National Rural Health Mission (2005-2012) Project Implementation Plan 2010-11 Presentation to Sub-Group meeting (on 22.1.2010). Anil Chandra Punetha, IASCommissioner of Family Welfare andEO Principal Secretary to Govt. (HM
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1. Andhra Pradesh Welcomes Sub-Group Team Members from MOHFW & NHSRC, New Delhi
2. National Rural Health Mission (2005-2012) Project Implementation Plan 2010-11 Presentation to Sub-Group meeting (on 22.1.2010) Anil Chandra Punetha, IAS
Commissioner of Family Welfare and
EO Principal Secretary to Govt. (HM&FW dept.)
Govt. of Andhra Pradesh :: Hyderabad
3. NRHM Expected Outcomes
4. Present Scenario
5. % Marriage of girl before age 18
6. AP – 3 Antenatal Check-ups
7. Trend of Pregnant Women who Received TT 2+
8. AP - Institutional Deliveries
9. Place of Delivery and Assistance
10. Social Confounder for Safe & Institutional Deliveries (DLHS-3)
11. Inter State Comparison of MMR
12. % of Breastfeeding
13. % of Breastfeeding (DLHS-3)
14. AP – Full Immunization
15. Early Childhood Mortality Rates
16. Key Areas Identified for Priority Action in 2010-11
17. Themes identified for priority action in 2010-11
18. Activity wise NRHM Progress
19. Support to the Program
20. Support to the Program
21. Support to the Program
22. Support to the Program
23. Support to the Program
24. Support to the Institutions thru’ Societies
25. Increase in Human Resources
26. NRHM - Human Resources (Progress between 2005-2009)
28. Infrastructure Up-gradation (Construction / Renovation)
29. Program wise Budget / Expenditure for 2008-09 and 2009-10
30. Proposal for 2010-11
31. Proposed PIP for 2010-11 ABSTRACT
32. Proposed PIP for 2010-11 RCH Flexible Pool
33. Proposed PIP for 2010-11 RCH Flexible Pool
34. Proposed PIP for 2010-11 RCH Flexible Pool
35. Proposed PIP for 2010-11 Mission Flexible Pool
36. Proposed PIP for 2010-11 Mission Flexible Pool
37. Proposed PIP for 2010-11 Strengthening of Routine Immunization
38. Proposed PIP for 2010-11 Strengthening of Routine Immunization
39. Proposed PIP for 2010-11 National Disease Control Program
40. Proposed PIP for 2010-11 Convergence and Coordination
41. Proposed PIP for 2010-11 Direction and Administration (Treasury route)
42. Proposed PIP for 2010-11 Pulse Polio Immunization
43. Special Package for the Socially Excluded Communities
44. Introduction Govt. of India has identified 4 high focused districts viz. Nellore, Adilabad, Warangal and Khammam.
GoAP considered low performing health facilities i.e. 180 PHCs and 30 CHCs in 18 districts.
Health facilities under 10 ITDA areas have also identified under this package including 2 PHCs which are far to reach in Non-ITDA areas.
Gujarat model (Chiranjivi) pilot project is proposed to be implemented in Tribal areas of Khammam District.
Provision made for Nutrition support to pregnant and lactating women in identified areas.
Focused on Maternal Death Audit and Impact Analysis.
Strengthening of HMIS
45. Areas Needs to Addressed 20% of the high focused health facilities identified for implementation.
300 PHCs and 30 CHCs are identified as high focused.
Focus on backward & inaccessible areas.
184 PHCs and 20 CHCs of ITDA areas and inaccessible 24 PHCs of Non-ITDA Districts are identified as high focused.
Training & Skill Development.
Multi skill training program for Medical & Paramedical staff.
Sensitization workshops to VHSCs & HDS members.
Proposed to conduct Baseline, Midline, End line surveys, and Maternal & Infant Death Audit.
Strengthening of MIS.
46. 1) Identification of Focused Areas Total PHCs … 1570
Total high focus PHCs … 300 (20% of PHCs are identified as High Focused PHCs)
Total CHCs … 169
Total high focus CHCs … 30 (20% of CHCs are identified as High Focused CHCs)
Category–I : 30 PHCs each from GoI identified high focused 4 districts viz. Khammam, Warangal, Adilabad and Nellore.
Category–II : 10 PHCs each from rest of 18 districts except Hyderabad.
