government of india r f...

(Results-Framework Document)for

R F D

Department Of Health and Family Welfare

(2013-2014)

Government of India

06/01/2014 11.53 AMGenerated on

Section 1:Vision, Mission, Objectives and Functions

Results-Framework Document (RFD) for Department Of Health and Family Welfare-(2013-2014)

Availability of quality Healthcare on equitable, accessible and affordable basis across regions and communities withspecial focus on under-served population and marginalized groups.

Mission

1. To establish comprehensive primary healthcare delivery system and well functioning linkages with secondary and

tertiary care health delivery system.2. To improve maternal and Child Health outcomes.3. To reduce the incidence of

communicable diseases and putting in place a strategy to reduce the burden of non-communicable diseases.4. To

ensure a reduction in the growth rate of population with a view to achieving population stabilization.5. To develop the

training capacity for providing human resources for health (medical, paramedical and managerial) with adequate skill

mix at all levels.6. To regulate Health service delivery and promote rational use of pharmaceuticals in the Country.

Objectives

1 Universal access to Primary Health Care services for all sections of society with effective linkages to secondary and tertiary health care.

2 Improving Maternal and Child Health.

3 Focusing on Population stabilization in the Country.

4 Developing human resources for health to achieve health goals.

5 Reducing overall disease burden of the society.

6 Strengthening Secondary and Tertiary Health Care.

Functions

1. Policy formulation on issues relating to health and family welfare sectors. 2. Management of hospitals and other health institutions

under the control of Department of Health and Family Welfare. 3. Extending support to states for strengthening their health care and

family welfare system. 4. Reducing the burden of Communicable and Non-Communicable diseases. 5. Focusing on development of

human resources through appropriate medical and public health education. 6. Providing regulatory framework for matters in the

Concurrent List of the Constitution viz. medical, nursing and paramedical education, pharmaceuticals, etc. 7. Formulation of guidelines

on issues relating to implementation of National Leprosy Elimination Programme & strengthening supervision and Monitoring support to

States/UTs.

1

Vision


Page : 2 of 77

Section 2:Inter se Priorities among Key Objectives, Success indicators and Targets

Results-Framework Document (RFD) for Department Of Health and Family Welfare -(2013-2014)

Objective Weight Action Unit

Target / Criteria Value

Weight

80%100% 70% 60%90%

Very Good Fair PoorExcellent GoodSuccessIndicator

Universal access to Primary Health Careservices for all sections of society witheffective linkages to secondary and tertiaryhealth care.

32.00 Strengthening of HealthInfrastructure

Operationalization of24X7 Facility at PHClevel out of the totalnumber of 24000PHCs

% 34.5 33.5 33.034.035.04.00[1] [1.1] [1.1.1]

Operationalisation ofCHCs into FirstReferral Units (FRU)out of the totalnumber of 4000CHCs

% 34.5 33.5 33.034.035.04.00[1.1.2]

Increase in theservice delivery byMobile MedicalUnits(MMU) overbaseline figure as on31.03.2013

% 10 6 58123.00[1.1.3]

Increase in thenumber PatientTransported overthe baseline figurefor 2012-13.

% 10 6 58124.00[1.1.4]

Establishment ofSpecial New BornCare Units in DistrictHospitals

% 12 6 59152.00[1.1.5]

Strengthening ofCommunity Involvement

Utilization of fundsby new VillageHealth, Sanitation &NutritionCommittees(VHSNC) releasedup to the end ofprevious financial

% 50 40 3545552.00[1.2] [1.2.1]


Page : 3 of 77





Weight

80%100% 70% 60%90%


year

Augmentation of availabilityof Human Resources inidentified High PriorityDistricts

Deployment of newANMs

Number 1250 900 800100013003.00[1.3] [1.3.1]

Deployment of newDoctors/Specialists

Number 250 175 1502003003.00[1.3.2]

Deployment of newStaff Nurses

Number 500 400 3754506003.00[1.3.3]

Capacity Building ASHA Training (upto VI th & VIIthModule)

Number 80000 40000 20000600001000004.00[1.4] [1.4.1]

Improving Maternal and Child Health. 8.00 Promote InstitutionalDeliveries

InstitutionalDeliveries as apercentage of totaldeliveries

% 82 78 7580853.00[2] [2.1] [2.1.1]

Promote safe deliveries Reduction in unsafedeliveries in identifyHigh PriorityDistricts

% 5 3 2462.00[2.2] [2.2.1]

Tageting Full Immunisation(Age group of 0-12 months)

Target Childrenimmunised

% 85 81 7983873.00[2.3] [2.3.1]

Focusing on Population stabilization in theCountry.

8.00 Promoting Post PartumIUCD

Increase in IUCDinsertions overprevious financialyear

% 10 7 68152.00[3] [3.1] [3.1.1]

Registration of pregnancyin first trimester

Increase in theregistratin over theprevious

% 15 10 812202.00[3.2] [3.2.1]


Page : 4 of 77





Weight

80%100% 70% 60%90%


financial year

Promoting Intra UterineDevice (IUD) Insertion

Increase in IUDInsertion over theprevious financialyear

% 10 7 68152.00[3.3] [3.3.1]

National Inspection &Monitoring Committee(PCPNDT Act) visits

Increase in numberof visits

% 20 15 1018252.00[3.4] [3.4.1]

Developing human resources for health toachieve health goals.

9.00 Strengthening &Upgradation of Govt.Medical Colleges

Completion ofUpgradation ofidentified MedicalColleges

Number 20 13 1015245.00[4] [4.1] [4.1.1]

Setting up one NationalInstitute of Para-medicalSciences(NIPS) and 8Regional Institutes ofParamedical Sciences(RIPS)

Commencement ofWork for NIPS

Date 15/03/2014 25/03/2014 31/03/201420/03/201405/03/20141.00[4.2] [4.2.1]

Commencement ofWork for RIPS

Number 5 2 1361.00[4.2.2]

Establishment of NursingInstitutes at various levels

Commencement ofteaching in ANMSchools

Number 25 15 320271.00[4.3] [4.3.1]

Release of funds forestabilishment GNMSchools

Number 25 15 1020281.00[4.3.2]

Reducing overall disease burden of thesociety.

18.00 Reduce incidence ofMalaria cases

Annual ParasiteIncidence (API)

Per 1000population

1.40 1.67 1.801.521.302.50[5] [5.1] [5.1.1]

Reduce incidence ofFilariasis

Remaining EndemicDistricts

Number 45 35 3040502.00[5.2] [5.2.1]


Page : 5 of 77





Weight

80%100% 70% 60%90%


(64) achieving MicroFilaria rate of < 1%

Reduce incidence of Kala-azar

BPHCs reportingless than 1 case ofKala-azar per 10000population out of275 remaining suchBPHCs

Number 140 125 1201301502.00[5.3] [5.3.1]

Reduce incidence ofLeprosy

Annual prevalencerate of < 10 perLakh population inHigh burdenDistricts (209)

Number 70 60 5565751.00[5.4] [5.4.1]

ReconstructiveSurgeriesconducted

Number 2700 2100 1800240030000.50[5.4.2]

Control of Tuberculosis New SputumPositive (NSP)Success rate

% 88 75 7085901.00[5.5] [5.5.1]

Default rateamongst CAT-IIpatient

% 13 14 1513.512.51.00[5.5.2]

MDR TB Casesnotified put ontreatment

% 50 40 3545550.50[5.5.3]

Reduction in Prevalence ofBlindness

Cataract Surgeriesperformed (inLakhs)

Number 63 49 4256700.50[5.6] [5.6.1]

Spectacles to schoolchildren screenedwith

Number 7.2 5.6 4.86.480.50[5.6.2]


Page : 6 of 77





Weight

80%100% 70% 60%90%


refractive error (inLakhs)

Collection ofdonated eyes forcornealtransplantation

Number 45000 35000 3000040000500000.50[5.6.3]

Strengthening facilities fordiagnosis and treatment ofcancer

Development ofDistrict CancerFacilities

Number 70 60 5065750.50[5.7] [5.7.1]

Strengthening ofTertiary CancerCentres

Number 4 2 1351.00[5.7.2]

Establishment of TobaccoTesting laboratories

Operationalization ofnew TobaccoTesting labs forNicotine and Tar

Number 4 2 1360.50[5.8] [5.8.1]

