monitoring report of tamil nadunhsrcindia.org/sites/default/files/tamil nadu monitoring...pg. 2...

NHSRC

Monitoring Report of Tamil Nadu

Jan-Mar 2013

V Roddawar

05/13/13

The report is based on HMIS data analysis, health provider and beneficiary interviews and monitoring visit to Vellore district of Tamil Nadu. The monitoring visit includes all levels of health facilities in the district. One needs to be cautious in interpretation of HMIS data, the state and districts may have good performance of health indicators but there might be problem in reporting data. Details of visit provided in the annexure-A

pg. 1 NHSRC

Contents Executive Summary .................................................................................................................... 3

1. Facility Mapping ..................................................................................................................... 8

2. Maternal Health ...................................................................................................................... 9

2.1. Maternal Death ............................................................................................................... 10

3. Human Resources for Health.............................................................................................. 11

4. Janani-Shishu Suraksha Karyakram (JSSK) .................................................................... 13

4.1 User fee in Out Patient Department (OPD) and In Patient Department (IPD) ... 13

4.2 Drugs and Consumables ................................................................................................ 13

4.3 Diagnostics ....................................................................................................................... 14

4.4 Diet ..................................................................................................................................... 14

4.5 Referral Transport ........................................................................................................... 15

4.6 Display of entitlements .................................................................................................. 16

4.7 Awareness of community .............................................................................................. 17

4.8 Grievance Redressal Cell ............................................................................................... 17

4.9 Out of pocket expenditure / informal charges ........................................................... 17

5. Outreach activities ................................................................................................................ 18

5.1 Immunization ................................................................................................................... 18

6. Child Health ........................................................................................................................... 19

7. Family Planning .................................................................................................................... 20

8. WIFS and Sanitary Napkins ............................................................................................... 21

9. School Health Programme................................................................................................... 22

10. Health Management Information Systems (HMIS) ..................................................... 22

11. Mobile Medical Units ........................................................................................................ 23

12. Integrated Disease Surveillance Project (IDSP) ........................................................... 23

13. Quality of Services .............................................................................................................. 24

13.1 Infrastructure .................................................................................................................. 24

13.2 Information Display ..................................................................................................... 24

13.3 Infection Prevention ..................................................................................................... 25

13.4 Emergency preparedness ............................................................................................. 25

14 Disease Control Programme .............................................................................................. 25

pg. 2 NHSRC

14.1 Revised National Tuberculosis Control Programme (RNTCP) ........................... 25

14.2 National Leprosy Eradication Programme (NLEP) ................................................. 26

Tables

Table 1 District Profile – Vellore, TN ..................................................................................... 7

Table 2 District Health Facilities ............................................................................................. 7

Table 3 Functional delivery points in public health facilities of Vellore district, TN

2013................................................................................................................................................. 8

Table 4 Key health indicators of Tamil Nadu Vs Vellore ................................................... 9

Table 5 Comparison of selected maternal indicators of Vellore, TN – 4th quarter of

2011-12 to 2012-13 ........................................................................................................................ 9

Table 6 Human Resource for Health – Vellore, TN 2013 .................................................. 12

Table 7 Available Specialists in health facilities, Vellore, TN ........................................ 12

Table 8 Status of different types of new born care facilities in Vellore, TN ................ 19

Table 9 Family Planning indicators of Vellore, TN for 4th quarter (2011-12 and 2012-

13) ................................................................................................................................................. 21

Table 10 IDSP laboratory surveillance form ....................................................................... 24

Graphs

Graph 1 Facility wise contribution of institutional deliveries for the 4th quarter 2011-

12 – Vellore, TN ......................................................................................................................... 10

Graph 2 Analysis of Maternal Deaths in Vellore district, TN ......................................... 11

Graph 3 Para-medical staff – sanctioned Vs Positioned, Vellore, TN 2013 ................... 12

Graph 4 Duration of stay after delivery in Vellore, TN from Jan to March 2013 ......... 15

Graph 5 Month wise ambulance service against reported deliveries from Jan to

March 2013– Vellore, TN ......................................................................................................... 16

Graph 6 Immunisation Coverage of various antigensagainst estimated live births for

fourth quarter of 2011-12 to 2012-13 ....................................................................................... 18

Graph 7 reported Infant death (up to Sept’ 2012), Vellore, TN ........................................ 20

Graph 8 Distribution of sanitary napkins through VHN and schools from Jan to Mar

2013............................................................................................................................................... 21

Graph 9 Week wise disease trend analysis for first 9 weeks of 2013 ............................. 23

Graph 10 TU wise performance of RNTCP from Jan to March 2013, Vellore, TN ....... 26

pg. 3 NHSRC

Executive Summary

The Monitoring report for Tamil Nadu is based on the HMIS data analysis and field

visit to Vellore district of Tamil Nadu from 7th to 9th May 2013. The monitoring visit

includes all levels of health facilities in the district. Details of visit provided in the

annexure-A

1. Facility Mapping

Out of 68 round the clock PHCs, 81% are conducting more than 10 deliveries per

month.

Except few, none of the sub-centers are operational as delivery points even though

they have adequate infrastructure with attached staff quarter.

There are total 7 blood bank and 18 blood storage units are licensed and functional

in the district.

2. Maternal Health

The ANC registration against expected pregnancies jumped 28%; from 56 % in 2011-

12 to 84% in 2012-13,

Around 3.1 % drop in hypertension in pregnancy cases against ANC reported. This

year % of severe anemia (HB <7) treated cases dropped by 1.4 % in comparison with

previous year.

Secondary and tertiary contribute 37% and PHCs & CHCs contribute 34 and 29 % of

the total deliveries in the 4th quarter of 2012-13.

Number of C-section deliveries against institutional deliveries increased by 5.4 % in

comparison with previous year’s fourth quarter.

2.1 Maternal Death

Around 48 maternal deaths were reported during 2011-12 and 25 deaths up to Sep

2012. MDRs show that, 40 % maternal deaths belong to Schedule Caste (SC) and 28

% from BCs, 16 % MBCs and 8 % each from ST and other communities. 64% of the

deaths, occurred in medical colleges and 16% during transit.

pg. 4 NHSRC

Major causes of maternal deaths are PPH (20%), PIH (16%), Sepsis (16%) and other

reasons are 20 %. Around 38 % of deaths occurred less than 24 hours and 29 %

within one to two weeks.

3. Human Resource for Health

400 village health nurses are positioned at health sub centers against 454, which is 12

% shortfall against sanctioned.

More than 50 % of Health Inspectors (HI), Block Extension Educator (BEE) and Non-

Medical Supervisor (NMS) positions are vacant in the district.

Around 50 % of x-ray and lab technician positions are vacant in the district.

Around 11 MOs were trained in Life Saving Anesthetic Skills (LSAS) and 3 MOs in

Emergency Obstetric Care (EmOC) during the financial year 2012-13.

4. Janani-Shishu Suraksha Karyakram (JSSK)

OPD and IPD services are free in all the facilities and no shortage of drugs

Provision of free diet available in all health facilities and the cost per head is Rs.80

per day.

More than 90 % of the beneficiaries discharge after three days, which indicates good

intake of diet provision in health facilities.

Only 16% (n=24) of the beneficiaries availed the ambulance service to reach the

health facility and for drop-back 29 % beneficiaries would be utilizing the service.

There are no signages for JSSK, and grievance redressal mechanism is unavailable in

the visited facilities.

5. Outreach activity

Cumulative figures of Vellore in last quarter of 2012-13 shows overall increase in

immunization as compared to the last year.

6. Child health

Still birth constitute one % of total live births recorded and male infant deaths are

slightly higher (1.25%) than female infant deaths (1%) (Up to September 2012).

pg. 5 NHSRC

98 % of total infant deaths occur in rural areas and out of total infant deaths, 56 %

deaths occur within one week time.

7. Family planning

As per the DLHS III, the district reported 18.2 total unmet needs and only 6% of the

total unmet needs were catered in the district, which slightly improved between two

different quarters.

8. WIFS and Sanitary Napkins

WIFS progamme covers around 2.56 lakhs girls and line listing of total 100,158

adolescent girls available across 40 PHCs. However, there is no coverage of boys

under WIFS

Total 1.18 lakhs napkins were distributed, which include 52,638 through VHN and

66,115 through schools in the fourth quarter of 2012-13.

9. School health programme

The district covers around 1070 government and 168 aided schools covering 2.64

lakhs students from 1st grade to 12th grade in the district.

10. Health Management Information System

There are more than 20 different formats for information systems are being used by

different programs.

11. Mobile Medical Units

The district has 20 MMU in 20 blocks and on an average each MMU covers 1200

OPD load per month. The lowest OP being 500 and the highest OP 3000 per month.

