Haryana Report

8/2/2019 Haryana Report

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HARYANASTATE REPORT


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Haryana1

Haryana

Index

S. No. Content Page No.

1 Summary of Approvals 2 5

2 Demographic Profile 6 7

3 Progress of NRHM 8 11

4 Reproductive & Child Health 12 15

5 Immunization 16 16

6 Revised National Tuberculosis Control Programme (RNTCP) 17 20

7 National Vector Borne Disease Control Programme (NVBDCP) 21 22

8 National Leprosy Eradication Programme (NLEP) 23 23

9 Integrated Disease Surveillance Project (IDSP) 24 24

10 National Programme for Control of Blindness (NPCB) 25 25

11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 26 26

12 RoP Approvals under Mission Flexible Pool 27 29


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HARYANA

Summary of Approvals

Financial Management under NRHM (Rs. in crore)

Years Allocation Release Expenditure

% Release

against

Allocation

% Expenditureagainst Release

2005-06 69.33 85.14 53.88 122.80 63.29

2006-07 117.69 134.69 90.66 114.44 67.31

2007-08 137.59 131.79 105.83 95.78 80.30

2008-09 151.84 186.08 105.59 122.55 56.74

2009-10 149.69 0.00

Total 626.14 537.69 355.95 85.87 66.20

S. No. Timeline Activities Achievement %

1 ASHA Selection 13152 88Training 5000

2 VHSC 6282 90

3 24X7 PHCs 160 39

4 Mobile Medical Unit 6 29

5 Rogi Kalyan Samiti 2938 554

Budget Allocations (2005-09) ( Amount in Crores)

Allocation Releases Expenditure

RCH Flexipool

2005-06 25.31 11.43 8.34

2006-07 33.99 30.13 20.942007-08 26.11 27.75 21.95

2008-09 41.92 49.16 13.77

2009-10 42.71

Total (A) 170.04 118.47 65.00

NRHM Flexipool

2005-06 23.50 1.12

2006-07 28.75 34.32 2.10

2007-08 50.25 46.51 31.83

2008-09 36.52 42.39 21.94

2009-10 37.69

Total (B) 153.21 146.72 56.99

National Disease Control Programme2005-06 8.26 6.19 4.27

2006-07 9.12 7.74 11.14

2007-08 9.69 5.44 8.32

2008-09 15.24 8.99 2.98

2009-10 13.12 0.40 0.00

Total (C) 55.43 28.76 26.71

Grand Total (A + B + C) 378.68 293.95 148.7


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Haryana3

Record of Proceedings (2005-2009) for Mission Flexible Pool

Approval for Infrastructure (Rs. in Crore)

S. No Health Facilities 2005-06 2006-07 2007-08 2008-092009-

10

1 Sub C 2.43 0.00 0.00 0.00

2 PHC 0.00 0.00 1.53

3 CHC 11.60 2.40 0.00 0.00 0.67

4 DH 0.00 66.00 66.00

5 Equipment 0.00 0.00 0.00

6 Transport 0.00 6.27

7 Others 6.96 0.00 5.95 0.78

Total 14.03 9.36 0.00 71.95 75.25

Approval for Human Resource Support (Rs. In Lakh)

S. No Personnel 2005-06 2006-07 2007-08 2008-092009-

10

1 Doctors 0.00 0.00 2.27

2 Specialists 0.00 0.00 0.00

3 Staff Nurses 0.00 0.00 15.49

4 ANM 0.00 14.00 23.96

5 Others 0.00 0.00 8.41

Total 0.00 0.00 0.00 14.00 50.13

Approval of other activities (2005-2009) in Rs. Lakh

S.No Initiative2005-06 2006-07 2007-08 2008-09 2009-10 Re

ma

rksReleasedApproved Approved Approved Approved

ASHA

1 ASHA 888.5

TOTAL 888.5

Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters

2 Rogi Kalyan Samiti 590

3Rogi Kalyan Samiti HQ

Hospital 105

4

Rogi Kalyan Samiti

CHC/ Sub Divisional

Hospital 116

5 Rogi Kalyan Samiti-PHC 336

6 Untied funds to CHC

1427 Untied Fund for PHC 102 315.75


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8 Untied Fund for SC 243 46.3 246.5 246.5

9 Untied Fund for VHSC 671.25 628.2

10Annual MaintenanceGrants CHC

274.511

Annual Maintenance Grant

-PHC204

12

Annual MaintenanceGrant- SC 246.5

TOTAL 243 942.3 1233.5 2094.7

Infrastructure related matters

13

Emergency & Referral

Services544.66 580

14 MMU 695.6 47.34

TOTAL 695.6 544.66 627.34

Status of Infrastructure 2005-2010

Health Facilities As per RHS 2008 New Construction Upgradation / Renovation

Number of Sub Centre 2433 269 63

Number of PHC 420 63 23

Number of CHC 86 10 11

Number of DH 21As per State Data

Sheet, NRHM

6 8

Status of NRHM as on 15.05.2009

1 ASHASelection 13152

Training 5000

2 VHSC 5331

3 Joint A/C 5287

4 24X7 Facility 207

5 FRU 67

6 Contractual Manpower

Doctors & Specialist 26

AYUSH Doctors

Staff Nurse 179Paramedics 260

ANM 2174

7 JSY Beneficiaries (in Lakhs) 0.92


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National Disease Control Programme

NLEPThe state has already achieved the goal of elimination of leprosy. The state is advised to carry out

in depth situational analysis in districts/blocks reporting large number of new cases and take

suitable actions.