Ensure availability ofminimum mental healthcare services

Starting of AcademicSession in Centresof Excellence

Number 4 2 1351.00[5.9] [5.9.1]

Approval for startingup of PG courses inMental HealthSpecialities

Number 20 10 515250.50[5.9.2]

Opportunistic screening,diagnosis and managementof Diabetes, CardiovascularDiseases and Stroke

Set up NCD Clinicsand Cardiac CareUnits in DistrictHospitals

Number 70 50 4060800.50[5.10] [5.10.1]

Screening of NCDsat District Hospitalsand

Number 70 50 4060800.50[5.10.2]


Page : 7 of 77





Weight

80%100% 70% 60%90%


Efficient Functioning of the RFD System 3.00 Timely submission of Draft RFD2014-15 for Approval

On-time submission Date 06/03/2014 08/03/2014 11/03/201407/03/201405/03/20142.0*

Timely submission of Results for2012-13

On-time submission Date 02/05/2013 06/05/2013 07/05/201303/05/201301/05/20131.0

* Mandatory Objective(s)

below

Provide Health Care to theElderly Population

Operationalization ofGeriatric OPD and10 beds ward atDistrict Hospitals

Number 75 65 60701000.50[5.11] [5.11.1]

Establishment ofRegional GeriatricCentres

Number 4 2 1350.50[5.11.2]

Estabilshment ofNational Institute ofAging at AIIMS Delhi& MMC, Chennai

Number 1 1 0120.50[5.11.3]

Strengthening Secondary and TertiaryHealth Care.

10.00 Setting up of Institutions (6No.)

Commencement ofNursing TeachingAcademic Sessionin Medical Colleges

Number 4 2 1354.00[6] [6.1] [6.1.1]

Completion ofconstruction work inHospitals

% 90 80 75851003.00[6.1.2]

Upgradation of Govt.Medical colleges (8 No.)

Completion ofconstruction work

Number 3 1 0243.00[6.2] [6.2.1]


Page : 8 of 77





Weight

80%100% 70% 60%90%


Transparency/Service deliveryMinistry/Department

3.00 Independent Audit ofimplementation ofCitizens’/Clients’ Charter (CCC)

% of implementation % 95 85 80901002.0*

Independent Audit ofimplementation of PublicGrievance Redressal System

% of implementation % 95 85 80901001.0

Administrative Reforms 6.00 Implement mitigating strategiesfor reducing potential risk ofcorruption

% of implementation % 95 85 80901001.0*

Implement ISO 9001 as per theapproved action plan

% of implementation % 95 85 80901002.0

Implement Innovation ActionPlan (IAP)

% of milestones achieved % 95 85 80901002.0

Identification of core and non-core activities of theMinistry/Department as per 2ndARC recommendations

Timely submission Date 28/01/2014 30/01/2014 31/01/201429/01/201427/01/20141.0

Improving InternalEfficiency/Responsiveness.

2.00 Update departmental strategy toalign with 12th Plan priorities

Timely updation of thestrategy

Date 17/09/2013 01/10/2013 08/10/201324/09/201310/09/20132.0*

Ensuring compliance to the FinancialAccountability Framework

1.00 Timely submission of ATNs onAudit paras of C&AG

Percentage of ATNssubmitted within due date (4months) from date ofpresentation of Report toParliament by CAG .duringthe year.

% 90 70 60801000.25*

Timely submission of ATRs tothe PAC Sectt. on PAC Reports.

Percentage of ATRSsubmitted within due date (6 months) from date ofpresentation of Report toParliament by PAC .duringthe year.

% 90 70 60801000.25



Page : 9 of 77





Weight

80%100% 70% 60%90%


Early disposal of pending ATNson Audit Paras of C&AG Reportspresented to Parliament before31.3.2012.

Percentage of outstandingATNs disposed off duringthe year.

% 90 70 60801000.25

Early disposal of pending ATRson PAC Reports presented toParliament before 31.3.2012

Percentage of outstandingATRS disposed off duringthe year.

% 90 70 60801000.25



Page : 10 of 77

Section 3:Trend Values of the Success Indicators


Target Valuefor

ProjectedValue for

Objective ProjectedValue for

Action Success Indicator

FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

-- 34.5%Operationalization of24X7 Facility at PHClevel out of the totalnumber of 24000PHCs

Universal access to Primary HealthCare services for all sections ofsociety with effective linkages tosecondary and tertiary health care.

Strengthening of HealthInfrastructure

34.5 34.5 --[1] [1.1] [1.1.1]

-- 34.5%Operationalisation ofCHCs into FirstReferral Units (FRU)out of the total numberof 4000 CHCs

34.5 34.5 --[1.1.2]

-- 10%Increase in the servicedelivery by MobileMedical Units(MMU)over baseline figure ason 31.03.2013

10 10 --[1.1.3]

-- 10%Increase in the numberPatient Transportedover the baselinefigure for 2012-13.

10 10 --[1.1.4]

-- 12%Establishment ofSpecial New BornCare Units in DistrictHospitals

12 12 --[1.1.5]

-- 50%Utilization of funds bynew Village Health,Sanitation & NutritionCommittees (VHSNC)released up to the endof

Strengthening ofCommunity Involvement

50 50 --[1.2] [1.2.1]


Page : 11 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

previous financial year

7200 1250NumberDeployment of newANMs

Augmentation ofavailability of HumanResources in identifiedHigh Priority Districts

1250 12508000[1.3] [1.3.1]

1000 250NumberDeployment of newDoctors/Specialists

250 2501100[1.3.2]

2500 500NumberDeployment of newStaff Nurses

500 5003000[1.3.3]

100000 80000NumberASHA Training (up toVI th & VIIth Module)

Capacity Building 80000 80000130000[1.4] [1.4.1]

82 82%Institutional Deliveriesas a percentage oftotal deliveries

Improving Maternal and Child Health. Promote InstitutionalDeliveries

82 8282[2] [2.1] [2.1.1]

-- 5%Reduction in unsafedeliveries in identifyHigh Priority Districts

Promote safe deliveries 5 5 --[2.2] [2.2.1]

87 85%Target Childrenimmunised

Tageting FullImmunisation (Age groupof 0-12 months)

85 8585[2.3] [2.3.1]

-- 10%Increase in IUCDinsertions overprevious financial year

Focusing on Population stabilizationin the Country.

Promoting Post PartumIUCD

10 10 --[3] [3.1] [3.1.1]

-- 15%Increase in theregistratin over the

Registration ofpregnancy in first

15 15 --[3.2] [3.2.1]


Page : 12 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

previous financial yeartrimester

-- 10%Increase in IUDInsertion over theprevious financial year

Promoting Intra UterineDevice (IUD) Insertion

10 10 --[3.3] [3.3.1]

-- 20%Increase in number ofvisits

National Inspection &Monitoring Committee(PCPNDT Act) visits

20 20 --[3.4] [3.4.1]

30 20NumberCompletion ofUpgradation ofidentified MedicalColleges

Developing human resources forhealth to achieve health goals.

Strengthening &Upgradation of Govt.Medical Colleges

20 2024[4] [4.1] [4.1.1]

31/12/2011 15/03/2014DateCommencement ofWork for NIPS

Setting up one NationalInstitute of Para-medicalSciences(NIPS) and 8Regional Institutes ofParamedical Sciences(RIPS)

-- --31/10/2012[4.2] [4.2.1]

4 5NumberCommencement ofWork for RIPS

5 52[4.2.2]

12 25NumberCommencement ofteaching in ANMSchools

Establishment of NursingInstitutes at variouslevels

25 2515[4.3] [4.3.1]

31 25NumberRelease of funds forestabilishment GNMSchools

25 2525[4.3.2]

1.1 1.40Per 1000population

Annual ParasiteIncidence (API)

Reducing overall disease burden ofthe society.