Every block has a micro plan with fixed dates at block level.

12. Integrated Disease Surveillance Project (IDSP)

Total 112 cases of dengue reported, 78 in Vellore and 34 in Tirupathur division from

Jan to Feb 2013. Around 70% of the reported total cases fall above 14 years of age.

13. Quality of services

None of the PHC have proper protocols for disposal of bio-medical waste. These

PHCs are still dependent on deep burial pits, where they dump bio-medical waste

including placenta.

Secondary care facilities have tied up with third party agency to dispose bio-waste.

These have proper color coded buckets in OT, labor and lab rooms

pg. 6 NHSRC

14 Disease control programme

Out of seven TUs, one TU is managed by Community Health and Development

(CHAD), CMC Vellore under PPP model and 5 DMCs under NGO partnership.

There are around 50 MDR cases detected, 10 released from treatment and 40 cases

on medication in regional center for drug-resistant TB center.

During fourth (2012-13) quarter 27 new cases were detected, which include 21 MB

and 6 PB.

During the year 2012-13, total 139 new cases detected, which include 76 MB and 63

PB cases.

pg. 7 NHSRC

District Background

Table 1 District Profile – Vellore, TN

Table 2 District Health Facilities

Source: District PIP 2013-14

Vellore District Profile, TN

State Tamil Nadu

District HQ Vellore

District revenue divisions

3

Taluks 9

Blocks 20

Corporation & Municipalities

12

Town Panchayats 16

Revenue villages 843

Panchayats villages 743

Population 3,928,106

Literacy 79.65%

Bensity 650/KM2

District Boarders

North Andhra Pradesh

East Thiruvallur

West Krishnagiri

South Thiruvannamalai & Kancheepuram

Health facilities - Vellore Dist. Number

District Hospital 1

Sub Divisional Hospital 10

Community Health Centers 20

Primary Health Centers 66

Urban PHC 14

Upgraded PHC 14

Health Sub-Centers 454

Anganwadi centers 2422

VHWSC 851

pg. 8 NHSRC

1. Facility Mapping

Vellore district has three revenue divisions, nine taluks, 20 blocks, 12 municipalities

with 16 town panchayats and 843 revenue villages. The district has 3.9 million

population with 79.6% literacy rate as per 2011 census. For every 50,000 population

one PHC is available in the district, there are total 78 PHCs in 20 blocks, on an average

each block has 1.95 lakhs population and per block 4 PHCs available in the district. For

every 6 to 7 thousand population one Health Sub-Centre (HSC) is available in the

district. On an average, every block has 22 -23 HSC available, which totals to 454 sub-

centers in the district. Every village has one Village Health Water and Sanitation

Committee (VHWSC) totaling 851 and 2422 Anganwadi Centers (AWC) with 2302

Anganwadi Worker (AWW); a shortage of 5% AWW.

Table 3 Functional delivery points in public health facilities of Vellore district, TN 2013

Sl .No Health facilities - Vellore District Number

1 Total No. of SCs/conducting >3 deliveries per month 454/0

2 Total No. of 24X7 PHCs/conducting >10 deliveries per month 68/55

3 Total No. of CHCs ( Non- FRU) conducting > 10 deliveries /month 18

4 Total No. of CHCs ( FRU) conducting > 20 deliveries /month with C-section

2

5 Total No. of any other FRUs (excluding CHC-FRUs)/conducting > 20 deliveries per month with C-section

8/7

6 Total No. of DH conducting > 50 deliveries /month with C-section 1

7 Total No. of Medical colleges conducting > 50 deliveries/month with C-section

1

8 No. of Blood bank licensed and functional 7

9 No. of Blood Storage Units licensed and functional 18

Source: District PIP 2013-14 None of the sub-center are operational as delivery point. Out of 68 round the clock PHCs, 81% conduct more than 10 deliveries per month. All non-FRU CHCs are conducting more than 10 deliveries and 2 FRU CHCs are conducting more than 20 deliveries including C-sections. District hospital and government medical college are conducting more than 50 deliveries per month. There are total 7 blood banks and 18 blood storage units licensed and functional in the district.

pg. 9 NHSRC

Table 4 Key health indicators of Tamil Nadu Vs Vellore

Sl. No. Health indicators Tamil Nadu Vellore

1 MMR (per 100,000 live births) 2007-09 SRS 97 97

2 CBR ( per 1000 population) 2001 15.9 16

3 CDR ( per 1000 population) 2011 7.4 6.5

4 IMR (2011) 22 22

2. Maternal Health

Comparison of selected maternal health indicators of Vellore for the fourth quarter of 2011-12 to 2012-13 shows improvement across all key indicators. The ANC registration against expected pregnancies increased by 28 %; from 56 % in 2011-12 to 84 % in 2012-13%. Nevertheless, % of ANC registration in first trimester against reported registration remain the same. As shown in table 5 below, around 3.1 % drop in hypertension in pregnancy cases as against previous year (4.3%) was reported. This year % of severe anemia (HB <7) treated cases dropped by 1.4 % in comparison with previous year. Table 5 Comparison of selected maternal indicators of Vellore, TN – 4th quarter of 2011-12 to 2012-13

Sl. No.

Key Indicators – Vellore, TN

Jan to Mar Jan to Mar

2012 2013

1 % ANC Registration against Expected Pregnancies

56 84

2 % ANC Registration in first trimester against Reported ANC registration

81 82

3 % Severe anemia (Hb<7) treated against reported ANC registration

2.7 1.3

4 % Hypertension in pregnancy- detected against ANC reported

4.3 1.2

4 % Institutional Deliveries against Estimated Deliveries

36.5 60

5 % Home deliveries( SBA& Non SBA) against estimated deliveries

0.5 0.3

6 C Section deliveries against institutional deliveries

9.4 14.8

Source: HMIS

Home deliveries, SBA and non SBA dropped marginally (by 0.2 %) and number of C-

section deliveries against institutional deliveries increased by 5.4 % in comparison with

pg. 10 NHSRC

SEC Hospitals 37%

PHC 33%

UG-CHC 17%

UG-CHC (MCH) 7%

CHC 5%

UG-PHC 1%

SEC Hospitals PHC UG-CHC UG-CHC (MCH) CHC UG-PHC

previous year. District hospital, government medical college and other FRUs

(excluding CHC) conduct 37 % of total institutional deliveries in the district. PHCs and

CHCs conducted 34 and 29 % of the total deliveries (Q4 2012-13 data). PHCs and CHC

generally perform normal deliveries and CHC MCH centers, GH and government

medical colleges caters to complicated and C-section deliveries.

VHNs are the basic pillar of public health at community level for prevention and

promotion of health care in Tamil Nadu. VHNs are qualified para-medics who possess

great experience working at community level. However, despite most HSC having

good infrastructure with attached VHN quarters, none of the sub-center conduct

deliveries except few.

Graph 1 Facility wise contribution of institutional deliveries for the 4th quarter 2011-12 – Vellore, TN

2.1. Maternal Death The MMR of Tamil Nadu is 97 per 100,000, which is one of the lowest MMR in India .The state and district has robust mechanism of maternal and infant death audits. District constituted MDR task force and district magistrate regularly reviews maternal deaths every month and follow-up action to reduce the MMR at district level. Last year, the district has trained 20 district medical officers, 20 block medical officers, 15 private hospitals and 52 MOIC on maternal death review. Facility based MDR committees have been constituted at all levels of delivery points in the district. Around 48 maternal deaths reported during 2011-12 and 25 deaths up to September 2012. Community based

pg. 11 NHSRC

MDR was also constituted at the district level and 5 MDR have been audited by community. Out of 25 maternal deaths reviewed, 40 % belongs to Schedule Caste (SC) and 28 %, 16

% from BCs and MBCs and 8 % each from ST and other community. Most of the deaths,

64 %, occurred in medical colleges and 16 % during transit. Major causes of maternal

deaths are PPH (20%), PIH (16%), Sepsis (16%) and other reasons are 20 %. Around 38

% of deaths occurred less than 24 hours and 29 % within one to two weeks. Below

graphs provides analysis of maternal deaths up to September 2012 for Vellore district.

