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OPERATIONAL GUIDELINES

for

State Programme Implementation Plan

(2012-13)

OPERATIONAL GUIDELINES for State Programme Implementation Plan (2012-13) Jammu and Kashmir NATIONAL RURAL HEALTH MISSION

Jammu and Kashmir

NATIONAL RURAL HEALTH MISSION

ABBREVIATIONS

AYUSH

Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy

AD

Allopathic Dispensary/ New Type PHC

ASHA

Accredited Social Health Activist

ANC

Antenatal Checkup

ANM

Auxiliary Nurse Midwife

AFHC

Adolescent Friendly Health Centre

AWC

Anganwadi Centre

AWW

Anganwadi Worker

ADMO

Assistant District Medical officer (AYUSH)

BMO

Block Medical Officer

BPL

Below Poverty Line

BAM

Block Accounts Manager

BB

Blood Bank

BM&EO

Block Monitoring & Evaluation Officer

BSU

Blood Storage Unit

CHC

Community Health Centre

CMO

Chief Medical Officer

DHS

District Health Society

DIO

District Immunization Officer

DMEIO

District Mass Education and Information Officer

DPMU

District Programme Management Unit

DPM

District Programme Manager

DAM

District Accounts Manager

D M& EO

District Monitoring & Evaluation Officer

FBNC

Facility Based Newborn Care.

FRU

First Referral Unit

FMPHW

Female Multi Purpose Health Worker

HBNC

Home Based Newborn Care

HMIS

Health Management Information System

ICDS

Integrated Child Development Services

IMR

Infant Mortality Rate

IUCD

Intra Uterine Contraceptive Device

JSY

Janani Suraksha Yojana

JSSK

Janani Shishu Suraksha Karyakaram

MCTS

Mother and Child Tracking System

MMA

Medical Methods of Abortion

MMR

Maternal Mortality Rate

MAC

Medical AID Centre/ Sub Centre

MVA

Manual Vacuum Aspiration

NBCC

Newborn Care Corner

NBSU

Newborn Stabilization Unit

NMR

Neonatal Mortality Rate

NRC

Nutrition Rehabilitation Centre

NRHM

National Rural Health Mission

NPCC

National Programme Co-ordination Committee

PHC

Primary Health Centre

PRIs

Panchayati Raj Institutions

PIP

Programme Implementation Plan

PNC

Postnatal Checkups

RCH

Reproductive & Child Health Programme

RKS

Rogi Kalyan Samiti

ROP

Record of Proceedings

SHS

State Health Society

SDH

Sub District Hospital

SC

Sub Centre

SNCU

Sick Newborn Care unit

TFR

Total Fertility Rate

VHND

Village Health & Nutrition Day

VHSNC

Village Health Sanitation & Nutrition Committee

WIFS

Weekly Iron Folic Acid Supplementation

NATIONAL RURAL HEALTH MISSION

National Rural Health Mission (NRHM) was launched at the National Level in April 2005. However, in J&K State it was started in December 2005. The Goal of the Mission is to improve the availability of and access to quality health care by people especially for those living in rural areas. NRHM aims to undertake architectural corrections in the health system enabling it to promote policies that strengthen public health management and service delivery throughout the country with special focus on those States which have weak public health indicators and/ or weak infrastructure. Jammu and Kashmir State is one of the focused States. NRHM is a platform to provide affordable, equitable and accessible health services, especially people residing in rural areas.

In the first phase of NRHM (2005-12), the focus was on bridging infrastructure gaps and augmentation of manpower to improve the delivery of health care services. NRHM is now poised to enter the second phase and the focus in this phase would be more on health system reforms for sustainable turnaround of health system in the State. The State would focus on strategies/ interventions which are aligned with key goals of NRHM viz reduction of MMR, IMR and stabilization of TFR.

OBJECTIVES OF NATIONAL RURAL HEALTH MISSION

i. To reduce Maternal Mortality Rate (MMR)

ii. To reduce Infant Mortality Rate (IMR)

iii. To reduce Total Fertility Rate (TFR)

STRATEGIES

i) Strengthening of the Health Institutions providing Primary Health Care (CHCs, PHCs and Sub Centres) so as to provide all the basic and emergency obstetric care.

ii) Strengthening of the Routine Immunization for the vaccine preventable diseases.

iii) Improving the health services and the services determining the health of the society viz sanitation and potable drinking water.

iv) Decentralizing the health planning and management of the health institutions by way of:

Constitution of District Health Missions and District Health Societies for planning and implementing the health related initiatives in the respective districts. Formation of Rogi Kalyan Samitis (RKS) and Village Health Sanitation and Nutrition Committees (VHSNC).

v) Bringing all the centrally sponsored Health schemes under the umbrella of NRHM.

Programme Action Plan (PIP) for 2012-13 The Ministry of Health and Family Welfare, Govt. of India conveyed administrative approval to the implementation of State PIP for the year 2012-13 for an amount of Rs. 312.54 crores

including Supplementary PIP of Rs.41.78 crores. The State PIP has been approved for the components and activities detailed in forthcoming paragraphs subject to compliance of following key conditionalities.

Key Conditionalities

A) Rational and equitable deployment of HR with the highest priority accorded to high focus districts and delivery points.

Rational and equitable deployment would include posting of staff on the basis of case load, posting of specialists in teams (e.g. Gynecologist and Anesthetist together), posting of EmOC/ LSAS trained doctors in FRUs, optimal utilization of specialists in FRUs and above and filling up vacancies in high focus/ remote areas.

B) Facility wise performance audit and corrective action based thereon.

Performance parameters must include OPD/ IPD/ normal deliveries/ C. Sections (wherever applicable).

Non-compliance with either of the above conditionalities given at A and B may translate into a reduction in outlay upto 7 ½% and non-compliance with both translating into a reduction of upto 15%.

C) Gaps in implementation of JSSK may lead to a reduction in outlay upto 10%.

D) Continued support under NRHM for 2nd ANM would be contingent on improvement in ANC coverage and immunization as reflected in MCTS.

E) Vaccines, logistics and other operational costs would also be calculable on the basis of MCTS data.

F) All buildings/vehicles supported under NRHM should prominently carry NRHM logo in English, Hindi and Regional language.

G) The State has been directed to ensure mandatory disclosure of the following information on the State website of NRHM:

¸ Facility wise deployment of all contractual staff engaged under NRHM with name

and designation.

¸ MMUs- total number of MMUs, registration numbers, operating agency, monthly schedule and service delivery data on a monthly basis.

¸ Patient Transport ambulances and emergency response ambulances- total number of vehicles, types of vehicle, registration number of vehicles, service delivery data including clients served and kilometers logged on a monthly basis. ¸ All procurements- including details of equipments procured (as per the directions of CIC which have been communicated to the States by this Ministry vide letter 'No.Z.28015/162/2011-H' dated 28th November 2011). ¸ Buildings under construction/renovation total number, name of the facility/hospital along with costs, executing agency and execution charges (if any), date of start & expected date of completion.

The major heads of operation are:

1. RCH Flexible Pool

2. NRHM Flexible Pool

3. Immunization

The detailed district wise/ activity wise budget for the year 2012-13 has already been circulated to the District Health Societies for implementation of the approved activities during the current year. The approval, however, is subject to the compliance of Key Conditionalities given above. The District Health Societies shall furnish the monthly progress report in the format given in Annexure A .

Components under the National Rural Health Mission

MATERNAL HEALTH

Janani Suraksha Yojana (JSY) In order to promote safe Institutional deliveries, the GOI has implemented JSY throughout the country including J&K. Under this scheme, the incentives are being paid to mother beneficiaries at the following norms:

S.No

Area

Incentive

for

mother

beneficiary

1

Rural areas

Rs. 1400.00

2

Urban areas

Rs. 1000.00

3

BPL mothers (aged 19 years and above) delivering at home upto two living children only

Rs. 500.00

ASHAs will facilitate Antenatal checkups and accompany the mothers to the health institutions for delivery and will get the following incentives:

S.No

Districts

Incentive for ASHA

1

High Focus Districts

Rs.600.00

2

Other Districts

Rs.350.00*

*Excluding Rs 250.00 for referral transport which will be borne by JSSK.

JSY cards, MCP cards and broader guidelines of JSY have already been made available to the District Health Societies.

NOTE:

JSY guidelines to be strictly followed and payments made as per the eligibility criteria. JSY benefit to the mother should be paid at the Health facility immediately after the delivery and before discharge. All payments to be made through crossed cheques / e-banking. The DDO should ensure that the JSY, MCP Card and Discharge slip have been prepared before making payment to the beneficiary as well as ASHA. JSY card and MCP card to be filled at the time of registration of pregnant women and not at the time of disbursement of cheque to the beneficiary and should be followed till the completion of pregnancy. Regular monitoring by Deputy Chief Medical Officers (District Nodal officers) for JSY. Physical verification of JSY beneficiaries to be done by the State and district level health authorities as per the following norms:

i) State level officers 2%.

ii) Chief Medical Officer 5%.

iii) District Nodal Officer (Deputy CMO) 5%

iv) Block Medical Officer 10%

Accuracy of JSY data reported at the HMIS portal of MOH&FW to be ensured besides furnishing quarterly progress reports to the State Health Society as per the prescribed format for onward transmission to Ministry within the given timeframe. The list of JSY beneficiaries to be displayed at prominent places in the Health facility.

Grievance redressal mechanisms as stipulated under JSY guidelines to be activated at the district and State levels. Quarterly reports of complaints received and action taken thereon by the Grievance Redressal Cell to be submitted to the State Health Society.

Mother and Child Health Card (MCP) The State has already initiated Joint MCP card developed by the Ministry of Health & Family Welfare and Social Welfare for monitoring the services of MCH and Nutrition interventions. This card will be filled at the time of first ANC. ASHA incentives and JSY benefits to the mother will be given upon verification and checking the entries in the Joint MCP card prepared by the ANM.

Janani Shishu Suraksha Karyakram (JSSK) The Janani Shishu Suraksha Karyakram (JSSK) has been implemented in the State with a view to encourage all pregnant women to deliver in Public Health Facilities and full fill the commitment of achieving cent percent institutional deliveries.

All Pregnant women and sick neonates till 30 days after birth who access government Health Institutions including SMGS Hospital, Jammu, Lal Ded Srinagar, G.B. Pant Hospital Srinagar and SKIMS Srinagar shall be entitled for availing following benefits:-

S. No

Entitlements for Pregnant Women:

Entitlements for Sick Newborn till 30 days after birth

1

Free delivery

Free and zero expense treatment.

2

Free caesarian section

3

Free drugs and consumables

Free drugs &consumables.

4

Free diagnostics (Blood, Urine tests and Ultrasonography etc.)

Free diagnostics.

5

Free diet during stay (upto 3days for normal delivery and 7days for caesarian section)

Diet for mother during the stay of sick children in hospital for 5 days.

6

Free provision of blood (Relatives and attendants should be encouraged to donate blood for replacement)

Free provision of blood. (Relatives and attendants should be encouraged to donate blood for replacement)

7

Free transport from home to health institution, between health institutions in case of referrals and drop back home

Free transport from home to health institution, between health institutions in case of referrals and drop back home.

8

Exemption from all kinds of user charges

Exemption from all kinds of user charges.

NOTE:

JSSK entitlements to be ensured to all pregnant women and sick newborns accessing Govt. health institutions. Drop back to be ensured to at least 70% of pregnant women delivering in the public health facilities. Effective IEC to be ensured.

Grievance Redressal Cells constituted for JSY shall also look into the Grievances for JSSK. Submission of Quarterly Reports to be ensured.

Accredited Social Health Activist (ASHA) ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services. She is a trained female health activist in the community who creates awareness on health and its social determinants and mobilizes the community towards local health planning and increased utilization and accountability of the existing health services. She is a good promoter of health practices.