Reduce incidence ofMalaria cases

1.40 1.400.85[5] [5.1] [5.1.1]


Page : 13 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

-- 45NumberRemaining EndemicDistricts (64) achievingMicro Filaria rate of< 1 %

Reduce incidence ofFilariasis

45 45 --[5.2] [5.2.1]

-- 140NumberBPHCs reporting lessthan 1 case of Kala-azar per 10000population out of 275remaining such BPHCs

Reduce incidence ofKala-azar

140 140 --[5.3] [5.3.1]

-- 70NumberAnnual prevalence rateof < 10 per Lakhpopulation in Highburden Districts (209)

Reduce incidence ofLeprosy

70 7041[5.4] [5.4.1]

2570 2700NumberReconstructiveSurgeries conducted

2700 27002120[5.4.2]

88.0 88.0%New Sputum Positive(NSP) Success rate

Control of Tuberculosis 88.0 88.088[5.5] [5.5.1]

-- 13%Default rate amongstCAT-II patient

13 13 --[5.5.2]

-- 50.0%MDR TB Casesnotified put ontreatment

50.0 50.0 --[5.5.3]

65 66NumberCataract Surgeriesperformed (in Lakhs)

Reduction in Prevalenceof Blindness

66 6660[5.6] [5.6.1]


Page : 14 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

3 7.2NumberSpectacles to schoolchildren screened withrefractive error (inLakhs)

7.2 7.24[5.6.2]

60000 45000NumberCollection of donatedeyes for cornealtransplantation

45000 4500048000[5.6.3]

70 70NumberDevelopment of DistrictCancer Facilities

Strengthening facilitiesfor diagnosis andtreatment of cancer

70 708[5.7] [5.7.1]

6 4NumberStrengthening ofTertiary CancerCentres

4 45[5.7.2]

4 4NumberOperationalization ofnew Tobacco Testinglabs for Nicotine andTar

Establishment ofTobacco Testinglaboratories

4 46[5.8] [5.8.1]

1 4NumberStarting of AcademicSession in Centres ofExcellence

Ensure availability ofminimum mental healthcare services

4 46[5.9] [5.9.1]

36 20NumberApproval for starting upof PG courses inMental HealthSpecialities

20 2014[5.9.2]

70 70NumberSet up NCD Clinicsand Cardiac CareUnits in DistrictHospitals

Opportunistic screening,diagnosis andmanagement ofDiabetes, Cardiovascular

70 7055[5.10] [5.10.1]


Page : 15 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

-- 06/03/2014DateOn-time submissionEfficient Functioning of the RFDSystem

Timely submission of DraftRFD 2014-15 for Approval

-- -- --*


Diseases and Stroke

70 70NumberScreening of NCDs atDistrict Hospitals andbelow

70 7080[5.10.2]

70 75NumberOperationalization ofGeriatric OPD and 10beds ward at DistrictHospitals

Provide Health Care tothe Elderly Population

75 7539[5.11] [5.11.1]

8 4NumberEstablishment ofRegional GeriatricCentres

4 40[5.11.2]

-- 1NumberEstabilshment ofNational Institute ofAging at AIIMS Delhi &MMC, Chennai

1 1 --[5.11.3]

-- 4NumberCommencement ofNursing TeachingAcademic Session inMedical Colleges

Strengthening Secondary andTertiary Health Care.

Setting up of Institutions(6 No.)

4 4 --[6] [6.1] [6.1.1]

-- 90%Completion ofconstruction work inHospitals

90 90 --[6.1.2]

-- 3NumberCompletion ofconstruction work

Upgradation of Govt.Medical colleges (8 No.)

3 3 --[6.2] [6.2.1]


Page : 16 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

-- 02/05/2013DateOn-time submissionTimely submission of Resultsfor 2012-13

-- -- --

-- 95%% of implementationTransparency/Service deliveryMinistry/Department

Independent Audit ofimplementation ofCitizens’/Clients’ Charter

-- -- --*

-- 95%% of implementationIndependent Audit ofimplementation of PublicGrievance Redressal System

-- -- --

-- 95%% of implementationAdministrative Reforms Implement mitigating strategiesfor reducing potential risk ofcorruption

-- -- --*

-- 95%% of implementationImplement ISO 9001 as perthe approved action plan

-- -- --

-- 95%% of milestones achievedImplement Innovation ActionPlan (IAP)

-- -- --

-- 15/10/2013DateTimely submissionIdentification of core and non-core activities of theMinistry/Department as per2nd ARC recommendations

-- -- --

-- 90%Percentage of ATNssubmitted within due date (4months) from date ofpresentation of Report toParliament by CAG .duringthe year.

Ensuring compliance to the FinancialAccountability Framework

Timely submission of ATNs onAudit paras of C&AG

-- -- --*

-- 90%Percentage of ATRSsubmitted within due date ( 6months) from date ofpresentation of Report toParliament by PAC .during

Timely submission of ATRs tothe PAC Sectt. on PACReports.

-- -- --



Page : 17 of 77



Target Valuefor

ProjectedValue for



FY 11/12

Unit

FY 13/14FY 12/13 FY 14/15

Actual Valuefor

Actual Valuefor

FY 15/16

the year.

-- 90%Percentage of outstandingATNs disposed off during theyear.

Early disposal of pendingATNs on Audit Paras of C&AGReports presented toParliament before 31.3.2012.

-- -- --

-- 90%Percentage of outstandingATRS disposed off during theyear.

Early disposal of pendingATRs on PAC Reportspresented to Parliament before31.3.2012

-- -- --



Page : 18 of 77

Section 4:Acronym


AcronymSI.No Description

Auxiliary Nurse Midwife1 ANM

Annual Parasite Incidence2 API

Accredited Social Health Activist3 ASHA

Ayurveda Yoga-Naturopathy Unani Siddha & Homoeopathy4 AYUSH

Block Primary Health Centres5 BPHCs

Community Health Centre6 CHC

Page : 19 of 77

Section 4:Acronym



Disability Prevention and Medical Rehabilitation7 DPMR

First Referral Unit8 FRU

Infant Mortality Rate9 IMR

Intra Uterine Devices10 IUD

Multi Drug Resistance - Tuberculosis11 MDR-TB

Maternal Mortality Ratio12 MMR

Page : 20 of 77

Section 4:Acronym



Mobile Medical Unit13 MMU

National AIDS Control Organization14 NACO

Non Communicable Diseases15 NCD

National Institute of Paramedical Sciences16 NIPS

Primary Health Centre17 PHC

Panchayati Raj Institutions18 PRI

Page : 21 of 77

Section 4:Acronym



Revised National Tuberculosis Control Programme19 RNTCP

Sub Centre20 SC

Tuberculosis21 TB

Total Fertility Rate22 TFR

Village Health, Sanitation and Nutrition Committee23 VHSNC

Page : 22 of 77

Section 4:Description and Definition of Success Indicators and Proposed Measurement Methodology


Success indicator Description Definition MeasurementSI.No General Comments

OPERATIONALISATION OF 24 X7 FACILITY AT PHC LEVEL

To ensure round the clock accessto public health facilities, PrimaryHealth Centres are expected toprovide 24-hour service in basicObstetric and Nursing facilities.Under NRHM, PHCs are being

operationalized for providing 24X7services in a phased manner by

placing at least 1-2 MedicalOfficers and more than 3 Staff

Nurses in these facilities. All 24x7PHCs, providing delivery services,

would also have newborn carecorners and provide basic new

born care services includingresuscitation, prevention of

infections, provision of warmthand early and exclusively breast

feeding.

PHC is the first contact pointbetween village community

and the Medical Officer. ThePHCs were envisaged to

provide an integratedcurative and preventivehealth care to the rural

population with emphasis onpreventive and promotive

aspects of health care. ThePHCs are established andmaintained by the StateGovernments under the

Minimum Needs Programme(MNP)/Basic Minimum

Services (BMS) Programme.As per minimum requirementa PHC is to be manned by aMedical Officer supported by

14 paramedical and otherstaff. There were 23,887PHCs functioning in the

country as on March 2011.

PRIMARY HEALTH CENTRES(PHCS)

1 STAFF FOR NEW PRIMARYHEALTH CENTRE

MedicalOfficer........................................................................................

..1Pharmacist

.................................................

............................................................1

Nurse Mid-wife (StaffNurse).....................1 + 2additional Staff Nurses on

contractHealth Worker

(Female)/ANM...........................................................................

1Health Educator

.................................................

..................................................1

Health Assistant(Male)........................................................................................

......1Health Assistant

(Female)/LHV............................................................................

