STATE REPORT

HARYANA

Haryana Index

S. No. 1 2 3 4 5 6 7 8 9 10 11 12 Summary of Approvals Demographic Profile Progress of NRHM Reproductive & Child Health Immunization

Content

Page No. 25 67 8 11 12 15 16 16 17 20 21 22 23 23 24 24 25 25 26 26 27 29

Revised National Tuberculosis Control Programme (RNTCP) National Vector Borne Disease Control Programme (NVBDCP) National Leprosy Eradication Programme (NLEP) Integrated Disease Surveillance Project (IDSP) National Programme for Control of Blindness (NPCB) National Iodine Deficiency Disorder Control Programme (NIDDCP) RoP Approvals under Mission Flexible Pool

Haryana

HARYANA Summary of Approvals Financial Management under NRHM (Rs. in crore) % Release Allocation Release Expenditure against Allocation 69.33 85.14 53.88 122.80 117.69 134.69 90.66 114.44 137.59 131.79 105.83 95.78 151.84 186.08 105.59 122.55 149.69 0.00 626.14 537.69 355.95 85.87 Timeline Activities Selection ASHA Training VHSC 24X7 PHCs Mobile Medical Unit Rogi Kalyan Samiti Achievement 13152 5000 6282 160 6 2938

Years 2005-06 2006-07 2007-08 2008-09 2009-10 Total S. No. 1 2 3 4 5

% Expenditure against Release 63.29 67.31 80.30 56.74 66.20 % 88 90 39 29 554

Budget Allocations (2005-09) ( Amount in Crores) Allocation Releases RCH Flexipool 2005-06 25.31 11.43 2006-07 33.99 30.13 2007-08 26.11 27.75 2008-09 41.92 49.16 2009-10 42.71 Total (A) 170.04 118.47 NRHM Flexipool 2005-06 23.50 2006-07 28.75 34.32 2007-08 50.25 46.51 2008-09 36.52 42.39 2009-10 37.69 Total (B) 153.21 146.72 National Disease Control Programme 2005-06 8.26 6.19 2006-07 9.12 7.74 2007-08 9.69 5.44 2008-09 15.24 8.99 2009-10 13.12 0.40 Total (C) 55.43 28.76 Grand Total (A + B + C) 378.68 293.95

Expenditure 8.34 20.94 21.95 13.77 65.00 1.12 2.10 31.83 21.94 56.99 4.27 11.14 8.32 2.98 0.00 26.71 148.7

Haryana

Record of Proceedings (2005-2009) for Mission Flexible Pool

Approval for Infrastructure (Rs. in Crore) S. No 1 2 3 4 5 6 7 Health Facilities Sub C PHC CHC DH Equipment Transport Others Total 2005-06 2.43 11.60 2.40 2006-07 2007-08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2008-09 0.00 0.00 0.00 66.00 0.00 5.95 71.95 200910 0.00 1.53 0.67 66.00 0.00 6.27 0.78 75.25

6.96 14.03 9.36

Approval for Human Resource Support (Rs. In Lakh) S. No 1 2 3 4 5 Personnel Doctors Specialists Staff Nurses ANM Others Total 0.00 0.00 2005-06 2006-07 2007-08 0.00 0.00 0.00 0.00 0.00 0.00 2008-09 0.00 0.00 0.00 14.00 0.00 14.00 200910 2.27 0.00 15.49 23.96 8.41 50.13

S.No

Approval of other activities (2005-2009) in Rs. Lakh 2005-06 2006-07 2007-08 2008-09 Initiative Released Approved Approved Approved ASHA

2009-10 Approved

Re ma rks

ASHA

888.5

2 3

TOTAL 888.5 Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters Rogi Kalyan Samiti 590 Rogi Kalyan Samiti HQ Hospital Rogi Kalyan Samiti CHC/ Sub Divisional Hospital Rogi Kalyan Samiti-PHC Untied funds to CHC Untied Fund for PHC 102 315.75 105

4 5 6 7

116 336 142

Haryana

8 9 10 11 12

Untied Fund for SC Untied Fund for VHSC Annual Maintenance Grants CHC Annual Maintenance Grant -PHC Annual Maintenance Grant- SC TOTAL Emergency & Referral Services MMU TOTAL

243

46.3

246.5 671.25

246.5 628.2

204

274.5 246.5

243 942.3 Infrastructure related matters

1233.5

2094.7

13 14

544.66 695.6 695.6 544.66

580 47.34 627.34

Status of Infrastructure 2005-2010 Health Facilities Number of Sub Centre Number of PHC Number of CHC Number of DH As per RHS 2008 2433 420 86 21 As per State Data Sheet, NRHM New Construction 269 63 10 6 Upgradation / Renovation 63 23 11 8

Status of NRHM as on 15.05.2009 1 2 3 4 5 ASHA VHSC Joint A/C 24X7 Facility FRU Doctors & Specialist AYUSH Doctors Staff Nurse Contractual Manpower Paramedics ANM JSY Beneficiaries (in Lakhs) Selection Training 13152 5000 5331 5287 207 67 26 179 260 2174 0.92

Haryana

National Disease Control Programme NLEP The state has already achieved the goal of elimination of leprosy. The state is advised to carry out in depth situational analysis in districts/blocks reporting large number of new cases and take suitable actions. IDSP It is a Phase II state. The recruitment of key human resources needs to be fast tracked and completed in a time bound manner. The data reporting should start from all the districts. NBCP UCs for GIA released to State Blindness Control Society not being received timely. SOE for Cash Grant are also not being received timely. Performance of School Eye Screening Programme needs to be improved. NVBDCP Malaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs to identify the areas for focused interventions. Capacity building for case management and strengthening of health facilities need to be taken on priority basis for diagnosis and case management. Filaria and Kala-azar, are not reported from the state of Haryana. RNTCP Overall performance of the State is not good. Total Case Detection and cure rate need to be improved. This appears to be due to gaps in key HR (STO, DTO and other levels), weak supply chain management and supervision.