Criteria for selection of ASHA One ASHA has to be in place for a population of 1000. ASHA must be a woman resident of the village--- Married/Widow/Divorced and preferably in the age group of 25 to 45 yrs. She should be a literate woman with formal education up to Eighth Std. In case the special circumstances require relaxation of the educational qualification of ASHA, the District Health Society needs to send the proposal to the State Health Society with full justification for seeking approval from Ministry of Health and Family Welfare, Government of India. She should have effective communication skills, leadership qualities and be able to reach out to every section of the community. Adequate representation from disadvantaged population groups should be ensured to serve such groups better.

10000 ASHAs have been engaged in the State so far. However during the year 2012-13, engagement of 2000 additional ASHAs has been approved in the Programme Implementation Plan (PIP). ASHAs are in place in majority of the villages and have been trained in module I to V. In the year 2012-13, the ASHAs will be trained in Module VI-

VII.

Uniforms to ASHA in High Focus Districts @ Rs. 1000.00 and in 750.00. The amount has to be e-transferred to the account of ASHA.

other districts @ Rs.

All payments to ASHAs be made through payees account Cheque/ electronic transfer on 10th of every month.

ASHAs are not paid any fixed monthly remuneration. However, they are paid performance based incentives.

Incentives for ASHAs:

S.No

Activity

Amount of Incentive

1

Incentive for full ANC

Rs 250/- per case Approved with the condition of registration of PW within 12 wks, completion of 4 ANC, testing for Hemoglobin, Routine urine, 100 IFA and TT injection. The payment would be made after entry in joint MCP card and verified by the ANM/SN/MO.

2

Incentive under JSY

Rs.350/- per delivery Rs.600/-per delivery in HFDs (with conditions of JSY)

3

Incentive for HBNC

Rs 250/- on completion of six visits (3rd, 7 th , 14 th , 21 st , 28 th and 42 nd day) in case of institutional deliveries and seven visits ((1 st ,3rd,7 th ,14 th ,21 st ,28 th and 42 nd day) in case of home deliveries subject to certification by ANMs.

4

Incentive for full immunization per child(upto 1 year age)

Rs 100 per child for full immunization in 1 st year of age

4

Incentive for full immunization per child upto 2 years age(all vaccination received between 1st and 2nd year age after completing full immunization at 1 year age)

Rs 50 per child for ensuring complete immunization upto 2nd year of age of Child.

6

Mobilizing Drop out Children for Immunization Sessions on VHND

Rs 150 /- subject to the condition that no drop out child is left without immunization in her area.

7

Incentive for facilitating the monthly meeting of VHSNC followed by the meeting of the Women and Adolescent Girls

Rs. 150/-

8

Incentive for birth registration

Rs 50/-

9

Incentive for death registration

Rs 50/-

10

Incentive for events reporting (diarrhea, epidemic, accidents, etc )

Rs 100/-

11

Maternal Death Reporting

Rs 100/-

12

Infant Death Reporting

Rs 100/-

13

Incentive to ASHA for Roster duty at ASHA help desk in selected Delivery points. (Annexure B)

Rs. 100 for 8 hours duty on rotation basis.

S.No

Activity

 

Amount of Incentive

14

Reimbursement for Mobile user charges for ASHA

Rs. 100 per month

15

ASHA incentive for sale of 50 sanitary napkins packs.

Rs. 50/-

16

ASHA incentives for testing 50 salt samples per month in endemic districts

Rs. 25/- per month

17

Early case detection of Leprosy

   

MB

500/-

PB

300/-

18

Motivation

of

any

beneficiary

for

 

tubectomy/laproligations

 

Rs 150 /- per operation

19

Motivation

of

any

beneficiary

for

 

vasectomy

 

Rs 200 /- per operation

20

Providing DOTS to the TB. Patients

 

Rs 250 /- on completion of treatment

21

Pulse Polio Day

 

Rs 75 /- x 3 days = Rs 225

Job functions of ASHA

ÿ Activities as mentioned in the table above and mobilizing the Pregnant Ladies for Antenatal checkups/dropouts for immunization.

ÿ Accompanying the pregnant ladies to the institution for delivery.

ÿ Tracking of Pregnant women from early registration in the first trimester upto post natal care after delivery in her respective areas.

ÿ Tracking of Children upto full immunization stage

ÿ Maintenance of ASHA Diary

ÿ Record of house hold visits, under one year children, pregnant ladies and the eligible couple register.

ÿ Assisting the FMPHWs and AWWs in organizing Village Health & Nutrition Days.

ÿ Facilitating the monthly meeting of VHSNC followed by the meeting of women and adolescent girls.

ÿ Maintenance of register in which all the services provided viz registration of pregnant women, ANC, immunization, Oral pills, IUCD, sterilization- Male female, referral of sick newborns/children/ infants, spacing methods etc. are recorded with signature of the concerned health person.

ÿ Monthly reports generated by ASHA as per her diary is to be consolidated at SC level.

ÿ ASHA is a main service provider for Home Based Neonatal Care. She has to provide newborn care through a series of home visits which include the skills for weighing the newborn, measuring newborn temperature, ensuring warmth, promoting hand

washing, providing skin, cord & eye care, supporting exclusive breast feeding, accessing low birth weight babies through the use of protocols and managing such babies through various means like monitoring weight supporting / counseling etc., detect signs and symptoms of sepsis, recognize post partum complications in the mother and refer appropriately etc.

ASHA Diary ASHA has to record and track the pregnant women upto 42 days postnatal period and has also to follow the children till they are fully immunized. Besides, she has to attend Village Health and Nutrition Days for mobilizing women and children to avail health services being provided on VHN Day. She has also to facilitate holding of meeting of the Village Health Sanitation and Nutrition Committees (VHSNCs) and maintain records of untied funds of VHSNCs. All these activities need to be recorded for tracking them later on. The State Health Society is providing the diary to the District Health Society for distribution among ASHA for this purpose.

Drug kit for ASHA

ASHA have been provided drug kit in the previous year which will be replenished by the Block Medical Officer out of the available stock of medicines.

Home Based Newborn Care (HBNC) Kit will be provided to ASHAs for Home Based Newborn Care. The contents of the kits will be as under:

S.No.

Equipment

No.

1

Baby weighing scale with sling

1

2

Digital thermometer

1

3

Digital watch/Timer device

1

 

Consumables

 

4

Cotton

 

5

Gauze

 

6

Soap & Soap Case

 

7

Baby Blankets, Locally made and Locally Procured

2

8

Spoon-stainless steel

1

ASHA Help Desk/ASHA Greh (New Activity)

Escorting pregnant women to the hospital for institutional delivery is one of the important activities that an ASHA performs. The ASHA has to escort the pregnant women even during the odd hours which necessitates for keeping a provision of Help desk-cum-rest room at the hospitals which would provide space to the ASHAs for freshening up and taking rest for some time. Besides, it will also act as a help desk to provide required information to ASHAs. To begin with, this has to be initiated and operationalized in 30 health institutions including District Hospitals and few CHCs on the basis of delivery load given in Annexure C

ASHA GREH will be having one room with attached toilet and bathroom facility, having proper electrical fittings like light, fan or heater etc. The room should have a provision of at least two beds with all other accessories like bed sheets, bed covers, pillows, drinking water facility etc. Relevant informative documents on health issues shall remain available in ASHA GREH for reference. The room should be exclusively used by ASHAs and accessible for use on 24x7 basis.

The management of ASHA GREH shall be assigned to ASHAs selected on the basis of performance and belonging to the nearby locality. Each selected ASHA shall be assigned the task of managing ASHA GREH on daily rotation basis. A roster duty register shall be maintained to record the use of the facility and performance of the duty by ASHAs. ASHAs will receive incentives for performing duty on roster basis. The overall management of ASHA GREH will be under the control of Rogi Kalyan Samiti (RKS) of the concerned health institution.

ASHA shall be given incentive of Rs. 100 / day for performing roster duty for 8 hours. ASHAs from the adjoining areas will be called for roaster duty to be prepared by the concerned Block Medical Officer and submitted to the Medical Superintendent of the concerned Hospital. The incentives to ASHA for performing roaster duty shall be paid by the concerned Block Medical Officer.

Cost of Operationalization of ASHA HELP DESK/ASHA GREH will be Rs. 10, 000/facility as per the breakup given below:

S.No

Items

Upto a maximum of

1

Two wooden Beds @ Rs. 1500/-

Rs. 3000/-

2

Bedding and Linen @ Rs. 1500/

Rs 3000/-

3 Fan and Heater

Rs 2000/-

4 Table and Chair

Rs. 2000/-

Total

Rs.10,000/-

Delivery points

At present there are 133 functional delivery points (Annexure D) in the State as per the benchmark set by GoI i.e.

i. SCs conducting > 3 deliveries/ month.

ii. PHCs/Non-FRUs conducting > 10 deliveries/month.

iii. FRUs conducting >20 deliveries/ month.

iv. District Hospitals conducting >50 deliveries/ month.

Services to be provided in these Delivery Points:

A) All District Hospitals and other similar district level facilities to provide the following

services:

24x7 service delivery for CS and other Emergency Obstetric Care.

1st and 2nd trimester abortion services.

Facility based MDR.

Essential newborn care and facility based care for sick newborns.

Family planning and adolescent friendly health services

RTI/STI services.

Functional Blood Storage Unit / Blood Bank.

B) CHCs and other health facilities at sub district level (above block and below district level) functioning as FRUs to provide the same comprehensive RMNCH Services as the district hospitals.

C) 24x7 PHCs and Non FRUs to provide the following services:

24x7 BeMOC services including conducting normal delivery and handling common obstetric complications. 1st trimester safe abortion services. (MVA upto 8 weeks and MMA upto 7 weeks) RTI/STI services. Essential newborn care and facility based care for sick newborns. Family planning

and MMA upto 7 weeks) RTI/STI services. Essential newborn care and facility based care for sick
and MMA upto 7 weeks) RTI/STI services. Essential newborn care and facility based care for sick
and MMA upto 7 weeks) RTI/STI services. Essential newborn care and facility based care for sick
and MMA upto 7 weeks) RTI/STI services. Essential newborn care and facility based care for sick

D) All identified SCs/ facilities will:

Conduct Delivery by SBAs.

Provide IUD Services

Provide Essential New born care services.

Provide ANC, PNC and Immunization services.

Provide Nutritional and Family planning counseling.

Conduct designated VHND and other outreach services.

Maternal Death Review (MDR) Under NRHM, various attempts are being made to reduce Maternal Mortality by improving quality of maternal health care delivery and stepping up monitoring. Government of India has decided to take up Community based maternal death review (CBMDR) and the Facility based maternal death review (FBMDR) which would help in identifying the gaps in the existing health care delivery systems, prioritizing and planning for intervention strategies and to reconfigure health services.

The Maternal Death Review will be taken up both at Facility level and Community level in all Districts of the State.

Community-Based MDR Community based MDR using a verbal autopsy format is a method of finding out the medical causes of death and ascertaining the personal, family or community factors that may have contributed to the death. The verbal autopsy consists of interviewing people who are knowledgeable about the events leading to the death such as family members, neighbors and traditional birth attendants.

Community based reviews must be taken up for all deaths that occurred in the specified geographical area, irrespective of the place of death, be it at home, facility or in transit.

Procedure for Community-Based Verbal Autopsy

i) The ASHA/AWW/ANM will inform/intimate all women deaths in the age group of 15 to 49 years from her area by telephone to the BMO within 24 hour. The local panchayats and other relevant persons/ groups may also be encouraged to inform the BMO about women s death in their area.

ii) The ASHA/AWW/ANM will fill up the format for primary informant (Annexure E) for all women deaths (age 15-49) and send the format to the BMO within 24 hours. Format for primary informer gives information whether the death is a suspected maternal death or a non maternal death.

iii)

Line listing of maternal deaths should be submitted to the BMO by the ASHA, by 5th of every month. In case no death has occurred during the month, the ASHA has to submit a Nil report.

iv) The ASHA/AWW/ANM should also ensure the presence of the respondents during the visit of the investigation team

Facility-Based MDR Facility Based Maternal Death Review will be taken up for all Government hospitals viz. Medical College/DHs/SDHs/CHCs where more than 500 deliveries are conducted in a year.

