed

2011-12


5 Hospital Development Societies (HDS)

a) Primary Health Centres 1624.00

b) Community Health Officeer 309.00

c) Area Hospitals 54.00

d) District Headquarters Hospitals 85.00

6 Construction of Health Facility Buildings



c) Community Health Centres 1875.00

d) Developing the Project hospital at Srisailam ITDA in to a multi specialty hospital for Primitive tribal Chenchu citizens.

200.00

e) Strengthening of existing SCNUs 190.00

f) New SCNUs ( 20 bedded) 190.00

g) New SCNUs ( 12 bedded) ( Tribal) 240.00

h) Refurbishment of New Born Stabilization Units 1320.00

7 Strengthening of Community Health and Nutrition Clusters 500.00

8 Salaries of Second ANM 12745.44

9 Salaries for MPHA (Male) 2485.36

10 Procurement of Equipment & Medicines 4022.25

11 Nutrition Support Intervention

a) Village Health & Nutrition Day 886.33

b) Establishment of Nutrition rehabilitation centers (SAM) 609.27

12 RNTCP 143.00

13 Quality Assurance Cell for monitoring MCH activities & Trainings 21.24

14 Mainstreaming of AYUSH 2959.53

15 CUG Mobile connection to Tribal areas ANMs 123.00

16 Salaries of NPs (Nurse Practioners) 617.76

17 Strengthening of RCH services through CHNC 760.00

18 PHC mobile for strengthening RCH services 686.40

19 PG Diploma Course in Public Health 75.00

Total NRHM Flexible Pool 51035.80

III) Strengthening of Routine Immunization

1 Mobility for supervision at District-level 23.81

2 Mobility for supervision at state-level 3.00

3 Review meetings for the DIOs 3.58

4 Alternative Vaccine Delivery 300.53

5 Vaccine Transport 59.04

6 Support for Computer Assistance to DIOs 27.60

7 Support for two Computer Assistance to JD(CH&I) 2.88

8 Cold chain repairs and maintenance of equipment 33.16

9 Printing of Mother & Child Protection Cards and Registers 150.00

10 Special plan for Underserved Areas 33.94

11 Social Mobilization by ASHA /Link workers 1272.60

12 Cold Chain electricity charges

a) Central Vaccine Stores 8.40

b) Regional Vaccine Stores 7.92

13 Hiring services of ANMs in vacant places of SCs (urban areas) 100.80

14 Repairs to vaccine delivery vans 15.60

276

S N Activity Budget

proposed

2011-12

15 Handling and Service charges (Airport charges, etc.) 5.00

16 Training to Health Workers on Immunization 364.83

17 Maintenance of Data Loggers to WICs/WIF at state headquarters 0.60

18 Adverse Events Following Immunization 3.13

19 Supportive supervision from state-level 23.00

20 Providing fuel to Generators at CVS, RVS and districts 8.50

21 Procurement of Spare Parts 34.50

22 Procurement of Vaccine Carriers 9.31

23 Procurement of Spare ice packs 1.25

SRI Total 2492.96

IV National Disease Control Programme

1 National Vector Borne Diseases Control Programme 1801.04

2 Revised National T.B. Control Programme 1978.24

3 National Programme for Control of Blindness 2500.00

4 National Iodine Deficiency Disorders Control Programme 26.00

5 National Leprosy Eradication Programme 215.00

6 Integrated Disease Surveillance Programme 272.92

NDCP Total 6793.20

V Monitoring & Evaluation

1 Strengthening of M&E/HMIS/MCH Tracking 502.94

2 Operationalising HMIS at Sub-District Level 49.46

3 Operationalising MCH Tracking 644.12

M&E Total 1196.51

VI Direction and Administration (Treasury route)

1 001 Direction & Administration - Headquarters Office 393.18

2 001 Direction & Administration - District Family Welfare Bureau 4111.60

3 003 Training - Regional FW Training Centres 481.40

4 003 Training - Training of ANM, Dayas & LHVs 868.45

5 003 Training - ANM Training Schools run by LBs & VOs 412.50

6 003 Training - Training and Employment of MPW(Male) 452.86

7 101 Rural Family Welfare Services - Sub-centres 25588.32

8 102 Urban Family Welfare Clinics - Urban Family Welfare Centres 1932.55

9 103 Mother & Child Health - Medical Termination of Pregnency 35.84

10 200 Other Services - Maintenance of Sterilisation Beds 383.98

11 200 Other Services - Micro Surgical Recanalisation 0.20

Treasury budget Total 34660.88

VII Pulse Polio 2200.00

GRAND TOTAL 131875.78

pip 2011-12 ap nrhm

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