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RCH INTERVENTIONS

PUNJAB

SHIMLA MEETING: 24TH & 25TH SEPT. 08

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MATERNAL HEALTH INTERVENTIONS

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Total Number of Institutions

Institutions NumberDelivery Facilities

District Hospital 20 20

Sub- Division Hospital 38 38

CHCs 127 127

- PHSC CHCs 112 112

- DHS CHCs 15 15

Block PHCs 118 -

PHCs 394 75

Sub-Centers 2858

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For 172 Regular Institutions the State has 142 Gynecologists. 25 Gynecologists have been recruited on contract basis. Advertisement has been issued for recruitment of 40 Gynecologists on regular basis. Shortage of Gynecologists.

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Up-gradation of Institutions :

• 50 CHCs upgraded to EmOC centers with appointment of 1 Gynecologist, 1 Pediatrician and 5 Staff Nurses (wherever required) upto the year 2007-08.

• 10 more CHCs being upgraded to EmOC centers in the current financial year.

• 75 PHCs upgraded into 24 x 7 delivery institutions with appointment of 1 Safe-Motherhood Consultant (lady doctor) & 3 Staff Nurses upto the year 2007-08. 1 gen-set has been provided in these institutions for 24 hr electricity supply.

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• 25 PHCs being upgraded into 24 x 7 delivery centers in the current financial year.

• 135 Health Institutions given Rs. 20 lac each for up-gradation to IPHS level.

• New born care corners and blood storage units have been set-up in 25 EmOC centers.

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Deliveries : (Appx.)

Total deliveries 4,90,000 per year

Home deliveries 2,35,000 (48 %)

Institutional deliveries

2,55,000 (52 %)

Government Institutions

(22 %)

Private Institutions (30 %)

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Deliveries in Govt. Institutions –

2007-08 & 2008-09:

2007-08 2008-09

upto August upto August

16,599 20,990

(increase of 4391 i.e. about 26 % )

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Deliveries in upgraded Institutions :

Institutions 2007-08 2008-09CHCs (50) 1714 2016PHCs (75) 0 1675

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JANANI SURAKSHA YOJANA• Estimated No. of deliveries in a year in

the state of Punjab = 4,90,000

• Estimated No. of deliveries of BPL/SC/St @35% = 1,75,000

• Estimated No. of Beneficiaries upto 2 living Children @50% = 87,500

• Progress:Year Beneficiaries2007-08 29,2562008-09 13,683 (upto Aug.)

Marginal Improvement:

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ASHA• 13,351 ASHAs appointed in 12,550 villages

in the State (Jan. 2008).

• As per norm of 1 ASHA for 1000 population, 4,398 more ASHAs are to be appointed.

• Training of master trainers of ASHAs at State level & district level has been completed.

• The training of ASHAs at the block level will be conducted in the month of October.

• Rs. 5.32 crore (Rs. 4,000/- per ASHA) given to ASHAs and Rs. 1.18 crore spent so far.

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Efforts made by the Department : Posting of Gynecologists has been

rationalized and 19 Gynecologists who were earlier posted in dispensaries and PHCs have been posted in regular CHCs and District Hospitals.

Recruitment drive for Gynecologists on contract basis. Advertisement issued for the 3rd time (by 30/9/2008).

Advertisement issued for recruitment of 49 Gynecologists on regular basis.

Institution-wise monitoring of deliveries is done every month.

Gynecologist-wise monitoring of deliveries is done month wise.

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A pilot project of on-line data management of care of the pregnant women by ANMs and delivery details in 2 districts of the State is under process.

Recruitment process for filling up 511 vacant posts of ANMs and 954 second ANMs in bigger Sub-Centers initiated.

Department is going to monitor registration of pregnancies, Sub-Centers and Districts wise.

Data on status of ante-natal care in 25% population will be available in about 4 months time in the survey being undertaken (Sex-Ratio Survey).

Task for web based application for on-line monitoring of Pregnancy Registrations, Institutional Deliveries, JSY beneficiaries, Immunization, Family Planning Programme, Child Health Programme, Staffing Positions, Financial Reports etc. has been initaited, work allotted to Punjab Engineering College, will be completed by November 08

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Constraints in MCH Interventions :

• We have not been able to fill up the following posts for the upgraded CHCs/ PHCs –

25 out of 50 Gynecologists in the 50 CHCs

31 out of 50 Pediatricians in the EmOC Centers

27 out of 75 Medical Officers (Female) in 75 PHCs

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• Main reason is difficult working hours and locations and less remuneration. Even doctors in Village Dispensaries under Zila Parishads are getting Rs. 25,000/- per month. Ayurveda and Homepathic doctors on contract basis have been given Rs. 20,000/- per month. Salary of Rs. 20,000 and Rs. 15,000 for Gynecologists and MO(F) not adequate. We are approaching GoI for its enhancement.