30 CHCs: Selected on the basis of key performance indicators as a bench mark.
47. 2) Identification of Backward & Tribal areas Total ITDA areas … 10
Tribal ITDA PHCs … 184
Tribal CHCs … 20
Inaccessible Non-ITDA PHCs … 24
48. Human Resources:
Special drive to fill up all the vacancies in the identified SCs/ PHCs / CHCs
Providing Furniture, Equipment and Television.
Security and Clean bed sheets, clean toilets, facilities for bathing, adequate lighting, 24 hour water and electricity supply:
Each PHC - Rs.1,00,000/-
Each CHC - Rs.1,50,000/-
Mobility: Provision of hiring vehicle to MOs
49. Providing CUG Mobile to ANM & ASHA
To facilitate the ANM / ASHA to intimate the name based ANC Particulars for registrations.
To intimate adverse conditions of pregnancy of an ANC to MOs.
Transportation of ANC to delivery through 108.
To inform near by FRU for immediate medical / surgical attendance.
To intimate Maternal and infant deaths.
Incentives to Staff:
Performance based incentives @ Rs.50,000/- to PHCs & Rs.75,000/- to CHCs are proposed basing on following Indicators:
OPD, 100% ANC, <80% institutional deliveries, <90% PN Care, 100% Sterilizations, 100% immunization and utilization NRHM funds.
The awarded incentives will be shared among all the staff of the institution.
50. Special package for institutional Deliveries in Tribal areas of Khammam district The Special package for institutional deliveries is proposed to be implemented on a pilot basis in tribal areas of Khammam district.
Khammam has been identified as LWE by Ministry of Home Affaires and is one of the identified high focused district by GOI.
To improve access to institutional delivery Traibal areas.
To provide financial protection @ Rs.2000/- to poor families in remote, inaccessible and difficult areas.
The private empanelled providers are reimbursed on capitation payment basis according to which they are reimbursed at a fixed rate for each delivery carried out by them
51. 3) Training & Skill Development Multi skill training programme for Medical, Para Medical & Staff Nurses.
EMONC Training for MOs & Staff Nurses & ANMs.
LSA training to Medical Officers.
IMNCI training for MOs & Staff Nurses & ANMs.
Sensitization workshops to VHSCs / HDS members.
52. 4) Impact Analysis Impact analysis involves an in-depth examination of a policy, programme.
To assess its potential impact on health and of the opportunities for adjusting the policy, programme to ensure a more positive impact on health.
It includes a review of the available evidence, exploration of the opinions, experience and expectations of those who may be affected and, if needed, production and analysis of new data.
Impact assessment will draw on assessment and evaluation and also will evaluate whether the project is meeting their defined objectives or not.
Proposed to conduct Base Line, Mid line and End line surveys on important performance Indicators.
53. Maternal & Infant Death Audit Maternal mortality is a key indicator of the quality of health services.
Audit in medical practice is defined as the logical and critical analysis of the quality of medical care.
Audit can measure the structure that is the resources and personnel available, process that happens in the practice and outcome that indicated the results of care.
Prompt reporting of deaths by
ASHAs, 104 HIHL, SMS by ANM/ ASHA and Conduct of audit by Dy. DM&HO / Sr. Medical Officer.
Proposed Incentives on intimation
ASHA / ANM … Rs.100/- per death
SMS services … Rs.5/- per death
Honorarium to MO … Rs.300/- per audit
Hiring of Vehicle … Rs.1,000/- per visit
54. 5) Strengthening of MIS
55. Web Based MIS – Flow
56. 6) Ensure presence of Staff By introducing the Bio-Metric attendance system in the health facility.
The system is also aimed at bringing more transparency as some staff members mark proxy attendance of their colleagues.
Biometric system is proposed to install @ 40,000/- per each instrument.
57. 7) Special Nutrition support to pregnant and lactating women The NFHS-3 shows that the average body-mass index for reproductive age women in AP is just 19.5kg / m2;
46% of women are below the recommended minimum BMI of 18.5kg/m2.
Among this same age group, 50% are anemic.
This state of poor nutrition results from a cycle of malnutrition and poor growth.
Women have low birth weight babies, subsequently grow to be malnourished that results to mortality.
The object of the nutrition support in Andhra Pradesh is a prerequisite to lower the MMR directly and indirectly IMR.
58. Budget Abstract of Special Package