Haryana

Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF HARYANA The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 55 and Maternal Mortality Ratio is 186 (SRS 2004 - 06) which are lower than the National average. The Sex Ratio in the State is 861 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: Table I: Demographic, Socio-economic and Health profile of Haryana State as compared to India figures S. No. 1 2 3 4 5 6 7 8 9 10 11 12 Item Total population (Census 2001) (in million) Decadal Growth (Census 2001) (%) Crude Birth Rate (SRS 2007) Crude Death Rate (SRS 2007) Total Fertility Rate (SRS 2007) Infant Mortality Rate (SRS 2007) Maternal Mortality Ratio (SRS 2004 - 2006) Sex Ratio (Census 2001) Population below Poverty line (%) Schedule Caste population (in million) Schedule Tribe population (in million) Female Literacy Rate (Census 2001) (%) Haryana 21.14 28.43 23.4 6.6 2.6 55 186 861 8.74 4.09 0 55.7 India 1028.61 21.54 23.1 7.4 2.7 55 254 933 26.10 166.64 84.33 53.7

Table II: Health Infrastructure of Haryana Particulars Required In position Sub-centre 3005 2433 Primary Health Centre 500 420 Community Health Centre 125 86 Multipurpose worker (Female)/ANM at Sub 2853 2592 Centres & PHCs Health Worker (Male) MPW(M) at Sub Centres 2433 2031 Health Assistant (Female)/LHV at PHCs 420 285 Health Assistant (Male) at PHCs 420 106 Doctor at PHCs 420 350 Obstetricians & Gynaecologists at CHCs 86 8 Physicians at CHCs 86 9 Paediatricians at CHCs 86 18 Total specialists at CHCs 344 45 Radiographers 86 63 Pharmacist 506 372 Laboratory Technicians 506 388 Nurse/Midwife 1022 411 (Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI) 6 Shortfall 572 80 39 261 402 135 314 70 78 77 68 299 23 134 118 611

Haryana

The other Health Institution in the State are detailed as under: Health Institution Medical College District Hospitals Referral Hospitals City Family Welfare Centre Rural Dispensaries Ayurvedic Hospitals Ayurvedic Dispensaries Unani Hospitals Unani Dispensaries Homeopathic Hospitals Homeopathic Dispensary Number 3 21

8 472 1 19 1 20

Haryana

Note on Progress of NRHM in Haryana (June 2009) National Rural Health Mission has been launched with a view to bring about improvement in health system and health status of people, especially those who live in rural areas of the country. The State of Haryana is steadily progressing towards attaining the goals and objectives shared under National Rural Health Mission (NRHM), National Population Policy (NPP) and Millennium Development Goals (MDG). The activities under National Rural Health Mission are transforming the health care delivery to rural populace with increasing accessibility to quality services and the opportunity to participate actively in managing these services as well. The state has increased coverage under JSY; improvement in infrastructure; availability of paramedical and medical personnel. Brief information on the progress is as follows: Institutional Framework of NRHM Meeting of State & District Health Mission have been held regularly. Meeting of State Health Mission held 8 times and of District Health Mission held 210 times. Merger of societies is completed in 21 districts. 6282 VHSCs have been constituted & 6282 joint accounts have been operationalised at sub centre level. Rogi Kalyan Samities are operational at 21 DH, 91 CHCs & 336 PHCs. 9 districts have started developing their own IDHAP. Infrastructure Improvements A total of 160 PHC have been strengthened with three Staff Nurses each to make them functional for 24x7 work. About, 40 CHC are functioning on 24X7 basis & facility survey is completed in 40 (including others health institution below district level). A total of 25 SDH, 40 CHC and others below district level and 21 District Hospitals are functioning as FRUs. 6 districts have functional Mobile Medical Unit (MMU) to provide services to remote areas. Human Resources A total of 13,152 ASHAs have been selected & 5000 are trained in 1st Module. ASHAs need to be provided the drug kits. About 1675 Sub-centers are functional with an ANM and 2212 SCs are strengthened with 2nd ANM. The contractual appointment of AYUSH Doctors is not done. As far as manpower augmentation is concerned, 26 specialists, 415 SN, 2174 ANMs have been recruited on contractual basis to meet the demand for the health services. Services Institutional deliveries have improved from 2.16 lakhs (2006-07) to 2.75 lakhs (2007-08). During the year 2008-09 there were 3.18 lakhs Institutional deliveries in the state. JSY beneficiaries have increased from 0.23 lakhs (2006-07) to 0.57 lakhs (2007-08). The number of JSY beneficiaries was 0.48 lakh during the year 2008-09. Female sterilisation has increased from 0.55 lakh (2006-07) to 0.71 lakh (2007-08) and male sterlisation has increased from 9744 (2006-07) to 9752 (2007-08). During 2008-09- 77,409 female & 10030 male sterilisation have been reported. A total of 19 districts are implementing IMNCI & 3486 people are trained so far. About, 98169 VHND held since the launch of NRHM. First Phase of Community Monitoring has been operationalised in the state.