• There is erratic & inadequate supply of vaccines by GOI leading to gaps in immunization coverage.

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There is shortage of Gynecologists, Pediatricians, Anesthetists.

• For posting of Gynecologists in EmOC centers, there is shortage of 25 out of 50.

• For posting of Pediatricians in EmOC centers, there is shortage of 31 out of 50.

• For empanelment of Anesthetists, there is shortage at 12 places.

• Female Medical Officers are not available at 27 places (24x7 PHCs).

• Staff Nurses are not available at 98 places.

• OT Assistants are not available at 35 places.

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India Punjab

Birth Rate (SRS 2006) 23.5 17.8

Death Rate (SRS 2006) 7.5 6.8

Life Expectancy at birth 62.15 68.25

Sex Ratio (Census 2001) 933 876

IMR (SRS 2006) 57 44

TFR (SRS 2005) 2.9 2.1

Maternal Mortality Ratio (SRS 2005) 301 178

Ante Natal Care (at least 3 checkup) (%) (NFHS III)

50.7 72.5

Institution Delivery (%) (NFHS III) 41 53

Contraceptive Use (%) (NFHS III) 56 63.3

Vaccine coverage (%) (NFHS III) 44 60

HEALTH INDICATORS

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CHILD HEALTH INTERVENTIONS

Reducing early neonatal and neonatal deaths through home based and institutional care of the new born by creating awareness generation and inter-personal communication with special focus on management of hypothermia, asphyxia and infections of the new born.

Session wise computerized micro-plan of all the beneficiaries (PW & Infants) prepared for implementation of Immunization and MCH services as well as M&E. Micro-plan available on web-site.

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Formats for M&E by DIOs and Civil Surgeons already in use. Scrutiny of formats undertaken at State HQ by SEPIO.

Supervision of Immunization and MCH Program by SEPIO.

4 districts i.e. Amritsar, Tarn Taran, Patiala & Ludhiana selected as IMNCI districts.

IMNCI trainings undertaken.

For promotion of breast feeding, NGOs have been involved. Baby friendly health initiative has been incorporated under which ANMs and Staff Nurses from Hospitals/ CHCs are to be trained.

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34 sub-centers in the State & 16 slum areas in Distt. Ferozepur have been adopted for co-ordination in MCH services by NGOs.

Regular review meetings for sensitization and monitoring of Immunization and MCH Program held under the Chairpersonship of PSHFW.

Current status of male & female IMR will be available within 4 months from survey being undertaken in the State (by hiring an agency).

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IMMUNIZATION COVERAGE

Year BCG DPT OPVMeasles

TT-2

2005-06561406

531806

531806

510755534156

2006-07548285

536117

537564

503062537810

2007-08516374

498503

498503

503062471736

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FAMILY WELFARE PROGRAM

• TFR in Punjab as per SRS data 2006 is 2.1 which is practically the maintenance level.

• Progress:

Year Vasectomy Total Sterilization

2005-06 15,762 1,07,591

2006-07 5,615 93,758

2007-08 13,110 1,03,908

• In the previous 3 years IUD insertions were 104.2%, 97.3% & 93.9% of ELA respectively.

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PROGRAM MANAGEMENT•State Program Management Unit- All the

posts filled-up

Details StatusFamily Welfare Specialist 1

Procurement Manager ( Vacant)

1

Manager Finance & Accounts 1

Manager (Monitoring & Evaluation)

1

Manager Human Resource Development

1

State NGO Coordinator 1

Programme Coordinator – ARSH & Gender

1

Programme Coordinator – BCC 1

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District Program Management Unit

