NAGALAND STATE REPORT

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1

Nagaland

Index

S. No. Content Page No.

1 Summary of Approvals 2 – 5

2 Demographic Profile 6 – 7

3 Progress of NRHM 8 – 12

4 Reproductive & Child Health 13 – 16

5 Immunization 17 – 17

6 Revised National Tuberculosis Control Programme (RNTCP) 18 – 19

7 National Vector Borne Disease Control Programme (NVBDCP) 20 – 20

8 National Leprosy Eradication Programme (NLEP) 21 - 21

9 Integrated Disease Surveillance Project (IDSP) 22 – 22

10 National Programme for Control of Blindness (NPCB) 23 – 24

11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 25 – 25

12 RoP Approvals under Mission Flexible Pool 26 - 30

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NAGALAND

Summary of Approvals

Financial Management under NRHM (Rs. in crore)

Years Allocation Release Expenditure % Release

against Allocation

% Expenditure against Release

2005-06 30.42 29.60 13.99 97.32 47.28 2006-07 49.14 43.88 37.01 89.30 84.34 2007-08 56.19 44.53 41.37 79.25 92.92 2008-09 53.57 54.52 53.79 101.77 98.66 2009-10 62.66 0.00

Total 251.97 172.52 146.16 68.47 84.72

S. No. Timeline Activities Achievement %

1 ASHA Selection 1700 103 Training 1700

2 VHSC 1278 97 3 24X7 PHCs 33 39 4 Mobile Medical Unit 11 100 5 Rogi Kalyan Samiti 160 138

Budget Allocations (2005-09) ( Amount in Crores) Allocation Releases Expenditure

RCH Flexipool 2005-06 8.70 6.61 1.64 2006-07 8.90 3.73 5.06 2007-08 11.88 7.87 6.46 2008-09 15.26 17.22 12.02 2009-10 19.25

Total (A) 63.99 35.43 25.18 NRHM Flexipool

2005-06 7.83 0.87 2006-07 21.03 22.62 12.55 2007-08 24.1 18.08 20.16 2008-09 17.04 17.34 23.46 2009-10 19.1

Total (B) 81.27 65.87 57.04 National Disease Control Programme

2005-06 11.07 7.06 4.38 2006-07 10.86 10.45 12.52 2007-08 11.55 7.07 4.22 2008-09 11.86 7.90 6.22 2009-10 13.29 0.00 0.00

Total (C) 58.63 32.47 27.34 Grand Total (A + B + C) 203.89 133.77 109.56

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

Approval for Infrastructure Facilities (Rs. in Crore)

S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10 1 Sub C 0.33 0.28 0.00 0.00 3.08

2 PHC 1.36 0.00 0.00 3.53

3 CHC 5.00 0.00 0.56 1.17

4 DH 1.00 0.00 0.00 0.00

5 Eqpmt 0.80 0.00 0.00 1.32

6 Transp 0.00 4.01

7 Others 8.91 0.00 9.67 6.79

Total 5.33 12.35 0.00 10.23 19.90

Approval for Human Resource Support (Rs. in Crore) S. No Personnel 2005-06 2006-07 2007-08 2008-09 2009-10

1 Doctors 0.00 0.00 3.23

2 Specialists 0.00 0.15 0.77

3 Staff Nurses 0.18 0.00 0.00 1.37

4 ANM 0.69 0.00 1.61 2.42

5 Others 0.18 0.00 3.25 3.65

Total 0.00 1.05 0.00 5.01 11.44

RoP Approvals for Various Years in Rs. Lakh

S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10 Remar

ks Released Approved Approved Approved Approved ASHAs

1 ASHA 57.29 82.71 100.07

170

2 Performance related incentives for ASHA 19.85 25.15

TOTAL 77.14 107.86 100.07 170 Untied Funds, Annual Maintenance Grants and RKS funds related matters

3 Rogi Kalyan Samiti 55 4 Rogi Kalyan Samiti- DH 55 55 55

5 Rogi Kalyan Samiti- CHC

21 21 21

6 Rogi Kalyan Samiti-PHC 128 128 84 7 Untied Fund for CHC 10.5 10.5 10.5 8 Untied Fund for PHC 21.75 21.5 32 21 9 Untied Fund for SC 33 24.4 39.7 39.7 39.7

10 Untied Fund for VHSC 39.7 127.8 127.8 127.8

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11 Annual Maintenance Grant - CHC

21 21 21

12 Annual Maintenance Grant -PHC

43.5 42 64 42

13 Annual Maintenance Grant- SC

36 39.7 34.2

TOTAL 33 184.35 502.5 538.7 456.2 Infrastructure related matters

14 Emergency & Referral Services 35 63 119

182

15 MMUs 561 19.8 218.57 TOTAL 596 63 138.8 400.57

Status of Infrastructure 2005-2010 Health Facilities As per RHS 2008 New Construction Upgradation / Renovation Number of Sub Centre 397 85 0 Number of PHC 86 0 31 Number of CHC 21 0 14 Number of DH 11

As per State Data Sheet, NRHM

0 11

Status of NRHM as on 15.05.2009

1 ASHA Selection 1700 Training 1700

2 VHSC 1278

3 Joint A/C @ Sub Centre and VHSC 1278

4 24X7 Facility 54

5 FRU 11

6 Contractual Manpower

Doctors & Specialist 71 AYUSH Doctors 21

Staff Nurse 113 Paramedics 75

ANM 251 7 JSY Beneficiaries (in Lakhs) 0.22

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National Disease Control Programme

NLEP

The 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.