Haryana

General Overall improvement in health system since NRHM Achievements Made VHSC are formed in 6282 village Panchayats in Haryana Dental Surgeons with dental equipments and Dental Units are available in - all Districts Hospitals/Sub Dist Hospitals, CHCs and PHCs. ASHAs have been selected. Special Incentives for Doctors working in difficult/Rural Areas (Mewat). Availability of quality drugs. Untied Funds, Annual Maintenance Grants, Rogi Kalyan Samitis (RKS) funds being utilized. There are different schemes to increase institutional deliveries. Voucher Scheme for Promotion of Institutional Deliveries in Urban Slums

Areas for Further Improvement The State need to strengthen the existing referral transport system in the State. Strengthening of Financial Management Systems and improving capacities of functionaries is required. RKSs are operational at most places and their capacity to use funds should be improved. SPMU and DPMUs are formed and BPMU is in progress which needs to be strengthened. Streamline system for Inventory Management Mewat needs special focus as a high priority district for all RCH indicators.

Infrastructure Facility survey is under process to identify the gaps in the infrastructure, manpower and services. Satisfactory progress in infrastructure development. Well managed physical infrastructure which includes cleanliness, availability of water and drainage system and other basic facilities

Human Resources Haryana has separate directorate for Ayurved which looks after all the AYUSH components in the state. There are manpower mismatches in the State. State needs to focus on multi-skilling of doctors for anesthesia and obstetrics. State need to strengthen SPMU and DPMUs. The State needs to strengthen the 24x7 PHCs with 3 staff nurses. Service Delivery The state government has initiated Janani Suvidha Yojana,Jaccha Baccha and Delivery Hut Scheme to increase institutional deliveries and reduce maternal and infant mortality. There is an urgent need to strengthen the referral transport system in the State. State had established Trauma Centres at Karnal, Ambala and Sirsa, Rewari and Trauma Centres at Bahadurgarh, Palwal, Gurgaon from State Budget along with equipments and manpower Poor convergence and support at the lower levels of the systems.

Haryana

An Analysis of Financial Monitoring Report for the FY 2008-09 A. RCH Flexible Pool Component wise expenditure & Utilization under RCH against the approved PIP Haryana A.1 A.2 A.3 Rs. in lakhs % Utilization against PIP 40.71% 11.31% 68.75%

Activities SPIP Expenditure Maternal Health 816.42 332.38 Child Health 59.92 6.77 Family Planning Services 982.66 675.58 Adolescent Reproductive and A.4 Sexual Health/Arsh 91.15 7.88 8.64% A.5 Urban RCH 261.34 47.01 17.99% A.7 Vulnerable Groups 20.00 0.00 0% A.8 Innovations/PPP/ NGO 503.37 88.58 17.60% Infrastructure & Human A.9 Resources 1110.01 482.37 43.46% A.10 Institutional Strengthening 269.70 316.57 117.38% A.11 Training 444.37 210.90 47.46% A.12 BCC / IEC 95.34 88.49 92.82% A.13 Procurement 872.60 801.39 91.84% A.14 Programme Management 243.66 155.95 64.00% 5770.54 3213.86 55.69% Total Based on table above and records available in FMG, the observations and areas of concern are as under:General Observations: 1. Only, Rs.32.13 crore i.e. 56% of the approved PIP of Rs.57.71 crore has been utilized under RCH-II as compared to national level expenditure of 71%. 2. There is 53% increase in expenditure as compared to 2007-08. 3. Since the launch of RCH-II, Rs. 82.24 crores, i.e. 69% has been utilized by the state against the release of Rs. 118.46 crores during the period 2005-06 to 2008-09. 4. Remarkable expenditure of 117.38% has been noticed under Institutional Strengthening. 5. More than 90% expenditure in BCC/IEC, Procurement is quite appreciable. Areas of Concern: 1. Nil expenditure is reported under Vulnerable Groups. 2. FMR was not sent on prescribed format. 3. Expenditure reported under the head Child Health is less than 12% of the amount approved in PIP, Rs.59.92 lakhs. 4. Expenditure reported under the head Adolescent Reproductive and Sexual Health / ARSH is less than 10% of Rs.91.15 lakhs the amount approved in PIP.

10

Haryana

B.

Mission Flexible Pool:Component-wise expenditure under NRHM against approved PIP

Haryana B1 B2 B3 B4 B5 B6 B7 B10 B11 B12 B14 B16 B19 B22 B25 Activities ASHA Untied Funds Hospital Strengthening Annual Maintenance Grants New Constructions/ Renovation and Setting up Corpus Grants to HMS/RKS District Action Plans (Including Block, Village) IEC-BCC NRHM Mobile Medical Units (Including recurring expenditures) Referral Transport Additional Contractual Staff (Selection, Training, Remuneration) Training Procurements New Initiatives/ Strategic Interventions (As per State health policy) State level health resources center(SHSRC) Total SPIP Expenditure 0.00 22.36 1233.50 944.93 6600.00 8984.33 0.00 246.94 0.00 11.88 0.00 284.92 0.00 0.00 0.00 544.66 1400.00 25.72 0.00 285.72 0.00 5.31 12.63 2.83 4.82 2023.78 0.00 278.08 0.00 15.37

Rs. In Lakhs % Utilization against PIP Error 76.61% 136.13% Error Error Error Error Error Error 0.89% 144.56% 0% Error 0% Error

10089.60 12838.18 127.24% Based on table above and records available in FMG, the observations and areas of concern are as under:General Observations: 1. As compared to 2007-08, 651% increase has been noticed in expenditure during 2008-09, but the expenditure in 2007-08 was as low as Rs.17.10 Crores against the releases of 46.51 Crores. 2. Since the launch of the programme, Rs.146.72 Crores were released to the state and utilisation is appreciable Rs.148.83 Crores (101%). Areas of Concern: The expenditure under ASHA, Annual Maintenance Grants, New Construction, Corpus Grants to HMS/RKS, Distrct Action Plans, IEC-BCC NRHM, MMU, Procurements and SHSRC to be looked into as no provision made in PIP. Out of Rs.100.89 crores approved by the NPCC and Rs. 42.39 crores released, the state has utilised Rs.128.38 crores i.e. 127.24% of approved PIP, while the national average of expenditure is 68.14%.The reason of excess expenditure booked is that the state has booked previous year expenditure during 2008-09. 3. More than 100% expenditure has been incurred under Hospital Strengthening, Additional Contractual Staff (Selection, Training and Remuneration).