Graph 2 Analysis of Maternal Deaths in Vellore district, TN

3. Human Resources for Health

pg. 12 NHSRC

There are around 400 village health nurses positioned at health sub centers against 454, which is 12 % shortfall against sanctioned. However, 80 % and above of all positions include MOs, AYUSH MOs, SN, ANM, and VHNs are positioned in the district. Around 50 % of x-ray and lab technician positions are vacant in the district. Table 6 Human Resource for Health – Vellore, TN 2013

Sl. No. Human Resources - Vellore Sanctioned Positioned Shortage

1 Medical Officers 224 184 18%

2 Staff Nurse (Regular) 18 14 22%

3 Staff Nurse (Contractual) 248 218 12%

4 Village Health Nurse (VHN) 454 400 12%

5 ANM 102 86 16%

6 Lab Technician 59 31 47%

7 X-Ray technician 6 3 50%

8 AYUSH Doctor (Regular) 33 29 12%

9 AYUSH Doctor (Contractual) 24 24 0%

Source: district PIP 2013-14

There are 29 specialist, which include 7 pediatrician, 6 Anesthetics and 16 gynecologist

available in the district. Around 11 MOs were trained in Life Saving Anesthetic Skills

(LSAS) and 3 MOs in Emergency Obstetric Care (EmOC) during the financial year 2012-

13.

Table 7 Available Specialists in health facilities, Vellore, TN

Sl. No. Specialist - Vellore, TN Regular

1 Pediatricians 7

2 Anesthetics 6

3 Gynecologists 16

4 MOs trained in LSAS 11

5 MOs trained in EmOC 3

Graph 3 Para-medical staff – sanctioned Vs Positioned, Vellore, TN 2013

pg. 13 NHSRC

6

9 8

13

19 20

18 18

20 20 20 20

0

5

10

15

20

25

Block ExtensionEducator

Block HealthSupervisor Tech

Non-MedicalSupervisor

Block HealthSupervisor

CommunityHealth Nurse

Para-MedicalOphthalmicAssistants

P A R A - M E D I C A L S T A F F - S A N C T I O N E D V S P O S I T I O N E D V E L L O R E , T N 2 0 1 3

Position Sanctioned

There are around 184 various para-medical personnel available across different health

facilities out of 333 sanctioned, which is about 45% shortfall against approved.

Nonetheless, Community Health Nurse (CHN) and Para-Medical Ophthalmic

Assistants (PMOA) positions are almost filled across 20 different blocks of the district.

More than 50 % of Health Inspectors (HI), Block Extension Educator (BEE) and Non-

Medical Supervisor (NMS) positions are vacant. The NMS are public health point

persons responsible for prevention and promotion of health care at community level.

4. Janani-Shishu Suraksha Karyakram (JSSK)

4.1 User fee in Out Patient Department (OPD) and In Patient Department (IPD)

OPD and IPD services are free in all the facilities. Out of 24 beneficiaries interviewed

across different health facilities, no one reported paying user charges for OPD and IPD

services.

4.2 Drugs and Consumables

It is observed that there is no shortage of drugs in all health facilities in the district. No

beneficiary reported buying medicine from private medical store.

pg. 14 NHSRC

4.3 Diagnostics

Diagnostic services are free at all levels

of facilities, which include routine blood

and urine examination. Pregnant

women are exempted from paying

money for laboratory tests. At primary

level all facilities are organizing ANC

meeting with all listed pregnant women

in that catchment area. The meeting is a

platform to educate ANC mothers about

ANC care and inform about state and

central government schemes. During

these meetings ANC mothers undergo

regular check-up and ultrasound scanning for genetic anomalies and other routine

examinations. The health facility provides lunch for all ANC mothers who attend the

clinic.

4.4 Diet

Provision of free diet is available in

all health facilities. PHCs tie-up with

local hotels to provide three meals

for PNC mothers and the cost per

head is Rs.80 per day. CHCs and DH

have separate kitchens to cook food

for the inmates of the hospital. Staff

nurse generally takes additional

charge of these kitchens. Almost all

interviewed beneficiaries were

satisfied with the food provided by

the health facilities.

As shown in graph 4, more than 90 % of all beneficiaries are discharged after three days

of delivery, which indicates good intake of diet provision in health facilities. Almost all

mothers are aware that they will be discharged after three days.

Community Kitchen, Natrampalli CHC

Pallikonda PHC-ANC weekly meeting

pg. 15 NHSRC

Graph 4 Duration of stay after delivery in Vellore, TN from Jan to March 2013

Source: HMIS

4.5 Referral Transport

Only 16% (n=24) of the beneficiaries availed the ambulance service to reach the health

facility and remaining 20 beneficiaries either used their own vehicle (Auto) or used local

bus. For drop-back 29 % beneficiaries would be utilizing the service and remaining 17

beneficiaries would be using their own vehicle (Auto). During exit interviews, all

beneficiaries informed that they are aware of ambulance services but due to various

reasons could not avail the facility. Around 50 % respondents said that they visited

health facility during full-term for usual check-up but admitted to the hospital for

delivery.

2452

2056

2591

134 85 249

0

500

1000

1500

2000

2500

3000

January February March

D U R A T I O N O F S T A Y - V E L L O R E , T N

Deliveries conducted at Public Institutions

Of which Number discharged under 48 hours of delivery

pg. 16 NHSRC

Graph 5 Month wise ambulance service against reported deliveries from Jan to March 2013– Vellore, TN

There is no exclusive ambulance for referral

transport but they depend on 108 ambulance

service, which is already overburdened with

high number of causalities. Beneficiaries

also reported that the response time for 108

ambulance is 15-35 mins longe than

expected (30 mins). Administration and

finance department informed that the fund

has been released to all level health facilities

to implement JSSK but secondary and

tertiary level hospitals have returned the

funds related to transportation.

It is evident from the reported data that only 7 to 10 % of the beneficiaries are availing

the ambulance facility and remaining

depend on private vehicles which is one of

the major reason for out of pocket

expenditure among the PWs.

4.6 Display of entitlements

The signage of JSSK not displayed in health

facilities visited, when discussed with the

district officials, they informed that JSSK

24

52

20

56

25

91

18

1

15

5

27

0

J A N U A R Y F E B R U A R Y M A R C H

A M B U L A N C E S E R V I C E A G A I N S T D E L I V E R I E S - V E L L O R E , T N

Deliveries conducted at Public Institutions

Total Number of times the Ambulance was used for transporting patients during the month

Pallikonda PHC 108

PHC Vinnampalli

pg. 17 NHSRC

progamme started in January 2013 in the district. However, display of JSY is visible in

all health facilities visited and display of state health schemes such as Dr. Muthu

Lakshmi Reddy Maternity Benefit Scheme and CM comprehensive health insurance

schemes were also well displayed

4.7 Awareness of community

When enquired about JSSK entitlements with beneficiaries, they were aware about

entitlements under different schemes including JSSK. Weekly ANC meeting at PHC

level is a good platform to create awareness about different schemes and also for ANC

checkup. Village Health Nurse (VHN) also acts as catalyst to create awareness among

communities. Socially and politically, communities are empowered to demand health

services. State has also maternity benefit schemes, which provides Rs.12,000 for BPL

families. The scheme provides amount in three instalments, 1st installment after

completion of full ANC check-up, 2nd after delivery and 3rd instalment after completion

of full immunization of child.

4.8 Grievance Redressal Cell

There is no grievance redressal mechanism available in the visited facilities, when

enquired with the beneficiaries (n=24), 46 % said MO, 42 % VHN and 13 % said they

will approach nurse. No one has said that they don’t know but there is no formal

system to address beneficiary’s grievance in health facilities.

4.9 Out of pocket expenditure /

informal charges

Interaction with beneficiaries

revealed that out of pocket

expenditure arise mostly on

transportation. Around 45 %

interviewed beneficiary have used

their own vehicle (auto) for

convenience even though they know

the availability of ambulance

services. State level programme

officer informed that they are in the

process of pooling ambulance to

place at health facility with centralized call center for assured referral services for

eligible mothers.

Pallikonda PHC

pg. 18 NHSRC

5. Outreach activities

5.1 Immunization

Cumulative figures for district Vellore shows overall increase in immunization as

compared to the last year. The full immunization was 46% in the last quarter of 2012

while it is 73% in the fourth quarter of 2012-13. BCG-measles drop out %age was

reported zero in 2012 to -6% in 2013. At the same time dropout from BCG to DPT3 has

increased from 31% in 2012 to 100% in 20131. Facilities visited had functional ILR and

deep freezer with temperature card duly filled and adequate temperature maintained.

In Vellore, due to shortage of power supply, most of the ILR/deep freezers are

dependent on power generator or UPS.

Graph 6 Immunisation Coverage of various antigensagainst estimated live births for fourth quarter of 2011-12 to 2012-13

Source: HMIS

The district has good performance of planned versus held immunization sessions which

correlates with immunization achievement in the district. However, HIMS show that

very low number of ASHAs attended immunization session because ASHAs were new

to the district and all sessions were attended by village health nurse who does

community mobilization.

1 One needs to be cautious in interpretation of HMIS data, the district may have good performance of immunization activities but

there might be problem in reporting data.

