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Andhra pradesh welcomes sub group team members from mohfw nhsrc new delhi l.jpg

Andhra PradeshWelcomesSub-Group Team Membersfrom MOHFW & NHSRC, New Delhi


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National Rural Health Mission (2005-2012)Project Implementation Plan 2010-11Presentation toSub-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


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NRHM Expected Outcomes

  • Achieve a cure rate (TB - DOTS) of – 85% by 2012

  • Reduce prevalence rate of Leprosy to – 0.43 per 10,000 by 2012

  • Increase Cataract operations to – 6 lakhs per annum by 2012 (AP).

  • Reduce Malaria Mortality Rate to – 60% by 2012

  • Reduce Filaria / Microfilaria rate to – 80% by 2012.

  • Upgrading all health facilities to IPHS.

  • Increase utilization of FRUs from 20% bed occupancy to 75%.

Source: # SRS 2009* NFHS-III (2005-06) ** SRS Special Survey (2004-06)





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Trend of Pregnant Women who Received TT 2+




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Social Confounder for Safe & Institutional Deliveries (DLHS-3)







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Key Areas Identified for Priority Action in 2010-11


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Themes identified for priority action in 2010-11










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NRHM - Human Resources(Progress between 2005-2009)

26



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Infrastructure Up-gradation (Construction / Renovation)

28


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Program wise Budget / Expenditure for 2008-09 and 2009-10

(Rupees in crores)



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Proposed PIP for 2010-11ABSTRACT

(Rupees in lakhs)


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Proposed PIP for 2010-11RCH Flexible Pool

(Rupees in lakhs)


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Proposed PIP for 2010-11RCH Flexible Pool

(Rupees in lakhs)


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Proposed PIP for 2010-11RCH Flexible Pool

(Rupees in lakhs)


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Proposed PIP for 2010-11Mission Flexible Pool

(Rupees in lakhs)


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Proposed PIP for 2010-11Mission Flexible Pool

(Rupees in lakhs)


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Proposed PIP for 2010-11Strengthening of Routine Immunization

(Rupees in lakhs)


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Proposed PIP for 2010-11Strengthening of Routine Immunization

(Rupees in lakhs)


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Proposed PIP for 2010-11National Disease Control Program

(Rupees in lakhs)


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Proposed PIP for 2010-11Convergence and Coordination

(Rupees in lakhs)


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Proposed PIP for 2010-11Direction and Administration (Treasury route)

(Rupees in lakhs)


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Proposed PIP for 2010-11Pulse Polio Immunization

(Rupees in lakhs)


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Special Package for the Socially Excluded Communities


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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


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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.

  • Impact Analysis.

    • Proposed to conduct Baseline, Midline, End line surveys, and Maternal & Infant Death Audit.

  • Strengthening of MIS.


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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)

  • Selection Criteria:

    • 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.


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2) Identification of Backward & Tribal areas

  • Total ITDA areas … 10

  • Tribal ITDA PHCs … 184

  • Tribal CHCs … 20

  • Inaccessible Non-ITDA PHCs … 24


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Human Resources:

Special drive to fill up all the vacancies in the identified SCs/ PHCs / CHCs

Infrastructure

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

Proposed Special Package

Contd..


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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.

Proposed Special Package


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Special package for institutional Deliveriesin 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


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3) Training & Skill Development

Multi skill training programme for Medical, Para Medical & Staff Nurses.

SBA Training

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.


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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.


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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


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5) Strengthening of MIS

Facility Details – Implementation of HMIS

Training Sub District Level Users

Data Collection / Checking / Consolidation

Data Quality Analysis

Implementation of Tally Software (Accounts)

Time bound Data Entry


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Web Based MIS – Flow

Report Generation at different levels

All states submitting their report to Center

National HQ - Delhi

Reports to State Govt.

Monthly Report

NRHM/DHQ/3/M

10th of every month

Data

Server

Annual Report

NRHM/DHQ/1/A

Due Date 5th April

Quarterly Report

NRHM/DHQ/2/Q

Due Date 10th of month of Quarter

Quarterly Report

NRHM/SG/1/Q

Due Date 10th of month of Quarter

Report for the state collated

Report from facilities submitted electronically at District HQ

Data Capturing Unit

Monthly Report

NRHM/PHC/3/M

Due Date: 5th of following month

Monthly Report

NRHM/DH/3/M

Due Date: 5th of following month

Monthly Report

NRHM/CHC/3/M

Due Date: 5th of following month

Report collected in paper format

Annual Report

NRHM/SG/1/A

Due date 15th April

State HQ

District HQ

PHC

District Hospital

CHC’s

Sub Centre

Monthly Report

NRHM/HSC/3/M

Due Date: 5th of following month


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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.


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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.




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