.1

[1.1.1] Operationalization of 24X7 Facility at PHClevel out of the total number of 24000 PHCs


Page : 23 of 77




OPERATIONALISATION OF 24 X7 FACILITY AT PHC LEVEL

To ensure round the clock accessto public health facilities, PrimaryHealth Centres are expected toprovide 24-hour service in basicObstetric and Nursing facilities.Under NRHM, PHCs are being

operationalized for providing 24X7services in a phased manner by

placing at least 1-2 MedicalOfficers and more than 3 Staff

Nurses in these facilities. All 24x7PHCs, providing delivery services,

would also have newborn carecorners and provide basic new

born care services includingresuscitation, prevention of

infections, provision of warmthand early and exclusively breast

feeding.

PHC is the first contact pointbetween village community

and the Medical Officer. ThePHCs were envisaged to

provide an integratedcurative and preventivehealth care to the rural

population with emphasis onpreventive and promotive

aspects of health care. ThePHCs are established andmaintained by the StateGovernments under the

Minimum Needs Programme(MNP)/Basic Minimum

Services (BMS) Programme.As per minimum requirementa PHC is to be manned by aMedical Officer supported by

14 paramedical and otherstaff. There were 23,887PHCs functioning in the

country as on March 2011.

PRIMARY HEALTH CENTRES(PHCS)

1 ..................................................1

Lower Division Clerk.............................................................................................1

LaboratoryTechnician.................................................................................

........1Driver (Subject to availability ofVehicle)....................................

....................1Class

IV...............................................................................................

................4Total (excluding contractual

staff):..........................................................................15

[1.1.1] Operationalization of 24X7 Facility at PHClevel out of the total number of 24000 PHCs


Page : 24 of 77




CHCs are being establishedand maintained by the State

Government underMNP/BMS programme. As

per minimum norms a CHC isrequired to be manned by

four Medical Specialists i.e.Surgeon, Physician,

Gynecologist andPediatrician supported by 21paramedical and other staff(See Annexure-D for IPHS

norms). It has 30 in-doorbeds with one OT, X-ray,

Labour Room and Laboratoryfacilities. It serves as a

referral centre for 4 PHCsand also provides facilities forobstetric care and specialistconsultations. As on March,2011, there are 4,809 CHCs

functioning in the country

FIRST REFERRAL UNITS(FRUS)

Upgradation of District

COMMUNITY HEALTH CENTRES(CHCS)

2 STAFF FOR COMMUNITYHEALTH CENTRE:

1. Medical Officer (One trainedin Public Health & remaining 3should be qualified Surgeon,

Obstetrician, Physician,Pediatrician).............................

...........................42. Nurse Mid– Wife(staff

Nurse).............................................................................7

3.Dresser......................................................................................

...........................14. Pharmacist/Compounder

.....................................................................................1

5. LaboratoryTechnician.................................................................................

......16. Radiographer

..............................................................................................1

7. WardBoys....................................

[1.1.2] Operationalisation of CHCs into FirstReferral Units (FRU) out of the total number of4000 CHCs


Page : 25 of 77




Hospitals, Sub DistrictHospitals and Community

Health Centres as Firstreferral Units is being

attempted to provide forComprehensive Obstetric

Care for Women and AcuteRespiratory Infection (ARI)

treatment for children. Itrequires holistic planning bylinking Human Resources,

Blood Storage Centers(BSCs) and other logistics.

The definition of FRUincludes the following three

components.a.Essential Obstetric Care

b.Provision of Blood StorageUnit

c.New Born Care ServicesFRU Guidelines could be

refer to, if necessary

COMMUNITY HEALTH CENTRES(CHCS)

2 ...................................................28.

Dhobi.........................................................................................

..........19. Sweepers

.................................................

......................................................310.

Mali............................................................................................

.........111. Chowkidar

.................................................

.................................................1

12.Aya............................................................................................

...................113.

Peon..........................................................................................

................1Total:

.................................................

..............................................................25

[1.1.2] Operationalisation of CHCs into FirstReferral Units (FRU) out of the total number of4000 CHCs


Page : 26 of 77




The main objective is toprovide basic healthcare

facilities in remote, far-flunghilly and tribal areas through

the use of Mobile MedicalUnits. As a first step, it is

envisaged to have one MMUin all the districts in the

country.

MOBILE MEDICAL UNITS (MMU)3 [1.1.3] Increase in the service delivery by MobileMedical Units(MMU) over baseline figure as on31.03.2013

Transportation from the siteof accident or home or any

other place to nearestappropriate First ReferralUnit hospital in case of

medical need, andtransportation from a Medical

Facility to a higher medicalfacility.

PATIENT TRANSPORT SYSTEM4 [1.1.4] Increase in the number Patient Transportedover the baseline figure for 2012-13.

These are specialised newborn and sick child care units

at district hospitals withspecialised equipments,

which include phototherapyunit, oxygen hoods, infusion

pumps, radiant warmer,Laryngoscope and ET tubes,

nasal cannulas Bag andmask, and weighing scale.

These units have a

SPECIAL NEW BORN CHILD CAREUNITS (SNCU)

5 [1.1.5] Establishment of Special New Born CareUnits in District Hospitals


Page : 27 of 77




minimum of 12 to 16 bedswith a staff of 3 physicians,10 nurses, and 4 supportstaff to provide round the

clock services for a new bornor child requiring special caresuch as managing newborn

with neonatal sepsis andchild with pneumonia,

dehydration, etc., preventionof hypothermia, prevention ofinfection, early initiation and

exclusive breast feeding,post-natal care, immunisation

and referral services.

SPECIAL NEW BORN CHILD CAREUNITS (SNCU)

5 [1.1.5] Establishment of Special New Born CareUnits in District Hospitals

VHSNC is expected toprepare village level health

action plan. It comprisesPanchayat president /

member, representative fromcivil society, Anganwadi

Worker (AWW) and AuxiliaryNurse Midwife (ANM). Toencourage Panchayats toconstitute VHSNCs, untiedgrants are given through

NRHM.

VILLAGE HEALTH SANITATIONAND NUTRITION COMMITTEE

(VHSNC)

6 [1.2.1] Utilization of funds by new Village Health,Sanitation & Nutrition Committees (VHSNC)released up to the end of previous financial year


Page : 28 of 77




These grants are used tomeet local health needs of

the villages, includingmaintenance needs of the

Sub centres.

VILLAGE HEALTH SANITATIONAND NUTRITION COMMITTEE

(VHSNC)

6 [1.2.1] Utilization of funds by new Village Health,Sanitation & Nutrition Committees (VHSNC)released up to the end of previous financial year

HIGH PRIORITY/FOCUSSEDSTATES/DISTRICTS

The mission cover the entirecountry. The 18 high focus stateare Uttar Pradesh, Uttaranchal,Madhya Pradesh, Chhattisgarh,

Bihar, Jharkhand, Orissa,Rajasthan, Himachal Pradesh,Jammu and Kashmir, Assam,Arunachal Pradesh, Manipur,

Meghalaya, Nagaland, Mizoram,Sikkim and Tripura. The rest of

the states have to follow thepattern of high focus states forprogramme management units

and upgradation of SC, PHC andCHC through integrated financial

envelope.The State Health Mission shall

prepare the roadmap forarchitectural correction of the

Health System, includingmerger/integration of vertical

structures; delegation and

The Auxiliary Nurse Midwivesis one of the main agents forincreasing the utilization of

health & Family WelfareServices in India.

Auxiliary Nurse Midwives7 An ANM is expected toparticipate in Maternal Health,

Child Health and FamilyPlanning Services; Nutrition

Education; Health Education;Collaborative Service for

Improvement of EnvironmentalSanitation; Immunisation for

Control of CommunicableDiseases; Treatment of Minor

Ailments and First Aid inEmergencies and Disasters.

In addition to these duties, theANM would perform the

following functions in guidingand training the female

Accredited Social HealthActivist (ASHA), as envisaged

in the Guidelines on ASHA,under NRHM:

Holding weekly / fortnightlymeeting with ASHA to discuss

the

[1.3.1] Deployment of new ANMs


Page : 29 of 77




decentralisation of administrativeand financial powers; empowering

the PRIs; preparation ofOperational Guidelines for theimplementation of the Mission;logistics arrangements; disease

surveillance; IEC; and MIS,whereas, the District Health

Mission shall control, guide andmanage all public health

institutions in the district and atsub-district levels. It will be

responsible for preparation andimplementation of an integratedDistrict Action Plan in respect offunds received from all fundingagencies into the District Health

Fund.