51 49 51 46

73 76 77 73

0

10

20

30

40

50

60

70

80

90

BCG% OPV3% Measles% Fully Immunised%

V E L L O R E , T N - I M M U N I S A T I O N ( 0 T O 1 1 M N T H S ) A G A I N S T E S T I M A T E D L I V E B I R T H S - J A N T O M A R

2011-12 2012-13

pg. 19 NHSRC

5.2 ASHA

ASHAs are known as Village Health

Volunteers (VHV) in Tamil Nadu and

these VHVs are one year old in the district.

Vellore district has about 82 ASHAs,

representing 34 34 in tribal area and 48 in

plain areas. It is reported that the plain

area ASHA were less than a year old

whereas in tribal areas they are one year

old. Most of the tribal area ASHA were

dropped out due to various reasons. However, the district has planned to select 124

more ASHA in the coming year. All ASHA were trained up to module 5 and none of

the ASHAs were trained in module 6 and 7. District has distributed drug kits to all

ASHAs and 32 HBNC kits to tribal area ASHAs.

The support structures at district level include community health Nurse and village

health nurse. It is observed that ASHAs act as complement and supplement to village

health nurse, wherein ASHAs are more active in outreach services.

6. Child Health

The IMR of the state was 22 and administratively the

district has two health units (HUDs). The district has

all functional new born care centers as against

sanctioned. There are total 10 NBCCs, 2 NBSUs and 2

SNCUs available in the district. Out of 2 SNCUs, one

located in government medical college of Vellore and

another in district head quarter hospital in Walaja.

Apart from new born care, there are two nutritional

rehabilitation centers available in Vellore HUD.

Table 8 Status of different types of new born care facilities in Vellore, TN

Status NBCC NBSU SNCU NRC

Sanctioned

Functional

Sanctioned

Functional

Sanctioned

Functional

Sanctioned

Functional

Vellore HUD

6 6 1 1 2 2 2 2

Tirupathur HUD

4 4 1 1 2 2 0 0

ASHA, Vinampalli. AWC

Natrampalli CHC

pg. 20 NHSRC

District total 10 10 2 2 4 4 2 2 Source: district PIP 2013-14

The district constituted maternal and child death task force headed by district

magistrate, which reviews maternal-child deaths every month at the district

headquarters. The infant death reviews suggest that still birth constitute one % of total

live births recorded and male infant deaths are slightly higher (1.25%) than female

infant deaths (1%) (Up to September 2012) in the district. 98 % of total infant deaths

occur in rural areas and out of total infant deaths, 56 % deaths occur within one week

time. However, during 8 to 28 days period, 14 % of infant deaths were reported. As

against total live birth records, 1.5 % deaths in male children and 1.4 %in female infant

deaths were recorded in the district.

Graph 7 reported Infant death (up to Sept’ 2012), Vellore, TN

7. Family Planning

Performance of family planning programmes reflects poor outcome in the district. As

per the DLHS III, the district had 18.2% unmet need. Only 6% of the total unmet needs

were catered to in the district, which slightly improved; from 2 % in 2011-12 to 6 % in

2012-13. However, there is huge gap between demand and supply. There is an urgent

need to appraise family planning activities in the district, which should accommodate

the needs of the district. One needs to be cautious in interpretation of HMIS data, the

district may have good performance of family planning activities but there might be

problem in reporting data.

34

83

22

68

24

78

33

49

0 - 2 4 H O U R S 1 - 7 D A Y S 8 - 2 8 D A Y S 2 9 - 3 6 5 D A Y S

I N F A N T D E A T H S

Male Female

pg. 21 NHSRC

Table 9 Family Planning indicators of Vellore, TN for 4th quarter (2011-12 and 2012-13)

FP Key Indicators 2012 2013

Jan to Mar Jan to Mar

Estimated eligible couples for unmet need - Calculated using DLHSIII for the quarter - Vellore, TN

1,21,536 1,23,966

% Total reported FP Users against estimated eligible couples

2% [2847]

6% [6913]

% Total IUDs reported against total reported FP users

24% [690]

38% [2618]

% Total OCP users against total reported FP users

2% [47]

4% [267]

% of Total sterilization (against Estimated Level of Achievement)

1.53% [1866]

2.19% [2722]

% Postpartum sterilization out of total female sterilizations

92% [1711]

96% [2718]

% Male sterilizations out of total sterilizations 0.05% [1]

0.14% [4]

% Female sterilizations out of total sterilizations

99.94% [1865]

99.85% [2718]

8. WIFS and Sanitary Napkins

Health sub-center level, VHN maintains line listing of all adolescent population, which

include school going and out of school girls. WIFS progamme covers around 2.56 lakhs

girls and line listing of total 100158 adolescent girls available across 40 PHCs. WIFS

programme include distribution of IFA and albendazole tablets. Total 1.18 lakhs

sanitary napkins were distributed in the fourth quarter of 2012-13; 52,638 through VHN

and 66,115 through schools.

Graph 8 Distribution of sanitary napkins through VHN and schools from Jan to Mar 2013

9893 19415 23330

13911

21625

30579

0

10000

20000

30000

40000

50000

60000

Jan' 2013 Feb' 2013 Mar' 2013

Distribution of Sanitary Napkins, Vellore

VHN School

pg. 22 NHSRC

9. School Health Programme

The district covers around 1070 government and 168

aided schools covering 2.64 lakhs students from 1st grade

to 12th grade in the district. The approach of SHP in

Vellore is PHC based doctor supported by staff nurse

across 20 blocks in the district. Every block has four

dedicated SHP teams to screen the children. In Tirpathur

health unit district, there are total 42 SHP teams available

in 10 blocks. Total 15 AYUSH doctors, 4 dentist and 202 dedicated ANMs are available.

Most school children were screened two times a year.

10. Health Management Information Systems (HMIS)

District is uploading facility wise (PHC

level) data in national web portal. There

is a dedicated State Health Data Resource

Centre (SHDRC) under TNSHP,

whichanalyzes district wise data. Most of

the facilities are included in the hierarchy

of web portal. Besides, there are more

than 20 different information systems

being used by different programs.

Multiple information systems functioning

parallel to each other leads to duplication

of work and require additional efforts of

health staff e.g. PICME (local version of

MCTS) and HMIS. Gaps still exist in

computerization of data form important

programs such as Blood Banks, Trainings

etc.

HMIS system is area-wise reporting

based on the family health register. The system was designed for HSC level reporting;

later option of consolidated as well as granular data entry was given from PHC level.

Area wise reporting helps in taking care of the entire population in the area however

leads to duplication in the HMIS, therefore performance monitoring of each facility

becomes difficult. State in the process of reporting facility based HMIS, which is

recommended by GoI. There are no evidence of private sector data reporting. Similarly

reporting from urban areas in the information systems is limited.

Kandaneri HSC

PHC Vinnampalli

pg. 23 NHSRC

11. Mobile Medical Units

The district has 20 MMU in 20 blocks and on an average each MMU covers 1200 OPD

load per month. The lowest OP coverage is 500 and the highest OP 3000 per month.

Every block has a micro plan with fixed dates at block level. VHN also plays an

important role in social mobilization for MMUs. However, no diagnostic services are

available in the MMUs and they only prescribe for general aliments.

12. Integrated Disease Surveillance Project (IDSP)

District has robust IDSP programme, which is reviewed every month by district

magistrate. There are total 117 institutions reporting L-form and 114 P-form, which

include private and other hospitals (ESI) in the district. Total 454 S-forms are reporting

to the district surveillance officer (DSO). Total 112 cases of dengue reported, 78 in

Vellore and 34 in Tirupathur division from Jan to Feb 2013. Around 70% of the

reported total cases fall above 14 years of age. However, there is no mortality reported

among dengue cases.

Graph 9 Week wise disease trend analysis for first 9 weeks of 2013

pg. 24 NHSRC

Table 10 IDSP laboratory surveillance form

Sl. No Diseases January

2013 February

2013

1 Dengue 82 30

2 Hep-A 7 3

3 Hep-E 5 3

4 Malaria 16 8

5 Scrub Typhus 55 18

6 TB 167 174

7 Typhoid 269 143

8 Leprosy 9 3

9 Chloera 0 0

10 chikungunya 0 0

13. Quality of Services

13.1 Infrastructure

Adequate infrastructure is available in

all health facilities. The initiative by

state to improve infrastructure under

TNHSP was visible in secondary and

tertiary hospitals. It has been observed

that due to NRHM, primary care

infrastructure has been improved over

a period of time. All construction

under health department is

undertaken by health division of PWD

department. Almost all PHC have same design with a big campus. It seems there are

two facilities, which have been accredited by NABH. One visited facility, Natrampalli,

has been audited and is going to ISO certification. On an average, 370 OP and 6 IP per

1,000 population were reported under HMIS for the 4th quarter of 2012-13 in the district.