Procedure for Facility-Based Autopsy

i) All Maternal deaths occurring in the hospital, including abortions and ectopic gestation related deaths, in pregnant women or within 42 days after termination of pregnancy irrespective of duration or site of pregnancy should be informed immediately by the Medical officer who has treated the mother and was on duty at the time of occurrence of death to the Facility Nodal officer (FNO)

ii) The FNO of the hospital should inform the maternal death to the District Nodal

Officer (DNO) and State Nodal Officer on telephone within 24 hours of the occurrence of death.

iii) The Nodal Officer of the hospital should complete the format for Primary informant Annexure E and send it to the District Nodal Officers within 24hrs of the occurrence of maternal death

At the District level the Maternal Death Review is envisaged at two levels.

¸ Maternal Death Review under chairmanship of CMO.

¸ Maternal Death Review by District Level Committee under chairmanship of District Magistrate.

Composition of District Level Committee

District Magistrate

Chairperson

Chief Medical Officer

Member Secy/ Convener

Dy. Chief Medical Officer

Member

District Nodal Officer (MDR)

Member

Facility Based Nodal Officer (MDR)

Member

Representative of Federation of Obstetric and Gynaecological Society of India (FOGSI)

Member

Committee should meet at least once in a month to review the maternal death cases and should submit the minutes of the meeting and corrective actions taken to reduce the maternal deaths to the State Health Society. The meeting of the District Committee shall be held irrespective of the fact whether any maternal death has occurred in that particular month or not.

o

Maternal Death Reporting:- A provision of Rs. 100.00 has been kept for reporting maternal death by a community volunteer/ ASHA. The report of such deaths will be submitted to the District Health Society who will take appropriate action.

o

Maternal Death Investigation (Verbal Autopsy):- An amount of Rs. 250 per investigation shall be provided to Deputy CMO/BMO/MO for Maternal Death Investigation (Verbal Autopsy). Investigation reports are to be furnished to GOI through State Health Society on monthly basis/Quarterly basis.

Road Map for Priority Action on Maternal Health is enclosed as Annexure B

CHILD HEALTH

Before launch of NRHM in the State, the Infant Mortality Rate was 52 as per Sample Registration Survey (SRS) 2006. Different strategies have been adopted under NRHM which are directed towards reduction of IMR in the State. As per the targets fixed by MoH&FW, GoI the State has to achieve the following targets by end of March 2013.

Indicator

Current

Status

Target

(SRS 2010)

2012-13

Early Neonatal Mortality

 

30

24

Neonatal

Mortality

Rate

35

27

(NMR)

Infant Mortality Rate (IMR)

43

34

Under 5 Mortality

 

48

37

With these targets in consideration, the following specific interventions are being taken up in the Districts during the current year:

A) Facility Based New born Care:- During the current year, emphasis will be laid upon strengthening of existing Facility Based Newborn Care Units viz. SNCUs/NBSUs/NBCCs at different levels, as most of these units have been established but need to be operationalized so as to achieve the desired outputs.

Sick Newborn Care Units: - Sick Newborn Care unit (SNCU) is a neonatal unit in the vicinity of labour room at District hospital which would provide level-II care for Sick New Borns. Seven SNCUs have been established till date & eight more are to be established during this year. Please refer Annexure G for list of Hospitals where SNCUs are to be set up.

Operational cost has been approved for 5 functional SNCUs @ Rs 10 lakhs and @ Rs. 5 lakhs for the SNCUs which have been established but are yet to be operationalized. Please refer Annexure H for list of Hospitals in this regard. The component wise detail of Operational Cost is given below:

Recurring or running cost per year

Operational cost of Rs. 10.00 Lakhs (for One Year)

Operational cost of Rs. 5.00 lakhs (for six months)

Consumables

Rs. 3,50,000

1,75,000

Maintenance cost

Rs. 6,50,000

3,25,000

Sub Total

Rs. 10,00,000

5,00,000

Consumables for SNCU includes meconium aspirator adaptors, infusion pumps, Cuvettes, Vacuum tubes, lancets, capillary tubes, sealing compound, masks & caps, surgical gloves, suction tubes, feeding tubes, syringes & needles, cotton wool, compress gauze, connectors, disinfectants & antiseptics, adhesive tapes, scalpels, umbilical venous catheters, blood transfusion sets, endotracheal tubes, electrodes for ECG recorder, microscopic slides, paper sheets crepe for sterilization pack, etc.

Human Resources approved for this financial year for each SNCU at District Hospitals:-

1. One Child Specialist.

2. Four Medical Officers (MBBS) to be engaged on contract basis.

3. Five Staff Nurses.

4. One Lab Technician.

5. One Data Entry Operator for ARSH/ SNCU/HMIS at DH.

Newborn Stabilization Units:- Stabilization unit is facility within or in close proximity of the Maternity ward where sick and low birth weight new born can be cared for short period. 69 NBSUs have been established till date in the State whereas work is in progress in 14 NBSUs. Strengthening of existing NBSUs will be carried out this financial year for which an amount @ Rs 1.75 lakh /unit has been approved as operational cost for 45 functional NBSUs. List annexed as Annexure I .

Recurring or running cost per year

Amount in Rupees

Consumables

Rs.25,000

Maintenance cost

Rs. 1,50,000

Sub Total

Rs. 1,75,000

Consumables for NBSU includes I/V cannula 24/26 G, mucous extractors, feeding tubes, oxygen cylinder 8 F, suction tubes, Sterile gloves, Cotton wool, Disinfectants etc.

Newborn Care Corners: Baby care corners are to be established in the PHCs (Delivery point) in phased manner by way of addition/alternation of the existing space within/ nearer to the labour room for paying special attention to the sick newborn. 269 Newborn Care Corners have been established in the State till date. In the previous years the grant for setting up of NBCC was only Rs. 25000/- & in most of the facilities the equipment purchased includes Oxygen cylinders, Suction apparatus, Laryngoscope etc whereas in many of the Institutions radiant warmers were not purchased. An amount of Rs. 42.50 lakhs @ Rs 85,000 per unit has been approved for procurement of equipments for NBCCs including radiant warmer for 50 delivery points/facilities. List of institutions annexed as Annexure J .

List of Equipments for NBCC

S No.

Item Description

Essential/Desirable

Quantity

1

Open care system: radiant warmer, fixed height, with trolley, drawers,

E

1

O2-bottles

2

Resuscitator hand-operated for neonate, neonate,500ml

E

1

3

Weighing Scale, spring

E

1

4

Pump suction, foot operated

D

1

5

Room Thermometer

E

1

6

Light examination, mobile, 220-12 V

D

1

 

Consumables required for NBCC

7

I/V Cannula 24 G, 26 G

E

8

Extractor, mucus, 20ml

E

9

Towels for drying and wrapping the baby

E

10

Sterile equipment for cutting and tying the cord

E

11

Tube, feeding, CH07, L40cm,

E

12

Oxygen cylinder 8 F

D

13

Sterile Gloves

E

Moreover, for strengthening of existing NBCCs Operational cost for 200 units @ Rs 20,000/unit has been approved this financial year. List annexed as Annexure K .

Recurring or running cost per year

Amount in Rupees

Consumables

Rs.5,000

Maintenance cost

Rs. 15000

Sub Total

Rs. 20,000

Note: Detailed Guidelines/Toolkit for setting up of SNCUs/ NBSUs/ NBCCs has already been circulated to the districts. These guidelines are also available on website of National Rural Health Mission, J&K www.jknrhm.com.

Strengthening of SMGS Hospital Jammu / GB Pant Hospital Srinagar:

For tertiary care hospitals Rs 2 Crore each have been approved for Strengthening of the paediatrics department of SMGS Hospital Jammu & GB Pant Hospital Srinagar this financial year.

Note:

All procurement/purchases should be made as per the rates approved by the Central Purchase Committee. All codal formalities should be observed while making purchases.

per the rates approved by the Central Purchase Committee. All codal formalities should be observed while

B. Home Based Newborn Care:- Home Based New Born Care is an effective approach for achieving the desired reduction in infant mortality in rural and poor population. 10000 ASHAs are working in the State.

Training of Module 6 & 7 is being rolled out shortly. By the end of this financial year it is expected that most of the ASHAs will get trained in Module 6 & 7 to implement effectively Home Based New Born Care. Training on MCP cards for HBNC will be imparted to the ASHAs during monthly meetings. HBNC visits will be monitored by the ASHA facilitators, MCP cards will be filled by the ANM in order to ascertain their Home visit & ASHA will be entitled for Rs. 250 on completion of her six visits (Day 3, 7, 14, 21, 28, 42) in case of institutional deliveries and seven visits (Day 1, 3, 7, 14, 21, 28, 42) in case of Home deliveries.

C. Janani Shishu Suraksha Karyakram (JSSK) JSSK has been implemented in the State vide Govt. Order No. 516-HME of 2011 free entitlements for sick newborn for 30 days after birth are given at under Maternal Health.

D. Nutrition Rehabilitation Centre NRC (New Activity) NRC is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Once discharged from the NRC, the child continues to be in the nutrition rehabilitation program till he/she attains the defined discharge criteria as per the guidelines.

Location and size of NRC NRC is a special unit, located in a health facility and dedicated to the initial management and nutrition rehabilitation of children with severe acute malnutrition. The unit should be a distinct area within the health facility and should be in proximity to the pediatric ward/inpatient facility.

The NRC should have the following Facilities:

Patient area to house 10 beds; in NRC adult beds are kept so that the mother can

be with the child. Play and counseling area with toys; audiovisual equipment like TV, DVD player

and IEC material. Nursing station

Kitchen and food storage area attached to ward, or partitioned in the ward, with

enough space for cooking, feeding and demonstration. Attached toilet and bathroom for mothers and children, along with two separate hand washing areas.

The approximate covered area of the NRC should be about 150 square feet per bed, plus 30% for ancillary area. A 10 bedded NRC should have a covered area of about 1950 square feet; this will include the patient area, play and counseling area, nursing station, kitchen, storage space, two bathrooms and two toilets. NRC should have a cheerful, stimulating environment; it should be child friendly. Walls can be brightly painted and decorated. Ward should have sufficient space for all mothers/caregivers staying with the children to sit together and be given cooking and feeding demonstration.

To begin with, the State will establish two Nutrition Rehabilitation Centres (NRCs). In this financial year one in G.B Pant Hospital, Srinagar and one in SMGS Hospital, Jammu. Rs. 19.6 lakhs have been approved for this activity during this financial year @ Rs. 2 Lakh as establishment cost & Rs. 7.8 lakh as operational cost per unit.

 

Approved Budget for 10 bedded NRC

 

S.

no.

Items

Unit cost

Total cost

A.

One-time expenditure

 

A1

Civil Work (renovation)

   
 

1.1 Ward

25,000

25,000

 

1.2 Kitchen

20,000

20,000

 

1.3 Bathroom and toilets

15,000

15,000

A2

Cots and Mattresses (10 Cots & mattresses @ Rs 2500 each)

2,500

25,000

A3

Essential Ward equipments

50,000

50,000

A4

Other Ward equipments

35,000

35,000

A5

Kitchen equipments

30,000

30,000

 

One-time expenditure

 

2,00,000

B.

Recurrent expenditure

 

B1

Kitchen Supplies

15,000 (per month)

1,80,000

B2

Pharmacy Supplies and Consumables

15,000(per month)

1,80,000

B3

Other Costs

   
 

Wage Compensation and food for mother/care giver* (Rs 100 X 10 beds X 30days X 12 months)

Rs.100/day

3,60,000

 

Maintenance of equipments, linen, Cleaning supplies

3,500(per month)

42,000

 

Contingency

1,500(per month)

18,000

 

Subtotal

64,500

7,80,000

 

TOTAL COST (A+B)

 

9,80,000

* The Mother/ Care taker of Child shall prepare special diet for the child as prescribed by the Medical officer under the supervision of Staff Nurse, for this purpose mother of child shall be provided wage compensation/ food @ Rs 100 per day.

Medical Superintendent of Hospital shall utilize the services of one Medical Officer (MBBS) and One Staff Nurse from existing hospital staff for providing services in the Nutrition Rehabilitation Centre. The Staff will be trained in facility based management of SAM.