IDSPIt is a Phase II state. The recruitment of key human resources needs to be fast tracked andcompleted in a time bound manner. The data reporting should start from all the districts.

NBCPUCs for GIA released to State Blindness Control Society not being received timely. SOE forCash Grant are also not being received timely. Performance of School Eye Screening Programme

needs to be improved.

NVBDCPMalaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs to

identify the areas for focused interventions. Capacity building for case management and

strengthening of health facilities need to be taken on priority basis for diagnosis and casemanagement. Filaria and Kala-azar, are not reported from the state of Haryana.

RNTCPOverall performance of the State is not good. Total Case Detection and cure rate need to beimproved. This appears to be due to gaps in key HR (STO, DTO and other levels), weak supply

chain management and supervision.


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Haryana6

Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF HARYANA

The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 55 and

Maternal Mortality Ratio is 186 (SRS 2004 - 06) which are lower than the National average.

The Sex Ratio in the State is 861 (as compared to 933 for the country). Comparative figuresof major health and demographic indicators are as follows:

Table I: Demographic, Socio-economic and Health profile of Haryana State as

compared to India figures

S. No. Item Haryana India

1 Total population (Census 2001) (in million) 21.14 1028.61

2 Decadal Growth (Census 2001) (%) 28.43 21.54

3 Crude Birth Rate (SRS 2007) 23.4 23.1

4 Crude Death Rate (SRS 2007) 6.6 7.4

5 Total Fertility Rate (SRS 2007) 2.6 2.7

6 Infant Mortality Rate (SRS 2007) 55 557 Maternal Mortality Ratio (SRS 2004 - 2006) 186 254

8 Sex Ratio (Census 2001) 861 933

9 Population below Poverty line (%) 8.74 26.10

10 Schedule Caste population (in million) 4.09 166.64

11 Schedule Tribe population (in million) 0 84.33

12 Female Literacy Rate (Census 2001) (%) 55.7 53.7

Table II: Health Infrastructure of Haryana

Particulars Required In position ShortfallSub-centre 3005 2433 572

Primary Health Centre 500 420 80

Community Health Centre 125 86 39

Multipurpose worker (Female)/ANM at Sub

Centres & PHCs

2853 2592 261

Health Worker (Male) MPW(M) at Sub Centres 2433 2031 402

Health Assistant (Female)/LHV at PHCs 420 285 135

Health Assistant (Male) at PHCs 420 106 314

Doctor at PHCs 420 350 70

Obstetricians & Gynaecologists at CHCs 86 8 78

Physicians at CHCs 86 9 77

Paediatricians at CHCs 86 18 68

Total specialists at CHCs 344 45 299

Radiographers 86 63 23

Pharmacist 506 372 134

Laboratory Technicians 506 388 118

Nurse/Midwife 1022 411 611

(Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)


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Haryana7

The other Health Institution in the State are detailed as under:

Health Institution Number

Medical College 3

District Hospitals 21

Referral Hospitals

City Family Welfare CentreRural Dispensaries

Ayurvedic Hospitals 8

Ayurvedic Dispensaries 472

Unani Hospitals 1

Unani Dispensaries 19

Homeopathic Hospitals 1

Homeopathic Dispensary 20


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Haryana8

Note on Progress of NRHM in Haryana

(June 2009)

National Rural Health Mission has been launched with a view to bring about improvement in

health system and health status of people, especially those who live in rural areas of the country. The

State of Haryana is steadily progressing towards attaining the goals and objectives shared underNational Rural Health Mission (NRHM), National Population Policy (NPP) and MillenniumDevelopment Goals (MDG). The activities under National Rural Health Mission are transforming the

health care delivery to rural populace with increasing accessibility to quality services and theopportunity to participate actively in managing these services as well. The state has increased

coverage under JSY; improvement in infrastructure; availability of paramedical and medical

personnel. Brief information on the progress is as follows:

Institutional Framework of NRHM

Meeting of State & District Health Mission have been held regularly. Meeting of State HealthMission held 8 times and of District Health Mission held 210 times. Merger of societies is completed

in 21 districts. 6282 VHSCs have been constituted & 6282 joint accounts have been operationalised at

sub centre level. Rogi Kalyan Samities are operational at 21 DH, 91 CHCs & 336 PHCs. 9 districtshave started developing their own IDHAP.

Infrastructure Improvements

A total of 160 PHC have been strengthened with three Staff Nurses each to make them

functional for 24x7 work. About, 40 CHC are functioning on 24X7 basis & facility survey iscompleted in 40 (including others health institution below district level). A total of 25 SDH, 40 CHCand others below district level and 21 District Hospitals are functioning as FRUs. 6 districts have

functional Mobile Medical Unit (MMU) to provide services to remote areas.

Human Resources

A total of 13,152 ASHAs have been selected & 5000 are trained in 1st Module. ASHAs need

to be provided the drug kits. About 1675 Sub-centers are functional with an ANM and 2212 SCs arestrengthened with 2nd ANM. The contractual appointment of AYUSH Doctors is not done. As far as

manpower augmentation is concerned, 26 specialists, 415 SN, 2174 ANMs have been recruited on

contractual basis to meet the demand for the health services.

Services

Institutional deliveries have improved from 2.16 lakhs (2006-07) to 2.75 lakhs (2007-08).