IDSP

It is a Phase II state. All districts are reporting weekly Surveillance data and Weekly Outbreak Report in time but data need to be entered in IDSP portal.

NBCP The performance of Cataract Surgery needs to be further improved in NE States in view of large cataract backlog.Eye care infrastructure need to be strengthened. Shortage of eye surgeons, PMOAs etc.All the NE States are required to furnish utilization certificates in respect of funds released to them under NPCB timely for release of next installment.

NVBDCP Incidence of malaria, Pf cases and deaths due to malaria is showing a fluctuating trend. Vector Borne Diseases such as Filaria, Kala-azar, JE, Dengue and Chikungunya are not endemic in the state.

RNTCP Overall total case detection rate and new smear positive (NSP) case detection rate is satisfactory. Cure rate and sputum conversion rate is also satisfactory

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Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF NAGALAND The Total Fertility Rate of the State is NA. The Infant Mortality Rate is 21 and Maternal Mortality Ratio is NA (SRS 2004 - 06). The Sex Ratio in the State is 900 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: Table I: Demographic, Socio-economic and Health profile of Nagaland State as compared to India figures S. No. Item Nagaland India

1 Total population (Census 2001) (in million) 1.99 1028.61 2 Decadal Growth (Census 2001) (%) 64.53 21.54 3 Crude Birth Rate (SRS 2007) 17.4 23.1 4 Crude Death Rate (SRS 2007) 5.0 7.4 5 Total Fertility Rate (SRS 2007) NA 2.7 6 Infant Mortality Rate (SRS 2007) 21 55 7 Maternal Mortality Ratio (SRS 2004 - 2006) NA 254 8 Sex Ratio (Census 2001) 900 933 9 Population below Poverty line (%) 32.67 26.10 10 Schedule Caste population (in million) 0 166.64 11 Schedule Tribe population (in million) 1.77 84.33 12 Female Literacy Rate (Census 2001) (%) 61.5 53.7

Table II: Health Infrastructure of Nagaland

Item Required In Position Shortfall Sub-centre 535 397 138 Primary Health Centre 80 86 - Community Health Centre 20 21 - Multipurpose Worker (Female)/ANM 483 696 - Health Worker (Male)/MPW(M) 397 300 97 Health Assistants(Female)/LHV 86 31 55 Health Assistants(Male) 86 15 71 Doctor at PHCs 86 79 7 Surgeons 21 1 20 Obstetricians & Gynaecologists 21 0 21 Physicians 21 0 21 Paediatricians 21 0 21 Total specialists at CHCs 84 1 83 Radiographers 21 1 20 Pharmacist 107 113 - Laboratory Technicians 107 64 43 Nurse Midwife 233 520 -

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

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

Health Institution Number Medical College District Hospitals 11 Referral Hospitals

City Family Welfare Centre Rural Dispensaries

Ayurvedic Hospitals - Ayurvedic Dispensaries 85

Unani Hospitals - Unani Dispensaries -

Homeopathic Hospitals 1 Homeopathic Dispensary 115

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Note on Progress of NRHM in Nagaland

(June 2009)

The National Rural Health Mission (NRHM) in Nagaland was launched in Feb‘06. Within the time span of these few years, the state has shown significant improvement in health care delivery both in terms of physical infrastructure and service delivery output. The Mission adopts a synergistic approach by relating Health to determinants of good health viz. of nutrition, sanitation, hygiene and safe drinking water. The activities under National Rural Health Mission are transforming the health care delivery to rural populace with increasing accessibility to quality services and the opportunity to participate actively in managing these services as well. 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 Health Mission held 27 times and of District Health Mission held 35 times. Merger of societies is completed in 11 districts. 1278 VHSCs have been constituted & 1278 Joint Accounts operationalised at sub centre level. Rogi Kalyan Samities are operational at 11 DH, 21 CHCs & 86 PHCs. All districts have started developing their own IDHAP.

