State Programme Implementation Plan ( 2008-09)

1. State Programme Implementation Plan ( 2008-09) FINAL REVISED DRAFT Department of Health Care, Human Services & Family Welfare Government of Sikkim

2. Socio-demographic Profile - Sikkim • Total population :540,851(2001) • 6,00,000 approx (2007). • Male :288,484 • Female :252,367 • % of Schedule Tribes :20.6% • % of Schedule caste population :5.0% • Literacy rate :68.8%

3. Demographic Profile • Density of Population : 76 per sq. km • Decennial growth Rate: 32.98 % • Sex Ratio : 875 • Sex Ratio (0-6yrs) : 963

4. STATE ADMINISTRATIVE SET-UP • DISTRICTS - 4 • SUBDIVISIONS - 9 • BLOCKS - 24 • GRAM PANCHYATS - 163 • CENSUS VILLAGE - 452

5. Current Health Status * source: NFHS 3, SRS 2006, Census 2001

6. Health Infrastructure of the State • State Referral Hospital : 01 • Dist. Hospital/CHC :04 • PHC :24 • PHSC :147 • District Tuberculosis Center :01 • Sikkim Manipal Medical College hospital :01

7. Planning Process 1. Situational Analysis through Secondary Data and Multi-level Consultations 2. Needs Assessment using the decentralized methodology ( Village planning) 3. Facility Plan) 4. Development of DHAP of 2008 – 09 and Development of NRHM prospective plan up to 2012 3. Development of PHC & SDAP plans through participative methods 5. Development of NRHM State Programme Implementation Plan

8. RCH

9. Maternal Health – Situational Analysis • ANC Coverage ( Full) : 27.2% • 3 ANC : 69.4% • Inst. Delivery : 47.2% • Prevalence of Anaemia : 53.1% • PHC providing 24X7 delivery but certain criteria not fulfilled • 1 CHC functioning as per IPHS/FRU (Namchi)/ 1CHC partial BSU

10. Maternal Health - Strategies • Operationalizing FRU in 2 CHCs • Upgradation of PHC (24X7) = 30% (8) • M.O.’s training in Obstetric and Anaesthesia. • Ground level Convergence Action • SBA Training • IEC activities • Referral transport • VHND • Mobility Support to ANM

11. RCH II 2. Janani Suraksha Yojana(JSY) • Full ANC Coverage : NFHS3 (27.2%) • 3 ANC Coverage : NFHS3 ( 69.4%) • Institutional deliveries:NFHS3 (49%) • No of JSY beneficiaries : 1619/2300 (70.39%) (till Jan,08) Inst: 1100 Home 519

12. RCH II 2. Janani Suraksha Yojana(JSY) RCH II 2. Janani Suraksha Yojana (JSY) Strategy • Micro plan through ANM and ASHA • Disbursement of funds through PHCs • Advance fund available to mothers through ASHA

13. Child Health Situational Analysis • IMR – 33.7 NFHS/ 30 SRS 2006 • Full Immunisation – 69.6% • Under weight children <3yrs – 22.6% • Moderate Malnutrition <3yrs – 13% • Symptoms of ARI- 5%

14. Child Health - Strategies • IMNCI trainings • VHND • Appointment of Peadiatricians (FRU) in CHC • Focused BCC to promote infant feeding • New borne Care corner

15. Family Planning -Situational Analysis

16. Family Planning Strategies • NSV Camps • M.O.’s training in NSV • Spacing methods promotion • Quality Control – District level Quality Assurance committee formed. • Coordinated grass root level targeting of eligible couple • Increased male participation in FP • Targeting young women for delayed child birth • IEC activities

17. Adolescent Health – Situational Analysis • Marriage below 18yrs – 31% • Drug addiction & alcoholism on the rise • Teenage pregnancies & unsafe abortion on the rise Source: DLHS 2

18. Adolescent Health Strategies • Formation of adolescent group • IEC activities & Training of manpower • Information & Referral to de-addiction centre • Organize training as per GOI guidelines (ARSH)

19. School health programme School health programme Activities: • Health cards for every student • Health check-up • Life style counseling • Training of school teachers in basic screening • IEC on Reproductive Health & HIV/AIDS

20. Capacity Building Strategies • Training on SBA • Adolescent health issue • IUD insertion, NSV • IMNCI • Training on MOs on RTI/STI, • Anaesthesia and EmOc, • Training of VHWSC

21. IEC/BCC Strategies • Development of state BCC strategy • Development of user friendly BCC tool kits • Monitoring and implementation of communication activities • Improve the quality of RCH services (in terms of HR development, incentives )

22. Budget Summary

23. Budget cont..

24. Budget cont..

25. Revision in PIP subsequent to appraisal • Maternal health Budget has been reduced • JSY budget has been reduced • Family Planning • Female sterilization camp and IUD camp has been deleted • Urban health centre shifted to next year • Innovative scheme for institutional delivery has been added • Training load has been has been reduced after scrutiny

26. Revision in PIP Cont… • IEC/BCC • The asset part has been deleted • No of activity has been reduced • Detail of activities has been provided • Procurement • IUD cost has been deleted • FRU equipment has been incorporate in NRHM additionalities