Medical Officer shall be the overall in-charge of the unit and will be responsible for clinical management of children admitted in the NRC. The MO will examine each patient every day and will attend to emergency calls as per the need.

The nurse posted in the unit will be responsible for the nursing care including weight record; measure, mix and dispense feed; give oral drugs; supervise intra venous fluids; assess clinical signs and fill the multi chart with all the routine information. The nurse will also counsel mothers/caregivers on the emotional needs of their children and encourage them to give sensory stimulation. She will be also in charge of the structured play therapy.

Details of equipments and supplies for NRC

i. Essential Ward equipments

Glucometer (1) Thermometers (preferably low-reading) (2) Weighing scales (Digital) (3: one each to be kept in Ward, OPD and Emergency area) Infantometer (1 each for OPD & NRC) Stadiometer (to measure standing height) (1) Resuscitation equipments Suction equipment (low pressure)

ii. Other Ward equipments

IV stands Almiras, Shoe racks, Dust bins, Room Heaters

IEC Audio/visual materials (TV; DVD player) Toys for structural play Calculator & Clock Reference height and weight charts

iii.Kitchen equipments Cooking Gas Dietary scales (to weigh to 5 gm.) Measuring jars Electric Blender (or manual whisks) Water Filter Refrigerator Utensils (large containers, cooking utensils, feeding cups, saucers, spoons and jugs, etc.)

iv.Drugs and Consumables Antibiotics: (Ampicillin/Amoxicillin/Benzyl penicillin Chloamphenicol Cotrimoxazole Gentamycin Metronidazole Tetracycline or Chloramphenicol eye drops Atropine eye drops ORS Electrolyte and minerals Potassium chloride Magnesium chloride/ Sulphate iron syrup Multivitamin Folic acid vitamin A syrup Zinc Sulfate or dispersible Zinc tablets Glucose (or sucrose) IV fluids (ringer s lactate solution with 5% glucose; 0.45% (half normal) saline with 5% glucose; 0.9% saline (for soaking eye pads) Cannulas, IV sets, Pediatric Nasogastric tubes

v. Kitchen Supplies Supply for making Starter and Catch up Diet Dried Skimmed Milk Whole dried milk Fresh whole milk Puffed rice vegetable oil Foods similar to those used in home

D.Infant and young Child Feeding (IYCF):

Beast feeding is to be initiated within one hour after birth of the child. During the current financial year, breast feeding week (1 7 August 2012) will be organized at all delivery points, block and district headquarters for promoting breast feeding. An amount of Rs.

5000/- has been approved to be kept at the disposal of the heads of the institutions for carrying out activities like IEC and organizing camps.

E. Infant Death Review (IDR) One of the prime objectives of NRHM is to reduce the Infant Mortality Rate (IMR). Various attempts are being made to reduce Infant Mortality by improving quality of child health care delivery through strengthening of Facility Based Newborn Care Units, introduction of Home Based Newborn Care Programme and stepping up monitoring. However, it has been felt that prompt reporting and review of infant Deaths can provide insight into the cause of death and the possible solutions to check the problem.

The Infant Death Review will be taken up both at Community level and Facility level in all Districts of the State.

Community-Based IDR Community based IDR using a verbal autopsy format is a method of finding out the medical causes of death and ascertaining the personal, family or community factors that may have contributed to the deaths. The verbal autopsy consists of interviewing people who are knowledgeable about the events leading to the death such as family members, neighbors and traditional birth attendants.

Community based reviews must be taken up for all deaths that occurred in the specified geographical area, irrespective of the place of death, be it at home, facility or in transit.

Procedure for Community-Based Verbal Autopsy

i)

The ASHA/AWW/ANM will inform/intimate all infant deaths in the age group of 0 to 1 year from her area by telephone to the BMO within 24 hour. The local panchayats and other relevant persons/ groups may also be encouraged to inform the

BMO about women deaths in their respective areas.

ii)

The ASHA/AWW/ANM will fill up the format for primary informer for all infant deaths and send the format to the BMO within 24 hours.

iii)

Line listing of the infant deaths should be submitted to the BMO by the ASHA, by 5th of every month. In case no death has occurred during the month, the ASHA has to submit a nil report.

iv)

The ASHA/AWW/ANM should also ensure the availability of the respondents during the visit of the investigation team.

Facility-Based IDR Facility Based Infant Death Review will be taken up for all Government hospitals including Medical Colleges (District, Sub district, CHCs) where more than 500 deliveries are conducted in a year.

Procedure for Facility-Based Autopsy

i) All Infant deaths occurring in the hospital, should be reported immediately by the Medical officer who has treated the child and was on duty at the time of occurrence of

death to the Facility Nodal officer (FNO)

ii) The FNO of the hospital should report the infant death to the District Nodal Officer (DNO) and State Nodal Officer by telephone within 24 hours of the occurrence of death.

iii) The Nodal officer of the hospital should complete the primary informant format and send it to the DNO within 24hrs of the occurrence of infant death.

At the District level the Infant Death Review is envisaged at two levels.

¸ Infant Death Review under chairmanship of CMO.

¸ Infant Death Review by District Level Committee under chairmanship of District Magistrate.

The District Level MDR Committees shall also review the infant deaths in the District. However, one Pediatrician will be included in the aforesaid committee for review of Infant Deaths.

Committee should meet at least once in a month to review the infant death cases and should submit the minutes of the meetings and corrective actions taken to reduce the infant deaths to the State Health Society irrespective of the fact whether any infant death occurred in that particular month or not.

Infant Death Reporting: - A provision of Rs.100 has been kept for reporting infant death by a community volunteer/ ASHA. The report of such deaths is to be submitted to the District Health Society who will take appropriate action. Formats for infant death reporting are annexed at Annexure L

Infant Death Investigation (Verbal Autopsy):- An amount of Rs. 250 per investigation shall be provided to Deputy CMO/BMO for Infant Death Investigation (Verbal Autopsy).

Investigation reports are to be furnished to GOI through State Health Society on monthly and quarterly basis

Emphasis needs to be given to:

ÿ Initiation of Breast feeding within one hour after Birth.

ÿ A minimum stay of 48 hours of the mother & the child after delivery at the Health

facility followed by post natal visits by ASHAs/ANMs upto 42 days to monitor the well being of mother & Child.

ÿ Full immunization of the children as per the Universal Immunization schedule.

ÿ Proper Facility Based Newborn Care.

Road Map for Priority Action on Child Health is enclosed as Annexure F

URBAN RCH

Urban RCH is being implemented in Capital cities of Srinagar & Jammu under NRHM; Urban Health Posts and Urban Health Centres have been established in cities of Srinagar & Jammu.

Urban Health Centres Manpower One Medical Officer, Three ANMs and One Helper

Urban Health Posts Two ANMs and One Part Time Cleaner

Note: Funds under Urban RCH have been approved for six months only. Further approval shall be given subject to the sharing of work done performance of UHCs / UHPs with the Ministry of Health and Family Welfare, GoI. The Chief Medical Officers Jammu / Srinagar shall furnish the progress report of Urban Health Centres / Posts to the State Health Society by 30 th September 2012 for its onward transmission and taking up the matter with GoI for sanction of funds for next six months.

ROAD MAP FOR PRIORITY ACTION UNDER URBAN RCH

Carry out a comprehensive third party evaluation of UHCs/ NGO performance including an assessment of reasons for low expenditure (9.6 % in the first 9

months of 2011-12). State to apprise MoH&FW of action taken on the basis of the findings of the evaluation by September 2012. Monitor performance of UHCs/NGOs against targets. Staffing at UHCs to be linked to case load.

by September 2012. Monitor performance of UHCs/NGOs against targets. Staffing at UHCs to be linked to

TRIBAL RCH

Under Tribal RCH, AMCHI units have been setup under NRHM in District Hospitals, CHCs, PHCs of Leh and Kargil. AMCHI healers are to be engaged in these AMCHI units on contractual basis upto 31st March 2013.

Manpower for AMCHI Units Two AMCHI Healers per District Hospital One AMCHI Healer per CHC; and One AMCHI Healer per PHC

The medicines have been approved for these AMCHI units at the following rates:

S.No

Activity

Unit Cost

1

Procurement of medicines for AMCHI at District Hospital

1,00,000/-

2

Procurement of medicines for AMCHI at CHC

75,000/-

3

Procurement of medicines for AMCHI at PHC

25,000/-

ROAD MAP FOR PRIORITY ACTION UNDER TRIBAL HEALTH During the year 2012-13 Monitoring progress (physical and financial) on all health activities in notified tribal areas.

On a quarterly basis, a progress report, including constraints faced and action proposed to be sent to the State Health Society for onward transmission to MoHFW.

The State shall focus on health entitlements of vulnerable social groups like SCs, STs, OBCs, minorities, women, disabled, migrants etc

Establishing Control Room for Ambulances (Toll Free No. 102) The control rooms are being established in each of the District Hospital to regulate and use all ambulances optimally. A toll free number 102 will be obtained for these control

rooms. These control rooms shall be manned round the clock by operators who shall control and direct the flow of ambulances as per requirement. These are being established to ensure optimal delivery care to the patients/clients calling for help, i.e. stabilization before transport, emergency admission, preparation of the institution to receive a critical patient, etc.

Detailed guidelines for operationalizing these control room have been circulated to the Chief Medical Officers.

Blood Storage Centre (BSC) 26 Blood Storage Centres, the details of which mentioned in Annexure M , have been approved for the financial year 2012-2013 in the State. Some of these are already in the process of getting licensed and these BSCs need to be strengthened. List of equipments to be procured for such Blood Storage Centres is as follows:

S.No

Name of Equipment

Quantity required

1

Blood Bank Refrigerator having

capacity of 50 blood units

01

2

Air Conditioner

01

3

Autoclave

01

4

Binocular Microscope

01

5

Deep Freezer for freezing ice packs

01

6

Dry Incubator

01

7

Insulated Blood Bags Containers

01

8

Table Top Centrifuge

01

9

Micropippets of different capacities

One each

10

Consumables, reagents, disinfectants

As per workload

Special incentives to doctors With a view to ensure the availability of Doctors in remote areas of the State, the Government has approved special incentive of Rs.20,000.00, Rs 15,000 and Rs. 10,000.00 for Allopathic / ISM doctors hired under NRHM and serving in Category A , (inaccessible areas), Category B (very difficult areas) and Category C (difficult areas) respectively. List of health institutions falling in such areas is enclosed as Annexure N . The incentive is an additional lump sump allowance payable over and above the existing pay/salary structure to the Allopathic / ISM doctors working on contractual basis under NRHM.

In addition to this, the incentives shall also continued to be paid @ Rs.8000.00 and Rs. 4000.00 per month for MBBS / AYUSH Doctors serving in the areas notified under SRO

201 of 2006 in respect of Category A (Very difficult) and Category B (Difficult) respectively. The incentive is an additional lump sump allowance payable over and above the existing pay/salary structure to all categories of doctors irrespective of the fact whether they are appointed on regular basis or on adhoc basis or under SRO 255 on contractual basis or under NRHM on contractual basis. The incentive is payable after production of a certificate from CMO/ADMO concerned that his/her performance during the period of report has remained good and has done adequate work in terms of OPD,

conduct of deliveries (wherever

IPD, immunization antenatal, postnatal checkups applicable).

and

The incentives should be linked to the place of work and no transfer/shifting should be allowed from the place where the person is getting incentive.

Permissible Manpower

Sub-Centres During 2011-12, districts were allowed to hire one additional ANM on contractual basis in all the Sub-Centres which shall be continued in the year 2012-13 as well. The local residency of the ANM needs to be given priority while making recruitment.

MACs renamed as Sub Centres During 2011-12, districts were allowed to hire one Male Multipurpose Health Worker on contractual basis in all the MACs (renamed as Sub-Centres) which shall be continued in the year 2012-13 as well. The local residency of the MPHW needs to be given priority while making recruitment.