Auxiliary Nurse Midwives7 activities undertaken during theweek/fortnight.

Acting as a resource person,along with Anganwadi Worker

for the training of ASHA. Informing ASHA about date

and time of the outreachsession and also guiding her to

bring the prospectivebeneficiaries to the outreach

session. Participating and guiding in

organizing Health Days atAnganwadi Centre.

Taking help of ASHA inupdating eligible couples

register of the villageconcerned.

Utilising ASHA in motivatingthe pregnant women for

coming to Sub-Centre for initialcheck-ups.

ASHA helps ANMs in bringingmarried couples to Sub-

Centres for adopting familyplanning.

Guiding ASHA in motivatingpregnant women for taking full

course of iron folic acid



Page : 30 of 77













structures; delegation anddecentralisation of administrative

and financial powers; empoweringthe PRIs; preparation of

Operational Guidelines for the



Auxiliary Nurse Midwives7 (IFA) tablets and TT injections,etc.

Orienting ASHA on the doseschedule and side affects of

oral pills. Educating ASHA on danger

signs of pregnancy and labourso that she can timely identifyand help beneficiary in getting

further treatment.InformingASHA about date, time andplace for initial and periodic

training schedule. ANM wouldalso ensure that during the

training ASHA gets thecompensation for performanceand also TA/DA for attendingthe training. ANM is expectedto get information from ASHAsregarding the progress madeand consolidate the report at

PHC level. ASHA would act asa bridge between the ANM andthe village and be accountable

to the Panchayat.



Page : 31 of 77




implementation of the Mission;logistics arrangements; disease





Fund.



Auxiliary Nurse Midwives7 An ANM is expected toparticipate in Maternal Health,

Child Health and FamilyPlanning Services; Nutrition

Education; Health Education;Collaborative Service for

Improvement of EnvironmentalSanitation; Immunisation for

Control of CommunicableDiseases; Treatment of Minor

Ailments and First Aid inEmergencies and Disasters.

In addition to these duties, theANM would perform the

following functions in guidingand training the female

Accredited Social HealthActivist (ASHA), as envisaged

in the Guidelines on ASHA,under NRHM:

Holding weekly / fortnightlymeeting with ASHA to discussthe activities undertaken during

the week/fortnight. Acting as a resource person,along with Anganwadi Worker

for the



Page : 32 of 77













structures; delegation anddecentralisation of administrative

and financial powers; empoweringthe PRIs; preparation of

Operational Guidelines for the



Auxiliary Nurse Midwives7 training of ASHA. Informing ASHA about date

and time of the outreachsession and also guiding her to

bring the prospectivebeneficiaries to the outreach

session. Participating and guiding in

organizing Health Days atAnganwadi Centre.

Taking help of ASHA inupdating eligible couples

register of the villageconcerned.

Utilising ASHA in motivatingthe pregnant women for

coming to Sub-Centre for initialcheck-ups.

ASHA helps ANMs in bringingmarried couples to Sub-

Centres for adopting familyplanning.

Guiding ASHA in motivatingpregnant women for taking fullcourse of iron folic acid (IFA)tablets and TT injections, etc. Orienting ASHA on the doseschedule and side affects of

oral pills.



Page : 33 of 77




implementation of the Mission;logistics arrangements; disease





Fund.



Auxiliary Nurse Midwives7 Educating ASHA on dangersigns of pregnancy and labourso that she can timely identifyand help beneficiary in getting

further treatment.InformingASHA about date, time andplace for initial and periodic

training schedule. ANM wouldalso ensure that during the

training ASHA gets thecompensation for performanceand also TA/DA for attendingthe training. ANM is expectedto get information from ASHAsregarding the progress madeand consolidate the report at

PHC level. ASHA would act asa bridge between the ANM andthe village and be accountable

to the Panchayat.


The Accredited Social HealthActivist (ASHA) is the

essential link between thecommunity and the healthfacility. A trained female

ACCREDITED SOCIAL HEALTHACTIVIST (ASHA)

8 [1.4.1] ASHA Training (up to VI th & VIIth Module)


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community health worker –ASHA – is being provided ineach village in the ratio of

one per 1000 population. Fortribal, hilly, desert areas, thenorms are relaxed for one

ASHA per habitationdepending on the workload

ACCREDITED SOCIAL HEALTHACTIVIST (ASHA)

8 [1.4.1] ASHA Training (up to VI th & VIIth Module)

Institutional Deliveriesinclude the deliveries in the

following categories of healthfacilities:

• Hospitals• Dispensaries / Clinics

• UHC/UHP/UFWC• CHC/ Rural Hospital

• PHC• Sub Centre

• AYUSH Hospital/Clinic

INSTITUTIONAL DELIVERIES9 [2.1.1] Institutional Deliveries as a percentage oftotal deliveries

Un-safe delivery is defined asdeliveries conducted at home

or institute not attended byskilled staff and/or trained

birth attendant (dais).

UN-SAFE DELIVERY10 [2.2.1] Reduction in unsafe deliveries in identifyHigh Priority Districts


Page : 35 of 77




Un-safe delivery is defined asdeliveries conducted at home

or institute not attended byskilled staff and/or trained

birth attendant (dais).

UN-SAFE DELIVERY10 [2.2.1] Reduction in unsafe deliveries in identifyHigh Priority Districts

Immunisation programme isone of the essential

interventions for protection ofchildren from life

threatening diseases, whichare avertable.

IMMUNISATION PROGRAMME11 [2.3.1] Target Children immunised

An Intrauterine ContraceptiveDevice (IUCD) is a smalldevice made of plastic or

copper that is placed into theuterus as an effective method

of contraception. Insertionshould only be undertaken by

a trained family planningprofessional.

INTRAUTERINE CONTRACEPTIVEDEVICE (IUCD)

12 [3.1.1] Increase in IUCD insertions over previousfinancial year

System aim to strengthenfrontline health workers and

the health systems withinwhich they work, by enabling

the registration of

PREGNANCY REGISTRATIONSYSTEMS

13 [3.2.1] Increase in the registratin over the previousfinancial year


Page : 36 of 77




pregnancies, births andoutcomes to achieve targets

of reduced maternal,neonatal and infant mortality.Accurate, population-based

numerators anddenominators can help to

improve accountability of thehealth system to provide

expected routine antenataland post-natal care, as wellas emergency support andreferral, as needed. Thus

pregnancy registrationsystems can enhance health

systems, increaseaccountability and reduce

mortality.

PREGNANCY REGISTRATIONSYSTEMS

13 [3.2.1] Increase in the registratin over the previousfinancial year

Immediate postpartuminsertion (within 10 minutes

of delivery of the placenta) ofcopper-bearing

intrauterine devices (IUDs) isgenerally safe and effective,

although compared withinterval insertion it carries a

higher risk of expulsion.

POSTPARTUM INSERTION OFCOPPER-BEARING INTRAUTERINE

DEVICES (IUDS)

14 [3.3.1] Increase in IUD Insertion over the previousfinancial year


Page : 37 of 77




Immediate postpartum IUDinsertions can be

implemented in mostdeveloping-country settingsand any available copper-

bearing IUD can be used forthis purpose.

POSTPARTUM INSERTION OFCOPPER-BEARING INTRAUTERINE

DEVICES (IUDS)

14 [3.3.1] Increase in IUD Insertion over the previousfinancial year

GOI has constituted NIMCwith following terms &

conditions:-:• Undertake field visits toStates/UTs in connection

with effective Implementationof the PC & PNDT Act, 1994.

• Convene Meetings withmembers of the State

Appropriate Authority, StateAdvisory Committee

constituted to monitor theimplementation of the PC &

PNDT Act, 1994.• Evaluation of records

maintained by the DistrictAppropriate Authority,

including examination of theconsolidated reports of Form-F submitted by all registered

USG clinics

NATIONAL INSPECTION &MONITORING COMMITTEE (NIMC)

UNDER PCPNDT ACT

15 [3.4.1] Increase in number of visits


Page : 38 of 77




by the 5th of every month.• Convene meetings with theDistrict/Sub-district AdvisoryCommittees and sensitizemembers of their roles and

responsibilities forimplementation of the law.

• Random inspection ofrecords maintained by the

facility including Registration(Form-A), renewal, Form-Fetc. as per the provisions ofthe PC & PNDT Act, 1994.