This suggests an OPD utilization rate of nearly 1.5/capita/annum which is reasonable,

although IPD utilization needs improvement

13.2 Information Display

Information related to health programs are well displayed except JSSK entitlements,

which started in January 2013 in the district. Visited facilities have displayed citizen

charter, facility catchment area with number of HSCs, RKS and month wise facility

performance of institutional deliveries. However, state schemes like Dr. Muthu

Unaivaniyambad HSC

pg. 25 NHSRC

Lakshmi Reddy Maternity Benefit and CMs

comprehensive health insurance scheme

were well displayed outside of all visited

facilities. Health sub-centers are also well

display information on health related

activities. It seems most of the film fraternity

are actively engaged in RNTCP and

HIV/AIDS awareness. CHC Natrampalli

has a display of Expected Date of Deliveries

(EDD) and also a chart depicting type of

deliveries – normal and LSCS, which is

commendable.

13.3 Infection Prevention

None of the PHC have proper protocols for

disposal of bio-medical waste. These PHCs are still dependent on deep burial pits,

where they dump bio-medical waste including placenta. Usually, health workers take

the responsibility for the disposal of hospital waste.

However, secondary care facilities have tied up with third party agency to dispose bio-

waste and CHC meet the expenditure from RKS or AMC grant. Secondary care

facilities have proper color coded buckets in OT, labor and lab rooms and in some

facilities they are in partial use. Needles and syringes are properly mutilated and

disinfected before putting in waste bin. However, the district needs additional trainings

and robust monitoring as far as infection prevention practices are concerned.

13.4 Emergency preparedness

District headquarter hospital has dedicated casualty division to attend the emergency

cases. There is an increasing trend in number of emergency case in urban areas of the

district. Some of the primary and secondary care facilities have emergency

preparedness but there is still scope to improve the emergency preparedness as per

standard protocol.

14 Disease Control Programme

14.1 Revised National Tuberculosis Control Programme (RNTCP)

Vellore district has seven Treatment Units (TUs) and 36 Designated Microscopic

Centers (DMC). Out of seven TUs, one TU is managed by Community Health and

Development (CHAD), CMC Vellore under PPP model and 5 DMCs under NGO

partnership. However, out of 36 DMCs only 5 RNTCP LT are posted and rest of them

are vacant. Interaction with DTCO revealed that there are some legality issues

regarding recruitment of LTs in the district, which is pending in the court. Most of the

pg. 26 NHSRC

DMC are dependent on other lab technicians in the health facility for sputum

examination. It is also observed that, almost all TU are above population norms, which

should be 5 lakhs per TU. As per the revised RNTCP population norms, the district

needs 14 to 15 TUs.

Graph 10 TU wise performance of RNTCP from Jan to March 2013, Vellore, TN

Drug-Resistant TB center and Intermediate Reference Laboratory (IRL) for culture of

drug susceptibility located in CMC, Vellore for five district of Tamil Nadu. There are

around 50 MDR cases detected, 10 released from treatment and 40 cases on medication

in regional center for drug-resistant TB center.

14.2 National Leprosy Eradication Programme (NLEP)

Tamil Nadu achieved the status of elimination of leprosy and the current prevalence

rate is 0.42 per 10,000 population. District Leprosy Officer (DLO) supervises the leprosy

activities in the district. Out of 20, only 8 non-medical supervisors available in the

district and there is inadequate staff for leprosy detection at PHC level. There is no skin

smear test available in any health facility and almost all cases were detected based on

nerve and skin patches. During fourth (2012-13) quarter 27 new cases detected, which

include 21 MB and 6 PB.

At district headquarters, total 101 cases are under treatment by the end of March 2013,

which include 75 MB and 26 PB. Total 5 leprosy cases were detected in March 2013, out

of them 1 MB and 4 PB. During the year 2012-13, total 139 new cased detected, which

include 76 MB and 63 PB cases. 7 deformity cases were detected and 11 cases were

referred to Reconstructive Surgery (RCS). However, these health facilities do not have

capacity to treat disabilities and they refer to nearby leprosy referral center.

135 137 146 146 145 145 151

73 82 81 86 90

77 69 89 90 89 91 90 91 91 85 85 86 86 86 87 86

020406080

100120140160

TU wise performance of RNTCP Jan to Mar 2013

ANCDR New Smear+ treated Sputum conversion rate Cure rate

pg. 27 NHSRC

Annexure – A

Facilities visited – Vellore, Tamil Nadu

Sl. No. Date Facility visited Block Persons interacted

1 07.05.2013 PHC, Pallikonda Anaicut MOs, Dental MO, SN, LT

2 07.05.2013 Health Sub Centre, Kandaneri

Anaicut VHN, CHN, AWW and ASHA

3 07.05.2013

Health Sub Centre, Unaivaniyambad

Anaicut VHN

4 07.05.2013

PHC, Vinnampalli

Sholingur MO, Dental MO, SN, LT and NCD SN

07.05.2013

Anganwadi Centre, Vinnampalli

Sholingur AWW, VHN, CHN, ANC and PNC

5 07.05.2013

PHC, Melpadi Sholingur MO, Dental MO, SN, LT and NCD SN

6 08.05.2013 PHC, Madanur Madhanur MO, Dental MO, SN, LT and NCD SN

7 08.05.2013 CHC, Natrampalli

Natrampalli MO, Dental MO, SN, LT TB-TU, and NCD SN

9 09.05.2013 District Headquarter hospital, Walajah

Walajah MO, SN, LTs, BBS, Emergency ward,

10 09.05.2013 DTCO, Vellore Vellore AD, DTCO

11 09.05.2013 NLEP, Vellore Vellore NMS, DDHS

12 09.05.2013 DMC, Vellore Vellore HV

pg. 28 NHSRC

Tamil Nadu April 12 - Jan 13

Comparison with Last Year Performance using HMIS data from National Web portal

National Health Systems Resource Centre

pg. 29 NHSRC

Tamilnadu - Apr'12 - Jan'13

DLHSIII

Population (Census-2011) 7,21,38,958

Estimated Pregnancies

12,76,851

ANC

CBR (SRS-2011) 15.9 Estimated Deliveries 11,60,774

ANC Check-up in first trimester

76.8

Apprehended Infant Deaths ( IMR = 24 taken

from SRS - 2011 ) 27528

Estimated Live Births

11,47,009

3 or more ANC Check-up 95.6

Estimated Eligible couples ( 17% of population)

1,22,63,623

Estimated Maternal Complications( 15%

of Estimated pregnancies)

1,91,528

Atleast 1 TT received 97.

2

Indicator Apr'12 - Jan'13 Projected for 2012

- 13 Last Year 2011

- 12 100 IFA Tablets 54.

7

3ANC Check up against estimated pregnancies

52% 63% 70%

Deliveries

Institutional Deliveries (Public+Private) against estimated deliveries

59% 71% 80%

Institutional Delivery

94

Met need for EmOC * 27.80% 33% 116.73%

Home Delivery 5.7

Reported Live Births against estimated Live Births

64% 77% 85%

Home Delivery by SBA

1.5

BCG to Measles dropout rate

-1% -1% 0%

New born & post natal care

pg. 30 NHSRC

Fully Immunised against estimated Live Births

54% 65% 80%

Abortion (Induced + Spontaneous)

Immunisation session held as % of required VHNDs

580% 580% 738%

Still Birth 88.6

Childhood Disease Diphtheria

0 0 0

Live Birth 1.2

Childhood Disease Pertussis

0 0 0

Breastfed within 1 hour of birth

76.1

Childhood Disease Measles 28 33.6 938

PNC within 48 hrs of delivery

Childhood Disease Malaria 138 165.6 1102 Immunisation

Sterilization - Female per 1000 eligible couple

16.82

20.18

23.79

BCG 99.5

Sterilization - Male per 1000 eligible couple

0.07

0.08

0.14

DPT3 89.5

Reported Abortion Rate per 1000 Estimated live births

61.9

74.3 93.9

Measeles 95.