24X7 PHCs In addition to the required Manpower positioned in PHCs as per sanctioned strength, the additional manpower under NRHM is also being provided on contractual basis with the purpose to provide basic obstetric care round the clock in the PHCs designated as 24x7. The category wise maximum permissible limit under NRHM (including already engaged) is as follows:

ÿ One Medical Officer (MBBS)

ÿ Two Staff Nurses.

ÿ One Laboratory Technician.

At PHC level under NRHM

ÿ Each PHC has been provided with 1 AYUSH Doctor and 1 AYUSH Pharmacist (Dawasaaz) during the year 2011-12 which shall be continued in the year 2012-13 as

well.

ÿ One Additional MBBS doctor and one additional AYUSH doctor has been provided in PHCs notified as falling in remote areas as per SRO 201 of 2006 from the year 2009-10 which shall be continued in the year 2012-13 as well.

FRUs under NRHM In addition to the required Manpower positioned in FRUs as per sanctioned strength, the additional manpower under NRHM is being engaged in CHCs designated as FRUs with the objective to provide Basic and Emergency Obstetric Care round the clock.

The Category wise maximum permissible limit under NRHM (including already engaged) is as follows:

i. Two Medical Officers (MBBS)

ii. Two Staff Nurses

iii. Two O.T. Technicians

iv. Two X-ray Technicians

v. Two Laboratory Technicians

vi. Additional 8 Staff Nurses for CHC Kupwara, Magam, Bijbhera, Akhnoor, R S Pura and Ramgarh

Newly created District Hospitals The objective of providing manpower in newly created District Hospitals remains to provide the basic and emergency obstetric care round the clock. The Category wise

maximum permissible limit in each of the District Hospital of newly created districts under NRHM (including already engaged) is as follows:

i. Two MBBS doctors

ii. Ten Staff Nurses.

iii. Two O.T. Technicians

iv. Two X-ray Technicians

v. Two Lab. Technicians.

Old District Hospitals The objective of providing additional manpower in old District Hospitals remains to provide basic and emergency obstetric care round the clock.

i. Ten Staff Nurses in Old District Hospitals on contractual basis. ii. However, Govt Hospital, Sarwal, Jammu and G.B.Pant Hospital, Srinagar have also been provided Ten Staff Nurses each on contractual basis on the pattern of District Hospitals.

Strengthening of Institutional Mechanism

District Health Societies: 22 District Health Societies have been constituted for planning and implementing the health related initiatives in the respective districts.

Rogi Kalyan Samitis. 571 RKS have been constituted and registered at the level of District hospital/ CHC/PHC for community management of public hospitals. RKS at the level of new type PHCs are to be constituted on the pattern of PHCs. The District Health Societies shall initiate immediate action on constitution of the RKS for new type PHCs.

Sufficient budget is provided to the District Hospitals, CHCs, PHCs and Sub Centres as Corpus fund, Untied fund & Annual Maintenance Grant for improvement and maintenance of physical infrastructure and meeting the day-to-day needs of these institutions. This budget should be utilized after identifying the needs and approval of the RKS/VHSC. The institution wise details of the budget are as under:-

S.No.

Name of the Institution

Corpus Fund ( Rs. in Lacs)

Untied fund (Rs. in Lacs)

Annual * Maintenance Grant ( Rs. in Lacs)

1

District Hospital

5.00

Nil

Nil

2

Community Health Centres (CHCs)

1.00

0.50

1.00

3

Primary Health Centre (PHC)

1.00

0.25

0.50

4

New Type PHCs

1.00

0.25

0.50

5

Sub Centres (SC) including MACs which have been renamed as Sub Centres

Nil

0.10

0.10

*Annual Maintenance Grant is provided to the institutions located in Govt. building(s) only.

NOTE

ß The funds for New Type PHCs shall be utilized only after constitution of RKS.

ß Meetings of RKS should be held as per schedule envisaged in the guidelines. However, incase due to some exigency, the Hon ble MLA is not in a position to attend the meetings (s), the same may be held under the Chairmanship of any of the members present (preferably CMO/BMO as the case may be) on the schedule date.

ß It has further to be ensured that the requisite quorum for the meeting is present and that the minutes of the meeting are properly recorded and circulated among all members including concerned Hon ble MLA.

The guidelines with regard to spending of these grants are annexed as Annexure O

VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEES (VHSNCS) The Ministry of Health and Family Welfare, GoI vide their No. Z.18015/15/2011-NRHM-II dated 25-07-2011 has conveyed instructions to rename Village Health and Sanitation Committees as Village Health Sanitation and Nutrition Committees (VHSNCs). With a view to sensitize the PRIs about various schemes of NRHM, the State Health Society is providing diaries to Sarpanches. The diary also contains guidelines regarding constitution of Village Health Sanitation and Nutrition Committees and the norms for utilization of untied grants eligible for the committees.

1. During the current financial year, ASHAs shall be involved for facilitating meeting of Village Health Sanitation and Nutrition Committee in terms of GoI guidelines, as per the following conditions:

i) Making payment of an incentive @ Rs 150/- to each ASHA for facilitating the monthly meeting of VHSNC followed by the meeting of women and adolescent girls.

ii) Payment of the incentive should be made out of the untied grants given to each VHSNC under NRHM.

iii) ASHAs should coordinate for both VHSNC and monthly meeting of women and adolescent girls.

iv) The concerned ANM at Sub-Centre / PHC will certify the conduction of the meeting.

2. Further, the under mentioned guidelines should be followed for convening the meetings of VHSNC:-

i) The meeting of VHSNC should be followed by the meeting of Women and Adolescent girls where the issues pertaining to Nutrition, Reproduction & Child Health, Sanitation & Hygiene, Breast Feeding, Menstrual Hygiene, Age at Marriage, Contraception, Pre-School Education and Female Literacy etc. should be discussed.

ii) The meeting of VHSNCs should be convened every month in consultation with the members of VHSNC and President of Gram Panchayat.

iii) ASHAs should make all possible efforts for the sufficient publicity of the meeting so as to ensure wider participation of women and adolescent girls of the village.

iv)

The meeting should be fixed on the date other than that of Village Health & Nutrition Day (VHND).

FAMILY PLANNING

The State has achieved the target of reduction of Total Fertility Rate (TFR) to 2.0 (SRS 2010) against the target of TFR to 2.1by 2012. The State has to achieve the target of 1.8 by the end of 12 th Five year Plan.

Family Planning Programme is being strengthened by distribution of Condoms/ contraceptives through ASHAs at Village level at the door steps of needy clients. It will not only help in avoiding unwanted pregnancies but also protection against HIV/ AIDS and other Sexually transmitted diseases. The scheme is being implemented as pilot project in 4 districts of Jammu Division viz. Rajouri, Poonch, Udhampur & Doda.

The approved activities and the permissible amount are mentioned in the table:-

S No.

Activity

Target

Permissible Amount

1

World Population Day Celebration: (Such as mobility, IEC activities etc.): funds earmarked for District and block level activities

One per District

Rs 2,00,000 lakh/ district

2

Sterilization Camps

   

a) Male

One Per District

Rs. 35000 per camp

b) Female

One Per District

Rs. 15000 per camp

3

Package for Sterilization

   

a) Male

Targets being given separately in District PIP

Rs.1500 per case

b) Female

Rs. 1000 per case

4

Compensation for IUCD service

Targets being given separately in District PIP

Rs. 20 per case

The permissible budget for Male and Female Sterilization camps is given:

S.No.

Heads

Camp

Management

for

Camp

Management

for

Male Sterilization

Female Sterilization

1

Transport for service providers team per actual/entitlement

as

 

8000.00

 

8000.00

2

POL / Transport for acceptors

   

5000.00

 

5000.00

3

Contingency

   

2000.00

 

2000.00

4

IEC

(Newspaper,

Handbill,

Cable

T.V.

 

20000.00

 

Nil

Banners etc)

   

Total

35000.00

15000.00

However, while organizing such camps all efforts should be made to conduct around 100 cases in each of the camp.

The guidelines issued by Govt. of India for this component have already been provided to all the Districts.

Quality Assurance Committees (QAC) QACs for monitoring family planning activities have been constituted at the District Level. The quarterly meetings of these committees need to be organized for which Rs 5000.00 per quarter are being provided to each of the district. The Districts are required to submit the Minutes of these Meetings to the State Health Society on regular basis.

Block Level NRHM Sammelans During the current financial year, the block level NRHM Sammelans shall be organized in each of the block. These Sammelans aim at creating awareness among the PRIs, prominent citizens, NGOs, health functionaries viz CMOs, BMOs/MOs (Block PHCs) and mainly for the field functionaries like Field NGOs, FMPHWs, ASHAs and AWWs who are directly associated with the implementation of various schemes/ programmes under NRHM at the ground level. Rs. 20000/- has been approved for each Sammelan at Block Level.

Guidelines for organizing BLOCK Level NRHM Sammelans have been circulated to the districts.

Road Map for Priority Action on Family Planning during the year 2012-13 is enclosed as Annexure P

ADOLESCENT HEALTH

Adolescent Reproductive and Sexual Health (ARSH): - Ministry of Health and Family Welfare, Government of India has included Adolescent Reproductive and Sexual Health (ARSH) as a key technical strategy under the National RCH II programme. Mainly strategy focuses on reorganizing adolescent population that will yield dividends in terms of delaying age at marriage, reducing incidence of teenage pregnancy, prevention and management of obstetric complications including access to early and safe abortion services.

A core package of services that includes preventive, promotive, curative and counselling

services will be delivered during routine clinics at District level and further shall extend

to

sub-centre, PHCs and CHCs, and dedicated adolescent clinics on fixed days and time

as

well as through outreach activities.

ÿ

Adolescent Clinics: Adolescent Friendly Health Clinics (AFHCs) have been established across all the 22 districts of the state in addition to one clinic each in Govt. Medical College Jammu/ Kashmir at divisional level. In addition, 3 new Adolescent Clinics have been approved to be established one each in Govt. Hospital Sarwal, CHC Akhnoor and CHC Kupwara for which an amount of Rs.100000/- has been approved

ÿ

Manpower: In order to consolidate the role of AFHCs in providing youth friendly services to this high focused group, trained Lady Counselors and Data Entry Operators have been appointed in each Adolescent Clinic except 3 new clinics to be set up in the current financial year.

ÿ

Operating expenses: The existing 24 clinics and the 3 new CHCs approved during 2012-13 will continue to get a recurring amount of Rs. 20,000 per annum for each Adolescent Clinic as operating expenses for printing of the stationery/IEC material/Formats for the clinic @Rs 15000/- and Rs 5000/- as mobility support on account of holding outreach camps/meeting by the counselor in a year.

Menstrual Hygiene Programme: A new scheme for promotion of menstrual hygiene among adolescent girls (10-19) in rural areas has been launched under which the sanitary napkins shall be distributed among the school going and out of school adolescent girls.

ÿ Target districts:- The scheme has been launched on pilot basis in 10 Districts of J&K State where in total 7 districts, namely Rajouri, Poonch, Doda, Kishtwar, Ramban, Udhampur and Kathua are selected in Jammu Division and three districts namely Baramulla, Bandipora & Kupwara in Kashmir Division. Under the scheme, sanitary napkins are being procured by the Ministry of Health & Family Welfare, Govt. of India and supplied under the NRHM brand name Free days .

ÿ Operationalization:- In the State, the scheme shall be operationalized at two tier level through the wide network of the health care providers at Block/sub health centre level and ASHA as link worker between the service provider and the community at village level. The sanitary napkins shall be supplied directly to the block headquarters from the central supply and further be purchased by the ANM/LHV at Sub- Centre Level from the Block office and shall further be sold to the ASHA for future sale at village level to the adolescent girls falling under both APL/BPL categories.