Infrastructure Improvements

A total of 33 PHC have been strengthened with three Staff Nurses each to make them functional for 24x7 works. 21 CHC are functioning on 24X7 basis & facility survey completed in 21(including others health institution below district level). All District Hospitals are functioning as FRUs. All districts have functional Mobile Medical Unit (MMU)

Human Resources

A total of 1700 ASHAs have been selected & are trained on 1st Module. All the ASHAs have been provided with drug kits. 300 Sub-centres are functional with an ANM and 111 SCs have been strengthened with 2nd ANM. State has appointed 21 Contractual AYUSH Doctors to health institutions. As far as Manpower augmentation is concerned, 71 Doctors, 113 SN, 251 ANMs recruited on contractual basis Services Institutional deliveries improved from 0.01 lakhs (06-07) to 0.10 lakhs (07-08). During the year 2008-09, in the state 0.15 lakhs Institutional deliveries have been done. The number of JSY beneficiaries increased from 0.01 lakhs (06-07) to 0.10 lakhs (07-08). During the year 08-09 the number of JSY beneficiaries was 0.14 lakh. Female sterilizations have increased from 0.001 lakh (06-07) to 0.01 lakh (07-08) and male sterlisation has increased from 0 (06-07) to 18 (07-08). During year 2008-09, 2018 female & 100 male sterilization done so far. 3 districts are implementing IMNCI & 136 people trained so far. 688 VHND held since the launch 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

• Increase in general utilization of OPD and indoor services • Village institution in place with strong community participation • SPMU & DPMU are in place • 1700 ASHAs selected and trained. The 3rd and 4th Module is in process • The State has already initiated MMU for unreached population. • Partnerships with NGOs, three mission hospitals have been brought under the PPP model. • VHSC constituted and operational with joint accounts. • All District Hospitals strengthened to provide quality health services. • Full coverage of immunization has improved. • First phase of community monitoring pilot has been completed in the state.

Areas for Further Improvement

• Further strengthening of infrastructure, need to rationalise and fast track upgradation. • Large rural area >80% where health personals are not willing to stay • ASHAs are yet to fully understand their roles. • Shortage of medical doctors / specialists, rational postings required. • Need for capacity building of PRIs for better functioning of VHSC. • 75% SC are functional with ANM, need to strengthen the Sub centre with 2nd ANM

Infrastructure

• To meet ever increasing demands for quality health care personnel, the nursing schools in the state are need to be upgraded both in terms of infrastructural improvements and capacity expansion.

• Poor accommodation facility for health personals in rural areas, need to be improved. • Need to rationalise and fast track upgradation of public health Infrastructure.

Human Resources

• Serious dearth of, the state could not make many of its health facilities fully functional. • Innovative ideas like the ‘alternative delivery system’ have made some improvement in

overcoming these shortfalls. Incentive for the rural and posting at far flung areas have also been of great motivational factor in the current year.

• SPMU & DPMU are in place, still need to formulate BPMUs. • Shortage of manpower rational postings of specialists, performance based payment schemes

and referral audits need be reinforced.

Service Delivery • The State need to strengthen Health Management and Information System to facilitate the

smooth flow of information. • Institutional deliveries have been increased under JSY Scheme .

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An Analysis of Financial Monitoring Report for the FY 2008-09

A. RCH Flexible Pool

Component wise expenditure & Utilization under RCH against the approved PIP Rs. in Lakhs

Activities SPIP Expenditure % Utilization against PIP

Maternal Health 481.69 237.99 49.41 Child Health 52.40 23.02 43.93 Family Planning Services 53.55 11.00 20.54 Adolescent Reproductive and Sexual Health/ ARSH 5.40 0.00 0.00 Urban RCH 19.62 0.00 0.00 Infrastructure & Human Resources 583.48 204.38 35.03 Institutional Strengthening 92.65 57.13 61.66 Training 143.56 86.60 60.32 BCC / IEC 86.20 108.16 125.48 Procurement 317.29 401.48 126.53 Programme Management 102.00 72.35 70.93 Total 1937.84 1202.11 62.03

Based on table above and record available in FMG, observations are as under:- General Observations:-

1. Rs. 12.02 crore, i.e. 62.03% of the PIP approved 19.38 crore, has been utilized by the state of Nagaland under RCH-II as compared to National Level expenditure average of 71%.

2. The Expenditure under Maternal Health is just 49.41% of approved PIP which is very less.

3. Expenditure under IEC and Procurement is Rs. 1.08 Crores and Rs. 4.01 Crore respectively which is more than their approved PIP.

4. Since the launch of RCH-II programme, Rs. 22.90 Crore i.e. 65% amount has been utilized by the state against the release of Rs. 35.43 Crore during the period of the year 2005-06 to 2008-09.

5. Performance is good in training. Areas of Concern:-

1. No expenditure is incurred under ARSH and Urban RCH while their approved PIP is 0.05 crores and 0.20 crores respectively.

2. There is 189% increase in the expenditure as compared to 2007-08. 3. The expenditure under Family Planning is just 20.54%.

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4. Expenditure under Maternal Health & Family Planning is Rs. 2.49 Crores only i.e. 21% of total expenditure of Rs.12.02 Crore.