27. NRHM Initiatives

28. ASHA Scheme – Situational Analysis • Total ASHA Required – 637 • Selected 637 • Trained (4st Module) – 100% • Attrition 107 • Total in place – 530 • New recruitment will be 107 in 2008-09

29. Village Health & Sanitation Committtee(VHSC) • Village Health & Sanitation Committee 637 • More than Revenue block villages (based on district projections). 535 formed till date • Formation under process in 102 villages . • Training of VHSC members proposed

30. Provision of Untied fundsto PHSC,PHC &CHC • Untied funds & Maintenance funds to PHSC . 2007-08 utilization 90% • Untied funds & Maintenance funds to PHC Not utilised in 2007-08 as RKS registration just completed • Untied funds & Maintenance funds to CHC & State hospital • Not utilised in 2007-08 as RKS registration just completed

31. Up gradation of PHSCs to IPHS

32. Strengthening of Primary Health Centers

33. New PHCs proposed in 2007-08*

34. Strengthening of District Hospital and CHC to IPHS

35. Mainstreaming of AYUSH Systems

36. Strengthening Mission Directorate

37. Preparation of DHAP & Establishment of ANM/GNM Training school • Fund for Preparation of PHC plan/DHAP/SPIP for 2009-10 • Preparation of DPR for Establishment of ANM/GNM school as there is only one ANM/GNM training school. Further there is shortage of GNM in the state

38. Block Program Management Units & MMU • Recruitment of Manpower under BPMU is going on for 24 PHC’s. Recurring expenditure proposed. • Mobile Medical Units : Four units order placed. Two units delivered. Manpower being recruited. - Recurring expenditure proposed

39. State Health Resource Centre • Set up an cell of State Health Resource Center (SHRC) within Department of Health Care Human Service & Family Welfare under NRHM • Appoint a nodal officer from Department of Health Care Human Service & Family Welfare to head the cell and coordinate with all sections of the department and allied departments at State, District & sub-district levels • The SHRC will support the Govt. in all technical matters related to conceptualization, development of district and state PIPs, and provide technical support for all the program components under NRHM . Since the state does not have proper training support, the SHRC will play a major role.

40. Manpower for SHRC • State Project Coordinator cum Management Expert – Full Time – 1 No. • Public Health Expert – Full Time – 1 No. • Account cum Admin Asstt. – Full Time – 1 No. • Data Asstt. – Full Time – 1 No. • Office Boy – Full Time – 1 No. • Five no. Empanel Experts from IEC/BCC, Public Health, HR, MIS for Part Time (Per day basis) for 160 days in a Year

41. Integrated Bio Medical waste Management A. Organizational Arrangements • Appointment of the State IMEP Nodal Officer – Done. • Capacity-building & Training: Through the year • Formation and Implementation of the State IMEP Committee- May 2008 B. Awareness, Training and Communication • Training of the trainers: May- June 2008 • Training of Orientation Training of Health, Nursing and other – Throughout the year • Administrators of State Referral Hospital, District Hospitals. May 2nd week • Training of Nursing personnel, Paramedical personnel- Throughout the year • Training of Medical Officers- 1st qtr • Training of all MPHW, ANM- throughout the year

42. Integrated Bio Medical waste Management C. Monitoring & Evaluation • Streamlining of IMEP monitoring – Throughout the year D. IMEP Implementation Review • Monthly, Quarterly, Half yearly and Annual Review • Budget Proposed for equipment, consumables, training & monitoring

43. Emergency Medical Service • Increasing RTA and other accidents 55 per 1000 with high fatality 35%. Also other medical and surgical emergencies on rise. Compounded by difficult terrain and only coverage via public health services. Three pronged strategy: • Development and up gradation of The Emergency and Disaster Management Services at the district .level hospitals with special focus on Namchi District hospital. • Capacity building and skill development amongst the available health cadre in regard to EMS • Inter-sectoral convergence with other stake holders

44. Strengthening Birth & Death Registration Cell & Additionalities for RNTCP • Strengthening of Birth & Death Registration cell to reach 100% registration. Currently 91% - training of ASHA, BDO, MO etc - Purchase of laptop, LCD projector • Additionalities for RNTCP for items not covered/shortfall - TA/DA for staff, Awareness camps, Training, Culture & sensitivity tests

45. NRHM budget summary

46. Budget summary cont..

47. Budget summary cont..

48. Revision in PIP subsequent to appraisal • ASHA untied fund deleted • Strengthening of PHCs • PHN/LHV deleted • Equipment for East & South deleted • Ambulance reduced to 10 • New PHC • All proposals shifted to 2009-10 • New CHC • Manpower shifted to 2009-10 • Provision of house rent deleted • Hiring of office space for Mission Directorate added

49. Revision in PIP Cont… • Health Management Information System deleted • Integrated Biomedical Waste Management • Revision of budget • Emergency Medical Service • 2 District equipment shifted to next year • Non communicable Disease Deleted • Committed expenditure • Amount reduced in construction component projection as per the estimated expenditure likely in 2008-09 • Addition of ambulance cost.

50. Immunization