5

OPD All (per 1000 population)

1036.2

1,243.4 1864.2

Full immunisation

81.6

IPD (per 1000 population) 18.5

22.2 51.0

Unmet need for Family

Planning Operation Major (per Lakh population)

45.3

54.4 240.260 Spacing 5.4

Reported Infant and Child Deaths

1387

1,664.4 11505

Limiting 12.7

Reported Maternal Deaths 71

85.2 534

Total 18.1

* Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Chennai - Apr'12 - Jan'13

DLHSIII

Population (Census-2011)

46,81,087


82,855

ANC

CBR (SRS-2011) 15.9 Estimated Deliveries 75,322

ANC Check-up in first trimester 89.8


from SRS - 2011 ) 1786 Estimated Live Births 74,429

3 or more ANC Check-up

99.5


7,95,785

Estimated Maternal Complications( 15% of

Estimated pregnancies)

12,428

Atleast 1 TT received

100

pg. 31 NHSRC

Indicator Apr'12 - Jan'13

Projected for 2012 - 13 Last Year 2011

- 12 100 IFA Tablets

67.6


72% 87% 90%

Deliveries


93% 111% 111%


100

Met need for EmOC * 186.07% 223% 204.32%

Home Delivery 0


77% 93% 88%


0


0% 0% -14%



81% 97% 96%



23% 23% 15%

Still Birth 1.8


0 0 0

Live Birth 93.1


0 0 0 Breastfed within 1 hour of birth 46.5

Childhood Disease Measles

20 24 72 PNC within 48 hrs of delivery



28.90

34.68

36.34

BCG 96.8


0.33

0.40

0.45

DPT3 84.8


186.9

224.3 240.8

Measeles

85.1


554.2

665.0 643.5

Full immunisation

76.7


21.6 10.3 Unmet need for FP

Operation Major (per Lakh population)

50.1

60.1 43.879 Spacing 7.9


499

598.8 653 Limiting 6.9


27.6 47 Total 14.8


Coimbatore - Apr'12 - Jan'13

DLHSIII

pg. 32 NHSRC


34,72,578


61,464

ANC







5,90,338



9,220


99.2




59.5


45% 53% 74%

Deliveries


80% 96% 95%


96.8

Met need for EmOC * 144.22% 173% 173.25%

Home Delivery 3.2


55% 66% 96%


0


0% 0% 1%



49% 58% 92%



36% 36% 41%

Still Birth 90


0 0 0

Live Birth 1.6


0 0 0

Breastfed within 1 hour of birth 64.8


0 0 0

PNC within 48 hrs of delivery 94.5

Childhood Disease Malaria 0 0 0 Immunisation


17.25

20.70

23.42

BCG 100


0.04

0.05

0.15

DPT3 81.5


54.7

65.6 79.2

Measeles

95.3


984.3

1,181.2 1879.7

Full immunisation

75.8


34.1 52.4


Planning

pg. 33 NHSRC

Operation Major (per Lakh population)

