NATIONAL DISEASE CONTROL PROGRAMMES (NDCP)

Project Implementation Plan 2009-10 National Disease Control Programmes

Summary Budget for National Disease Control Programmes (Rs. In Lakhs)

Part D-NIDDCP 25.00

Part E-IDSP 327.36

Part F-NVBDCP 463.66

Part G-NLEP 152.95

Part H-NBCP 784.04

Part I-RNTCP 926.86

Total for NDCP 2679.87

Part – D

NIDDCP (National Iodine Deficiency Disorder Control Programme)

1. Introduction

Kerala State to be made virtually free from Iodine Deficiency Disorders

with state level effort to maintain optimal iodine nutrition primarily through

consumption of iodized salt.

In Kerala the goitre cell was established in 1988 and became fully functioned

by 1990.In 1992, the programme was renamed as NIDDCP with a view to

cover a wide spectrum of IDD like mental & physical retardation deaf-

mutism, cretinism, still birth, abortions etc. This is a 100% centrally

sponsored programme.

The studies in the state of Kerala have revealed that all districts have the

problem of IDD. Studies conducted by ICCIDD in association with IDD cell of

Director of Health services and Department Community Medicine, Medical

College, Thiruvananthapuram revealed that the prevalence of goitre in the

state is 16.6% and the consumption of iodized salt by the community is

limited to 48.9%. Further studies conducted by the state IDD cell justified the

above result.

As recommended by WHO/UNICEF/ICCIDD, the total goitre prevalence

rate of 16.6% suggests the prevalence of goiter in endemic proportions. The

prevalence of goiter in a population is the main indicator of iodine deficiency.

So the activities under IDD cell of the state are to be strengthened.

Administrative structure of IDD Cell, KERALA.

For effective implementation of NIDDCP, the union government decided to establish IDD control cells in all states during 7th plan period. The pattern of staff for the IDD CONTROL CELL, under Health Services Department is as follows. 1. Programme Officer – Technical officer - one (11070-18450) 2. Statistical Assistant – one (8390 – 13270) 3. Clerk Typist - one (4990 –7990) 4. Laboratory Technician – one (7990-12930) 5. Laboratory Assistant – one (4400 –6680)

A state level IDD monitoring lab is functioning under the IDD cell with a

view to effectively monitor the quality of iodized salt and the content of

iodine in urine samples.

Expenditure for 2008-09up to January 2009.

Tentative allocation of Govt. of India

State Government Budget provision

Expenditure up to

January 2009

Fund received from

NRHM for 2008-09

Rs.20 lakhs Rs.10 lakhs

Salaries – Rs.5.59lakhs

Programme – Rs 4.41 lakhs

5.11 Lakhs

4.28 lakh

NIL

TOTAL 10lakhs 9.39lakhs

The audits of accounts have been done by Accountant General, Kerala

up to the financial year 2007-08.

Proposed Activities for 2009-10

1. Salaries & allowances of staff 2. Conduct goitre survey in the state. 3. Collection subsequent lab analysis of the salt and urine samples for

their iodine content.

4. Analysis of iodine content in foodstuff, drinking water and soil. 5. Setting up of regional IDD lab. 6. Procure lab chemicals, reagents and lab consumables, lab equipments,

lap top, public address system etc. 7. Training and sensitization programme for doctors and paramedical

staff including lab Technicians. 8. Printing and distribution of IEC materials. 9. Conducting various competitions, highlighting IDD and the

importance of the use of iodized salt. 10. Celebration of global IDD prevention day. 11. Publicity through media. 12. Compilation of date.

Based on the above activities, the following estimated requirement for

2009-10 is proposed.

Year Fund required Activity

2009-10

Rs.25 lakhs

Rs. 10 lakh for salaries and allowances. Rs.15 lakh for other activities (As detailed above)

PART – E

IDSP (INTEGRATED DISEASE SURVEILLANCE PROJECT)

Introduction:--

Integrated Disease Surveillance Project, (IDSP) introduced in Kerala State is a

Five-year Project. The central Surveillance Unit of IDSP, Delhi was released

Rs. 481.60 lakhs so far.

The Proposed Plan of Action of IDSP, Kerala for 2009-10, is abstracted below. (Rs. in lakhs)

Component Unit Fund Require

d For

2009-10 (SSU and

DSU’s)

Remarks showing detailed explanation

1. Furniture & Fittings

1 H&FW Training centre and 14 DSU and 22 EDUSAT centres including 6 Medical Colleges

10.00 Committee room furniture, wooden Glass Partitions, fixtures and electric fittings.

2. Lab. Equipments

119 CHC’s 14 Dist. Labs, 1 State level Lab & 3 Regional PH Labs

75.00 CSU supplied the equipments balance equipments will be procured.

3. Lab. Materials & Supplies

119 CHC 14 Dist. Labs and 1 State PH Lab

21.52 Rs. 1.50 lakhs for State level PH lab Rs.10.50 lakhs for District Labs (14*75000)and Rs. 9.52 lakhs (119*8000) for 119 CHCs.