During the year 2008-09 there were 3.18 lakhs Institutional deliveries in the state. JSY beneficiaries

have increased from 0.23 lakhs (2006-07) to 0.57 lakhs (2007-08). The number of JSY beneficiaries

was 0.48 lakh during the year 2008-09. Female sterilisation has increased from 0.55 lakh (2006-07) to0.71 lakh (2007-08) and male sterlisation has increased from 9744 (2006-07) to 9752 (2007-08).During 2008-09- 77,409female & 10030 male sterilisation have been reported. A total of 19 districts

are implementing IMNCI & 3486 people are trained so far. About, 98169 VHND held since thelaunch of NRHM. First Phase of Community Monitoring has been operationalised in the state.


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General

Overall improvement in health system since NRHM

Achievements Made

VHSC are formed in 6282 village Panchayats in Haryana

Dental Surgeons with dental equipments and Dental Units are available in - all DistrictsHospitals/Sub Dist Hospitals, CHCs and PHCs.

ASHAs have been selected. Special Incentives for Doctors working in difficult/Rural Areas (Mewat).

Availability of quality drugs. Untied Funds, Annual Maintenance Grants, Rogi Kalyan Samitis (RKS) funds being utilized.

There are different schemes to increase institutional deliveries.

Voucher Scheme for Promotion of Institutional Deliveries in Urban Slums

Areas for Further Improvement

The State need to strengthen the existing referral transport system in the State. Strengthening of Financial Management Systems and improving capacities of functionaries is

required.

RKSs are operational at most places and their capacity to use funds should be improved.

SPMU and DPMUs are formed and BPMU is in progress which needs to be strengthened. Streamline system for Inventory Management

Mewat needs special focus as a high priority district for all RCH indicators.

Infrastructure

Facility survey is under process to identify the gaps in the infrastructure, manpower andservices.

Satisfactory progress in infrastructure development. Well managed physical infrastructure which includes cleanliness, availability of water and

drainage system and other basic facilities

Human Resources

Haryana has separate directorate for Ayurved which looks after all the AYUSH componentsin the state.

There are manpower mismatches in the State. State needs to focus on multi-skilling of doctors for anesthesia and obstetrics.

State need to strengthen SPMU and DPMUs.

The State needs to strengthen the 24x7 PHCs with 3 staff nurses.

Service Delivery The state government has initiated Janani Suvidha Yojana,Jaccha Baccha and Delivery Hut

Scheme to increase institutional deliveries and reduce maternal and infant mortality.

There is an urgent need to strengthen the referral transport system in the State.

State had established Trauma Centres at Karnal, Ambala and Sirsa, Rewari and TraumaCentres at Bahadurgarh, Palwal, Gurgaon from State Budget along with equipments andmanpower

Poor convergence and support at the lower levels of the systems.


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An Analysis ofFinancial Monitoring Report for the FY 2008-09

A. RCH Flexible Pool

Component wise expenditure & Utilization under RCH against the approved PIP

Haryana Rs. in lakhs

Activities SPIP Expenditure

% Utilization

against PIP

A.1 Maternal Health 816.42 332.38 40.71%

A.2 Child Health 59.92 6.77 11.31%

A.3 Family Planning Services 982.66 675.58 68.75%

A.4Adolescent Reproductive andSexual Health/Arsh 91.15 7.88 8.64%

A.5 Urban RCH 261.34 47.01 17.99%A.7 Vulnerable Groups 20.00 0.00 0%

A.8 Innovations/PPP/ NGO 503.37 88.58 17.60%

A.9Infrastructure & HumanResources 1110.01 482.37 43.46%

A.10 Institutional Strengthening 269.70 316.57 117.38%

A.11 Training 444.37 210.90 47.46%

A.12 BCC / IEC 95.34 88.49 92.82%

A.13 Procurement 872.60 801.39 91.84%

A.14 Programme Management 243.66 155.95 64.00%

Total 5770.54 3213.86 55.69%

Based on table above and records available in FMG, the observations and areas of concern are asunder:-

General Observations:1. Only, Rs.32.13 crore i.e. 56% of the approved PIP of Rs.57.71 crore has been utilized under

RCH-II as compared to national level expenditure of 71%.

2. There is 53% increase in expenditure as compared to 2007-08.3. Since the launch of RCH-II, Rs. 82.24 crores, i.e. 69% has been utilized by the state against

the release of Rs. 118.46 crores during the period 2005-06 to 2008-09.

4. Remarkable expenditure of 117.38% has been noticed under Institutional Strengthening.5. More than 90% expenditure in BCC/IEC, Procurement is quite appreciable.

Areas of Concern:

1. Nil expenditure is reported under Vulnerable Groups.2. FMR wasnot sent on prescribed format.3. Expenditure reported under the head Child Health is less than 12% of the amount approved in

PIP, Rs.59.92 lakhs.4. Expenditure reported under the head Adolescent Reproductive and Sexual Health / ARSH is

less than 10% of Rs.91.15 lakhs the amount approved in PIP.