• Facilities thesearch/Seizure of

records/instruments offacilities by District

Appropriate Authority,including building up a strong

case for conviction ofoffenders with regard to non-

registration of facilities /nonmaintenance of records,

carrying out sexdetermination

services/advertisement of


UNDER PCPNDT ACT



Page : 39 of 77




sex determination/violationsunder the PC & PNDT Act.• Follow-up with States/UTswith regard to action taken

report and court cases,against violations under the

Act.


UNDER PCPNDT ACT


Identified Govt. MedicalColleges are upgraded by

way of one time grant undercentral funding for starting

PG courses/increasing seatsin PG courses.

UPGRADATION OF IDENTIFIEDMEDICAL COLLEGES

16 [4.1.1] Completion of Upgradation of identifiedMedical Colleges

Under the centrallysponsored scheme namely

“Establishment of NIPS,RIPS and supporting the

state governments medicalcollege for conducting

paramedical courses throughone time grant,” the healthministry will establish oneNIPS at Najafgarh in Delhiand eight RIPS at Nagpur,

Bhopal, Bhubaneswar,Chandigarh, Coimbatore,Hyderabad, Lucknow and

Bihar.

NATIONAL INSTITUTE OFPARAMEDICAL SCIENCES (NIPS)IN DELHI AND EIGHT REGIONALINSTITUTES OF PARAMEDICAL

SCIENCES (RIPS)

17 [4.2.1] Commencement of Work for NIPS


Page : 40 of 77









Bihar.


SCIENCES (RIPS)

17 [4.2.1] Commencement of Work for NIPS







SCIENCES (RIPS)

18 [4.2.2] Commencement of Work for RIPS


Page : 41 of 77




Bihar.NATIONAL INSTITUTE OFPARAMEDICAL SCIENCES (NIPS)IN DELHI AND EIGHT REGIONALINSTITUTES OF PARAMEDICAL

SCIENCES (RIPS)

18 [4.2.2] Commencement of Work for RIPS

In order to meet the shortageof nurses and bring theavailability of nursing

personnel at par with thedeveloped countries new

schemes being envisaged forpromoting nursing in the

country. GOI policy is to openANM (Auxiliary Nursing and

Midwifery) schools and GNM(General Nursing and

Midwifery) Schools in thosedistricts, where there are no

such schools at present,thereby ensuring that all thedistricts of the country willhave at least one Nursing

School.

ANM (AUXILIARY NURSING ANDMIDWIFERY) AND GNM (GENERAL

NURSING AND MIDWIFERY)SCHOOLS

19 [4.3.1] Commencement of teaching in ANMSchools


Page : 42 of 77




In order to meet the shortageof nurses and bring theavailability of nursing

personnel at par with thedeveloped countries new

schemes being envisaged forpromoting nursing in the

country. GOI policy is to openANM (Auxiliary Nursing and

Midwifery) schools and GNM(General Nursing and

Midwifery) Schools in thosedistricts, where there are no

such schools at present,thereby ensuring that all thedistricts of the country willhave at least one Nursing

School.

ANM (AUXILIARY NURSING ANDMIDWIFERY) AND GNM (GENERAL

NURSING AND MIDWIFERY)SCHOOLS

20 [4.3.2] Release of funds for estabilishment GNMSchools

It is an index to highlightincidence of parasite whichcan be worked out through

following formula:API = (confirmed casesduring 1 year/population

under surveillance) x 1000.

ANNUAL PARASITE INCIDENCE(API)

21 24.MALARIA:The following indicators are

used for assessment ofMalaria:

a.Surveillance – Annual BloodExamination Rate (ABER):

Percentage of total no of slidesexamined annually out of total

[5.1.1] Annual Parasite Incidence (API)


Page : 43 of 77




It is an index to highlightincidence of parasite whichcan be worked out through

following formula:API = (confirmed casesduring 1 year/population

under surveillance) x 1000.

ANNUAL PARASITE INCIDENCE(API)

21 population under surveillance.This is calculated as:

Number of Slide Examined inthe Year

--------------------------------------------- X 100

Population under surveillance

b. Incidence of Malaria –Annual Parasite Incidence(API) : Confirmed MalariaCases annually per 1000

population under surveillance.This is calculated as :

Number of confirmed malariacases in the Year

-------------------------------------------------------- X 1000

Population under surveillance

[5.1.1] Annual Parasite Incidence (API)

Asymptomatic carriage ofmalaria/Filariasis parasites

occurs frequently in endemicareas and the detection of

parasites in a blood film froma febrile. In areas of very

high

ENDEMIC DISTRICTS22 FILARIAThe indicator for elimination of

Lymphatic Filarisis is the‘coverage of eligible people

under Mass DrugAdministration’ (MDA)This is calculated as :

[5.2.1] Remaining Endemic Districts (64) achievingMicro Filaria rate of < 1 %


Page : 44 of 77




transmission such estimatesof the attributable fraction

may be imprecise becausevery few individuals are

without parasites.Furthermore, non-malarialfevers appear to suppresslow levels of parasitaemia

resulting in biased estimatesof the attributable fraction.

ENDEMIC DISTRICTS22 Number of peopleadministered with anti-filarial

drugs during MDA----------------------------------------------------------------------------------

X 100Eligible population at the risk of

filarial

[5.2.1] Remaining Endemic Districts (64) achievingMicro Filaria rate of < 1 %

The indicator used for Kala-azar detection is annual newcase detection of Kala-azar

per 10,000 population.Number of Kala-azar cases

in the Year---------------------------------------

----------------- X 10000 Kala-azar Endemic

Population

KALA AZAR23 [5.3.1] BPHCs reporting less than 1 case of Kala-azar per 10000 population out of 275 remainingsuch BPHCs

209 High burdened districtshave been identified withannual prevalence rate of

<10 per lakh population foreradication of Leprosy

through focused

HIGH BURDEN DISTRICTS24 LEPROSY: Annual New Case

Detection Rate (ANCDR) =

Number of new cases detectedduring the year

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

[5.4.1] Annual prevalence rate of < 10 per Lakhpopulation in High burden Districts (209)


Page : 45 of 77




attention. Prevalence Rate(PR) is 3.74/10,000

population (March 2001)which was 57/10,000 in1981. Elimination level

<1/10,000) achieved in 13states. 4 State close to

achieve elimination Leprosyis endemic mainly in states of

Bihar, Jharkhand,Chattisgarh, U.P., WestBengal, Orissa and M.P.

where 64^% are found. Biharhas 24% of recorded leprosycases in India. A total of 5.59lakh cases were detected inIndia by 2000-2001 due to

intensification of theprogramme, the highest

number of cases detected inany year. Annual new casesdetected were 4 to 7.8 lakh.Out of the total 18.5 % were

children. Deformity cases(Grade-II and above) amount

new cases were 2.7%. MBcases among new caseswere 34%. Single lesioncases among new cases

HIGH BURDEN DISTRICTS24 ------------- X 100000Population as on 31st March



Page : 46 of 77




were 10% but vary from areato area. It varies from 22% inWardha to more than 80% in

Tamil Nadu, India.

HIGH BURDEN DISTRICTS24 LEPROSY: Annual New Case

Detection Rate (ANCDR) =

Number of new cases detectedduring the year

--------------------------------------------------- X 100000

Population as on 31st March


The term “case detection”denotes that TB is diagnosed

in a patient and is reportedwithin the national

surveillance system. Smear-positive is defined as a caseof TB where Mycobacteriumtuberculosis bacilli are visiblein the patient’s sputum when

properly stained andexamined under the

microscope.

‘New Case’ denotes a patientwho has never taken TB

treatment in the past or hastaken anti TB treatment, but

for less than 1 month.

TUBERCULOSIS25 [5.5.1] New Sputum Positive (NSP) Success rate


Page : 47 of 77




New Smear positive casedetection rate is calculatedby dividing the number ofnew smear positive cases

notified in the specific cohort(quarter/year) by the

estimated number of newsmear positive cases in the

population for the samequarter/year expressed as a

percentage.

The term new smear positivetreatment success rate

denote the proportion of newsmear positive TB cases

cured or treatment completedto the total number of newsmear positive TB casesregistered in the specific

cohort (quarter/year).