4. Office Telephone & AC for 4.80 Tele. Rs. 10,000 x 16;

equipments EDUSAT Conference Rooms of 1 SSU, 14 DSUs and 1 H&FW Training centre at Trivandrum

AC Rs. 20,000 x 16

5. Personal Cost/Contract Staff

1,Consultant (Training)1 Consultant (Finance), 14 Accountants, 15 Administrative Assistants and 1 Helper

24.72 Rs. 20,000 x 1for Consultant(Trg), Rs. 10,000 x 1for Consultant (Fin) of SSU, Rs. 7000 x 14 Accountant of 14 DSUs, Rs. 5,000 x 15 Administrative Assistants& Rs. 3000 for 1 Helper of SSU

6. IEC Sensitization workshops at SSU & DSU level, Printing of Reporting Formats, Expenses for review meetings at SSU and DSUs, Press Advertisements, TV telecasts and print media expenses of SSU

79.80 Dist. Level; Sensitization workshops Rs 30,000 x 14 =4.20 lakhs, Review meetings Rs. 10,000 x 28 =2.80 lakhs, Press advertisements, Print media (pamphlets, brochures and other including indigenous methods) 14 x 120000=16.8 lakhs, State Level:- Sensitization workshops Rs. 1,00,000 x 4 = 4.00 lakhs, Review meetings Rs 50,000 x 2 = 1 Lakh. Press Advertisement 1,50,000 x 12 = 18 lakhs, Print media 1,50,000 x 11 = 16.5 lakhs Telecasting, Broad casting on Radio Rs. 5,50000 x 3 = 16.50 lakhs

7. Operational cost

POL, Travel expenses, Maintenance of equipments, Stationery, telephone, and fax charges, urgent repairs of equipments, electricity charges.

90.00 For the establishment charges for running the offices of 1 SSU, 14 DSUs, 119 CHCs sufficient funds are provided in this component

TOTAL 327.36

The approved amount of 2008 – 09 proposal has not been received by the state

till now.

PART –F

NVBDCP (NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME)

Introduction

Kerala State lies at the southwestern part of peninsular India. The population

of the state as per 2001 census is 318 millions. The State has the lowest growth rate in

the country (9.42 -2001 census). The state has shown a reduction of decadal growth

rate from 14.32 (1981-91) to 9.42 (1991-2001). The state also has demonstrated the

lowest birth rate (18.3), death rate (6.4); infant mortality rate (16) in the country and

maternal mortality ratio is also low in the light of the fact that almost all deliveries

are conducted in the institutions in the state. Sex ratio is 1058 female per thousand

men; female literacy rate (86.87%) is also the highest in the country.

The state’s population is distributed in 14 districts having 63 Taluks,

152 development blocks, 999 Panchayaths, 1452 revenue villages, 5 municipal

corporations and 53 Municipal councils. Average population density of the

state is 819 persons per square kilometers, with district Alappuzha having the

highest population density (1489) and Idukki district having lowest

population density (252).

Public sector infrastructure:

There are 1273 Govt. Health institutions of which 7 Medical Colleges (2 in

Cooperative sector), 5 General Hospitals, 11 District Hospitals, 41 Taluk

Hospitals, 119 Community Health Centres, 111 Block Primary Health Centres,

816 Primary Health Centres and 5568 Sub Centres.

Manpower

There is 3271 Govt. Doctors, 1342 Medical College Doctors, 554 ESI

Doctors, 5583 Junior Public Health Nurses, 3509 Junior Health Inspectors, 666

Lady Health Inspectors, 676 Health Inspectors, 158 Lady Health Supervisors

and 161 Health Supervisors.