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B. Mission Flexible Pool:-

Component-wise expenditure under NRHM against approved PIP

Haryana Rs. In Lakhs

Activities SPIP Expenditure

% Utilization

against PIPB1 ASHA 0.00 22.36 Error

B2 Untied Funds 1233.50 944.93 76.61%

B3 Hospital Strengthening 6600.00 8984.33 136.13%

B4 Annual Maintenance Grants 0.00 246.94 Error

B5 New Constructions/ Renovation and Setting up 0.00 11.88 Error

B6 Corpus Grants to HMS/RKS 0.00 284.92 Error

B7 District Action Plans (Including Block,

Village) 0.00 5.31

Error

B10 IEC-BCC NRHM 0.00 12.63 Error

B11 Mobile Medical Units (Including recurringexpenditures) 0.00 2.83

Error

B12 Referral Transport 544.66 4.82 0.89%B14 Additional Contractual Staff (Selection,

Training, Remuneration) 1400.00 2023.78 144.56%

B16 Training 25.72 0.00 0%

B19 Procurements 0.00 278.08 Error

B22 New Initiatives/ Strategic Interventions (As per

State health policy) 285.72 0.00

0%

B25 State level health resources center(SHSRC) 0.00 15.37 Error

Total10089.60 12838.18 127.24%

Based on table above and records available in FMG, the observations and areas of concern are as

under:-

General Observations:

1. As compared to 2007-08, 651% increase has been noticed in expenditure during 2008-09, butthe expenditure in 2007-08 was as low as Rs.17.10 Crores against the releases of 46.51

Crores.

2. Since the launch of the programme, Rs.146.72 Crores were released to the state and utilisationis appreciable Rs.148.83 Crores (101%).

Areas of Concern:

The expenditure under ASHA, Annual Maintenance Grants, New Construction, Corpus

Grants to HMS/RKS, Distrct Action Plans, IEC-BCC NRHM, MMU, Procurements and

SHSRC to be looked into as no provision made in PIP.

Out of Rs.100.89 crores approved by the NPCC and Rs. 42.39 crores released, the state has

utilised Rs.128.38 crores i.e. 127.24% of approved PIP, while the national average of

expenditure is 68.14%.The reason of excess expenditure booked is that the state has booked

previous year expenditure during 2008-09.

3. More than 100% expenditure has been incurred under Hospital Strengthening, AdditionalContractual Staff (Selection, Training and Remuneration).


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BRIEFING NOTE ON RCH II: HARYANA

A. Background/ current status

1. RCH II Goals

Haryanas MMR has increased from 162 in SRS 01-03 to 186 in SRS 04-06. The IMR (SRS 2007) at

55 has reduced from 59 (SRS 2003), is the same as the national average. TFR at 2.6 (SRS 2007) is

only marginally lower than the national average of 2.7 (refer Annex 1).

2. RCH II Outcomes

Haryanas progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) ismixed (refer Annex 1):

Mothers having full ANCs has increased from 10.3% to 13.3%.

Institutional deliveries have increased from 35.7% to 46.9%.

Full immunisation in children 12-23 months has increased marginally from 59.1% to 59.6%. Children with diarrhoea receiving ORS has decreased from 32.3% to 31.7%.

Unmet need for family planning has increased from 14.7% to 16.0%. Further, use of moderncontraceptives has increased marginally from 54.3% to 54.5%.

3. Expenditure

Audited expenditure has increased from Rs. 8.34 crores in 05-06 to Rs. 20.71 crores in 06-07 and thendecreased to Rs. 18.82 crores in 07-08; reported expenditure in 08-09 is Rs. 32.14 crores i.e. 55.7% of

allocation (Rs. 57.70 crores). JSY accounted for 9.8% of the reported expenditure in 08-09.

B. Key achievements

1. Maternal Health, including JSY

Number of JSY beneficiaries in the state increased from 0.23 lakh in 06-07 to 0.35 lakh in 07-

08 to 0.48 lakh in 08-09. State has accredited 276 private institutions under the scheme. State has operationalised 160 PHCs as 24x7 so far against the target of 204 PHCs by 2010.

32 MBBS doctors have been trained in Life saving anaesthesia skills (LSAS) and 49 incomprehensive Emergency Obstetric Care (EmOC) so far against the target of 59.

279 Staff Nurses and 527 ANMs/LHVs have been trained in SBA as against a target of 1167.

The state has taken several steps to promote safe motherhood and institutional deliveries, andthey include: Delivery Huts with improved access to safe delivery in rural areas. They provide

safe delivery services with privacy, clean & hygienic environment locally in health facilitiesnearest to community at village level and have strong referral linkages with higherinstitutions. There are 564 functional delivery huts operational in 21 districts in the state.

Janani Suvidha Yojana a voucher scheme for women in urban slums to increase access toavailable private infrastructure by involving existing private healthcare providers and is

operational in 8 districts in the state; and Vikalp a state scheme for BPL women to accessMCH through private providers.

Jaccha Baccha scheme which incentivises SBAs performance for institutional deliveries andcovers ante natal, neo natal, and post natal care, emphasizes gender equity, ensures

monitoring and audit by community.

2. Child Health

IMNCI is ongoing in 19 (out of 21) districts of the state. 3,486 personnel have been trained inIMNCI so far.

Breastfeeding promoted by establishing counseling centres in each district hospital


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3. Other initiatives

Referral Transport strengthened by outsourcing to Red Cross Society in five Districts.Vehicles of Health Department and Red Cross pooled together and fitted with GPS. Control

Room established with hotline no. 102. Free ambulance services for all delivery cases, BPL

& Road side accidents. One ambulance to be provided per lac population.

6,200 registered societies consisting of educated women called SMS (Sakshar MahilaSamooh) have been engaged for intensive BCC.

C. Key issues

1. Maternal Health

Haryana along with Punjab, are the only two states which have shown an increase in MMR.

While monthly NRHM report submitted by the state reports 86 FRUs (including 21 DH, 25SDH & 40 CHCs) as functional, there are 46 FRUs that fulfil all the 3 critical criteria offunctionality (as reported during a recent review) as against the target of 59. State needs toensure that multiskilled MOs are placed at designated FRUs, since in a recent review the state

mentioned that EmOC and LSAS trained doctors were posted at PHCs, as were MOs trained

in blood storage.