11

Haryana

BRIEFING NOTE ON RCH II: HARYANA A. 1. Background/ current status RCH II Goals

Haryanas MMR has increased from 162 in SRS 01-03 to 186 in SRS 04-06. The IMR (SRS 2007) at 55 has reduced from 59 (SRS 2003), is the same as the national average. TFR at 2.6 (SRS 2007) is only marginally lower than the national average of 2.7 (refer Annex 1). 2. RCH II Outcomes

Haryanas progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) is mixed (refer Annex 1): Mothers having full ANCs has increased from 10.3% to 13.3%. Institutional deliveries have increased from 35.7% to 46.9%. Full immunisation in children 12-23 months has increased marginally from 59.1% to 59.6%. Children with diarrhoea receiving ORS has decreased from 32.3% to 31.7%. Unmet need for family planning has increased from 14.7% to 16.0%. Further, use of modern contraceptives has increased marginally from 54.3% to 54.5%. 3. Expenditure

Audited expenditure has increased from Rs. 8.34 crores in 05-06 to Rs. 20.71 crores in 06-07 and then decreased to Rs. 18.82 crores in 07-08; reported expenditure in 08-09 is Rs. 32.14 crores i.e. 55.7% of allocation (Rs. 57.70 crores). JSY accounted for 9.8% of the reported expenditure in 08-09. B. Key achievements 1. Maternal Health, including JSY Number of JSY beneficiaries in the state increased from 0.23 lakh in 06-07 to 0.35 lakh in 0708 to 0.48 lakh in 08-09. State has accredited 276 private institutions under the scheme. State has operationalised 160 PHCs as 24x7 so far against the target of 204 PHCs by 2010. 32 MBBS doctors have been trained in Life saving anaesthesia skills (LSAS) and 49 in comprehensive Emergency Obstetric Care (EmOC) so far against the target of 59. 279 Staff Nurses and 527 ANMs/LHVs have been trained in SBA as against a target of 1167. The state has taken several steps to promote safe motherhood and institutional deliveries, and they include: Delivery Huts with improved access to safe delivery in rural areas. They provide safe delivery services with privacy, clean & hygienic environment locally in health facilities nearest to community at village level and have strong referral linkages with higher institutions. There are 564 functional delivery huts operational in 21 districts in the state. Janani Suvidha Yojana a voucher scheme for women in urban slums to increase access to available private infrastructure by involving existing private healthcare providers and is operational in 8 districts in the state; and Vikalp a state scheme for BPL women to access MCH through private providers. Jaccha Baccha scheme which incentivises SBAs performance for institutional deliveries and covers ante natal, neo natal, and post natal care, emphasizes gender equity, ensures monitoring and audit by community. 2. Child Health IMNCI is ongoing in 19 (out of 21) districts of the state. 3,486 personnel have been trained in IMNCI so far. Breastfeeding promoted by establishing counseling centres in each district hospital

12

Haryana

3. Other initiatives Referral Transport strengthened by outsourcing to Red Cross Society in five Districts. Vehicles of Health Department and Red Cross pooled together and fitted with GPS. Control Room established with hotline no. 102. Free ambulance services for all delivery cases, BPL & Road side accidents. One ambulance to be provided per lac population. 6,200 registered societies consisting of educated women called SMS (Sakshar Mahila Samooh) have been engaged for intensive BCC. C. Key issues 1. Maternal Health Haryana along with Punjab, are the only two states which have shown an increase in MMR. While monthly NRHM report submitted by the state reports 86 FRUs (including 21 DH, 25 SDH & 40 CHCs) as functional, there are 46 FRUs that fulfil all the 3 critical criteria of functionality (as reported during a recent review) as against the target of 59. State needs to ensure that multiskilled MOs are placed at designated FRUs, since in a recent review the state mentioned that EmOC and LSAS trained doctors were posted at PHCs, as were MOs trained in blood storage. DLHS-3 facility surveys highlighted the following key gaps: only 32.2% and 45.8% of the 24-hour PHCs provide newborn care and referral services respectively; and 21.4% of the CHCs designated as FRUs provide C-section. Drop out between 1st trimester ANC and full ANC has increased from 3.4% points to 42.4% points (between DLHS-2 and DLHS-3). This is a serious concern, and state needs to ensure tracking of ANC dropouts during VHNDs. 2. Child Health Reduction in IMR is slow; 1 point per year between SRS 2003 and SRS 2007. Neonatal mortality rate (NMR infant deaths within 4 weeks of life per 1000 live births) at 34 (SRS 2007) accounts for 61.8% of the IMR, while early NMR (infant deaths within one week of life per 1000 live births) at 23 (SRS 2007) accounts for 67.6% of the NMR. Recent results from DLHS-3 show low progress or decline in the outcome indicators: full immunisation in children 12-23 months (59.1% to 63.6%) and a decrease in coverage of DPT and OPV; initiation of breastfeeding within one hour of birth has remained static at 17.4% & and a sharp decline in exclusive breastfeeding for 6 months from 33% to 5.3% (DLHS 2-3) and a decline in ORS use in children with diarrhoea (32.3% to 31.7%).