B. Mission Flexible Pool:-

Component wise expenditure & Utilization under NRHM against the approved PIP

Rs. In Lakhs

Activities SPIP Expenditure %Utilisation against PIP

ASHA 100.07 97.49 97.42 Untied Funds 210.00 32.00 15.24 Hospital Strengthening 99.00 182.99 184.84 Annual Maintenance Grants 124.70 0.00 0.00 New Constructions/ Renovation and Setting up 328.00 541.00 164.94 Corpus Grants to HMS/RKS 183.00 42.00 22.95 District Action Plans 55.00 55.03 100.05 Panchayti Raj Initiative 90.22 28.20 31.26 IEC-BCC NRHM 0.00 29.50 Mobile Medical Units 24.80 33.95 136.90 Referral Transport 119.00 3.60 3.03 Additional Contractual Staff (Selection, Training, Remuneration) 500.78 361.42 72.17

Training 500.00 221.89 44.38

Planning, Implementation and Monitoring 0.00 0.58 Procurements 371.27 522.72 140.79 Support Services 0.00 5.57 NRHM Management Costs/ Contingencies 115.82 170.30 147.04 Other Expenditure (Power Backup, Convergence etc.) 46.98 17.47 37.19 Total 2868.64 2345.71 81.77

Based on table on previous page and record available in FMG, observations are as under:-

General Observation:-

1. Since the start of the programme Rs. 65.87 Crore were released to the state, the utilization is

only Rs.58.59 Crore (89%) and Rs. 7.28 Crore (11%) remains unutilized. 2. Out of Rs. 28.69 Crore approved by the NPCC and released Rs. 17.34 Crore for the year,

state has utilised Rs.23.45 Crore i.e. 82% of approved PIP which is appreciable. 3. There is only 8% increase in the expenditure as compared to 2007-08. 4. State incurred more than 100% expenditure in activities like Hospital Strengthening, New

Constructions/Renovation, District Action Plan, Mobile Medical Units, Procurement and NRHM Management Costs, it is a good achievement.

5. Expenditure under ASHA is 97% of approved PIP i.e. Rs. 97.49 Crore, which is a good achievement.

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Areas of Concern:- 1. Expenditure under Untied Fund is just 15% of the approved PIP. 2. Expenditure under Annual Maintenance Grants is Rs.NIL whereas approved PIP is Rs. 1.25

Crore. 3. Expenditure under the head Referral Transport is 3.03% of the approved PIP. 4. Planning, Implementation & monitoring and support services were not planned but their

expenditure is Rs. 0.58 lakhs and Rs. 5.57 Lakhs respectively. 5. The performance under Corpus Grants to HMS/RKS and Panchayti Raj Initiative needs to

be improved.

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BRIEFING NOTE ON RCH II: NAGALAND

A. Background/ current status 1. RCH II Goals Nagaland’s MMR data is not available. Nagaland’s IMR (SRS 2007) at 21 has increased from 17 (SRS 2004). TFR at 3.7 (NFHS-3, 2005-06) has decreased from 3.8 (NFHS-2, 1998-99), but is a long way from the target of 2.1 for 2012 (refer Annex 1). 2. RCH II Outcomes Nagaland’s progress during the six year period between NFHS 2 (1998-99) to NFHS-3 (2005-06) is mixed (refer Annex 1):

• Mothers who had at least 3 antenatal care visits increased from 21.9% to 32.7%. • Institutional deliveries decreased from 12.1% to 11.6%. • Full immunisation in children 12-23 months increased from 14.1% to 21.0%. • Initiation of breastfeeding within one hour of birth more than doubled, from 24.5% to

54.1%. • Children with diarrhoea receiving ORS decreased from 29.7% to 16.5%. • Unmet need for family planning decreased from 30.2% to 26.1%. Further, use of modern

contraceptives has decreased from 24.2% to 22.5%. 3. Expenditure Audited expenditure has increased from Rs. 1.66 crores in 05-06 to Rs. 5.06 crores in 06-07 and decreased to Rs. 4.16 crores in 07-08; reported expenditure in 08-09 has increased to Rs. 12.02 crores i.e. 62% of allocation (Rs. 19.38crores). B. Key achievements 1. Maternal Health, including JSY

• Number of JSY beneficiaries in the state increased from 1,301 in 06-07 to 8,457 in 07-08. A total of 14,344 beneficiaries have availed of the services in 08-09. State has accredited 4 private institutions under the scheme.

• State has operationalised 11 FRUs (against the target of 19) and 33 PHCs as 24x7 (against the target of 86) as per NRHM monthly report submitted by state.

• 168 ANMs/SNs/ LHVs trained as SBA against the target of 258. • State is running RTI/STI clinics at health facilities, and has trained 68 MOs, 66 lab

technicians, and 406 MPWs so far. 2. Child Health

• 3 districts are implementing IMNCI and around 136 personnel have been trained so far. • Newborn care corners in 21 facilities are being completed.

3. Other initiatives

• 17 CHCs and 62 CHCs have been provided with the waste disposal unit during the year. C. Key issues 1. Maternal Health, including JSY

• Only 4 MBBS doctors have been trained in LSAS against the target of 19 and 3 MBBS doctors have been trained in EmOC against the target of 19.

• Blood storage facilities are inadequate for the planned FRUs.

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• The percentage of deliveries conducted by skilled birth attendants has declined from 32.8% to 25.9% as per the NFHS II & III findings; while institutional births have also declined to 11.6% (NFHS-3).