TUBERCULOSIS25 [5.5.1] New Sputum Positive (NSP) Success rate


Page : 48 of 77




Management of patients whohave been previously treated

for tuberculosis (TB) hasbeen a cause of much

debate.1 In 1991, the WorldHealth Organization (WHO)recommended the use of the

“category II retreatmentregimen” for all patients with

a prior history of TBtreatment. The category II

regimen added streptomycinto the first-line agents andextended treatment to 8

months. Multipleobservational studies haveexamined outcomes among

individuals receiving categoryII treatment and shown mixedresults. Overall success rates

are in the 60–80% range,with notably worse outcomes

seen among patients whofailed or relapsed after their

initial treatment episode.

CATEGORY II TREATMENT UNDERTUBERCULOSIS PROGRAMME

26 [5.5.2] Default rate amongst CAT-II patient


Page : 49 of 77




Multi-drug-resistanttuberculosis (MDR-TB) is

defined as tuberculosis thatis resistant to at least

isoniazid (INH) and rifampicin(RMP), the two most

powerful first-line treatmentanti-TB drugs. Isolates thatare multiply resistant to anyother combination of anti-TB

drugs but not to INH andRMP are not classed as

MDR-TB. MDR-TB developsin otherwise treatable TB

when the course ofantibiotics is interrupted andthe levels of drug in the bodyare insufficient to kill 100% ofbacteria. This can happen for

a number of reasons:Patients may feel better andhalt their antibiotic course,

drug supplies may run out orbecome scarce, patients may

forget to take theirmedication from time to time

or patients do not receiveeffective therapy.

MULTI-DRUG-RESISTANTTUBERCULOSIS (MDR-TB)

27 [5.5.3] MDR TB Cases notified put on treatment


Page : 50 of 77




Most tuberculosis therapyconsists of short-course

chemotherapy which is onlycuring a small percentage of

patients with multi-drugresistant tuberculosis. Delays

in second line drugs makemulti-drug resistant

tuberculosis more difficult totreat. MDR-TB is spread fromperson to person as readilyas drug-sensitive TB and in

the same manner. Even withthe patent off second line

antituberculosis medicationthe price is still high and

therefore a big problem forpatients living in poor

countries to be treated..

MULTI-DRUG-RESISTANTTUBERCULOSIS (MDR-TB)

27 [5.5.3] MDR TB Cases notified put on treatment

A cataract is a clouding of thelens inside the eye which

leads to a decrease in vision.It is the most common cause

of blindness and isconventionally treated withsurgery. Visual loss occurs

because

CATARACT28 [5.6.1] Cataract Surgeries performed (in Lakhs)


Page : 51 of 77




opacification of the lensobstructs light from passing

and being focused on totheretina at the back of the

eye. It is most commonly dueto biological aging but thereare a wide variety of othercauses. Over time, yellow-brown pigment is deposited

within the lens and this,together with disruption of the

normal architecture of thelens fibers, leads to reducedtransmission of light, which in

turn leads to visualproblems.Those with cataract

commonly experiencedifficulty appreciating colors

and changes in contrast,driving, reading, recognizing

faces, and experienceproblems coping with glare

from bright lights

CATARACT28 [5.6.1] Cataract Surgeries performed (in Lakhs)


Page : 52 of 77




The National Programme forControl of Visual Impairmentand Blindness was launchedin 1976 as a 100% centrallysponsored and incorporatesthe earlier Trachoma ControlProgramme that was started

in 1963 to reduce theprevalence of blindness

(1.49% in 1986-89) to lessthan 0.3%;

and to establish aninfrastructure and efficiencylevels in the programme to

be able to cater new cases ofblindness each year to

prevent future backlog withthe objectives :-

1.To establish eye carefacilities for every 5 lakh

population,2. To develop humanresources for eye care

services at all levels theprimary health centres,

CHCs, sub-district levels,3. To improve quality of

service delivery and

NATIONAL PROGRAMME FORCONTROL OF BLINDNESS

29 [5.6.2] Spectacles to school children screened withrefractive error (in Lakhs)


Page : 53 of 77




4. To secure participation ofcivil society and the private

sector.

NATIONAL PROGRAMME FORCONTROL OF BLINDNESS

29 [5.6.2] Spectacles to school children screened withrefractive error (in Lakhs)

This programme waslaunched in 1990-91 and

under this programme eachstate and union territory has

advised to prepare theirprojects on health education,

early detection, and painrelief measures. For this theycan get up to Rs. 15 lakh onetime assistance and Rs. 10lakh for four years recurring

assistance. The districtprogramme has fiveelements: 1.Health

education; 2.Early detection;3.Training of medical &

paramedical personnels.4.Palliative treatment andpain relief. 5.Coordination

and monitoring. The Districtprogrammes are linked withRegional Cancer Centres/

Government Hospitals/Medical

District Cancer Control Programme30 [5.7.1] Development of District Cancer Facilities


Page : 54 of 77




Colleges. For effectivefunctioning each district

where programme is startedhave one District CancerSociety that is chaired by

local Collector/Chief MedicalOffice. Other members are

Dean of medical college, Zilaparishad representative,NGO representative etc.

District Cancer Control Programme30 [5.7.1] Development of District Cancer Facilities

In India it is estimated thatthere are 2 to 2.5 million

cancer patients at any givenpoint of time with about 0.7million new cases coming

every year and nearly half dieevery year. Two-third of the

new cancers are presented inadvance and incurable stageat the time of diagnosis. More

than 60% of these affectedpatients are in the prime of

their life between the ages of35 and 65 years. With

increasing life expectancyand changing life styles

NATIONAL CANCER CONTROLPROGRAMME

31 [5.7.2] Strengthening of Tertiary Cancer Centres


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concomitant withdevelopment, the number ofcancer cases will be almost

three times the currentnumber. It has long been

realised that cancers of thehead and neck in both sexesand of the uterine cervix in

women are the mostcommon malignancies seen

in the country. The ageadjusted incidence rate per100,000 for all types in Indiain urban areas range from106-130 for men and 100-

140 for women but still lowerthan USA, UK and Japan

rates. 50% of all malecancers are tobacco related

and 25% in female (total 34%of all cancers are tobacco

related). There arepredictions of incidence of 7

fold increase in tobaccorelated cancer morbidity in

between 1995-2025. Tocontrol this problem the Govt.

of




Page : 56 of 77




India has launched aNational Cancer ControlProgramme in 1975 and

revised its strategies in 1984-85 stressing on primary

prevention and earlydetection of cancer with

goals1.The primary prevention of

tobacco related cancers.2.Secondary prevention of

cancer of the uterine cervix,mouth, breast etc.; and

3.Tertiary prevention includesextension and strengthening

of therapeutic servicesincluding pain relief on anational scale through

regional cancer centres andmedical colleges (including

dental colleges).



The Government of India haslaunched the National MentalHealth Programme (NMHP)in 1982, keeping in view the

heavy burden of mental

NATIONAL MENTAL HEALTHPROGRAMME

32 [5.9.1] Starting of Academic Session in Centres ofExcellence


Page : 57 of 77




illness in the community, andthe absolute inadequacy of

mental health careinfrastructure in the country

to deal with it aiming forPrevention and treatment of

mental and neurologicaldisorders and their

associated disabilities; Use ofmental health technology to

improve general healthservices and application ofmental health principles in

total national development toimprove quality of life with

following objectives:-1. To ensure availability and

accessibility of minimummental health care for all in

the foreseeable future,particularly to the most

vulnerable andunderprivileged sections of

population.2. To encourage applicationof mental health knowledge

in




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general health care and insocial development.

3. To promote communityparticipation in the mental

health services developmentand to stimulate effortstowards self-help in the

community.



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Section 5 :Specific Performance Requirements from other Departments


Organisation TypeRelevant Success

Indicator

What is yourrequirement fromthis organisation

Justification for thisrequirement

LocationType

Please quantify yourrequirement fromthis Organisation

What happens ifyour requirement is

not met.State Organisation Name

•It would hamper theachievement of Nationaltargets and programme

outcomes.

•Guidelines forincorporating variousHealth & FamilyWelfare schemes andtraining programmes,•Constant monitoring topromote quality Health& Family welfareservices in the country.

[1.3.1] Deployment ofnew ANMs

•To strengthen the nationalresponse to promote health

care of fellow citizens.