13

Haryana

A.

Progress on Key Indicators 1. RCH II Goals INDICATOR HARYANA Trend (year & source) 162 (SRS 01-03) 59 (SRS 2003) 3.0 (SRS 2003) 186 (SRS 04-06) 55 (SRS 2007) 2.6 (SRS 2007)

ANNEX 1

Maternal Mortality Ratio (MMR) Infant Mortality Rate (IMR) Total Fertility Rate (TFR) 2. RCH II Outcomes S. No. 1.

INDIA Current status RCH II/ NRHM (2012) goal 254 <100 (SRS 04-06) 55 (SRS 2007) <30 2.7 (SRS 2007) 2.1

RCH OUTCOME INDICATOR

Mothers who received 3 or more antenatal care checkups (%) 2. Mothers who had full antenatal check-up (%) 3. Institutional deliveries (%) Children 12-23 months age fully immunised 4. (%) Children age 6-35 months exclusively breastfed 5. for at least 6 months (%) Children with diarrhoea in the last 2 weeks who 6. received ORS (%) 7. Use of any modern contraceptive method (%) Total unmet need for family planning - both 8. spacing methods and terminal methods (%) * - Provisional results for DLHS-3 B. Trends in Financial Expenditure

HARYANA INDIA* DLHS2 DLHS3 DLHS2 DLHS3 (200204) (200708) (200204) (200708) 43.1 10.3 35.7 59.1 33.0 32.3 54.3 14.7 52.4 13.3 46.9 59.6 5.7 31.7 54.5 16.0 50.4 16.5 40.9 45.9 22.7 30.3 45.2 21.4 51.0 19.1 47.0 54.1 24.9 33.7 47.3 21.5

(Rs. crores) FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 Release 11.43 30.13 27.74 49.16 Audited Expenditure 8.34 20.71 18.82 32.14* * - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided. - Allocation for 2008-09: Rs. 57.70 crores.

C. Progress on Key Strategies 1. Demand side interventions Achievement (no. of beneficiaries) 200506 200607 200708 200809 1 Janani Suraksha Yojana 1,825 23,123 35,441 48,000 2 Total Sterilisation 92,950 85,751 80,895 na 3 IUD Insertions 1,50,900 1,53,850 1,63,354 na (Source: M&E Division reports, and JSY reports from the states) Indicators S. No.

14

Haryana

2. Technical interventions S. No. 1. 2. Indicators No. of First Referral Units (FRUs) operationalised Achievement upto March 2009 Number % 86 145.8 (against the target of 59 FRUs) 160 78.4 (against the target of 204 PHCs) 276 NA 19 90.4 (out of 21 districts) 3,486 NA 98,169 NA

No. of PHCs operationalised to provide 24-hour services 3. No. of private institutions accredited under JSY 4. No. of districts implementing Integrated Management of Neonatal & Childhood Illness (IMNCI) 5. No. of people trained in IMNCI 6. No. of Village Health & Nutrition Days (VHNDs) held (Source: NRHM MIS report, April 2009)

15

Haryana

Immunization Haryana Evaluated Immunization Coverage Survey Indicator FI BCG Measles DPT3 Progress As per the evaluated survey the full immunization is 63.6 % in 2007-08 (DLHS 3) The State has trained 665 Health workers out of 3633. The State has constituted 19/20 district level AEFI committees. Issues The State continues to have high dropout from BCG to DPT 3 at 19% and BCG to Measles at 15% which is critical for further improvement in full immunization coverage. The state needs to expedite the Immunization training of Health Workers as it has trained only 18.3% (665/3633) of health workers. The State needs to strengthen AEFI reporting further to improve reporting of AEFI cases. The State should consider revision of microplans and better tracking of beneficiaries by ensuring availability of beneficiary/due list with the ANM/AWW/ASHAs at the session sites. NFHS 1 (1992-93) 63.2 84.8 71.8 78.5 NFHS 2 (1998-99) 83.4 94.6 89.1 88.8 NFHS 3 (2005-06) 74.2 97.2 86.3 85.1 CES (2005) 57.2 81.9 70.5 66.5 CES (2006) 74.9 85.1 76.8 76.7 DLHS 2 (2002-04) 59.1 83.5 65.4 73.6 DLHS3 (2007-08) 63.6 87.1 73.6 70.4

16

Haryana

Brief on National TB Control Programme in Haryana 1. Infrastructure Total Population No. of Districts No. of Tuberculosis Units (TUs) No. of Designated Microscopy Centres (DMCs) 2. Status of Implementation 3. 5 districts of Faridabad, Gurgaon, Jind, Karnal and Sonepat were implementing RNTCP covering nearly 36% of the State population since year 2000. Later whole of the State was approved for coverage under RNTCP with assistance of USAID. 6 more districts (Ambala, Fatehabad, Mahendragarh, Panchkula, Rewari and Yamunanagar) started service delivery during 4th quarter 2003. Remaining districts started service delivery latter and by 1st quarter 2004 whole of the State was covered under RNTCP. 241 lakh 20 54 208

State-wise performance: (Based on quarterly reports for 1st quarter 2009) Overall 162 TB Suspects/lakh pop are examined in 1st quarter 2009 which is satisfactory. Inspite of good referral of TB suspects total case detection rate of 145/lakh and new smear positive case detection rate of 53/lakh (56%) are low. Sputum conversion rate of 91% is satisfactory but cure rate of 84% in new smear positive patients is marginally low.