• Provision of ANC services is quite low: only 32.7% (NFHS-3) women received three ANC visits

2. Child Health

• IMR has increased between 2004 and 2007. • Proportion of underweight children under 3 years age has increased from 24.1% in NFHS-2

to 29.7% during NFHS-3. • Children with diarrhoea receiving ORS has dropped sharply from 29.7% (NFHS-2) to 16.5%

(NFHS-3). • Percentage of children 12-23 months fully immunised is very low at 21% (NFHS-3).

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ANNEX 1 A. Progress on Key Indicators

1. RCH II Goals

INDICATOR NAGALAND INDIA Trend (year & source) Current status RCH II/ NRHM

(2012) goal Maternal Mortality Ratio (MMR)

NA NA 254 (SRS 04-06)

<100

Infant Mortality Rate (IMR) 17 (SRS 2004) 21 (SRS 2007) 55 (SRS 2007) <30 Total Fertility Rate (TFR) 3.8 (NFHS2

1998-99) 3.7 (NFHS3

2005-06) 2.7 (SRS 2007) 2.1

2. RCH II Outcomes

S. No. RCH OUTCOME INDICATOR

NAGALAND INDIA NFHS–2 (1998-99)

NFHS–3 (2005–06)

NFHS–2 (1998-99)

NFHS–3 (2005–06)

1. Mothers who received 3 or more antenatal care checkups (%) 21.9 32.7 44.2 52.0

2. Institutional deliveries (%) 12.1 11.6 33.6 38.7

3. Children 12-23 months age fully immunised (%) 14.1 21.0 42.0 43.5

4. Children under 3 years, breastfed within one hour of birth (%) 24.5 54.1 16.0 23.6

5. Children with diarrhoea in the last 2 weeks who received ORS (%) 29.7 16.5 26.9 26.0

6. Use of any modern contraceptive method (%) 24.2 22.5 42.8 48.5

7. Total unmet need for family planning - both spacing methods and terminal methods (%) 30.2 26.1 15.8 12.8

B. Trends in Financial Expenditure

(Rs. crores) FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 Release 6.61 3.73 7.87 17.22 Audited Expenditure 1.66 5.06 4.16 12.02* * - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided. - Allocation for 2008-09: Rs. 19.38 crores.

C. Progress on Key Strategies

1. Demand side interventions

S. No.

Indicators

Achievement (no. of beneficiaries) 2005–06 2006–07 2007–08 2008–09

1 Janani Suraksha Yojana NA 1,301 8,457 14,344 2 Total Sterilisation 1,195 972 1,125 na 3 IUD Insertions 2,571 1,564 1,602 na

(Source: M&E Division reports, and JSY reports from the states)

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2. Technical interventions

S. No. Indicators Achievement upto March 2009

Number % 1. No. of First Referral Units (FRUs) operationalised 11 57.9 (against the

target of 19 FRUs) 2. No. of PHCs operationalised to provide 24-hour

services 33 38.4 (against the target of 86 PHCs)

3. No. of private institutions accredited under JSY 4 NA 4. No. of districts implementing Integrated Management

of Neonatal & Childhood Illness (IMNCI) 3 27.3 (out of 11 districts)

5. No. of people trained in IMNCI 136 NA 6. No. of Village Health & Nutrition Days (VHNDs) held 688 NA

(Source: NRHM MIS report, April 2009)

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Immunization

Nagaland

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 3.8 14.1 21.0 NA 32.5 13.1 NA

BCG 19.4 46.1 45.9 80.8 62.5 66.2 NA

Measles 10.0 19.6 27.4 63.4 46.1 38.2 NA

DPT 3 12.5 29.6 28.8 94.5 41.0 31.8 NA

Progress

� The State is showing an improving trend in immunization coverage with FI at 32.5% (CES

2006).

� The state has completed training of Health Workers.

� In 8 out 11 districts AEFI committees have been constituted.

Issues

� The State needs to address the issue of high dropout rate of 37% from BCG- DPT3 (NFHS-3)

for any further improvement of Immunization Coverage.

� The AEFI Surveillance needs to be strengthened with improved reporting of cases.

� The fund utilization under Immunization is poor for 2008-09.

� There is need for revision of microplans and better tracking of beneficiaries by ensuring

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

Counterfoils with tracking bags also need to be used for reducing dropouts.

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Brief on National TB Control Programme in Nagaland 1. Infrastructure Total Districts - 11 (Reporting Units – 8), TUs – 8, DMCs – 29

Total Population - 21.0 lakh 2. Status of Implementation

• All 8 districts started implementation of RNTCP in 4th quarter 2002. 3. State level Performance (Based on the quarterly reports for 1st quarter 2009)

• Overall total case detection rate and new smear positive (NSP) case detection rate is satisfactory.

• Cure rate and sputum conversion rate is also satisfactory.