The cost of the sanitary napkins has been fixed at Rs.5/- per pack containing six napkins (each pack) and shall be made available to the adolescent girls at the price of Rs. 6/- per pack. Initially, the ASHA will be given Imprest money of Rs. 300/- from the sub centre (untied fund) for purchase of sanitary napkin packs from the ANM at Rs. 5/- per pack and the ASHA will sell the pack to adolescent girl at Rs. 6/- regardless of APL/BPL status. The ASHA will be entitled to retain Re. 1/- as an incentive for sale of each pack of sanitary napkins and rest of Rs. 5/- will be used to purchase sanitary napkin packs for future sale. ASHA will receive one additional sanitary napkin free of cost from ANM each month for her personal usage apart from Re. 1/- as incentive.

Further, the storage of the sanitary napkins shall be made at PHC/SC level and in case if additional room for storage is required, it can be taken on rent out of untied funds. Also the revenue generated out of sale of the sanitary napkins shall be deposited by the ANM with the Block Medical Officer who shall further deposit the same into the District Health Society .The District Health Societies shall deposit these to the State Health Society for procurement of the napkins for further supply.

SABLA Programme: - SABLA is a new centrally sponsored, comprehensive scheme, called Rajiv Gandhi Scheme for Empowerment of Adolescent Girls or SABLA, merging the erstwhile Kishori Shakti Yojna (KSY) and Nutrition Programme for Adolescent Girls (NPAG) schemes to address the multi dimensional problems of Adolescent Girls (AGs).

ÿ Implementation: - In Jammu & Kashmir, Sabla is being implemented in 5 districts namely - Anantnag, Kupwara, Kathua, Jammu, Leh using the platform of ICDS.

Under the scheme, the following services are being provided in convergence with the Departments of Health and Family welfare, Social Welfare Department and State AIDS Control Society:

IFA supplementation, including supply of IFA tablets.

 

General health check-up, including recording of height, weight, BMI for all adolescent girls, by the Medical Officer/ANM.

Referral

to

specialized

healthcare

facilities,

as

required

for

conditions

like

malnutrition,

menstrual

problems,

frequent

headaches,

prolonged

acne,

worm

infestation, etc. Nutrition and Health Education.

 

Family welfare and ARSH services.

School Health Programme: - The School Health Programme shall focus on the health needs of the school going children so as to promote the preventive and rehabilitative health in the state of J&K.

ÿ Target Districts: - The School Health Programme shall be started initially on pilot basis in five SABLA districts in the State viz. Jammu, Kathua in Jammu Division and Anantnag, Kupwara and Leh in Kashmir Division.

ÿ Operationalization: - Under the programme, the School Health Committees shall be formed which shall be responsible for implementation and monitoring of the programme in all the Govt. and Govt.-Aided schools in the selected districts. The teams shall also conduct check-ups for children below 6 years at AWCs. The programme shall focus on three Ds- Deficiency, Disease and Disability. The referral of children shall be tied up and complete treatment at higher facilities shall be ensured. The nodal teachers from all the Govt. and Govt. aided schools shall be involved. School Health Cards shall be issued and height, weight measurement and BMI calculation shall be part of the School Health Card. In addition, under the school health programme apart from health needs of the school going children, the school health talks on prevention of diseases and promotion of health shall be given by the existing dedicated teams.

The School Health Programme shall be carried out by the Directorate of Health services Jammu/Kashmir and the Chief Medical officers of the respective Districts shall send a copy of the monthly compiled report to the Programme Manager in charge School Health Programme.

Weekly Iron and Folic Acid Supplementation for adolescents (WIFS) As adolescent anemia is a critical public health problem in the country, the Ministry of Health and Family Welfare, Government of India, based on the empirical evidence generated by these scientific studies, has developed programmatic guidelines for Weekly Iron and Folic Acid Supplementation (WIFS) of adolescent. This scheme is to reduce the prevalence and severity of anemia in adolescent population (10-19 years) and programme to be implemented for the following two target groups in both rural and urban areas:

A. Adolescent girls/boys who are school going and are in government/government aided schools from 6 th -12 th classes.

B. Adolescent Girls who are not in school or out of school.

The WIFS programme will also cover married non-pregnant adolescent girls in order to increase their pre-pregnancy iron stores and decrease prevalence of anemia among pregnant adolescent girls.

ÿ Target Districts: - The WIFS programme shall be started in the five Districts on pilot basis which are already selected under SABLA scheme namely Jammu, Kathua in Jammu Division and Anantnag, Kupwara and Leh in Kashmir Division.

ÿ Operationalization: - The implementation strategy of WIFS programme involves a fixed day approach i.e. Monday for WIFS distribution to ensure high compliance. The programme shall be implemented in both urban and rural areas. Under the programme, the school adolescent population, enrolled in 6 th to 12 th standard, in rural and urban regions will be reached. The programme shall encourage consumption of weekly IFA tablets and six monthly de-worming tablets through school and ICDS platform.

At district level, a monitoring committee comprising Health and Education departments will be formed to monitor the progress of the project and resolve programmatic issues. The meeting could be organized every six months with the participation of health and education block officials. Yearly meeting with nodal teachers could be organized to further streamline the project.

Road Map for Priority Action on Adolescent Centric Programmes is enclosed as Annexure Q

PC & PNDT AND GENDER MAINSTREAMING

MISSION:

The mission of PNDT programme is to improve the sex ratio at birth by regulating the pre-conception and prenatal diagnostic techniques misused for sex selection.

Regulatory Mechanism under

STATE LEVEL

PC&PNDT Act

v

State Supervisory Board under the Chairmanship of the Hon ble Health Minister, J&K and Co-Chairmanship of Hon ble Minister of State for Health

v

Mission Director NRHM appointed as State Nodal Officer PC&PNDT for coordination with the Ministry of Health and Family Welfare, GoI.

DIVISIONAL LEVEL

v

Divisional Advisory Committee under the Chairmanship of respective Divisional Commissioner.

v

Divisional Appropriate Authority ----- Director Health Services, Jammu/ Kashmir.

DISTRICT LEVEL

v

District Advisory Committee under the Chairmanship of concerned Deputy Commissioner.

v District Appropriate Authority ---- Concerned Chief Medical Officer.

DISTRICT ADVISORY COMMITTEE Reconstituted vide Government order No. 502-HME of 2011 dated: 20.09.2011

DISTRICT APPROPRIATE AUTHORITY CMOs have been designated as District Appropriate Authority vide Govt. Order No 609- HME of 2011 Dated: 22-11-2011

Composition of District Advisory Committee

ÿ District Development Commissioner / Dy. Commissioner

Chairman

ÿ Chief Medical Officer

Member Secretary

ÿ Medical Supdtt. District Hospital

Member

ÿ District Information Officer

Member

ÿ District Social Officer

Member

ÿ Senior Most Gynecologist of the District Hospital

Member

ÿ Senior Most Pediatrician of the District Hospital

Member

ÿ Leading advocate of the District to be nominated by Deputy Commissioner

Member

ÿ NGO to be nominated by Deputy Commissioner

Member

Deputy Commissioners concerned will co opt at least one people s representative as a special invitee in the District Advisory Committee

FUNCTIONS OF THE DIVISIONAL/DISTRICT ADVISORY COMMITTEES

ÿ To pay surprise visits or periodic visits to centres, Laboratories and clinics with a view to check compliance of the provision of Act and Rules.

ÿ To recommend to the appropriate authority cancellation or otherwise of registration of or prosecution against a centre laboratory or clinic.

ÿ To check and prevent contravention of provision of the Act or Rules in the area of its purview.

ÿ To advise appropriate authority about implementation of the Act and creation of public awareness on the issue of the sex selection;

ÿ To seize machine as may be found appropriate.

FUNCTIONS OF DIVISIONAL/DISTRICT APPROPRIATE AUTHORITY

¸ To grant, suspend or cancel registration of a Genetic counseling Centre, Genetic Laboratory or Genetic Clinics.

¸ To enforce standards prescribed for the Genetic Counseling Centre, Genetic

Laboratory or Genetic Clinics.

¸ To investigate complaints of breach of the provisions of this Act or the rules made there under and take immediate action.

¸ To seek and consider the advice of the Advisory Committee, constituted under sub section (5) on application for registration and on complaints for suspension or cancellation of registration

¸ To take appropriate legal action against the use of preconception sex selection techniques by any person at any place, brought to its attention or suo motto and also to initiate independent investigation in such matters.

¸ To create public awareness against the practice of preconception sex selection or prenatal determination of sex.

¸ To supervise the implementation of the provision of the Act and Rules; and

¸ To recommend to the State Supervisory Board modifications required in the Act or Rules in accordance with changes in technology or social conditions

¸ To recommended to the State Supervisory Board modifications required in the

Act or Rules in accordance with changes in technology or social conditions. Composition and functions of State/Divisional level committees are available on website

of pcpndt www.pcpndtjk.in

REWARD UNDER PC&PNDT A reward scheme has been introduced where under a reward of Rs. 50,000/- is being given to any person who gives information regarding the occurrence of sex-determination / female foeticide and Rs. 25,000/- is being given to any person who gives information about un-registered Ultrasound machine. Online filling of Form F on website of PC-PNDT www.pcpndtjk.

STRENGTHENING OF MONITORING MECHANISMS

ÿ Monitoring of sex ratio at birth through civil registration of birth data

ÿ Formulation of Inspection and Monitoring committees

ÿ Increasing the monitoring visits

ÿ Review and evaluation of registration records

ÿ Online availability of PNDT registration records

ÿ Online filling and medical audit of form Fs

ÿ Ensure regular reporting of sales of ultrasound machines from manufacturers

ÿ Enumeration of all Ultrasound machines and identification of un-registered ultrasound machine

ÿ Ensure compliance for maintenance of records mandatory under the Act

ÿ Ensure regular quarterly progress reports at state and district level

Road Map for Priority Action on PC & PNDT is enclosed as Annexure R

TRAININGS

The term training refers to the acquisition of knowledge, skills and competence as a result of the teaching of vocational or practical skills and knowledge that relate to specific useful competencies. The State of Jammu and Kashmir has resolved to go into the PIP for trainings in 2012-13 adhering to the dictum of the right person for the right training at the right place, so that trainings are effective and result-oriented.

Trainings /Workshops are an essential activity for updating the knowledge and skills of the workers of any organization. Upgradation of the skills of the health personnel has been taken up on priority basis under NRHM.

Aim of Trainings:

i)

Development of human resource potential in health care for optimum output.

 

ii)

Operationalization of health care institutions developed and strengthened as per the requirements of the State, with particular emphasis on maternal and child care units.

iii)

Up-gradation of current medical knowledge with evidence based inputs in alignment with current health care policies and requirements.

iv)

Creation of awareness among different stake-holders regarding issues of health and social well-being.

The

Mission

has

planned

training/workshops

during

2012-13

at

the

National/State/Divisional & District level in:-

ÿ Maternal Health.

ÿ Child Health.

ÿ Family Planning.

ÿ Immunization.

ÿ Adolescent Health.

ÿ Urban and Tribal RCH.

ÿ PC&PNDT

ÿ Quality Assurance.

ÿ Gender / Equity.

ÿ Intersectoral Convergence.

Trainings under the Maternal Health

Skilled Birth Attendance (SBA) Training: Any pregnancy can develop complications at any stage, so timely provision of obstetric care services is extremely important for management of such cases and as such, every pregnancy needs to be cared for by a

Skilled Birth Attendant (SBA) during pregnancy, childbirth and the post-partum period. GoI considers an SBA to be a person who can handle common obstetric and neonatal emergencies and is able to timely detect and recognize when a situation reaches a point beyond his/her capability, and refers the woman/newborn to an appropriate facility without delay. In order to strengthen the delivery points the Government of India has approved the budget for SBA trainings for ISM Doctors, Staff Nurses, ANMs//LHVs in SBA with the condition that State must ensure SBA training at delivery points first and then other facilities.

To ensure safe deliveries, SBA training is being imparted at district headquarters. Following categories of staff will be trained in each district:-

ÿ 4 ISM Doctors

ÿ 8 Staff Nurses

ÿ 8 ANMs/LHVs

Trainings under Child Health

IMNCI Training: Training in Integrated Management of Neonatal and Childhood Illnesses (IMNCI) includes both preventive and curative interventions that aim to improve practices in health facilities, the health system and at home. At the core of the strategy is integrated case management of the most common childhood problems with a focus on common causes of neonatal and child mortality.