DLHS-3 facility surveys highlighted the following key gaps: only 32.2% and 45.8% of the24-hour PHCs provide newborn care and referral services respectively; and 21.4% of theCHCs designated as FRUs provide C-section.

Drop out between 1st trimester ANC and full ANC has increased from 3.4% points to 42.4%points (between DLHS-2 and DLHS-3). This is a serious concern, and state needs to ensuretracking of ANC dropouts during VHNDs.

2. Child Health

Reduction in IMR is slow; 1 point per year between SRS 2003 and SRS 2007. Neonatal mortality rate (NMR infant deaths within 4 weeks of life per 1000 live births) at

34 (SRS 2007) accounts for 61.8% of the IMR, while early NMR (infant deaths within oneweek of life per 1000 live births) at 23 (SRS 2007) accounts for 67.6% of the NMR.

Recent results from DLHS-3 show low progress or decline in the outcome indicators: full

immunisation in children 12-23 months (59.1% to 63.6%) and a decrease in coverage of DPTand OPV; initiation of breastfeeding within one hour of birth has remained static at 17.4% &

and a sharp decline in exclusive breastfeeding for 6 months from 33% to 5.3% (DLHS 2-3)and a decline in ORS use in children with diarrhoea (32.3% to 31.7%).


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ANNEX 1

A. Progress on Key Indicators

1. RCH II Goals

INDICATOR HARYANA INDIA

Trend (year & source) Current status RCH II/ NRHM(2012) goal

Maternal Mortality Ratio

(MMR)

162

(SRS 01-03)

186

(SRS 04-06)

254

(SRS 04-06)


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2. Technical interventions

S.

No.

Indicators Achievement upto March 2009

Number %

1. No. of First Referral Units (FRUs) operationalised 86 145.8 (against thetarget of 59 FRUs)

2. No. of PHCs operationalised to provide 24-hourservices

160 78.4 (against thetarget of 204 PHCs)

3. No. of private institutions accredited under JSY 276 NA4. No. of districts implementing Integrated Management

of Neonatal & Childhood Illness (IMNCI)

19 90.4 (out of 21

districts)

5. No. of people trained in IMNCI 3,486 NA6. No. of Village Health & Nutrition Days (VHNDs)

held

98,169NA

(Source: NRHM MIS report, April 2009)


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Immunization

Haryana

Evaluated Immunization Coverage

Survey

Indicator

NFHS 1

(1992-93)

NFHS 2

(1998-99)

NFHS 3

(2005-06)

CES

(2005)

CES

(2006)

DLHS 2

(2002-04)

DLHS3

(2007-08)

FI 63.2 83.4 74.2 57.2 74.9 59.1 63.6

BCG 84.8 94.6 97.2 81.9 85.1 83.5 87.1

Measles 71.8 89.1 86.3 70.5 76.8 65.4 73.6

DPT3 78.5 88.8 85.1 66.5 76.7 73.6 70.4

Progress

As per the evaluated survey the full immunization is 63.6 % in 2007-08 (DLHS 3)

The State has trained 665 Health workers out of 3633.

The State has constituted 19/20 district level AEFI committees.

Issues

The State continues to have high dropoutfrom BCG to DPT 3 at 19% and BCG to Measles at

15% which is critical for further improvement in full immunization coverage.

The state needs to expedite the Immunization training of Health Workers as it has trained only

18.3% (665/3633) of health workers.

The State needs to strengthen AEFI reporting further to improve reporting of AEFI cases.

The State should consider revision of microplans and better tracking of beneficiaries by ensuring

availability of beneficiary/due list with the ANM/AWW/ASHAs at the session sites.


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Brief on National TB Control Programme in Haryana

1. Infrastructure

Total Population 241 lakhNo. of Districts 20No. of Tuberculosis Units (TUs) 54

No. of Designated Microscopy Centres (DMCs) 208

2. Status of Implementation

5 districts of Faridabad, Gurgaon, Jind, Karnal and Sonepat were implementing RNTCPcovering nearly 36% of the State population since year 2000.

Later whole of the State was approved for coverage under RNTCP with assistance ofUSAID.

6 more districts (Ambala, Fatehabad, Mahendragarh, Panchkula, Rewari andYamunanagar) started service delivery during 4

thquarter 2003.

Remaining districts started service delivery latter and by 1st quarter 2004 whole of the

State was covered under RNTCP.

3. State-wise performance: (Based on quarterly reports for 1st quarter 2009)

Overall 162 TB Suspects/lakh pop are examined in 1st quarter 2009 which is satisfactory.

Inspite of good referral of TB suspects total case detection rate of 145/lakh and newsmear positive case detection rate of 53/lakh (56%) are low.

Sputum conversion rate of 91% is satisfactory but cure rate of 84% in new smear positivepatients is marginally low.