165.2

198.3 331.800 Spacing 4.7


402

482.4 813 Limiting 9.2


18.0 27 Total 13.9


Cuddalore - Apr'12 - Jan'13

DLHSIII


26,00,880


46,035

ANC







4,42,150



6,905


95.6




34.7


53% 64% 65%

Deliveries


50% 60% 81%


92.3

Met need for EmOC * 1.85% 2% 40.93%

Home Delivery 7.7


61% 74% 86%


1.9


-4% -4% 7%



50% 61% 74%



21% 21% 21%

Still Birth 86.8


0 0 0

Live Birth 3


0 0 0



0 0 0



pg. 34 NHSRC


13.81

16.57

19.55

BCG 100


0.09

0.11

0.13

DPT3 90.6


40.6

48.8 53.9

Measeles

95.8


2180.5

2,616.7 5033.9

Full immunisation

86.9


42.0 26.8



29.3

35.1 139.914 Spacing 4.1


0 -

368 Limiting 18

Reported Maternal Deaths 0 -

19 Total 22.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Dharmapuri - Apr'12 - Jan'13

DLHSIII


15,02,900


26,601

ANC







2,55,493



3,990


98.2




60.7


61% 73% 89%

Deliveries


73% 87% 103%


92

Met need for EmOC * 5.11% 6% 103.00%

Home Delivery 7.3


82% 98% 114%


1.4


0% 0% 1%



62% 75% 101%


pg. 35 NHSRC


36% 36% 30%

Still Birth 90.3


0 0 0

Live Birth 0.8


0 0 0



0 0 0




23.55

28.27

34.58

BCG 100


0.03

0.04

0.07

DPT3 91.5


87.0

104.5 115.6

Measeles

98.3


1032.4

1,238.8 4997.2

Full immunisation

83.3


29.2 94.3



72.1

86.6 246.457 Spacing 5.7


0 -

495 Limiting 10.9



Dindigul - Apr'12 - Jan'13

DLHSIII


21,61,367


38,256

ANC







3,67,432



5,738


97.3




53.7


64% 77% 77%

Deliveries


62% 75% 77%


92.5

pg. 36 NHSRC


Home Delivery 7.5


71% 86% 87%


2.3


3% 3% 3%



62% 74% 81%



42% 42% 34%

Still Birth 83.2


0 0 0

Live Birth 2.3


0 0 0



0 0 0




17.46

20.96

30.84

BCG 100


0.05

0.06

0.12

DPT3 88.8


73.4

88.0 131.7

Measeles

98.9


1451.7

1,742.1 878.8

Full immunisation

87.5


23.7 12.4



4.5

5.4 2.730 Spacing 5.8


2

2.4 300 Limiting 12



Erode - Apr'12 - Jan'13

DLHSIII


22,59,608


39,995

ANC

pg. 37 NHSRC







3,84,133



5,999


99.7




54.5


43% 52% 56%

Deliveries


50% 60% 68%


98.5

Met need for EmOC * 6.80% 8% 249.02%

Home Delivery 1.5


54% 65% 75%


0.4


-1% -1% -3%



43% 51% 69%



38% 38% 25%

Still Birth 87.8


0 0 0

Live Birth 4.2


0 0 0



0 0 1




16.46

19.75

25.80

BCG 100


0.11

0.13

0.13

DPT3 95.8


48.3

58.0 95.7

Measeles

89.7


969.3

1,163.1 819.3

Full immunisation

81.6


22.0 16.6



29.6

35.5 244.202 Spacing 4.7


2

2.4 154 Limiting 9.7

pg. 38 NHSRC



Kancheepuram - Apr'12 - Jan'13

DLHSIII


39,90,897


70,638

ANC







6,78,452



10,596


100




46.8


50% 60% 60%

Deliveries


53% 64% 63%


94.7

Met need for EmOC * 16.63% 20% 98.30%

Home Delivery 5.3


63% 76% 72%


1.2


-1% -1% 4%



53% 64% 66%



29% 29% 27%

Still Birth 92.5


0 0 0

Live Birth 0


0 0 0



0 0 0




12.40

14.88

17.54

BCG 100

pg. 39 NHSRC


0.02

0.02

0.06

DPT3 95.9


43.2

51.9 47.0

Measeles

95.8


620.2

744.3 1073.4

Full immunisation

85.9


7.4 21.7



31.5

37.9 344.158 Spacing 4


0 -

269 Limiting 8.6



Kankyakumari - Apr'12 - Jan'13

DLHSIII


18,63,174


32,978

ANC





3 or more ANC Check-up 98


3,16,740



4,947


92.8




71


30% 36% 47%

Deliveries


53% 63% 74%


98.9

Met need for EmOC * 1.23% 1% 104.21%

Home Delivery 1.1


49% 58% 70%


1.1


0% 0% 3%



48% 58% 64%


pg. 40 NHSRC


37% 37% 20%

Still Birth 84.2


0 0 0

Live Birth 0.8


0 0 0



0 0 99




17.88

21.45

33.51

BCG 98.7


0.03

0.04

0.04

DPT3 83.8


24.8

29.8 60.0

Measeles

97.6


649.5

779.4 1369.3

Full immunisation

77.3


13.1 18.5



8.3

10.0 577.455 Spacing 3.6


0 -

127 Limiting 5.6



Karur - Apr'12 - Jan'13

DLHSIII


10,76,588


19,055

ANC







1,83,020



2,858


98.9




53.7


52% 62% 68%

Deliveries

pg. 41 NHSRC


55% 66% 74%


91.7

Met need for EmOC * 0.42% 1% 133.23%

Home Delivery 7.1


63% 76% 83%


0.7


-5% -5% 2%



60% 73% 79%



59% 59% 42%

Still Birth 92.2


0 0 0

Live Birth 0


0 0 0



0 0 0




13.79

16.54

18.07

BCG 100


0.05

0.06

0.15

DPT3 89.3


68.3

82.0 105.0

Measeles

94.5


1351.6

1,621.9 2692.3

Full immunisation

83.6


19.3 41.2



76.4

91.7 421.052 Spacing 4.8


0 -

235 Limiting 14.6



Krishnagiri - Apr'12 - Jan'13

DLHSIII


18,83,731


33,342

ANC

pg. 42 NHSRC







3,20,234



5,001


96.2




70.2


51% 61% 71%

Deliveries


58% 70% 85%


86.9


Home Delivery 13


66% 80% 93%


3.2


-2% -2% -1%



58% 69% 85%



41% 41% 39%

Still Birth 87.1


0 0 0

Live Birth 0.9


0 0 0



0 0 0




16.59

19.91

24.25

BCG 99.8


0.03

0.03

0.07

DPT3 88.6


34.7

41.6 67.3

Measeles

90.2


900.8

1,081.0 1636.2

Full immunisation

79.7


36.1 64.8



89.6

107.5 505.539 Spacing 6.5


0 -

352 Limiting 15.3

pg. 43 NHSRC



Madurai - Apr'12 - Jan'13

DLHSIII


30,41,038


53,826

ANC







5,16,976



8,074


93.8




56.3


42% 50% 80%

Deliveries


58% 69% 79%


95.4


Home Delivery 3.7


65% 78% 89%


0.7


-2% -2% -2%



44% 53% 80%



32% 32% 26%

Still Birth 81.5


0 0 0

Live Birth 2.7


0 0 0



0 0 0




15.54

18.64

22.67

BCG 100

pg. 44 NHSRC


0.08

0.10

0.11

DPT3 86.5


51.5

61.7 98.9

Measeles

92.9


862.2

1,034.7 1446.1

Full immunisation

62.5


13.8 24.0



52.3

62.7 110.390 Spacing 4.1


3




Nagapattinam - Apr'12 - Jan'13

DLHSIII


16,14,069


28,569

ANC







2,74,392



4,285


99.5




37.7


49% 59% 66%

Deliveries


53% 64% 83%


98.4


Home Delivery 1.6


66% 79% 80%


0.4


-1% -1% 1%



58% 70% 73%


pg. 45 NHSRC


40% 40% 37%

Still Birth 87.5


0 0 0

Live Birth 0


0 0 0



0 0 0




12.50

15.00

15.51

BCG 100


0.20

0.24

0.29

DPT3 96.8


63.2

75.9 66.9

Measeles

99.9


1135.0

1,362.0 2749.5

Full immunisation

95


28.9 70.8



0.0 -

450.910 Spacing 6.8 Reported Infant and Child Deaths

0 -

327 Limiting 21.2


12 Total 28 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Namakkal - Apr'12 - Jan'13

DLHSIII


17,21,179


30,465

ANC







2,92,600



4,570


97.8




65.9


58% 69% 78%

Deliveries

pg. 46 NHSRC


51% 61% 73%


94.8

Met need for EmOC * 7.09% 9% 158.08%

Home Delivery 5.2


56% 67% 76%


1.4


-2% -2% -1%



50% 60% 74%



623% 623% 22%

Still Birth 88.5


0 0 0

Live Birth 0.7


0 0 0



0 0 7




14.91

17.89

23.77

BCG 95.2


0.08

0.10

0.16

DPT3 85.2


54.1

64.9 133.7

Measeles

95.2


1127.1

1,352.5 2469.1

Full immunisation

81


20.3 89.8



68.6

82.3 244.484 Spacing 3.6


2

2.4 282 Limiting 10.4


1.2 15 Total 14


Peramablur - Apr'12 - Jan'13

DLHSIII

Population (Census-2011) 5,64,511


9,992 ANC

pg. 47 NHSRC







95,967



1,499


98.2




52.9


61% 74% 66%

Deliveries


60% 72% 80%


92.3


Home Delivery 7.7


70% 85% 92%


3.8


-4% -4% 6%



66% 79% 85%



157% 157% 31%

Still Birth 89.5


0 0 0

Live Birth 1.3


0 0 0



0 0 0




11.34

13.60

15.67

BCG 100


0.01

0.01

0.07

DPT3 90


53.9

64.7 85.2

Measeles

96


1392.5

1,671.0 2319.4

Full immunisation

83.1


26.4 56.1



0.0 -

459.867 Spacing 6 Reported Infant and Child Deaths

0 -

33 Limiting 17.2

pg. 48 NHSRC



Pudukkotai - Apr'12 - Jan'13

DLHSIII


16,18,725


28,651

ANC







2,75,183



4,298


99.2




43.6


62% 74% 83%

Deliveries


60% 72% 81%


97.9

Met need for EmOC * 0.70% 1% 135.79%

Home Delivery 2.1


70% 84% 99%


0.9


-1% -1% 2%



63% 76% 96%



61% 61% 48%

Still Birth 91.5


0 0 0

Live Birth 1


0 0 0



1 1.2 1




11.19

13.43

16.69

BCG 100

pg. 49 NHSRC


0.01

0.01

0.15

DPT3 98.4


46.7

56.0 57.9

Measeles

93.3


1257.1

1,508.5 1867.4

Full immunisation

89.9


26.4 37.4



7.6

9.1 166.242 Spacing 5.7


0 -

319 Limiting 15.3


7 Total 21 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Ramanathapuram - Apr'12 - Jan'13

DLHSIII


13,37,560


23,675

ANC







2,27,385



3,551


97.9




43.6


63% 75% 87%

Deliveries


65% 78% 72%


97.5

Met need for EmOC * 8.36% 10% 124.94%

Home Delivery 2.5


72% 86% 104%


0.5


-5% -5% 0%



60% 72% 97%


pg. 50 NHSRC


68% 68% 45%

Still Birth 84.5


0 0 0

Live Birth 1.8


0 0 0



0 0 0




16.14

19.37

26.12

BCG 96.5


0.09

0.11

0.08

DPT3 91.7


68.4

82.0 95.5

Measeles

96.1


1244.8

1,493.8 1400.5

Full immunisation

88.6


31.9 19.4