0%

10%

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1-09

Annualised New S+ve CDR Success rate

•Population projected from 2001 census

•Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)

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

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4. District wise performance (Based on the quarterly reports for 1st quarter 2009)

Districts

Suspects examined per lakh

population

Annualised total case detection rate/lac ( against

>144/lakh)

Annualised new sputum positive case

detection rate ( against

>53/lakh)

Sputum conversion in new sputum positive cases

(against >90.0%)

Cure rate in new sputum positive

cases (against >85%)

Dimapur 173 233 73 98% 90% 86% Kohima 138 108 46 62% 100% NA Kiphire 182 208 56 75% 93% 90% Longleng 111 135 29 38% 100% NA Mokokchung 131 115 63 83% 94% 89% Mon 208 169 72 96% 79% 96% Peren 211 140 60 80% 100% NA Phek 59 72 26 35% 92% 81% Tuensang 166 272 65 86% 97% 88% Wokha 119 94 63 84% 95% 100% Zunheboto 90 66 27 37% 86% 88%

5. Funds status as on 31st March 2009 (Rs. in lakh)

C/F Released Other Income Expenditure Balance 16.26 162.00 10.51 177.40 11.37

6. Drugs

• Drugs have been issued to the State according to the requirement.

• Issues

o Overall performance of the State had been satisfactory. Sputum conversion rate and cure rate

are satisfactory. o District-wise performance of Longleng, Phek, Wokha and Zunheboto is not yet good. In

Longleng, Wokha & Zunheboto case detection rate is low; sputum conversion rate is low in Longleng & Zunheboto and cure rate is low in district Phek.

o Three newer districts (Kiphire, Longleng and Peren) should be sanctioned the post of DTOs. o State is having only 2 MO-TCs for 13TUs. For effective supervision and monitoring of the

programme, all the TUs should be provided with MO-TCs. o Supervisory activities are sub-optimal both at State and District levels. One of the reasons is

non availability of MO-TCs in districts. o TB/HIV coordination committee (DCC) not yet formed in all the districts. o Performance of Longleng, Wokha and Zunheboto is not good and needs to be closely

monitored.

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Fact Sheet on NVBDCP-Nagaland

Background Information

The State has 11 districts with a population of 1.99 million. There are 21 CHCs, 84 PHCs, 397 Sub-centres and 1317 villages. There are 342 Multipurpose Workers (Female)/ANM, 300 Health Worker (Male), 15 Health Assistants (Female)/LHV, 15 Health Assistant (Male) and 45 Laboratory Technician.

Malaria

Epidemiological Situation

Year Total Slide examined

Total Malaria Cases

Total Pf Cases Deaths

2006 91953 3361 506 75 2007 103080 4877 783 11 2008 135910 5674 817 0

2009 (Upto. Mar) 25113 591 76 0

• Incidence of malaria, Pf cases and deaths due to malaria is showing a fluctuating trend during the last three years.

• The state has been covered under Global Fund Supported Intensified Malaria Control Project.

• State is being provided RD Kits for early diagnosis of Pf cases and ACT for effective treatment of P.falciparum cases.

Other Vector Borne Diseases such as Filaria, Kala-azar, JE, Dengue and Chikungunya are not endemic in the state. Central Assistance

(Rs. In lakhs) Year Allocation Release/Expenditure

Cash Kind Total Cash Kind Total 2004-05 58.15 364.15 422.30 58.15 220.38 278.53 2005-06 158.95 221.00 379.95 205.31 227.10 432.41 2006-07 274.04 473.96 748.00 241.22 454.06 695.28 2007-08 298.56 491.46 790.02 214.28 334.99 549.27 2008-09 383.08 455.09 838.17 381.15 228.89 610.04 2009-10(B.E) 417.33 451.11 868.44

Issues:

• The surveillance is very poor which needs to be strengthened by filling up all posts of Surveillance Workers.

• The quality spray has to be ensured through intensive supervised spray activities.

Nagaland

21

STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN NAGALAND

• Epidemiological scenario- Nagaland 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 63 leprosy cases on record as on March 2009.

• New case detection and treatment completion-

During 2008-09, a total of 65 new leprosy cases were detected as compared to 54 new cases detected during the corresponding period of previous year. Out of 2 cases discharged during the year as cured after completing treatment.

• During 2008-09, NLEP action plan amounting to Rs.52.23 lakh has been approved for the

State. Issues -

1. The state is advised to carry out in-depth situational analysis in districts/blocks reporting large number of new cases and take suitable actions 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.

2. The State should follow the under treatment cases, assess their status and remove those cases

from record who have completed full course of MDT.