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4. District wise Performance : (Based on quarterly report for 1st quarter of 2009)

6 districts (Ambala, Bhiwani, Hissar, Kaithal, Mahendragarh and Yamunanagar) have

very low TCD rate of 67/

lakh)

Sputum

conversion rate

new cases

(against

>90.0%)

Cure rate

new cases

(against

>85.0%)

Ambala 197 118 40 42% 96% 86%

Bhiwani 129 125 55 58% 90% 86%

Faridabad 149 182 50 53% 90% 85%

Fatehabad 164 138 75 78% 89% 84%

Gurgaon 183 159 56 59% 90% 81%

Hisar 127 111 44 46% 89% 85%

Jhajjar 129 154 58 61% 93% 84%

Jind 133 133 52 55% 91% 83%

Kaithal 102 110 54 56% 91% 82%

Karnal 156 151 54 57% 93% 87%

Kurukshetra 165 130 59 62% 92% 88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Qtr1-00

Qtr2-00

Qtr3-00

Qtr4-00

Qtr1-01

Qtr2-01

Qtr3-01

Qtr4-01

Qtr1-02

Qtr2-02

Qtr3-02

Qtr4-02

Qtr1-03

Qtr2-03

Qtr3-03

Qtr4-03

Qtr1-04

Qtr2-04

Qtr3-04

Qtr4-04

Qtr1-05

Qtr2-05

Qtr3-05

Qtr4-05

Qtr1-06

Qtr2-06

Qtr3-06

Qtr4-06

Qtr1-07

Qtr2-07

Qtr3-07

Qtr4-07

Qtr1-08

Qtr2-08

Qtr3-08

Qtr4-08

Qtr1-09

Annualised New S+ve CDR Success rate

Population projected from 2001 censusEstimated no. of NSP cases - 95/100,000 population per year (based on recent ARTI report)

Annualized New Smear-Positive Case Detection Rateand Treatment Success Rate in DOTS Areas, Haryana, 2000-2009*


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Haryana19

Mahendragarh 145 117 43 46% 98% 87%

Mewat 127 151 53 55% 89% 78%

Panchkula 281 167 65 68% 90% 83%

Panipat 154 171 46 48% 90% 85%

Rewari 177 157 43 45% 93% 73%

Rohtak 398 189 77 81% 89% 85%

Sirsa 160 129 58 61% 85% 80%

Sonipat 139 185 53 56% 93% 89%

Yamunanagar 158 118 51 54% 85% 81%

Tota 162 145 53 56% 91% 84%

5. Funds Status as on 31st

March 2009(Rs. in lakh)

C/F Released Expenditure Balance

0.00 422.00 345.39 76.61

6. Drugs

RNTCP Districts: Release Order of RNTCP drugs has been issued based on the requirementprojected in the quarterly report of 1

stquarter 09.

7. Issues

Human Resourceo Posts of 3 DTOs, 7 MO-TCs, 8 STSs and 10 STLSs are vacant.o 7 DTOs, 3 STSs and 1 STLS are not yet trained.o New District Palwal (April 09) Sanctioned for DTC staff required.o Post of contractual Microbiologist for IRL vacant. Govt. Microbiologist holds the

charge.

Logistics Some of the two wheelers for supervisory activities of STSs and STLSs arenot in good condition.

Supervision and Monitoring Internal evaluation frequency is less than expected. In2008 only 3 IE done.

Performance Overall performance of the State is not good. TCD rate of 145/lakh andNSPCD rate of 53/lakh (56%) are not good. TCD and NSPCD rate hasd been less than70% in 10 of 13 quarters since 1st quarter 2006.

Recording and Reporting Windows based EPI Centre not working at the State and 8districts are facing problem in entering data in it. Training of one DEO as TOT required.

ACSM One unit formed at the State for combined IEC activities. They proceed as pertheir own agenda. Districts own action plan not being followed.

TB-HIV Collaboration Collaboration activities have not yet started in the State.


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Haryana20

Intermediate Reference Laboratory (IRL)o STO is the Director of STDC. STDC is at Panchkula, IRL at Karnal and DOT Plus

Site at Rohtak.o Proficiency testing passed.o 250 sputum samples sent by the district to LRS for Culture and DST.o HR resistant cases till date are 25. Recently 10 more cases found HR resistant.o 3 LAs and 1 LT more required.o IRL Visits are sub-optimal.

DOT Plus - 12 cases are under Cat-IV treatment and 3 have died.


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Haryana21

Fact Sheet on NVBDCP-Haryana

Background Information

The State has 20 districts with a population of 21.14 million. There are 86 CHCs, 411 PHCs, 2433

Sub-centres and 6955 villages. There are 1906 Multipurpose Worker (Female)/ANM, 425 HealthWorker (Male), 73 Health Assistants (Female)/LHV, 106 Health Assistant (Male), 216

Laboratory Technician. In addition, the state has 470 Malaria Clinics.

Malaria

Epidemiological Situation

YearTotal slideexamined

Total Malariacases

Total Pfcases

Deaths

2006 2653461 47077 507 0

2007 2436431 30895 330 0

2008 2571866 35683 1397 0

2009(Upto Feb) 280268 200 3 0

Malaria has increased in the state as 35683 malaria cases and 1397 Pf cases were reported in 2008in comparison to 30895 cases and 330 Pf cases in 2007. During 2009 (Upto Feb.) there is decline

in both total malaria cases and Pf cases. However, the state needs to identify the areas for focusedinterventions.

Japanese Encephalitis: Worst affected districts in the state are Karnal, Kurukshetra, Kaithal andYamuna nagar. Out of these, Karnal, Kurukhestra and Ambala districts have been covered under

JE vaccination during 2007-08 respectively. The state is doing Malathion fogging, duringoutbreak, Health education.

Year Cases Deaths

2006 2 12007 85 46

2008 13 3

2009(Prov,upto March) 0 0

Dengue/DHF: Dengue cases and deaths in the state are indicated below:

Chikungunya

Total of 20 suspected Chikungunya fever cases and no death was reported during 2007. In the year2008, 35 suspected Chikungunya fever cases and no death were reported. In the year 2009 till 27

th

May, no suspected Chikungunya fever case and no death has been reported. For proactive

surveillance 5 Sentinel Surveillance Hospitals (SSH) with laboratory support have been identified in

Year Cases Deaths

2006 838 4

2007 365 11

2008 1137 9

2009

(Prov. Upto 27th

May.)