The following categories of staff will be trained in each district during the current financial year from the designated delivery points and their retention at the facility must be ensured:-

ÿ ANMs/ MPWs/ LHVs -24 per batch (ten districts).

Trainings under Adolescent Health

1. ARSH Training for Medical Officers, ANMs/LHVs and AWWs.

2. Capacity building of school teachers (2 teachers from each school) from districts selected under SABLA Programme for School Health Programme.

Other Trainings

Trainings under Immunization

1.

Training of vaccine handlers in cold chain system.

2.

Cold chain handlers training for block level cold chain handlers by state and district cold chain officers.

Trainings under Family Planning

1.

NSV Training.

2.

IUD Insertion Training.

3.

Post-partum IUCD (PPIUCD) Training.

4.

Interval IUCD Training.

General Guidelines:

All trainings are aimed at making health care facilities operational. Certain guidelines must be followed while nominating candidates, conducting trainings and following up on their performance:

1. For all technical trainings such as EmOC, LSAS, Blood transfusion, nomination of medical officers should be sought from centres where facilities are available i.e. FRUs/CHCs but specialists are not present.

2. Medical officers from all 24x7 PHCs must be trained in BEmOC, MTP, Safe abortion and IUCD insertion and facilities for the same be provided to them. Paramedical staff at PHCs and SCs must be trained in IUCD insertion.

3. A participant should be nominated for one technical training only.

4. For non interventional trainings like ARSH, IMNCI, Gender equity, infection control, all categories of health care staff- Medical Officers at the divisional level, and paramedical staff (LHVs, ANMs/MPWs) at the district level should be trained.

5. All trainings must begin with a questionnaire for pre-evaluation survey of the existing knowledge of the participants followed by a post-evaluation survey to assess the efficiency of the training.

6. Only trained staff may be used as resource persons for the training.

7. For all trainings, the utilization of funds must be strictly in accordance with the budget guidelines approved by GoI.

8. All DDOs must ask for the attendance of the candidates for the period of training after the candidate rejoins his place of posting.

9. TA/ DA to all nominees is to be paid by the organizers of the training and should not be drawn from the place of posting unless specifically mentioned.

10. Feedback of each training should be sent to the headquarters within a fortnight of the completion of the training.

11. The trained manpower must be posted at suitable institutions in consonance with their expertise, and the necessary facilities be provided to them for the utilization of their services.

12. The performance of all medical and paramedical staff who have undergone technical trainings (SBA, EmOC, BEmOC, LSAS, MTP, MVA, IUD insertion, training in Blood transfusion) must be monitored on monthly basis.

PROGRAM MANAGEMENT UNITS

The management structure in the form of Programme Management Support Units at State, Division, District and Block Levels have been established as shown below:

At the State level, State Programme Management Support Unit has been established headed by the Mission Director and comprising of officers from Finance, Planning, State Programme Manager, Programme Officers of various programmes etc. The State Programme Unit provides technical support to the State Health Society/State Health Mission in formulation and implementation of the planned activities.

At the Divisional Level, the Divisional Programme Management Unit is headed by Divisional Nodal Officer and supported by Divisional Accounts Manager, Divisional Monitoring and Evaluation Officer and one Junior Assistant. One Law Officer has also been engaged on contractual basis in the Divisional Nodal office to assist the State Health Society on legal issues. The Divisional Programme Management Unit has to perform all activities in their respective Division pertaining to planning, monitoring and coordinating with Divisional level Directorates / Offices in achievement of the financial and Physical targets set up under NRHM.

At the District Level all the 22 Districts are manned with one District Programme Manager, One District Accounts Manager and One District Monitoring and Evaluation Officer. One Data Entry Operator has been placed in all the 22 District Hospitals and one Data Entry Operator for every Deputy CMO office of the district.

At the Block Level all the 116 Blocks are manned with one Block Monitoring & Evaluation Officer and one Block Accounts Manager at every Block.

Reporting system of Programme Management Units

The following monitoring system needs to be ensured:- Block Programme Management unit shall report to the BMO as well as to the District Programme Management Unit. District Programme Management Unit shall report to the CMO as well as to the Divisional Programme Management Unit. Divisional Programme Management Unit shall report to the Divisional Nodal Officer as well as to the State Programme Management Unit.

The State Programme Management Unit headed by the Mission Director NRHM shall provide feedback to the higher authorities both in the State / GoI.

Road Map for Programme Management during the year 2012-13 A full time Mission Director is a prerequisite. Stable tenure of the Mission Director should also be ensured. A regular full time Director/ Joint Director/ Deputy Director (Finance) (depending on resource envelope of State), from the State Finance Services not holding any additional charge outside the Health Department must be put in place, if not already done, considering the quantum of funds under NRHM and the need for financial discipline and diligence. Regular meetings of state and district health missions/ societies must take place. Key technical areas of RCH to have a dedicated / nodal person at state/ district levels; staff performance to be monitored against targets and staff sensitised across all areas of NRHM such that during field visits they do not limit themselves only to their area of functional expertise. Performance of staff to be monitored against benchmarks; qualifications, recruitment process and training requirements to be reviewed. Delegation of financial powers to district/ sub-district levels in line with guidelines should be implemented. Funds for implementation of programmes both at the State level and the district level must be released expeditiously and no delays should take place. Evidence based district plans prepared, appraised against pre determined criteria; district plans to be a live document. Variance analysis (physical and financial) reports prepared and discussed/action taken to correct variances. Supportive supervision system to be established with identification of nodal persons for districts; frequency of visits; checklists and action taken reports. Remote/ hard to reach/ high focus areas to be intensively monitored and supervised. An integrated plan and budget for providing mobility support to be prepared and submitted for review/approval; this should include allocation to State/ District and Block Levels.

HMIS / MCTS

HMIS and MCTS are two important online monitoring tools of NRHM.

HMIS portal provides all the information uploaded at the facility level thus providing information about the workload of different institutions and the delivery of services provided there.

MCTS is useful in tracking the mother and child for their due services. The basic aim of this system is to track and monitor delivery of services given to the mother and child, thus giving a clear picture of the gaps in the service delivery of Health system.

In order to provide guidance and monitor implementation of the MCTS at the District level District-e-Mission Team has been constituted vide Govt. order no. 640-HME of

2011 dated 12-12-2011. The Composition and role of District Project e-Mission team is given as under:

Composition of District Project e Mission Team District Magistrate/Deputy Commissioner Chairman Chief Medical Officer Member Secretary District Informatics Officer-NIC Member District Programme Manager (NRHM) Member

District Monitoring and Evaluation Officer (NRHM)

Member

Role of District Project e Mission Team

a. Overall Responsibility of Project Implementation in the District.

b. Close Monitoring of the project.

c. Coordination with the concerned agencies.

d. Communication and training.

Monitoring and Evaluation for HMIS and MCTS State has envisaged following monitoring protocols for Programme Management Units at different levels to ensure proper implementation of HMIS and MCTS data from different level:

ÿ Block Monitoring and Evaluation Officer shall visit every PHC / CHC and 1/3 rd of the Sub Centres once a month. He will submit his tour report to the Block Medical Officer and District Health Society.

ÿ District Monitoring and Evaluation Officer shall visit every Block Head Quarter, 50% of the PHCs and 25% of the Sub Centres once a month. He will submit his tour report to the Chief Medical Officer and respective Divisional Nodal Officers.

Plan for Use and Feedback of HMIS/MCTS Data by the Districts and Blocks CMOs and BMOs shall hold regular monthly meetings to review the progress with regard to uploading of data, registration, updation and authentication of data on HMIS/MCTS portals. The BMOs should share the findings of the observations with the ASHAs / ANMs and take corrective steps for rectifying the errors in the filling of formats by the ANMs. The BMOs shall also ensure that the work plans are generated on monthly basis and provided to ANMs for tracking the pregnant women / children for their due services.

The progress with regard to follow up by the ANMs as per the work plans shall be reviewed by the BMOs in every meeting.

At the District level, the Chief Medical Officers shall also review the progress of the uploading and updation of the MCTS data. This will help in improving the quality of HMIS / MCTS data.

Monitoring Mechanisms The State has put in place a proper mechanism to monitor and evaluate physical and financial progress of NRHM periodically. At the State level, the Programme is being reviewed on quarterly basis through meetings under the Chairpersonship of the Hon ble Chief Minister of J&K. Monthly review meetings are conducted in both the Divisions under the Chairpersonship of the Hon ble Health Minister. Regular meetings of Governing Body are being held to assess and review the performance of NRHM programmes. Regular meetings of Executive Committee are conducted by Commissioner Secretary Health and Medical Education. The progress is also being reviewed on monthly basis by the Mission Director NRHM. Similarly at the District level Deputy Commissioner (Chairman District Health Society) also reviews the functioning of NRHM.

MONITORING PROTOCOLS FOR FIELD LEVEL OFFICERS The following protocols for regular monitoring of field activities are being followed.

Monitoring by field level officers

ÿ Each PHC MO shall visit all Sub Centres in his/her jurisdiction at least once every month to review the functioning of SCs and guide ASHA and ANM on critical aspects of outreach etc. including filling up formats for HMIS / MCTS.

ÿ Each Block Medical Officer shall visit all PHCs and at least 50% SCs in his/her

jurisdiction at least once every quarter to review the functioning and guide the officials.

ÿ Each District CMO shall visit all CHCs, at least 50% of PHCs and at least 25% of SCs in his/her jurisdiction at least once every quarter.

ÿ All the visits should be documented in the inspection register to be maintained at level of the facility concerned. As per the above protocol, every SC would receive at least one visit of PHC MO every month, one visit of BMO once every six months and one visit of the CMO once every year. Similarly each PHC would receive at least one visit of the BMO every month and CMO once every six months. Similarly each CHC would receive at least one visit of the CMO every quarter. The members of RKS, civil society, VHSNCs may also accompany on these supervision visits. These visits should be followed up with a tour report which should be compiled at the District Health Society and discussed in the quarterly reviews at the state level by the Mission Director.

Monitoring by Programme Management Units

ÿ Block Monitoring and Evaluation Officer shall visit every PHC /CHC and 1/3 rd of the Sub centres once a month. He will submit his tour report to the Block Medical Officer and District Health Society.

ÿ District Monitoring and Evaluation Officer shall visit every Block Head Quarter once a month and ½ of the PHC and 1/4 th of the Sub centres once a month. He will submit his tour report to the Chief Medical Officer and respective Divisional Nodal Officer.

Monitoring by District Monitors engaged under NRHM State has hired 8 Monitors (4for each division) who monitor and evaluate the progress of NRHM programmes in the districts assigned to them. Each monitor has to visit the districts allotted to him on regular basis and has to monitor all the activities and evaluate the performance of each District and has to submit a report of their findings on prescribed format to the Mission Director NRHM, J&K. The findings of reports of Monitors are being shared with CMOs, Director Health Services and Administrative Department.

MONITORING PROTOCOLS for State Level Officers.

At the State level, the Programme Mangers are also monitoring the programme related activities.

At the Divisional level, the Divisional Nodal Officers are monitoring and supervising all the programmes of NRHM in the Division with the assistance of Divisional Level Monitoring and Evaluation Officer.

ROAD MAP FOR PRIORITY ACTION:

Data is uploaded, validated and committed; data for the month available by the 15th of the following month.

Uploading of facility wise data by the first quarter of 2012-13.

Facility based HMIS to be implemented. HMIS data to be analysed, discussed with concerned staff at state and district levels and necessary corrective action taken.

Programme managers at all levels use HMIS for monthly reviews.

MCTS to be made fully operational for regular and effective monitoring of service delivery including tracking and monitoring of severely anemic women, low birth weight babies and sick neonates.

Pace of registration under MCTS to be speeded up to capture 100% pregnant women and children

Service delivery data to be uploaded regularly work plans for service delivery be generated on regular basis and should be distributed to ANMs.

Progress to be monitored rigorously at all levels

MCTS call centre to be set up at the State level to check the veracity of data and service delivery.