Nagaland

22

State: Nagaland Integrated Disease Surveillance Project (IDSP) –Fact sheet as on 17 June 2009

The state of Nagaland has an area of 16579 sq. km. and a population of 1.99 million. There are 11 districts, 52 blocks and 1317 villages. The State has population density of 120 per sq. km. (as against the national average of 312). The decadal growth rate of the state is 64.53% (against 21.54% for the country) and the population of the state continues to grow at a much faster rate than the national rate.(source:www.mohfw.nic.in/nrhm.htm.) Nagaland is a phase-II state under IDSP and has been inducted in the program during April 2005. Dr Kevichusa Medikru, from Directorate Health Services, Govt of Nagaland has been designated as the State Surveillance Officer (IDSP). The component wise action points are as under 1. Manpower Surveillance Officer and RRT team at state and district Headquarter designated. Appointment of Data managers, Data entry operator, accountant and administrative assistant completed in all districts. The offer letter to the recommended candidates for the positions of state/district epidemiologists ,microbiologists and state entomologists to be issued by state/district NRHM society. 2. IT & EDUSAT EDUSAT (Total=12) SIT equipments installed at State Headquarter and 11 DSUs. 3. Laboratory Strengthening Two priority district laboratory identified by the state were surveyed and state was given sanction in February 2009 to procure required equipments for those two laboratories. This procurement is under progress. 4. Data Reporting Nagaland has 11 districts. All districts are reporting weekly Surveillance data and Weekly Outbreak Report in time but data need to be entered in IDSP portal i.e. www.idsp.nic.in. 5.Outbreaks: Year Number Type 2008 1 Acute Flaccid Paralysis 2009 (upto May) 0 5. Training Training of Medical Officers, Health Workers and District Lab Technicians completed as per PIP numbers. State is yet to identify and suggest names of core trainers for undertaking trainings at all levels under IDSP. 6. Finance

Year Release(in lakhs) Expenditure(in lakhs) 2005-06 83.40 13.06 2006-07 89.00 129.92 2007-08 94.54 46.14 2008-09 81.73 Total 266.94 270.85

State has a negative balance amount 3.91 lakh FMR received upto March 2009. Audited Accounts and Utilization Certificate for the year 2007-08 received.

Nagaland

23

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

STATUS OF IMPLEMENTATION of NPCB IN NORTH-EASTERN STATES

Performance of Cataract Surgery during X Plan

State 2005-06 2006-07 2007-08 2008-09 Tar. Ach. Tar. Ach. Tar. Ach. Tar. Ach Arunachal Pradesh 1000 993 1000 776 1000 1043 2000 1172 Assam 45000 47100 45000 23500 45000 48346 50000 47749

Manipur 1000 1014 2000 604 1000 1156 2000 1744 Meghalaya 2000 1372 2000 827 2000 1023 2000 2308 Mizoram 1000 1211 800 859 1000 2715 3000 2397 Nagaland 500 741 500 450 500 583 1500 1048 Sikkim 500 351 1000 241 500 571 800 690 Tripura 8000 4359 8000 5186 8000 6708 7000 8429 Total 59000 57141 60300 32443 59000 62145

68300 65537

Grant-in-aid released & Expenditure Incurred by District/State Blindness Control Societies in NE

States (X Plan) (Rs. In lakhs)

States 2006-07 2007-08 2008-09

Released Exp Released Exp Released Exp

Arunachal

Pradesh

77.00 12.65 56.75 45.30 162.60 115.41

Assam 150.00 0.00 322.15 155.73 671.66

Manipur 42.41 21.01 124.50 43.36 106.47

Meghalaya 120.00 95.05 183.50 100.4 158.60 99.10

Mizoram 74.00 66.76 78.22 77.21 177.35 144.78

Nagaland 24.00 24.00 178.49 59.78 144.60

Nagaland

24

Major Issues:-

1. The performance of Cataract Surgery needs to be further improved in NE States in view of large cataract backlog.

2. Eye care infrastructure need to be strengthened. 3. Shortage of eye surgeons, PMOAs etc. 4. All the NE States are required to furnish utilization certificates in respect of funds released

to them under NPCB timely for release of next installment.

Sikkim 0 0 67.00 26.47 133.35

Tripura 175.50 28.86 184.63 20.90 24.35

Total 662.91 248.33 1195.24 529.12 1578.98

Nagaland

25

NIDDCP

Nagaland

Rs.in lakh Activity Amount proposed Amount

Approved Remarks

Establishment of IDD

3.29 7.00 There is no provisions for the Lab maintenance, equipment, transport, office expenses under NIDDCP. The State Government may carry out activities as per the fund allocation of GOI

Establishment of IDD Monitoring Lab

1.66 4.00

Health Education and Publicity

21.05 24.50

IDD Surveys 0.00 0.50

Office expenses, transport, training, equipment, sensitization of M.O's incentive to worker etc.

12.26 0.00

Total 38.26 36.00

Nagaland

26

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 performance incentives and anything else associated with ASHA) 2. Infrastructure related matters (including construction, strengthening, renovation, new construction 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, training institutions 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 Nagaland

Total MFP Approvals 1732.466 1578.29 2868.636 4207.23 RoP Approvals for Various Years in Rs. Lakh

S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10 Remarks Released Approved Approved Approved Approved

ASHAs

1 ASHA 57.29 82.71 100.07

170

2 Performance related incentives for ASHA 19.85 25.15

TOTAL 77.14 107.86 100.07 170 Infrastructure related matters 3 New District Hospitals 100