Kerala at a glance

Geographical Area. (Sq.Km) 38863

Rural Area (Sq.Km) 35498

Urban Area 3365

District 14

Taluks 63

Gramma Panchayath 999

CD block 152

Revenue villages 1452

Towns 197

Parliament constituency 20

Legislative constituency 140

City corporations 5

Municipalities 53

Population (2001 Census)

Population Total 31841374

Male 15468614

Female 16172760

Sex ratio 1058

Urban population 8266925

Rural population 23574449

Panchayath 26646964

Municipality and corporations 5194410

Scheduled caste 3123941

Scheduled Tribe 364189

Growth rate 9.43

Density of population 819/sq.km

Literacy rate 90.86%

Male 94.24%

Female 87.72%

No. of house holds 6726356

House hold size 4.7

District Population (in 000s)

as per census 2001

No. of CHCs/Block PHCs

No. of PHC

Thiruvananthapuram 3234 20 67

Kollam 2584 20 54

Pathanamthitta 1231 10 44

Alappuzha 2105 20 53

Kottayam 1952 16 52

Idukki 1128 9 49

Ernakulam 3098 22 65

Thrissur 2975 24 72

Palakkad 2617 18 76

Malappuram 3629 19 86

Kozhikode 2878 17 63

Wayanad 786 7 23

Kannur 2412 14 72

Kasaragod 1203 9 42

Total 31842 225 818

Vector Borne Diseases in Kerala

Kerala state was mainly endemic for malaria and lymphatic filariasis.

Malaria was prevalent in the hills and foothills of the state whereas lymphatic

filariasis was predominant in the coastal belt. Now both diseases are under

control but the state has been witnessing unprecedented upsurge of vector-

borne viral diseases since 1996. Japanese encephalitis (JE) first appeared in the

state in Kuttanadu area in Alapuzha district in the year 1996. Dengue fever,

which surfaced as a new problem in the state in 1997, assumed epidemic

proportions in 2003 and resulted in 3866 cases and 35 deaths. Dengue fever

has now become almost endemic in the state. Chikungunya fever, yet another

arboviral disease, which appeared in epidemic form during 2006-07, added a

new dimension to the entire scenario of vector borne diseases in Kerala.

1. Malaria

Malaria was successfully eradicated from the state as early as 1965. But

it got reestablished in the state after a few years following the importation of

cases from other endemic states coupled with the slow and gradual build up

of vector population in the absence of complete and regular rounds indoor

residual spray. There has been a paradigm shift in the epidemiology of

malaria in Kerala over the last decade. The highly malarious hill tracts of the

state have now become almost free from the disease, but the urban areas

especially those on the coastal belt which were free from malaria have now

become endemic for the disease. The shift is mainly due to the disappearance

of Anopheles fluviatilis, which was the principle vector in the hills and foothills,

and the appearance of Anopheles stephensi in the urban areas on the coastal

belt. The current problem is, therefore ‘urban malaria’ through Anopheles

stephensi, which has now become very much prevalent in the entire coastal

areas and also in some inland pockets.

Imported malaria has long been a serious problem in the state. The

recent phenomenon of developmental boom increased large-scale

construction activities across the state attracting huge migrant labour force

from other states, many of which are still endemic for malaria. As a result,

there has been influx of parasitic carriers increasing the vulnerability of the

state to malaria. This led to increase in indigenous cases in 4 districts:

Thiruvananthapuram, Thrissur, Wayanad and Kasaragod. Many other towns

are also under the threat of imported malaria which may lead to indigenous

malaria. Kerala is also facing border malaria problem especially in Kasaragod

and Thiruvananthapuram districts. Strategies to tackle these problems are

focal spray, monitoring of immigrants, early detection and treatment of

malaria patients coming from other states. Larvicides, spraying pumps,

fogging machines, ULV applicator, microscopes, more micro slides and

lancets are needed. Wages for spraying and fund for organized monitoring

system are also essential.

State Action Plan

Status of Health facilities

S. No Health facility

No

1 District Hospital / General Hospital 16

2 Block PHC 111

3 Add PHC/ Mini PHC 932

4 Sub centre 5408

5 Villages/Panchayaths 999

6 FTD Nil

7 ASHA 15171

8 Rapid response team formed (yes/no) yes

B. Human Resource

S. No Health facility Sanctioned In Place Trained

1 DMO (Full Time) 14 10 10

2 AMO 28 18 4

3 MO 3657 2586 1295

4 Lab Technician 776 757 425

5 Lab Technician (contractual)*

Nil Nil Nil

6 Health Supervisors (M)+HI

1025 837 -

7 Health Supervisors (F)/LHI

966 824 -

8 MPW (M)/JHI 3509 3106 1850

9 MPW (M) (contractual)# Nil Nil Nil

10 MPW (F)/JPHN 5583 4865 -

11 Malaria Technical Supervisor (contractual)*

Nil Nil Nil

12 ASHA 15171 15171 6000

* GFATM/World Bank, # Applicable to state that have been sanctioned., GFATM States Only -- Not applicable

C. District wise Epidemiological Situation: a brief analysis on the following parameters to assess performance (ABER- Surveillance) & impact (API, cases, deaths etc) may be given so as to identify gaps and areas requiring improvement