17

Haryana

Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, Haryana, 2000-2009*
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Qtr1-00 Qtr2-00 Qtr3-00 Qtr4-00 Qtr1-01 Qtr2-01 Qtr3-01 Qtr4-01 Qtr1-02 Qtr2-02 Qtr3-02 Qtr4-02 Qtr1-03 Qtr2-03 Qtr3-03 Qtr4-03 Qtr1-04 Qtr2-04 Qtr3-04 Qtr4-04 Qtr1-05 Qtr2-05 Qtr3-05 Qtr4-05 Qtr1-06 Qtr2-06 Qtr3-06 Qtr4-06 Qtr1-07 Qtr2-07 Qtr3-07 Qtr4-07 Qtr1-08 Qtr2-08 Qtr3-08 Qtr4-08 Qtr1-09

Population projected from 2001 census Estimated no. of NSP cases - 95/100,000 population per year (based on recent ARTI report)
4. District wise Performance : (Based on quarterly report for 1st quarter of 2009) 6 districts (Ambala, Bhiwani, Hissar, Kaithal, Mahendragarh and Yamunanagar) have very low TCD rate of <128/lakh (50%) and 5 districts (Ambala, Hissar, Mahendragarh, Panipat and Rewari) have very low NSPCD rate of <48/lakh (50%) Cure rate is very low in 2 districts of Mewat and Rewari. Suspects Annualised Annualised new Sputum examined total case sputum positive conversion rate per lakh detection rate case detection new cases population (against rate (against >67/ (against >180/lakh) lakh) >90.0%) 197 40 96% 118 42% 129 149 164 183 127 129 133 102 156 165 125 182 138 159 111 154 133 110 151 130 55 50 75 56 44 58 52 54 54 59 58% 53% 78% 59% 46% 61% 55% 56% 57% 62% 90% 90% 89% 90% 89% 93% 91% 91% 93% 92% Cure rate new cases (against >85.0%) 86% 86% 85% 84% 81% 85% 84% 83% 82% 87% 88%

Annualised New S+ve CDR

Success rate

District Ambala Bhiwani Faridabad Fatehabad Gurgaon Hisar Jhajjar Jind Kaithal Karnal Kurukshetra

18

Haryana

Mahendragarh Mewat Panchkula Panipat Rewari Rohtak Sirsa Sonipat Yamunanagar Tota 5.

145 127 281 154 177 398 160 139 158 162

117 151 167 171 157 189 129 185 118 145

43 53 65 46 43 77 58 53 51 53

46% 55% 68% 48% 45% 81% 61% 56% 54% 56%

98% 89% 90% 90% 93% 89% 85% 93% 85% 91%

87% 78% 83% 85% 73% 85% 80% 89% 81% 84%

Funds Status as on 31st March 2009(Rs. in lakh) C/F 0.00 Released 422.00 Expenditure 345.39 Balance 76.61

6.

Drugs RNTCP Districts: Release Order of RNTCP drugs has been issued based on the requirement projected in the quarterly report of 1st quarter 09.

7.

Issues Human Resource o Posts of 3 DTOs, 7 MO-TCs, 8 STSs and 10 STLSs are vacant. o 7 DTOs, 3 STSs and 1 STLS are not yet trained. o New District Palwal (April 09) Sanctioned for DTC staff required. o Post of contractual Microbiologist for IRL vacant. Govt. Microbiologist holds the charge. Logistics Some of the two wheelers for supervisory activities of STSs and STLSs are not in good condition. Supervision and Monitoring Internal evaluation frequency is less than expected. In 2008 only 3 IE done. Performance Overall performance of the State is not good. TCD rate of 145/lakh and NSPCD rate of 53/lakh (56%) are not good. TCD and NSPCD rate hasd been less than 70% in 10 of 13 quarters since 1st quarter 2006. Recording and Reporting Windows based EPI Centre not working at the State and 8 districts are facing problem in entering data in it. Training of one DEO as TOT required. ACSM One unit formed at the State for combined IEC activities. They proceed as per their own agenda. Districts own action plan not being followed. TB-HIV Collaboration Collaboration activities have not yet started in the State.

19

Haryana

Intermediate Reference Laboratory (IRL) o STO is the Director of STDC. STDC is at Panchkula, IRL at Karnal and DOT Plus Site at Rohtak. o Proficiency testing passed. o 250 sputum samples sent by the district to LRS for Culture and DST. o HR resistant cases till date are 25. Recently 10 more cases found HR resistant. o 3 LAs and 1 LT more required. o IRL Visits are sub-optimal. DOT Plus - 12 cases are under Cat-IV treatment and 3 have died.

20

Haryana

Fact Sheet on NVBDCP-Haryana Background Information The State has 20 districts with a population of 21.14 million. There are 86 CHCs, 411 PHCs, 2433 Sub-centres and 6955 villages. There are 1906 Multipurpose Worker (Female)/ANM, 425 Health Worker (Male), 73 Health Assistants (Female)/LHV, 106 Health Assistant (Male), 216 Laboratory Technician. In addition, the state has 470 Malaria Clinics.