5 0


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Haryana22

the state and linked with PGI, Chandigarh the Apex Referral Laboratory. NIV Pune has beenentrusted the supply of IgM ELISA test kits to the identified institutes.

Filaria and Kala-azar, are not reported from the state of Haryana.

Central Assistance

(Rs. In lakhs)

Year Allocation Release/Expenditure

Cash Kind Total Cash Kind Total

2004-05 310.62 95.33 405.95 0.00 91.49 91.49

2005-06 0.00 266.43 266.43 44.64 24.58 69.22

2006-07 33.38 161.62 195.00 4.61 279.35 283.96

2007-08 35.00 107.84 142.84 10.00 162.39 172.39

2008-09 113.30 108.28 221.58 30.00 17.93 47.93

2009-10(B.E.) 68.00 52.29 120.29

Issues:

Malaria:

Malaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs toidentify the areas for focused interventions.

Acute Encephalitis Syndrome (AES)/ Japanese Encephalitis (J.E.):

Intensive surveillance in the affected areas should be carried out. Sentinel surveillance sites need to be strengthened in the state.

Most of the cases are reported at Private clinics / hospitals that need to be involved in timelydiagnosis and prompt management including transportation / referral protocols for serious

patients.


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Haryana23

STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN HARYANA

Epidemiological scenario-The state is low endemic for leprosy and has already achieved the goal of elimination of

leprosy (i.e. prevalence rate of less than 1 case /10000 population). There were 464 leprosy

cases on record as on March 2009.

New case detection and treatment completion-During 2008-09, a total of 451 new leprosy cases were detected as compared to 379 new

cases detected during the corresponding period of previous year. Out of 369 cases discharged

during the year, 309 cases (83.7%) were released as cured after completing treatment.

NLEP action plan for the year 2009-10 amounting to 107 lakhs has been approved for thestate.

Issues

1. The state has reported low level of fund utilization in 2008-09. During 2008-09, the state

action plan was approved for Rs.144 lakhs, however the state could utilize only Rs. 49.3lakhs.

2. New leprosy cases are being detected in the state every year which suggest activetransmission of the disease in the community. The state is advised to carry out in-depth

situational analysis in districts/blocks reporting large number of new cases and take suitableactions like

(i) Ensuring completion of treatment in each of the new cases detected.(ii) Enhance awareness of the community to improve self reporting of suspected

cases to health facility and(iii) Carrying out family contact survey against all multibacillary and child cases.

3. The state has listed around 150 grade II disability cases since last 5 years. There is no Govt.

institutions/NGO providing reconstructive surgery services to leprosy affected persons withdisability in the state. Hence RCS services are not been provided to disabled leprosy affectedpersons in the state. The state is advised to identify centres for conducting RCS and send the

proposals to GOI for approval so that the backlog of leprosy cases with disability could bereduced in the state.

4. There are 19 leprosy colonies in the state. The state should ensure provision of proper healthcare facilities like ulcer care, provision of supportive drugs and dressing materials to thepersons affected with leprosy residing in these colonies.


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Haryana24

State : Haryana

Integrated Disease Surveillance Project (IDSP) Fact sheet as on 17 June 2009

The State of Haryana has an area of 44212 sq. km and a population of 21 lakhs. There are 21 districts,

119 blocks and 6955 villages. The State has population density of 478 per sq. km.

Haryana is a Phase II State under IDSP and has been inducted in the program during 2004-05 Dr. O.P.

Mittal has been designated as the State Surveillance Officer (IDSP).

1. Manpower

Surveillance Officer and RRT team at State and District headquarter designated. The offerletter to the recommended candidates for the positions of state/district Epidemiologists,Microbiologists and State Entomologists were issued by State/ district NRHM society. In

addition to the above one Data Manager and Data Entry operator have been appointed in all

districts and State Headquarter.

2. IT

Data Centres & Training Centres have been installed at all locations including State head

quarters, PGI Rohtak, and all districts. Hi-End VC equipments have been installed at State Head Quarters.

3. Laboratory StrengtheningPriority district lab identified in Bilaspur and Mandi and is being strengthened.

4. Data Reporting

Haryana has 21 districts. Weekly surveillance data and outbreak reports are reported to CSU

and simultaneously to be entered in IDSP portal i.e. www.idsp.nic.in. In most of the districts,there is late reporting of data

5. OutbreaksReporting of disease out break from the state has started. In 2008 Haryana has reported 10

outbreaks.