Dist: 1. THIRUVANANTHAPURAM

Year Population BSE ABER Total

malaria cases

Pf cases

API SPR SFR Death due to malaria

2004 3330545 148712 1.16 233 120 0.069 0.157 0.081 1

2005 3363117 170987 5.08 106 38 0.082 0.062 0.022 0

2006 3396008 170886 5.03 99 25 0.029 0.058 0.015 1

2007 3429221 165006 4.81 145 33 0.042 0.08 0.019 0

Dist. 2 KOLLAM

2004 2641360 127809 4.83 170 16 0.064 0.133 0.013 0

2005 2660721 174689 6.56 164 9 0.062 0.094 0.005 0

2006 2680224 179465 6.69 150 14 0.055 0.083 0.008 0

2007 2699870 162996 6.05 134 16 0.05 0.019 0.009 1

Dist. 3 PATHANAMTHITTA

2004 1245373 88683 7012 205 19 0.164 0.231 0.021 1

2005 1250005 106252 8.5 225 35 0.180 0.212 0.032 0

2006 1254655 99206 7.93 150 14 0.124 0.157 0.14 0

2007 1259322 77537 6.15 155 20 0.12 0.19 0.025 0

Dist. 4 ALAPUZHA

2004 2138427 71155 3.32 218 28 0.101 0.306 0.039 3

2005 2149569 85505 3.97 260 21 0.121 0.304 0.025 1

2006 2160767 82529 3.81 220 19 0.102 0.266 0.023 0

2007 2172025 76623 3.53 152 21 0.069 0.198 0.027 0

Dist: 5 KOTTAYAM

2004 1992774 123433 6.19 78 7 0.039 0.063 0.006 0

2005 2006245 148056 7.38 66 6 0.033 0..045 0.004 0

2006 2019807 170413 8.43 65 9 0.032 0.038 0.005 0

2007 2033461 151985 7.45 52 5 0.025 0.034 0.004 0

Year Population BSE ABER Total malaria cases

Pf cases

API SPR SFR Death due to malaria

Dist: 6 IDUKKI

2004 1152335 95545 8.29 65 5 0.056 0.068 0.005 0

2005 1160355 107301 9.247 48 10 0.041 0.045 0.009 0

2006 1168430 85494 7.31 72 8 0.061 0.084 0.009 0

2007 1176563 103888 8.86 91 11 0.077 0.07 0.01 0

Dist: 7 ERNAKULAM

2004 3183641 127827 4.01 150 14 0.047 0.117 0.011 2

2005 3212580 170092 5.29 186 10 0.098 0.109 0.006 0

2006 3241782 161340 4.97 148 25 0.045 0.091 0.015 3

2007 3271250 149726 4.59 113 13 0.03 0.09 0.008 0

Dist: 8 THRISSUR

2004 3053777 179349 5.87 218 34 0.071 0.122 0.02 0

2005 3080344 204675 6.64 168 14 0.055 0.082 0.007 2

2006 3107143 185669 5.97 193 39 0.062 0.103 0.021 0

2007 3134175 185415 5.90 177 13 0.05 0.099 0.007 0

Dist: 9. PALAKKAD

2004 2695251 120867 4.48 187 6 0.069 0.155 0.005 1

2005 2721826 164797 6.05 113 1 0.041 0.067 0.001 0

2006 2748663 164369 5.97 87 5 0.031 0.052 0.003 0

2007 2775764 149222 5.49 68 5 0.02 0.06 0.003 0

Dist: 10 MALAPPURAM

2004 3820395 252454 6.60 233 36 0.060 0.092 0.014 0

2005 3886182 288930 7.43 211 15 0.057 0.076 0.005 1

2006 3953101 277122 7.01 291 27 0.048 0.068 0.009 0

2007 4021174 285808 7.20 184 12 0.046 0.09 0.004 1

Dist: 11 KOZHIKODE

2004 2944574 130879 4.44 182 34 0.061 0.139 0.026 1

2005 2993835 174807 5.839 192 15 0.064 0.110 0.009 0

2006 3023383 185015 6.12 182 16 0.066 0.098 0.008 2

2007 3053224 165500 5.45 161 7 0.05 0.06 0.004 1

Dist: 12 WAYANAD

2004 827528 51810 6.26 50 9 0.060 0.097 0.017 1

2005 841630 51639 6.14 18 2 0.021 0.035 0.004 0

2006 855970 46698 5.45 21 2 0.024 0.045 0.004 0

2007 870556 45633 5.20 27 5 0.031 0.059 0.011 0

Dist: 13 KANNUR

2004 2464344 148085 6.00 278 38 0.112 0.188 0.026 1

2005 2489905 178150 7.17 260 36 0.105 0.146 0.020 1

2006 2499600 159406 6.31 237 34 0.095 0.148 0.021 0

2007 2515423 160756 6.41 225 49 0.097 0.190 0.030 3

Dist : 14 KASARAGOD

2004 1248294 81042 6.49 523 143 0.418 0.645 0.176 1

2005 1263648 92152 7.29 529 125 0.419 0.574 0.136 0

2006 1279190 68022 5.31 280 88 0.22 0.411 0.129 0

2007 1294240 82192 6.43 243 79 0.189 0.29 0.096 0

STATE TOTAL 2004 32758608 1747620 5.33 2790 510 0.085 0.150 0.029 12

2005 33071962 2118032 6.404 2554 337 0.077 0.121 0.016 6