Malaria Epidemiological Situation Total slide Total Malaria examined cases 2653461 47077 2436431 30895 2571866 35683 280268 200 Total Pf cases 507 330 1397 3

Year 2006 2007 2008 2009(Upto Feb)

Deaths 0 0 0 0

Malaria has increased in the state as 35683 malaria cases and 1397 Pf cases were reported in 2008 in comparison to 30895 cases and 330 Pf cases in 2007. During 2009 (Upto Feb.) there is decline in both total malaria cases and Pf cases. However, the state needs to identify the areas for focused interventions. Japanese Encephalitis: Worst affected districts in the state are Karnal, Kurukshetra, Kaithal and Yamuna nagar. Out of these, Karnal, Kurukhestra and Ambala districts have been covered under JE vaccination during 2007-08 respectively. The state is doing Malathion fogging, during outbreak, Health education. Year 2006 2007 2008 2009(Prov,upto March) Cases 2 85 13 0 Deaths 1 46 3 0

Dengue/DHF: Dengue cases and deaths in the state are indicated below: Year 2006 2007 2008 2009 (Prov. Upto 27th May.) Chikungunya Total of 20 suspected Chikungunya fever cases and no death was reported during 2007. In the year 2008, 35 suspected Chikungunya fever cases and no death were reported. In the year 2009 till 27th May, no suspected Chikungunya fever case and no death has been reported. For proactive surveillance 5 Sentinel Surveillance Hospitals (SSH) with laboratory support have been identified in Cases Deaths

838 365 1137 5

4 11 9 0

21

Haryana

the state and linked with PGI, Chandigarh the Apex Referral Laboratory. NIV Pune has been entrusted the supply of IgM ELISA test kits to the identified institutes. Filaria and Kala-azar, are not reported from the state of Haryana. Central Assistance Year 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10(B.E.) Issues: Malaria: Malaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs to identify the areas for focused interventions. Allocation Kind 95.33 266.43 161.62 107.84 108.28 52.29 (Rs. In lakhs) Release/Expenditure Cash Kind Total 0.00 91.49 91.49 44.64 24.58 69.22 4.61 279.35 283.96 10.00 162.39 172.39 30.00 17.93 47.93

Cash 310.62 0.00 33.38 35.00 113.30 68.00

Total 405.95 266.43 195.00 142.84 221.58 120.29

Acute Encephalitis Syndrome (AES)/ Japanese Encephalitis (J.E.): Intensive surveillance in the affected areas should be carried out. Sentinel surveillance sites need to be strengthened in the state. Most of the cases are reported at Private clinics / hospitals that need to be involved in timely diagnosis and prompt management including transportation / referral protocols for serious patients.

22

Haryana

STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN HARYANA Epidemiological scenarioThe state is low endemic for leprosy and has already achieved the goal of elimination of leprosy (i.e. prevalence rate of less than 1 case /10000 population). There were 464 leprosy cases on record as on March 2009. New case detection and treatment completionDuring 2008-09, a total of 451 new leprosy cases were detected as compared to 379 new cases detected during the corresponding period of previous year. Out of 369 cases discharged during the year, 309 cases (83.7%) were released as cured after completing treatment. NLEP action plan for the year 2009-10 amounting to 107 lakhs has been approved for the state.

Issues 1. The state has reported low level of fund utilization in 2008-09. During 2008-09, the state action plan was approved for Rs.144 lakhs, however the state could utilize only Rs. 49.3 lakhs. 2. New leprosy cases are being detected in the state every year which suggest active transmission of the disease in the community. The state is advised to carry out in-depth situational analysis in districts/blocks reporting large number of new cases and take suitable actions like (i) Ensuring completion of treatment in each of the new cases detected. (ii) Enhance awareness of the community to improve self reporting of suspected cases to health facility and (iii) Carrying out family contact survey against all multibacillary and child cases. 3. The state has listed around 150 grade II disability cases since last 5 years. There is no Govt. institutions/NGO providing reconstructive surgery services to leprosy affected persons with disability in the state. Hence RCS services are not been provided to disabled leprosy affected persons in the state. The state is advised to identify centres for conducting RCS and send the proposals to GOI for approval so that the backlog of leprosy cases with disability could be reduced in the state. 4. There are 19 leprosy colonies in the state. The state should ensure provision of proper health care facilities like ulcer care, provision of supportive drugs and dressing materials to the persons affected with leprosy residing in these colonies.

23

Haryana

State : Haryana Integrated Disease Surveillance Project (IDSP) Fact sheet as on 17 June 2009 The State of Haryana has an area of 44212 sq. km and a population of 21 lakhs. There are 21 districts, 119 blocks and 6955 villages. The State has population density of 478 per sq. km. Haryana is a Phase II State under IDSP and has been inducted in the program during 2004-05 Dr. O.P. Mittal has been designated as the State Surveillance Officer (IDSP). 1. Manpower Surveillance Officer and RRT team at State and District headquarter designated. The offer letter to the recommended candidates for the positions of state/district Epidemiologists, Microbiologists and State Entomologists were issued by State/ district NRHM society. In addition to the above one Data Manager and Data Entry operator have been appointed in all districts and State Headquarter. IT Data Centres & Training Centres have been installed at all locations including State head quarters, PGI Rohtak, and all districts. Hi-End VC equipments have been installed at State Head Quarters. Laboratory Strengthening Priority district lab identified in Bilaspur and Mandi and is being strengthened. Data Reporting Haryana has 21 districts. Weekly surveillance data and outbreak reports are reported to CSU and simultaneously to be entered in IDSP portal i.e. www.idsp.nic.in. In most of the districts, there is late reporting of data Outbreaks Reporting of disease out break from the state has started. In 2008 Haryana has reported 10 outbreaks. Training 87 Master Trainers were trained 22 DSOs were trained 2523 Health Workers were trained 58 District Lab Technicians were trained 86 Peripheral Lab Technicians were trained Finance Year 2004-05 2005-06 2006-07 2007-08 2008-09 Balance Amount Release (in lakhs) 23.00 194.80 0.00 90.00 73.52 Rs. 53.22 Lakhs Expenditure (in lakhs) 0.00 15.65 173.69 111.64 27.12

2.