4 Construction of Warehouses 304.87

5

Construction of New Subcentres 374 308.25

6

Construction & maintenance of Physical Infrastructure of PHC

53 328.4

7

Construction and maintenance of Physical infrastructure of SC

27.5

Nagaland

27

8 Upgradation of CHCs to FRU 56

9 Upgradation of CHCs toIPHS 500

10 Strengthen Nursing Training Institutions 55

11 CHC improvement at Meluri

117

12

Improving physical infrastructure of SHC/PHC/taluk/District hospital

83.48

13 Staff quarters at CHCs 168.00 14 Staff quarters at PHCs 160 15 Drug Warehousing 40

16

Nursing school 200 500

374

17 Emergency & Referral Services 35 63 119 182

18 MMUs 561 19.8 218.57 19 Telephone 8 0.5 0.75 9 TOTAL 500 1162.98 437.5 1023.55 1842.09 Human Resources related matters

20 Manpower at CHC

131.28

21 Manpower at CHC-MO 37.8 50.4

22 Manpower at CHC-SNs 17.64 18.9 23 Manpower at CHC-PHN 17.64 18.9

24 Manpower at CHC-Pharmacist 35.64 35.64

25 Manpower at CHC-Lab Tech 13.86 13.86

26 Manpower at CHC-AYUSH 37.8 37.8 27 Manpower at CHC-Dental 37.8 37.8 28 Specialists 15 18 29 MO 40.92 59.4 79.2

30

SN 1.08 30.48 39.48

42.3

31

PHN

1.08 22.57 27.72

29.7

32

Selection & Training Remuneration of ANMs 6.85 109.2 161 165

33

Incentive for field staff posted in underserved areas

10.6

TOTAL 9.01 334.45 500.78 558.1

Nagaland

28

Programme Management related matters

34

Preparation of District/Block/Village Health Action Plans

80 30 30 55 55

35 Review meetings on implementation status 35.1

36 Review Meeting-State level officers

1

37 Review Meeting-Districts level officers at state level

1

38 Review Meeting-CHC/ PHC level officers at district level

11

39

Review Meeting-NGO/ Village level functionaries at district level

11

40 Management cost/Contingencies 126.18 69 115 260

41

Review Meeting-CHC level-Monthly - 21 CHCs for 12 months

12.6

42

Review Meeting-District level-Bi monthly - 11 districts 6 times

16.5

43 Review Meeting-State level-Quarterly

6

TOTAL 80 156.18 99 205.17 374.1 Untied Funds, Annual Maintenance Grants and RKS funds related matters

44 Rogi Kalyan Samiti 55 45 Rogi Kalyan Samiti- DH 55 55 55 46 Rogi Kalyan Samiti- CHC 21 21 21 47 Rogi Kalyan Samiti-PHC 128 128 84 48 Untied Fund for CHC 10.5 10.5 10.5 49 Untied Fund for PHC 21.75 21.5 32 21 50 Untied Fund for SC 33 24.4 39.7 39.7 39.7 51 Untied Fund for VHSC 39.7 127.8 127.8 127.8

52 Annual Maintenance Grant - CHC 21 21

21

53 Annual Maintenance Grant -PHC 43.5 42 64

42

54 Annual Maintenance Grant- SC 36 39.7

34.2

TOTAL 33 184.35 502.5 538.7 456.2 Training & Capacity Building related matters

55 Visioning Workshop 1 4 4

56

Constitution & orientaiton of all community leaders on village, SHC, PHC, CHC Committees

5

57

Selection & training to non-governmental provided of health care-RMP/TBA

4.5 29.12

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29

58 Orientation of community leaders 10 51.12 51.12

59

Periodic Training of Community Health Workers -ASHA

TOTAL 10.5 43.12 55.12 51.12

Innovations related matters 60 Health Mela 55 61 Grant-in-aid to NGOs 20 62 Innovative funds 26.136 63 Setting up of EDUSAT 24

64

Alternative delivery system 53.87

25.99 63.36 65 Equipment-CHC 66.57 66 Equipment-PHC 35

67 Equipment-SC 50 68 Medicine 69 Dental equipments in 5 CHC 43

70 Medicine for DH 110 110 71 Medicine for CHC 63 63

72 Dental equipments in CHCs

32.4

73 Furniture PHC 38.7 74 Furniture SC 8

75

Non-Governmental Healthcare providers (Continuing support to the 3 mission hospitals at Impur, Vankhosang and Azuito)

5

15

76

School Health Programme (Provision for medicine for de-worming for 2,50,000 children twice a year. A course consist of 3 dosages, each costing Re.1)

15

77 IEC activities 11.48

78

Design of posters, writing slogans and preparation of finanl art work charges for five posters

1

79

Charges for printing 5 lakh copies of posters in 4 colour

25

80 Procurement of mosquito bed nets

144.47

Nagaland

30

81 Procurement of equipment: MH

0.88

82

Procurement of equipment: FP

15

83 Drugs & Supplies for MH

204.03

84

Procurement and distribution of quality equipments and drugs in the health system

80

85 Drug supply for CHC/FRU 130

TOTAL 130 150.136 53.87 445.26 755.62