2006 33388732 2035634 6.09 2101 325 0.062 0.103 0.016 6

2007 33708959 1962317 5.82 1927 291 0.057 0.09 0.014 6

C1. The States are to hold meetings for development of district wise Action Plan by analyzing the data on following parameters.

C2. High Risk Areas: Based on the epidemiological data in the above table identify the high risk areas according to definition in Malaria Action Programme (As per MAP 1995) for the prioritization criteria developed by expert committee 2002 (enclosed)

S. No

District High risk PHCs (No)

High risk Sub centre (no)

High risk Village (no)

High risk Population

(no)

Tribal Population

(no)

1 District. 1

2 District. 2

No High-risk areas in the state.

State Total

C3. Classify the areas as per following API ranges

S. No API District (No)

PHCs (No)

Sub centre (No)

Villages (No)

Population @ Village

(No)

% Population of State

1 <1 14 districts

100%

2 1 – 2

3 2 – 5

4 5 – 10

5 > 10

Total

C. GIS mapping (Based on epidemiological data for the years 2007 for identified 61 high endemic districts) List Attached

• Status of Village wise data entry of the district for 2007 in GIS format for identified high endemic districts: NIL

• Please bring the completed data set for 2007 for identified district.

D. Outbreak: Yes, if yes;

Particulars 2004 2005 2006 2007

No of outbreaks

4 4 2 2

Area affected

1.Thiruvanantha- puram (Valiyathura) 2. Thrissur Town 3. Malappuram (Thanur) 4. Kasaragod Town

1.Thiruvanantha- puram (Valiyathura) 2 Kollam, (Pallithottam), 3. Thrissur town 4. Kasargod Town

1.Thiruvanantha- puram (Valiyathura) 2. Kasaragod Town

1. Thrissur Town 2.Kasaragod

Town 3. Kollam (Pallithottam)

Period of outbreak

June, July, August June July, August June July, August June, July, August

No of deaths reported during outbreak

Nil Nil Nil Nil

Reasons for outbreak

Immigrant population and lack of surveillance in urban areas

Containment measures taken

Intensive surveillance by deploying the staff from other institutions, focal spray, Thermal fogging, anti larval measures, IEC activities etc.

In 2008 also there were 4 outbreaks due to influx of immigrant people from other states causing indigenous cases.

Malaria Outbreaks

Dist No. of cases Death

Kasaragod 4 0

Wayanad 3 0

Thrissur 10 0

2008

Thiruvananthapuram 2 0

E. Specific activities:

a. RD Kits (selected Pf endemic districts only): Not applicable

Requirement of Rapid Diagnostic Kits based on epidemiological data of 2007 for 2010-11

S. No.

Details Sub centre (no)

Village (no)

Total Population

Tribal Population

Slide Collection

1 Areas with high Pf % NIL

2 Of the above prioritized to be equipped with RDT during the year

NIL

3 No of RDTs Required for 2010-11

500*

* There is a huge influx of labour force from other endemic states.

• Planning for RDTs is to be done based on the ABER & expected no of Malaria Cases. Of the Malaria cases 50% are expected to be Pf; of the Pf cases 50% are expected to be in remote inaccessible areas – where RDTs are to be used.

• Villages planned to be equipped with RDTs should have trained ASHA b) Areas for supply of ACT

A. Planning for distribution of ACT 2009-10

S. No.

Details Nos Total

Population

Pf cases reported in previous

year

ACT Blisters

AS Tabs

SP Tabs

1 Districts identified for roll out of ACT

Nil

2 Clusters of PHCs around Pf resistance foci

Nil

B. Requirement of ACT

Pf cases reported in previous year S.

No.