29.8

35.8 8.598 Spacing 7.9


0 -

309 Limiting 19.6



Salem - Apr'12 - Jan'13

DLHSIII


34,80,008


61,596

ANC







5,91,601



9,239


97




59.9


52% 62% 77%

Deliveries

pg. 51 NHSRC


61% 74% 87%


95.6

Met need for EmOC * 2.21% 3% 107.38%

Home Delivery 3.6


66% 79% 92%


2


2% 2% 0%



52% 62% 89%



34% 34% 31%

Still Birth 92


0 0 0

Live Birth 0


0 0 0



0 0 8




14.92

17.90

22.10

BCG 100


0.02

0.02

0.04

DPT3 74.1


60.8

72.9 129.2

Measeles

95.6


814.0

976.8 1908.0

Full immunisation

67.2


13.1 113.5



31.1

37.4 260.833 Spacing 4.3


0 -

803 Limiting 12.9


1.2 41 Total 17.2


Sivaganga - Apr'12 - Jan'13

DLHSIII


13,41,250


23,740

ANC

pg. 52 NHSRC


ANC Check-up in first trimester 61





2,28,013



3,561


95.8




64.2


51% 61% 67%

Deliveries


53% 64% 85%


94

Met need for EmOC * 0.48% 1% 138.98%

Home Delivery 5.1


60% 72% 89%


4.2


-2% -2% -1%



52% 63% 88%



66% 66% 60%

Still Birth 86.9


0 0 0

Live Birth 1.1


0 0 0



0 0 0




15.79

18.95

26.18

BCG 100


0.08

0.10

0.27

DPT3 86.9


45.1

54.1 90.1

Measeles

94.6


1379.9

1,655.9 3057.2

Full immunisation

82.5


21.4 49.9



21.0

25.1 430.494 Spacing 6.9


0 -

304 Limiting 13.9

pg. 53 NHSRC



Thanjavur - Apr'12 - Jan'13

DLHSIII


24,02,781


42,529

ANC







4,08,473



6,379


98.7




69.3


58% 70% 77%

Deliveries


52% 63% 84%


99.1

Met need for EmOC * 0.67% 1% 233.79%

Home Delivery 0.9


61% 73% 83%


0.1


-1% -1% -1%



49% 59% 81%



42% 42% 54%

Still Birth 90.3


0 0 0

Live Birth 0.9


0 0 0

Breastfed within 1 hour of birth 75


0 0 16




21.04

25.25

29.24

BCG 100

pg. 54 NHSRC


0.06

0.07

0.14

DPT3 91.4


73.9

88.6 79.2

Measeles

90.9


1028.0

1,233.6 1396.3

Full immunisation

75.4


19.1 151.6



7.5

9.0 79.616 Spacing 7.9


0 -

378 Limiting 18.8



The Nilgiris - Apr'12 - Jan'13

DLHSIII


7,35,071


13,011

ANC







1,24,962



1,952


100




72.2


45% 55% 70%

Deliveries


38% 45% 75%


90.7


Home Delivery 9.3


45% 54% 76%


0.7


-8% -8% -5%



41% 49% 14%


pg. 55 NHSRC


58% 58% 30%

Still Birth 90


0 0 0

Live Birth 0.8


0 0 0



0 0 0




11.15

13.38

18.92

BCG 100


0.08

0.10

0.57

DPT3 93.7


45.9

55.1 65.8

Measeles

98.9


643.9

772.7 761.1

Full immunisation

90.3


14.7 230.6



12.1

14.5 0.000 Spacing 3.5


0 -

0 Limiting 5.9



Theni - Apr'12 - Jan'13

DLHSIII


12,43,684


22,013

ANC







2,11,426



3,302


96.2




48.3


54% 64% 63%

Deliveries

pg. 56 NHSRC


53% 64% 77%


93.3

Met need for EmOC * 0.76% 1% 111.15%

Home Delivery 6


65% 78% 87%


0


-7% -7% 0%



44% 53% 76%



30% 30% 28%

Still Birth 81.4


0 0 0

Live Birth 1.4


0 0 0



0 0 603




14.09

16.91

25.65

BCG 95.9


0.04

0.05

0.08

DPT3 76.1


44.3

53.2 66.2

Measeles

93.1


1114.0

1,336.8 2782.8

Full immunisation

72.1


13.2 34.9



4.9

5.9 190.241 Spacing 4.4


5

6.0 309 Limiting 8



Thiruvallur - Apr'12 - Jan'13

DLHSIII


37,25,697


65,944

ANC

pg. 57 NHSRC







6,33,368



9,892


98.7




56.4


46% 55% 74%

Deliveries


51% 62% 69%


97.4

Met need for EmOC * 10.50% 13% 122.38%

Home Delivery 2.6


59% 71% 75%


0


-5% -5% -1%



46% 55% 71%



31% 31% 31%

Still Birth 91.6


0 0 0

Live Birth 0


0 0 0



0 0 0




13.52

16.22

17.35

BCG 99.5


0.05

0.06

0.15

DPT3 94.2


40.9

49.0 53.8

Measeles

96.7


715.9

859.1 1281.4

Full immunisation

90.1


14.5 37.1



82.8

99.4 186.542 Spacing 4.7


2


pg. 58 NHSRC



Thiruvarur - Apr'12 - Jan'13

DLHSIII


12,68,094


22,445

ANC







2,15,576



3,367


97.9




54.1


41% 49% 61%

Deliveries


54% 65% 65%


96.5

Met need for EmOC * 0.12% 0% 113.28%

Home Delivery 3.5


64% 77% 78%


0.7


0% 0% 1%



48% 58% 72%



32% 32% 160%

Still Birth 87.1


0 0 0

Live Birth 0.6


0 0 0



0 0 0




11.46

13.75

21.56

BCG 100

pg. 59 NHSRC


0.18

0.22

0.73

DPT3 96.7


55.7

66.8 101.0

Measeles

98.6


1246.2

1,495.4 1498.5

Full immunisation

93.8


33.6 36.4



2.5

3.0 196.673 Spacing 8


2

2.4 172 Limiting 17.4



Thoothukkudi - Apr'12 - Jan'13

DLHSIII


17,38,376


30,769

ANC







2,95,524



4,615


93.2




46.7


52% 62% 74%

Deliveries


63% 76% 85%


97.8

Met need for EmOC * 115.05% 138% 132.60%

Home Delivery 2.2


63% 76% 85%


0.2


-7% -7% -3%



62% 74% 83%


pg. 60 NHSRC


58% 58% 41%

Still Birth 95.8


0 0 0

Live Birth 0


0 0 0



7 8.4 60




21.63

25.95

30.10

BCG 100


0.06

0.08

0.11

DPT3 98.4


57.5

69.0 72.2

Measeles

94.8


2139.2

2,567.0 2546.2

Full immunisation

86.8


63.5 64.7



291.9

350.3 409.290 Spacing 6.1


200

240.0 351 Limiting 16.9


22.8 21 Total 23


Tiruchirappalli - Apr'12 - Jan'13

DLHSIII


27,13,858


48,035

ANC







4,61,356



7,205


98.8




56.9


51% 61% 74%

Deliveries

pg. 61 NHSRC


56% 67% 76%


95.1


Home Delivery 4.3


60% 72% 79%


0.6


2% 2% 2%



42% 50% 75%



52% 52% 30%

Still Birth 82.3


0 0 0

Live Birth 0.5


0 0 0

Breastfed within 1 hour of birth 79


0 0 9




11.48

13.78

18.95

BCG 100


0.05

0.06

0.16

DPT3 91.8


52.6

63.2 110.4

Measeles

95.2


1038.4

1,246.1 2054.1

Full immunisation

90.7


26.0 59.5



0.1

0.1 302.853 Spacing 4.8


0 -

402 Limiting 16.7



Tirunelveli - Apr'12 - Jan'13

DLHSIII


30,72,880


54,390

ANC

pg. 62 NHSRC


ANC Check-up in first trimester 73





5,22,390



8,158


91.8




56.8


36% 43% 69%

Deliveries


50% 60% 79%


98.4

Met need for EmOC * 2.51% 3% 139.13%

Home Delivery 1.6


64% 77% 83%


0.6


3% 3% 0%



49% 58% 79%



61% 61% 29%

Still Birth 84.6


0 0 0

Live Birth 0.8


0 0 0



0 0 0




24.06

28.87

23.02

BCG 100


0.04

0.05

0.03

DPT3 77.3


60.4

72.4 80.0

Measeles

91.7


990.0

1,187.9 1715.3

Full immunisation

66.1


18.2 43.4



9.7

11.7 109.571 Spacing 4.8


0 -

529 Limiting 15.8

pg. 63 NHSRC



Tiruvanamalai - Apr'12 - Jan'13

DLHSIII


24,68,965


43,700

ANC







4,19,724



6,555


96.6




45


68% 81% 20%

Deliveries


61% 73% 86%


75.9


Home Delivery 23.5


78% 93% 92%


2.9


-3% -3% 9%



67% 80% 77%



56% 56% 178%

Still Birth 90.6


0 0 0

Live Birth 2.1


0 0 0



0 0 9




16.89

20.27

23.86

BCG 100

pg. 64 NHSRC


0.05

0.06

0.10

DPT3 90.2


56.9

68.3 72.3

Measeles

97.6


1433.1

1,719.7 1620.3

Full immunisation

83.4


16.4 93.1



32.5

39.0 283.763 Spacing 5.2


1




Vellore - Apr'12 - Jan'13

DLHSIII


39,28,106


69,527

ANC







6,67,778



10,429


96.3




58.8


56% 67% 67%

Deliveries


55% 66% 67%


93


Home Delivery 6.9


64% 76% 80%


4


-1% -1% 2%



55% 66% 76%


pg. 65 NHSRC


9681% 9681% 259%

Still Birth 95.3


0 0 0

Live Birth 1.2


0 0 0



0 0 3




11.12

13.34

26.34

BCG 100


0.03

0.03

0.03

DPT3 87.7


52.2

62.7 69.7

Measeles

98.5


967.7

1,161.3 1763.8

Full immunisation

79.9


18.6 41.8



4.7

5.7 343.041 Spacing 5.3


0 -

575 Limiting 12.9


1.2 33 Total 18.2


Viluppuram - Apr'12 - Jan'13

DLHSIII


34,63,284


61,300

ANC







5,88,758



9,195


97.9




43.5


63% 76% 68%

Deliveries

pg. 66 NHSRC


63% 75% 87%


94.3


Home Delivery 5


72% 87% 94%


0.3


-1% -1% 4%



62% 75% 81%



10980% 10980% 14332%

Still Birth 96


0 0 0

Live Birth 0.8


0 0 0



0 0 0




12.61

15.13

16.87

BCG 100


0.03

0.03

0.04

DPT3 99.3


59.2

71.1 106.1

Measeles

96


1097.6

1,317.1 1839.1

Full immunisation

94.7


21.1 51.6



5.4

6.4 191.495 Spacing 3.5


0 -

592 Limiting 12.6


1.2 22 Total 16.1


Virudhnagar - Apr'12 - Jan'13

DLHSIII


19,43,309


34,396

ANC

pg. 67 NHSRC







3,30,363



5,159


98.4




58.2


47% 56% 79%

Deliveries


52% 62% 68%


91.7

Met need for EmOC * 54.89% 66% 151.08%

Home Delivery 8.3


59% 70% 89%


2.4


2% 2% 1%



43% 51% 78%



37% 37% 32%

Still Birth 77.2


0 0 0

Live Birth 4.7


0 0 0



0 0 24




26.73

32.08

34.15

BCG 100


0.05

0.06

0.11

DPT3 69.5


68.4

82.1 93.4

Measeles

93.6


817.5

981.0 2350.9

Full immunisation

56.1


16.4 33.6



31.5

37.9 390.417 Spacing 7.1


252

302.4 463 Limiting 9.3

pg. 68 NHSRC


13.2 24 Total 16.4


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