6. Training

87 Master Trainers were trained

22 DSOs were trained

2523 Health Workers were trained 58 District Lab Technicians were trained

86 Peripheral Lab Technicians were trained

7. Finance

Year Release (in lakhs) Expenditure (in lakhs)

2004-05 23.00 0.00

2005-06 194.80 15.65

2006-07 0.00 173.69

2007-08 90.00 111.64

2008-09 73.52 27.12

Balance Amount Rs. 53.22 Lakhs


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Haryana25

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

NOTE ON STATUS IN HARYANA

Magnitude:Prevalence of blindness (2003-04) 1.89 %

Estimated blind persons 3.98 lakhs

Infrastructure developed

Upgraded Medical Colleges 1Upgraded District Hospitals 6

District Blindness Control Societies 17

Mobile Eye Care Units 4Eye Banks 1

Upgraded PHCs 80

Cataract Performance

YEAR TARGET ACHIEVEMENT

2007-2008 100000 128634

2008-2009 125000 136000

School Eye Screening

YEAR TEACHER TRAINED

IN SCREENING FOR

REFRACTIVE

ERRORS

SCREENED DETECTED

WITH

REFRACTIVE

ERRORS

PROVIDED

FREE

GLASSES

2007-2008 2900 654512 25162 8298

2008-2009 845 453043 6959 1141

GIA is released to District Blindness Control Societies (IX Plan)

(Rs in lakhs)

YEARRELEASED

EXPENDITURE BALANCE

2007-2008 121.00 125.00 -4.00

2008-2009 230.55 355.14 -124.59

Issues:

UCs for GIA released to State Blindness Control Society are not being received timely.

SOE for Cash Grant are also not being received timely. Performance of School Eye Screening Programme needs to be improved.


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Haryana26

NIDDCP

Haryana

Rs. In Lakh

ActivityAmountproposed

AmountApproved

Remarks

1

Establishment

of IDD Control

Cell

7.50 6.00

The State Government may carry out the

activities as per the fund allocation of GOI.

2

Establishmentof IDD

Monitoring

Lab

4.50 3.50

3

Health

Education andPublicity

10.00 12.00

4 IDD surveys 2.00 2.50

Total 24.00 24.00


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Haryana27

Mapping of Record of Proceedings of the NPCC of NRHM for

2005-06 to 2009-10

The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in

following broad thematic chapters

1. ASHA (including selection, training, drug kits, mentoring, specific performanceincentives and anything else associated with ASHA)

2. Infrastructure related matters (including construction, strengthening, renovation, newconstruction etc), equipments, transport (ambulances, EMRI, associated expenses) and

others)3. Human Resource related matters (including HR salary, contractual payments,

incentives, etc)4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC,

IDHAP, M&E, Mobility support to SHS etc)

5. Untied funds, AMG & RKS related mattes

6. Training & Capacity Building related matters (including trainings, workshops, traininginstitutions including their upgradation or new construction, courses, etc)

7. Innovations (including Procurement of medicines, School Health, Health Mela,

Insurance, Accreditations, Monthly VHND etc)

NATIONAL RURAL HEALTH MISSION

Haryana

Total MFP Approvals 3036.4 10090 15025.97

RoP Approvals for Various Years in Rs. Lakh

S.No Initiative

2005-06 2006-07 2007-08 2008-09 2009-10

RemarksReleased Approved Approved Approved Approved

ASHA

1 ASHA 888.5

TOTAL 888.5

Infrastructure related matters

2

Civil works-

Sc/PHC/CHC600

3 Infrastructure 3100

4

Upgradation of Health

Institutions 35005 Upgradation of CHC 1160 240

6

Strengthening HealthInstitutions as per IPHS

6600

7

State ProjectImplementation Unit at

Consultancy Services


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Haryana28

8

Emergency & ReferralServices

544.66 580

9 MMU 695.6 47.34

TOTAL 1160 1535.6 7144.66 7227.34

Human Resources related matters

10

Contractual Staff

recruited and in

position at Healthsystem Resource Centre(HHSRC) 23.14

11 ANM 306 1400 2395.98

12

Special Incentive forMewat, Morni &

Difficult areas 300

13 Accounts Assistants atCHC 98.28

TOTAL 306 1400 2817.4

Programme Management related matters

14Strengthening ofSIHFW & SHRC 50 78

15 Preparation of DHAP 270

16

State convergenceCommittee Quaterlymeetings

172.5

17 Household survey 140.09

TOTAL 270 172.5 190.1 78.0

Untied Funds, Annual Maintenance Grants and RKS funds related matters

18 Rogi Kalyan Samiti 590

19Rogi Kalyan SamitiHQ Hospital 105

20

Rogi Kalyan Samiti

CHC/ Sub DivisionalHospital 116

21

Rogi Kalyan Samiti-

PHC 336

22 Untied funds to CHC

14223 Untied Fund for PHC 102 315.75

24Untied Fund for SC 243 46.3 246.5 246.5

25 Untied Fund for VHSC 671.25 628.2

26Annual MaintenanceGrants CHC

274.527Annual MaintenanceGrant -PHC

204

28Annual MaintenanceGrant- SC 246.5

TOTAL 243 942.3 1233.5 2094.7


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Training & Capacity Building related matters

29Capacity Building andExperience sharing 27

30 MIS Training 25.72 254

31Continuous MedicalEducation (CME) 10

TOTAL 25.72 291

Innovations related matters

32 Health Melas 80 80

33

Intersectoral

Convergence95.63

34 BCC/IEC 440.05

35

Improving Quality Of

Service Delivery & ISO 60

36

Strengthening ofProcurement &

Logistics 214.19

37

Comprehensive Best

Health Village Scheme 61.59

38

Free Treatment of Cleft

Lips and Palate 10.2

39Down SyndromeScreening Programme 5

40

Prevention and

Treatment of RHD 10

41

De-worming andAnemia Control

Programme 200

42

Treatment to

Hemophilia Patients 96

43

Civil Registration

System 37

44

Strengthening of Lab at

Zonal Level andDistrict level for

NVBDCP 21

45

Funds for ASHA andcommunity workers forintensifying anti larval

activities and checking

of breeding sites 175

46

Drug supply for

CHC/FRU 426

TOTAL 426 80 95.63 1410.03

Documents

Haryana Report