District/ PHC Clusters identified for roll out of ACT

Total Population Adults Children

ACT Blisters

for adults

AS Tabs for children

SP Tabs for

children

1

Planning for distribution of Rapid Diagnostic Kits 2009-10 which was allocated in 2008-09 (Quantity as per allocation in Annexure)

S. No

District Name

RDTs to be

distributed in 2009-10

PHCs in inaccessible areas (No)

Sub centre in inaccessible areas (No)

Villages in inaccessible areas (No)

Population at Villages in inaccessible areas (No)

Slide Collection

in inaccessible areas (No)

1

2

3

4

Not applicable

5

Total

2

3

Total

c) Bednets All planning should be based on enumeration of bednets in households by Bednet Survey

A. Planning for distribution of Bednets

Eligible

Population

Tribal

population

Househ

old

s

(No)

Househ

old

s with

bednets

(no)

Total

Bednet

Required

(no)

Total

distrib

uted

till date

(no)

bednets

table

below

(No)

Planned to

be

distrib

uted

in the year

(no) as per

allocation

in

Total planned to be treated

ITNs LLINs

S. No.

District N

ame

Eligible S

ub

centre (n

os)

Eligible v

illages

(no)

A B C=AX2 D E F G

E+F

1 NIL

2

3

Total

NB: 2 nets per household; Avg size of household to be taken as 5

d) Planning for IRS: Please specify criteria for selection of areas for IRS: - (Specify whether the unit of planning is village / sub centre. Mention the cut off used for API, Pf% deaths for selection of areas; whether MAP criteria has been applied) Since the API is far below 2 in the state there are no regular rounds of IRS.

(Base the planning for IRS on epidemiological data)

N.B. Details of Micro planning for Spray squads to be done as per tables in Appendix 1 and summated above

Insecticide required (MTs) S.

No

District/ PHC Selected for IRS

PHCs (No) Selected for IRS

Sub centre

selected (no)

Village selected (no)

Total Populat

ion selecte

d

Tribal

Population

Spray squads required (no)

Trainings

batches of

spray squads (no)

Equipment

required (no)

Name of

insecticide

DDT

Malathion

SP

1 District 1

2 District 2

NOT APPLICABLE SINCE API IS BELOW 2

Total

• Associated activities for IRS:

- Specify what IEC activity will be carried out for sensitization & mobilization of

community for Spray also in also in advance information regarding spray dates

operations:

- Supervision Plan: within the PHC and from district level (Sub centre/ village wise)

Supervision Plan with village level date of spray and SC/PHC district level

supervision (Yes/No)

- Selection of sites for dumping insecticides completed? Yes/no

- Whether safeguards for storage & handling of insecticides ensured? Yes/ no

- Certification on functional status of equipment by DMO by day/ mth/ yr.

- Spare parts of spray equipments like lance available Yes/No

- Provision of protective gear for spray workers present Yes/No

- No of functional stirrup pumps? ________________No required________

- No required to be repaired_________________

- Certification by Panchayaths for coverage of IRS - planned or not

G Innovations

H. commodity Requirement

S. No. Innovations Describe details Fund Allocated (Rs)

1 Patient referral e.g. Like use of NRHM/ RKS flexi funds for transport of severe cases

2 Transportation of slides E g. Use of Public transport system

3 NGO/ CBO involvement Refer to PPP guidelines on www.nvbdcp.gov.in

4 Community mobilization eg. Mobilizing using street plays, puppet plays, self help groups

Previous year’s utilization (no)

Requirement for current year (No)

Balance Available (No)

Net requirement(2-3) Item

1 2 3 4

Insecticide For IRS (Kg) 100 Kg 1000 Kg Nil 1000 Kg

Insecticide For ITMN (Lts) Nil

Chloroquine (No.) 20 lacs 50000 4000000 Nil

Primaquine 2.5 (No.) 6000 25000 5000 20000

Primaquine 7.5 (No.) 22000 50000 10000 40000

ACT ( Artesunate +SP) Blister (No.)

0 1000 0 1000

Artesunate tabs (No.) 0 0 0 0

S+P Combination (No.) 0 0 0 0

Quinine Injection (No.) 0 100 0 100

Quinine Sulphate (No.) 0 0 0 0

Arteether Inj (No.) 0 0 0 0

RDK (No.) 0 500 0 500

Micro Slides (No.) 200000 1000000 - 1000000

Pumps (No.) - 1000 - 1000

Additional items required

Microscopes - 15 - 15

Lancets - 2000000 - 2000000

ULV applicator - 14 - 14

Fogging Machine - 50 - 50

Technical Malathion 0 500 Liter 0 500 Liter

Pyrethrum Extract 500 Lit. 500 Liter 0 500 Liter

F. Training: mention number of batches to be trained

Current year S. No

Trainings Cost per Batch

Previous year (no) Q1

(no) Q2 (no)