IMMUNIZATION

Government of India has declared 2012-13 as Year of Intensification of Routine Immunization . The immunization coverage needs to be strengthened all over the State with a special focus on poor performing Districts. The level of fully immunized children by age of one year (CES 2009) is 66.60 %.

Full immunization gives a child one of the best chances for healthy and disease free life. In this connection we need to address the following issues on priority basis:-. The birth dose of immunization should be ensured for all newborns delivered in the institutions, before discharge. Daily Immunisation services should be available in PHCs, CHCs/ DHs.

To reach the inaccessible areas by holding special immunization camps, and tracing the dropouts and bringing them to the immunization session by utilizing services of ASHAs.

Generating demand through IEC Activities.

Holding of VHNDs regularly & supervisory monitoring by BMO/CMO.

Focusing upon Name based tracking of Children for immunization.

Following activities have been approved in the current year for immunization

strengthening.

i. Mobility Support for Supervision and Monitoring at district and State level:-

An amount of Rs. 2,50,000/- has been allotted to each district. The said amount should be

allotted for incurring expenditure on POL for the Supervision and Monitoring of immunization programme by the Dy. CMO and DIO. Districts need to provide a minimum of Rs 20,000 to each block for supervision of Immunization activity from Block and PHC. Detailed monthly tour diary should be sent.

ii. Focus on Slums & underserved areas in urban areas:-

The funds under this sub head are meant for hiring of an ANM for providing immunization in the identified slum areas of Jammu (city), Anantnag, Srinagar (city),

Baramulla, Leh & Budgam Districts. The ANM has to conduct four sessions of

immunization every month for twelve months. The hired ANM is to be paid Rs. 450.00 per session for four sessions per month per slum of ten thousand population and Rs 300.00 per month has been kept as contingency for hiring of room and furniture etc for the sessions.

iii. ASHA Incentives under Immunization:- ASHA incentive for full immunization per child upto 1 year age= Rs 100. ASHA incentive for full immunization per child upto 2 yrs age = Rs 50. (Provided all vaccines received between 1 st & 2 nd year of age after completing full immunization at 1 year of age).

iv. Support for Computer Assistant.

Services of the Computer Assistant engaged under immunization strengthening programme at the State/district level shall be continued based on performance of previous

year.

v. Quarterly Review meetings:-

A review meeting has to be held at the district HQs on quarterly basis where in steps to improve the immunization Programme can be discussed. The BMOs, the Dy CMO, DIOs and DMEIOs should attend such meetings. The CDPOs and one medical officer of the PHC on rotation basis have also to be called to attend these meetings. The amount has to be utilized for meeting expenses like light refreshment to the participants and other organizational expenses. It is advised to call 3-4 ANMs from each block by rotation to attend such meetings. Participation of ANMs of Sub Centre should also be made mandatory. The Refrigerator Mechanic should also be invited for attending such meetings. The dates for review meetings be intimated to the State Health Society well in advance so that some officer from this office shall be in a position to attend the meetings. Moreover minutes of the meetings should reach office of State Health Society, J&K on regular basis.

vi. Preparation of Microplan:-

Microplan for immunization has to be prepared right form Sub Centre level. The microplan, besides institutional immunization services should include the outreach and underserved areas where immunization services have to be provided. It should be ensured that neither any outreach area nor any underserved area is left in the microplan. The

expenditure to be incurred in preparing Block/PHC levels microplan is Rs.1000.00 each

and for sub-center Rs. 100 each. All ANMs, ASHAs and AWWs are to be involved in this activity.

vii. POL for vaccine delivery from State to District and from District to PHC/CHC

level:-

This amount is to be utilized for POL charges required for carriage of vaccine under proper cold chain system from State to District and from District to Block Head Quarters.

viii. Alternate vaccine Delivery to Session Site:-

This amount is to be incurred at the rate of Rs. 150.00 per session for delivery of vaccine at session site falling in most difficult and hilly terrains and Rs 75.00 per session for other

than difficult areas. Preparation of microplan is mandatory for this activity as stated above. District Health Societies shall identify the sub centres on this basis in their respective district

ix. Consumables for computer including provision for internet access for RIMs

Rs. 400 per month per district has been approved for this activity.

x. Procurement of Plastic bags for Biomedical Waste Disposal:-

Two bags per session of immunization for every sub-centre functioning in each district

have to be procured and issued to the Sub Centres at the earliest.

xi. Procurement of Bleach / Hypochlorite Solution for safe disposal of waste

(syringes & needles)/Twin buckets:- Bleach/hydrochloride solutions are to be procured for every PHC and CHC functioning in each district. Two buckets preferably are to be procured for use of immunization waste for each PHC and CHC (excluding CHCs functioning as District hospitals in newly created districts).

The procurement/purchases should be made after fulfilling all codal formalities and as per the rates approved by the Rate Contract Committee.

Road Map for Priority Action on Immunization is enclosed as Annexure S

FINANCIAL MANAGEMENT

1. Cash and Bank Books:- All entries must be completed in the Cash Book and Bank Book on daily basis duly signed by the concerned DDO s.

2.

Ledger:- According to the entries of cash & bank books, all entries must be posted in the Ledger.

3. Journal:- Journal Ledger should be complete in all respect. All opening entries must be made in the journal along with adjustment entries as per audit report and Accounts for all the advance adjustment vouchers submitted by the concerned parties.

4. Vouchers:- All vouchers should be serially numbered and filed and kept under safe custody.

5. Bank Reconciliation Statement:- Bank Reconciliation Statement must be prepared to reconcile the Bank Book figures with the Bank statement and all un-reconciled bank entries must be identified and proper entries passed in the books of accounts. Stale cheques should also be identified and reverse entries made in the books of accounts.

6. Preparation of Trial Balance:- It is very important that trial balance to reconcile the ledger balances prepared at State/ District / Block levels. All the opening balances as per Audit Report may also be accounted for in the current financial year s Trial Balance. It must be ensured that Trial Balance of the current year is prepared at these levels.

7. Preparation of Receipts and Payment Account, Income and Expenditure Account at each level:- On the basis of final Trial Balance, it is necessary to prepare the final accounts at each level (State/Districts/Blocks) at the close of financial year.

8. Preparation of Action Taken Report (ATR):- Action taken points of Audit Report for the previous years should be discussed in the SHS/DHS meetings and the concerned State/District/ Blocks should prepare the Action Taken Report as per Auditor's and MoH&FW observations. A copy of the Compliance Report must be sent to State Health Society for onwards transmission to Ministry at the earliest.

9. Records Keeping:- All accounts records of NRHM must be kept under lock and key with specific responsibility assigned to concerned official/officers for their proper maintenance at all the levels. All vouchers relating to accounts transactions must be kept year wise in box files or duly bound files after audit. Records, mainly cash book, petty cash book, ledgers and paid vouchers, deposit receipts etc at district/Block level may be kept properly and safely under the custody of the District Chief Medical Officer/Block Medical Officer or by an authorized officer.

10. Reminders for Advance Adjustment:- Age wise analysis of advance must be conducted at all levels and reminders for settlement of advance and refund of unspent balance must be sent to all concerned on a quarterly basis and pursued vigorously.

11. Audit Reports: Audit reports of all previous years must be kept at State and District levels, preferably with soft copies as per retention schedule of the State Govt. The

previous audit reports must be scanned and also kept in computers. Action taken points of audit of previous years should be finalized. District Health Societies shall also ensure to undertake monthly District Audit and periodic assessment of the financial system in the subordinate offices.

12. Upkeep of Cheque Books and Cheque Registers:- All cheque books issued by the bank must be entered in a register and kept under safe custody of the concerned officer alongwith unused / cancelled cheques.

13. Cash verification certificate:- Cash verification certificate must be obtained from the concurrent auditor at the end of each month and verified in the presence of Programme officer of the concerned program.

14. Physical verification of Fixed Assets:- All the fixed assets must be physically verified by the designated committee and a physical verification certificate must be kept safely for verification.

15. Stock Registers:- Store keeper of concerned program should maintain/complete the stock registers upto date.

16. Important Agreements/MOUs:- All the important agreements such as EMRI agreement, Rent Agreement, Contractor Agreement, Security Agreement and MOUs duly registered must be kept in safe custody.

17. Income Tax Return:- All the TDS deducted by the District Health Societies must be deposited in time in the bank and quarterly Income tax Return must be filed through NSDL agencies.

18. Concurrent Audit:- The District Health Societies should complete and finalize their concurrent Audit with reports on monthly basis and action taken thereon.

19. Transfer of Funds/ Monitoring of Bank Balance: Regular monitoring of Bank Balances may be ensured for timely and adequate transfer of funds through e-transfer/ Demand Drafts from State to District and District to Block levels in time to ensure the achievement of stipulated targets. Closing bank balance certificate/ bank statement at the end of financial year must be obtained from the Branch Manager of concerned banks.

20. FMR/Statement of Funds Position:- FMR must include all the expenditure of the SHS/DHS and statement of funds position should also show same expenditure as mentioned in the FMR. These statements should be sent in a complete form to the State Health Society by the 5th of every month.

21. Uploading of FMR on HMIS web portal: Every District must ensure that quarterly FMRs are uploaded on HMIS web portal on a regular basis.

22. Committed and Uncommitted Unspent Balance:- District should also calculate the Committed and Uncommitted Unspent Balance at the end of every financial year under each component. 23. The District Health Societies shall not make any change in allocation among different components/ activities without approval of State Health Society. 24. The accounts of the State Health Societies/District Health Societies/ Implementing agencies grantee institution/ organization shall be open to inspection by the sanctioning authority and Audit by the Comptroller and Auditor General of India under the provisions of CAG(DPC) Act 1971, Internal Audit by Financial Management Group of State Health Society/Principal Accounts Office of the Ministry of Health & Family Welfare.

Road Map for Priority Action on Financial Management is enclosed as Annexure T

ANNEXURES

Annexure A

MONTHLY PROGRESS REPORT FOR THE Month

District

2012-13

OF THE FINANCIAL YEAR

S.No.

(A) Cummulative Achievements on Key Startegies As on Date

1

No. of District Health Societies Constituted

 

2

No. of Rogi Kalyan Samities (RKS) Registered for

 

I

District Hospital

 

ii

CHCs

 

iii

PHCs

 

iv

ADs

 

v

Any other Hospital(Mention name)

 

3

No. of Village Health Sanitation & Nutrition Committees Constituted

 

4

No. of VHSNCs for which accounts opened

 

5

No. of CHCs upgraded as FRUs (Give names on separate sheet)

 
 

No. of PHCs made Operationalized as

 

6

24x7 PHCs(Give names on separate sheet)

7

No. of ASHAs engaged

 

8

No. of ASHAs trained in Module I

 

9

No. of ASHAs trained in Module II-IV

 

10

No. of ASHAs trained in Module V

 

11

SNCUs established

 

12

No. of Stablization Units established (Give names on separate sheet)

 
 

No. of Baby Care Corners

 

13

Established(Give names on separate sheet)

 

No. of

 

14

Specialists/Doctors/Paramedics engaged

15

No. of Ambulances provided from

 

i

Regular side

 

ii

NRHM

 

16

No. of ARSH Clinics Setup

 

(B)Activity-wise Achievements during the year 2012-13

 
         

Ach.

 

S.NO

NAME OF THE ACTIVITY

Ach.

During

2011-12

Target

2012-

13

Cummulative

Ach. Ending

previous

month

During

the

reporting

month

Total

 

JSY

         

1

Total Deliveries (Home+ Institutional)

         

2

Total Institutional deliveries

         

3

Institutional deliveries escorted by ASHAs

         

4

Mother beneficiaries given incentive under JSY

         

a

Home Deleveries

         

i

Rural

         

ii

Urban

         
 

Total (a)

         

b

Institutional Deleveries

         

i

Rural

         

ii

Urban

         
 

Total (b)

         
 

Total (a+b)

         

No. of ASHAs given incentive under JSY

 

i

High focus Districts

         

ii

Non High focus Districts

         

Maternal Health

 

1

No. of Maternal Deaths reported in the District