3. 4.

5.

6.

7.

24

Haryana

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS NOTE ON STATUS IN HARYANA Magnitude:

Prevalence of blindness (2003-04) Estimated blind persons

1.89 % 3.98 lakhs

Infrastructure developed Upgraded Medical Colleges Upgraded District Hospitals District Blindness Control Societies Mobile Eye Care Units Eye Banks Upgraded PHCs Cataract Performance YEAR 2007-2008 2008-2009 School Eye Screening YEAR TEACHER TRAINED IN SCREENING FOR REFRACTIVE ERRORS 2900 845 SCREENED DETECTED WITH REFRACTIVE ERRORS 654512 25162 453043 6959 PROVIDED FREE GLASSES 8298 1141 (Rs in lakhs) BALANCE -4.00 -124.59 TARGET 100000 125000 ACHIEVEMENT 128634 136000 1 6 17 4

1 80

2007-2008 2008-2009

GIA is released to District Blindness Control Societies (IX Plan) YEAR 2007-2008 2008-2009 Issues: RELEASED 121.00 230.55 EXPENDITURE 125.00 355.14

UCs for GIA released to State Blindness Control Society are not being received timely. SOE for Cash Grant are also not being received timely. Performance of School Eye Screening Programme needs to be improved.

25

Haryana

NIDDCP Haryana Amount proposed 7.50 Amount Approved 6.00 Rs. In Lakh Remarks

Activity 1 Establishment of IDD Control Cell Establishment of IDD Monitoring Lab Health Education and Publicity IDD surveys Total

4.50

3.50 The State Government may carry out the activities as per the fund allocation of GOI.

3 4

10.00 2.00 24.00

12.00 2.50 24.00

26

Haryana

Mapping of Record of Proceedings of the NPCC of NRHM for 2005-06 to 2009-10

The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in following broad thematic chapters 1. ASHA (including selection, training, drug kits, mentoring, specific performance incentives and anything else associated with ASHA) 2. Infrastructure related matters (including construction, strengthening, renovation, new construction etc), equipments, transport (ambulances, EMRI, associated expenses) and others) 3. Human Resource related matters (including HR salary, contractual payments, incentives, etc) 4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC, IDHAP, M&E, Mobility support to SHS etc) 5. Untied funds, AMG & RKS related mattes 6. Training & Capacity Building related matters (including trainings, workshops, training institutions including their upgradation or new construction, courses, etc) 7. Innovations (including Procurement of medicines, School Health, Health Mela, Insurance, Accreditations, Monthly VHND etc)
NATIONAL RURAL HEALTH MISSION Haryana Total MFP Approvals 3036.4 10090 RoP Approvals for Various Years in Rs. Lakh 2005-06 2006-07 2007-08 2008-09 Initiative Released Approved Approved Approved ASHA ASHA TOTAL Infrastructure related matters Civil works600 Sc/PHC/CHC 15025.97 2009-10 Approved 888.5 888.5 Remarks

S.No 1

3 4 5

Infrastructure Upgradation of Health Institutions Upgradation of CHC Strengthening Health Institutions as per IPHS State Project Implementation Unit at Consultancy Services

3100 3500 1160 240 6600

6 7

27

Haryana

Emergency & Referral Services 8 9 544.66 MMU TOTAL Contractual Staff recruited and in position at Health system Resource Centre (HHSRC) ANM Special Incentive for Mewat, Morni & Difficult areas Accounts Assistants at CHC TOTAL 14 15 16 17 1160 695.6 1535.6 7144.66 580 47.34 7227.34

Human Resources related matters

10 11 12 13

306

1400

23.14 2395.98 300 98.28 2817.4

306 1400 Programme Management related matters

18 19 20 21 22 23 24 25 26 27 28

Strengthening of SIHFW & SHRC 50 78 Preparation of DHAP 270 State convergence Committee Quaterly 172.5 meetings Household survey 140.09 TOTAL 270 172.5 190.1 78.0 Untied Funds, Annual Maintenance Grants and RKS funds related matters Rogi Kalyan Samiti 590 Rogi Kalyan Samiti HQ Hospital 105 Rogi Kalyan Samiti CHC/ Sub Divisional Hospital 116 Rogi Kalyan SamitiPHC 336 Untied funds to CHC Untied Fund for PHC 102 315.75 142 Untied Fund for SC 243 46.3 246.5 246.5 Untied Fund for VHSC 671.25 628.2 Annual Maintenance Grants CHC Annual Maintenance 204 Grant -PHC 274.5 Annual Maintenance Grant- SC 246.5 TOTAL 243 942.3 1233.5 2094.7

28

Haryana

Training & Capacity Building related matters 29 30 31 Capacity Building and Experience sharing MIS Training Continuous Medical Education (CME) TOTAL 32 33 34 35 36 37 38 39 40 41 42 43 Health Melas Intersectoral Convergence BCC/IEC Improving Quality Of Service Delivery & ISO Strengthening of Procurement & Logistics Comprehensive Best Health Village Scheme Free Treatment of Cleft Lips and Palate Down Syndrome Screening Programme Prevention and Treatment of RHD De-worming and Anemia Control Programme Treatment to Hemophilia Patients Civil Registration System Strengthening of Lab at Zonal Level and District level for NVBDCP Funds for ASHA and community workers for intensifying anti larval activities and checking of breeding sites Drug supply for CHC/FRU TOTAL Innovations related matters 80 95.63 440.05 60 214.19 61.59 10.2 5 10 200 96 37 27 254 10 25.72 291 80

25.72

44

21

45 46

175 426 426 80 95.63 1410.03

29

Haryana