District Programme Management Unit

Recruited

Vacant

District Programme Coordinator

19 1

District Procurement Officer 4

District Account Officer 20 -

Monitoring & Evaluation Officer

20 -

Maintenance Engineer 17 -

District Accountant / Cashier 19 1

District Statistical Assistant 17 3

BCC facilitator 16 4

25

Block Program Management Unit

CategorySanctione

d Recruite

dVacan

t

Block Statistical Assistant

118 102 16

Block Accountant cum Cashier

118 102 16

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Mobile Medical Unit

Mobile Medical Unit RecruitedVaca

nt

Medical Officer (F) 17 3

Medical Officer (M) 15 5

Radiographer 17 3

Staff Nurse 18 2

Lab Technician 19 1

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Staff for PHCs/CHCs

Staff for PHC/CHC Recruited Vacant

Female Medical Officer 48 27

Obstetrician 25 25

Paediatrician 19 31

Anaesthetist 38 12

Staff Nurses 377 98

OT Assistant 15 35

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Focused attention on improving sex-ratio. Integrated approach of strict

implementation of the PC & PNDT Act, advocacy & measures for cause of the girl child and empowerment of the women.

PNDT cell has been created at the State HQs under NRHM.

Sensitization workshops are organized at the State HQ as well as district level for orientation of Appropriate Authorities to various provisions in the PNDT Act & Rules.

11 Panchayats awarded Rs. 3 lac each in the year 2006-07 for improving sex-ratio to 1000 or more.

PNDT & SEX-RATIO

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This year there is provision of award of Rs. 1.5 lac each for 20 outstanding Panchayats that achieve child sex-ratio of more than 1000.

There is incentive of Rs. 20,000/- each for informers of violation of the PNDT Act.

There is incentive of Rs. 10,000/- each for decoy patients who help to nab violators of the Act.

Balri Rakshak Yojna, a State sponsored scheme has already been launched for the cause of the girl child.

99 court cases/ FIRs registered against violators of the PC & PNDT Act till date.

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10 centers convicted by courts & 74 cases pending.

Direct action taken against 290 centers in the form of suspension/ cancellation of registration

As a result of strict implementation of the Act, number of sensitization workshops/ seminars/ conferences organized and awareness campaign undertaken, sense of fear is visible amongst wrong doers in the State.

As per SRS data pertaining to years 2004-06, child sex-ratio (0-4 yrs) has improved to 821 in contrast to 796 in the year 2001 which could have further declined to 765 in the absence of measures taken.

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Contract for survey of sex-ratio of 25% sample of State population has already been awarded to an agency, out-come of which will throw light on current region-wise, financial status-wise, all ages sex-ratio & child sex-ratio scenario which will facilitate region-wise future strategy for improving sex-ratio in the State.

Lot of awareness generation activities are underway for bringing a change in the mind-set of the society in favor of the girl child as well as regarding important provisions in the PC & PNDT Act.

Few samples of display publicity are:

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Why Female Foeticide ?

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DAUGHTERS ARE PART OF LIFE

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BCC/ IEC• Intra-communication with focus on NRHM

interventions has already been started. 4 regional workshops were organized in the year 2007-08 for sensitization of district and block level stake holders to new interventions under NRHM.

• Focus has been given on inter-personal communication by holding seminars/ conferences/ meetings/ focused group meetings at various levels for creating awareness on NRHM interventions especially RCH-II.

• Besides paid publicity trust has been given on awareness through news items.

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• Publicity through hoardings at important public places, press advertisements, bus back & side panels, exhibitions, wall display panels, posters, song & drama shows, exclusive girl child competitions with focus on MCH & Gender issues is undertaken.

• Television, cable network, Radio (primary and FM channels) & folk media have been used for spreading important messages through TV spots, talks, interviews, discussions etc.

• Co-ordination with the NGOs by holding sensitization workshops on important themes.

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Allocation Releases/ Expenditure

SN Sub Components 2008-092008-09

1Maternal Health 235.00 37.49Janani Suraksha Yojna 186.00 93.00

2 ASHA 334.50 396.033 Child Health & IMNCI 86.15 .604 Family Planning 920.60 266.785 ARSH 27.07 10.026 Urban RCH 135.60 32.90

7PNDT Sex Ratio 64.84 0Innovations / PPP/NGO 442.50 0

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Infrastructure & Human Development 1558.50 236.93

Logistic Management

323.34 40.08Quality Assurance and Infection Control ProgrammeHMIS Monitoring and Evaluation

9 Training 461.88 285.49

10 Behaviour Change Communications 291.76 40.75

11 Procurement 122.50 125.91

13Programme management Units SPMU and DPMUs

347.26 260.25

12 Flexi pool 157.50 1.20  Total A (RCH II) 5695.00 1827.43

PART A- RCH FLEXI POOL