CentralGovernment

•Full support andcommitment.

Department of AIDS ControlDepartments

[1.3.2] Deployment ofnewDoctors/Specialists

[1.3.3] Deployment ofnew Staff Nurses

[1.4.1] ASHA Training(up to VI th & VIIthModule)

[2.2.1] Reduction inunsafe deliveries inidentify High PriorityDistricts

[2.3.1] Target Childrenimmunised

[5.10.2] Screening ofNCDs at DistrictHospitals and below


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Indicator



LocationType





outcomes



care of fellow citizens

•Full support andcommitment

Department of HealthResearch





[4.3.1] Commencementof teaching in ANMSchools

[5.8.1]Operationalization ofnew Tobacco Testinglabs for Nicotine andTar


[6.1.1] Commencementof Nursing Teaching


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Indicator



LocationType




Academic Session inMedical Colleges

It would hamper theachievement of Nationaltargets and programme

outcomes.

[1.1.3] Increase in theservice delivery byMobile MedicalUnits(MMU) overbaseline figure as on31.03.2013

To strengthen the nationalresponse to promote health


Full support andcommitment.

Department of AYUSH

[1.1.4] Increase in thenumber PatientTransported over thebaseline figure for 2012-13.

[1.2.1] Utilization offunds by new VillageHealth, Sanitation &Nutrition Committees(VHSNC) released up tothe end of previousfinancial year


[2.1.1] InstitutionalDeliveries as apercentage of totaldeliveries



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Indicator



LocationType






[5.11.2] Establishmentof Regional GeriatricCentres


outcomes.

•Constant monitoring topromote quality Health& Family welfareservices in the country.




•Full support andcommitment

Ministry of Drinking Waterand Sanitation

Ministry

•Guidelines forincorporating variousHealth & FamilyWelfare schemes andtraining programmes,•Constant monitoring topromote quality Health& Family welfareservices in the country.


•Full support andcommitment.

Ministry of Defence


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Indicator



LocationType





[1.1.5] Establishment ofSpecial New Born CareUnits in DistrictHospitals






[3.1.1] Increase in IUCDinsertions over previousfinancial year

[3.2.1] Increase in theregistratin over theprevious financial year


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Indicator



LocationType




[3.3.1] Increase in IUDInsertion over theprevious financial year

[4.1.1] Completion ofUpgradation of identifiedMedical Colleges


[5.1.1] Annual ParasiteIncidence (API)

[5.5.3] MDR TB Casesnotified put on treatment

[5.6.1] CataractSurgeries performed(in Lakhs)

[5.10.1] Set up NCDClinics and CardiacCare Units in DistrictHospitals

[6.1.1] Commencementof Nursing TeachingAcademic Session inMedical Colleges


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Indicator



LocationType





Ministry of Railways









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Indicator



LocationType





[3.1.1] Increase in IUCDinsertions over previousfinancial year




[5.6.2] Spectacles toschool childrenscreened with refractiveerror (in Lakhs)


[5.11.1]Operationalization ofGeriatric OPD and 10beds ward at DistrictHospitals

[6.1.1] Commencementof


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Indicator



LocationType




Nursing TeachingAcademic Session inMedical Colleges

Guidelines forincorporating variousHealth & FamilyWelfare schemes andtraining programmes,•Constant monitoring topromote quality Health& Family welfareservices in the country.


Ministry of Panchayati Raj




[3.4.1] Increase innumber of visits

•Guidelines forincorporating

[1.1.5] Establishment ofSpecial New Born

Ministry of Women andChild Development


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Indicator



LocationType




various Health &Family Welfareschemes and trainingprogrammes,•Constant monitoring topromote quality Health& Family welfareservices in the country.

Care Units in DistrictHospitals

Ministry of Women andChild Development






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Indicator



LocationType





•Constant monitoring topromote quality Health& Family welfareservices in the country.


Ministry of Human ResourceDevelopment



[5.9.1] Starting ofAcademic Session inCentres of Excellence

[5.9.2] Approval forstarting up of PGcourses in MentalHealth Specialities

[6.1.1] Commencementof Nursing TeachingAcademic Session inMedical Colleges

•The progress ofimplementati-on will slowdown availability of quality

healthcare on equitableaccessible

•Number of personsprovided qualityhealthcare serviceswith special focus onunder-served and

[1.1.1]Operationalization of24X7 Facility at PHClevel out of the totalnumber of 24000

•To enhance the quality of life offellow citizens in the countrywith thrust on health care.

All StatesStateGovernment

•100% commi-tment& support for

effective implem-entationwith constant monito-ring.

All Organizationothers


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Indicator



LocationType




and affordable basisacross regions &

communities with specialfocus on under-served

population &marginalized groups.

marginalized-group.•Number ofcomprehensive primaryhealthcare deliverysystem established& their well-functioning linkageswith secondary &tertiary care healthdelivery system.•Majority Health relatedparameters.•Implement-ation andtimely reporting theprogress of variousHealth & familywelfare programmesand outcomes.

PHCs •To enhance the quality of life offellow citizens in the countrywith thrust on health care.

All StatesStateGovernment

•100% commi-tment& support for

effective implem-entationwith constant monito-ring.

All Organizationothers

[1.1.2]Operationalisation ofCHCs into First ReferralUnits (FRU) out of thetotal number of 4000CHCs



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Indicator



LocationType











[2.2.1] Reduction inunsafe deliveries inidentify High Priority


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Indicator



LocationType




Districts


[3.2.1] Increase in theregistratin over theprevious financial year


[4.2.1] Commencementof Work for NIPS

[4.2.2] Commencementof Work for RIPS



[5.2.1] RemainingEndemic Districts (64)achieving Micro Filariarate of < 1 %


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Indicator



LocationType




[5.3.1] BPHCs reportingless than 1 case ofKala-azar per 10000population out of 275remaining such BPHCs

[5.4.1] Annualprevalence rate of < 10per Lakh population inHigh burden Districts(209)

[5.5.3] MDR TB Casesnotified put on treatment


[5.7.1] Development ofDistrict Cancer Facilities

[5.7.2] Strengthening ofTertiary Cancer Centres

[5.10.1] Set up NCDClinics and CardiacCare Units in DistrictHospitals



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Indicator



LocationType




[5.11.1]Operationalization ofGeriatric OPD and 10beds ward at DistrictHospitals

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Section 6:Outcome/Impact of Department/Ministry


Outcome/Impact ofDepartment/Ministry

Jointly responsible forinfluencing this outcome /impact with the following

department (s) / ministry(ies)

SuccessIndicator

FY 11/12 FY 13/14FY 12/13 FY 14/15 FY 15/16Unit

0.0201 0.0199Average number of primaryhealth care centres per 1000population

Improved access to healthcare services

States/UTs 0.0198 0.01970.0221 Number

37.32 37.89Average number of primaryhealth care centres per district

38.33 39.0337.45Number

44 35Infant mortality rateReduction in Mortality Rate States/UTs 31 27392 Per 1000live births

7.1 7.0Crude death rate 7.0Per 1000populatio

81.4 75Institutional Deliveries as a %of Total deliveries

Improvement in MaternalHealth

States/UTs 75 75823 %

86.9 85Full Immunization (age group0-12 Month)

86 8785%

2.4 2.4Total Fertility RateReduction in growth rate ofpopulation

States/UTs 2.3 2.32.44 childrenborn perwoman

1.10 1.10Annual Parasite Incidence(Malaria)

Reduction in the burden ofcommunicable and noncommunicable diseases

States/UTs Under1 Under10.855 Per 1000populatio

- 70Annual prevalence rate ofLeprosy < 10 per Lakhpopulation in High burdenDistricts (209)

70 70-Numberof

2570 2700Reconstructive Surgeries(Leprosy) performed

2700 27002548Number


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Section 6:Outcome/Impact of Department/Ministry


Outcome/Impact ofDepartment/Ministry

Jointly responsible forinfluencing this outcome /impact with the following

department (s) / ministry(ies)

SuccessIndicator

FY 11/12 FY 13/14FY 12/13 FY 14/15 FY 15/16Unit

88.8 89.5New Sputum positive (NSP)Success rate

89.5 89.589%

0.074 0.076Number of doctors per 1000population

Development of humanresources

States/UTs 0.077 0.0780.0756 Number


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