Q3 (no)

Q4 (no)

Total (no)

Total Cost (Rs)

1 Medical specialists at District Hospital

- - - - - - 0 0

2 Medical Officers 60000 - 1 0 1 0 2 120000

3 Laboratory Technicians (induction)

60000 0 0 1 1 0 2 120000

4 Laboratory Technicians (reorientation)

60000 2 0 1 0 1 2 120000

5 Health Supervisors (M)

60000 0 1 0 0 1 2 120000

6 Health Supervisors (F)

60000 0 0 1 0 1 2 120000

7 Health Workers – MPW (M)

20000 0 14 14 14 14 56 1120000

8 Health Workers – MPW (F)

20000 0 14 14 14 14 56 1120000

9 ASHA 10000 0 14 14 14 14 56 560000

10 Community Volunteers other than ASHA

5000 0 14 14 14 14 56 280000

11 Others specify Pvt. MOs (PMP)

20000 0 2 3 4 5 14 280000

Total 60 62 62 64 248 3960000

G. BCC/ IEC: mention number of each

Current year

S. No

Activ

ities

Unit C

ost (R

s)

Previous y

ear (n

o)

Q1 (no)

Q2 (no)

Q3 (no)

Q4 (no)

Total (n

o)

Total Cost (R

s)

A. Print Media

1 Posters 10 - - - 40000 - 40000 400000

2 Hoardings 8000 - - - 40 - 40 320000

3 Newspaper advertisement

- - - - - - - -

B. Electronic Media

4 TV campaigns

- - - - - - - -

5 Radio campaigns

- - - - - - - -

C. Community level

6 Health camps 5000 - 20 20 20 20 80 400000

7 Village level awareness camps for IRS

- - - - - - - -

8 Others (specify)

Ward level camps to address immigrants

1000 - 60 60 60 60 240 240000

Total 1360000

H. PPP involvement

I. Others: Specify any other planning to be untaken For surveillance of immigrant population to control imported malaria, focal spraying in areas of construction work is needed. 1000 work days with wage of Rs 300/day is also required.

J. Do a SWOT analysis of the district as below

S. No. Schemes Previous year

(no) Planned in Current

year (no) Cost

1 Scheme I

2 Scheme II

3 Scheme III

4 Scheme IV

5 Scheme V

Total

Filaria

Filariasis still continues to be a major public health problem in the state.

The disease is prevalent in eleven districts in the state except Wayanad,

Idukki and Pathanamthitta. The disease in Kerala is caused by two species of

Filaria worm namely Wuchereria bancrofti and Brugia malayi, of which the

former is more predominant in urban areas whereas the later is confined to

rural areas only. Mass Drug Administration (MDA) for elimination of

lymphatic filariasis started in Kerala in two districts namely Alapuzha and

Kozhikode in 1997.Kannur district was also included in the programme in

2000.From 2004 onwards the programme is being implemented in eleven

districts except Wayanad, Idukki and Pathanamthitta.

Strengths

� Educated population � PHCs in all Panchayaths

Actions to be Taken

� IEC/BCC for prevention � Early diagnosis and prompt

treatment

Weakness

� Immigrant population � Climatic factors favorable for

mosquitogenic conditions

� Lack of Surveillance system in

urban areas

� Regular and systematic monitoring

of immigrant population � Long term measures for vector

control � Deployment of trained man power

Opportunities

� Infrastructure facilities � Well established Medical

institutions in Public and Private sectors

� Speedy Diagnosis Case management

Threats

� Migration of Parasite carriers from other endemic areas

� Rapid urbanization � Change in lifestyle

� Screening of immigrants � Legislation � IEC/BCC

Pre MDA survey results are furnished below:

Pre MDA survey results - 2004

S.No. District BSE Mf+ve Mf

Rate%

1 Thiruvananthapuram 3870 6 0.16

2 Kollam 3609 0 0

3 Alapuzha 4045 4 0.10

4 Kottayam 3632 1 0.03

5 Ernakulam 4512 4 0.09

6 Thrissur 3976 11 0.28

7 Palakkad 4156 160 3.85

8 Malappuram 3788 17 0.45

9 Kozhikode 3374 30 0.89

10 Kannur 4009 19 0.47

11 Kasaragod 4773 60 1.26

Total 31288 131 0.42

Pre MDA survey results-2005

S.No. District BSE Mf+ Mf

Rate%

1 Thiruvananthapuram 3411 6 0.18

2 Kollam 3883 0 0

3 Alapuzha 3989 23 0.58

4 Kottayam 4049 83 2.05

5 Ernakulam 4051 4 0.10

6 Thrissur 3940 3 0.08

7 Palakkad 4005 83 2.07

8 Malappuram 0 0 0

9 Kozhikode 1456 4 0.27

10 Kannur 4865 54 1.11

11 Kasaragod 3868 14 0.36

Total 37517 274 0.73

Pre MDA survey results-2007

S.No. District BSE Mf+ Mf

Rate%

1 Thiruvananthapuram 4093 12 0.44

2 Kollam 4111 0 0

3 Alappuzha 4037 5 012

4 Kottayam 3929 0 0

5 Ernakulam 4362 2 0.05

6 Thrissur 4000 1 0.03

7 Palakkad 4269 139 3.26

8 Malappuram 4000 20 0.50

9 Kozhikode 2618 2 0.08

10 Kannur 4040 25 0.62

11 Kasaragod 3096 11 036

Total 3855 223 0.58

Pre MDA survey results-2008

S.No. District BSE Mf+ Mf

Rate%

1 Thiruvananthapuram 4017 5 0.12

2 Kollam 3699 1 0.03

3 Alapuzha 4024 5 0.12

4 Kottayam 877 0 0

5 Ernakulam 4104 0 0

6 Thrissur 3480 2 0.06

7 Palakkad 4091 78 1.91

8 Malappuram 4000 0 0

9 Kozhikode 2618 2 0.08

10 Kannur 4040 25 0.62

11 Kasaragod 3096 11 0.36

Total 38046 129 0.34

MDA 2008 Report on distribution coverage

DISTRICT TARGET POPULATION

COVERED % of coverage

Thiruvananthapuram 2875000 2520493 87.67

Kollam 2647044 2498314 94.38

Alapuzha 1960820 1809882 92.30

Kottayam 1926945 1871258 97.11

Ernakulam 3014426 2764523 91.71

Thrissur 2886694 2766793 95.85

Palakkad 2717578 2600211 95.68

Malappuram 3585862 3404780 94.95

Kozhikode 2850670 2701908 94.78

Kannur 2312000 2116000 91.52

Kasaragod 1222709 1172819 95.92

TOTAL 27999748 26226981 93.67

Specific Constraints for implementation of the programme

The people in the endemic districts are not fully aware of the importance of

the MDA programme because the disease is not so rampant. The general

perception of the public about the disease is that the persons with external

disease manifestations are the only victims of the disease and the persons who

look otherwise normal are not affected by the disease. The public is not well

aware of the fact that the microfilaria carriers appear normal and they are the

potential sources of infection. These facts were reviled from the consumption

and complaints survey conducted in the district after the MDA Programme.

Another important problem is the anti propaganda, which badly affects the

smooth conduct of the programme. There have been articles in print media

and statements against the programme in the visual media. This anti

propaganda creates a sense of suspicion among the public and they become

more reluctant to take the drugs.

Even after repeated rounds of MDA in the state, the fear about the side

reactions of the drug cannot be completely alleviated. It requires specific IEC

strategy to sufficiently sensitize the public. There is also felt need to sensitize

the media personnel to avoid anti propaganda against the programme.The

elected representatives need to be made aware of the significance of the

programme so as to get them fully involved in the programme. In urban areas

where the disease is more prevalent than in the rural areas the activities need

to be

The involvements from the private medical practitioner as well as

Homeo and Indian systems of medicine are not encouraging. There is a need

for public private partnership to increase the compliance rate.

The honorarium of the drug distributors need to be enhanced.

Prioritization of the areas including the criteria of prioritization

There are several areas un-surveyed or partially surveyed for lymphatic

filariasis and Hydrocoele cases. Data needs to be updated for prioritization.

There are endemic pockets in the districts where morbidity management

clinics need to be Establishment of in PHCs and CHCs. With the updated

data on morbidity statistics areas may be delineated and in such areas

promotive activities be carried out for hydrocoel detection and operation.

Strategy & innovations proposed

The following IEC activities are suggested to increase the compliance rate.

� Message through FM radios � Scrolling messages through TV channels � Video spots � Discussions on TV Channels � Inter personal communication � Kitty shows in schools � Media workshops at state and district level � Sensitization workshops for elected representatives and community

leaders

� Mic announcement � Essay and quiz competition in schools and colleges � Involvement of Residence Associations in urban areas � Awareness Rally � Cinema Slides � SMS through Mobile Phones

Activity plan and budget for MDA 2009

Sl.no Activity Rate (Rs) Amount (Rs.)

01 Training of District level officers (One Day) 60,000 x 1 60,000

02 Training for Medical officer including Private medical officers at Dist: level

5,000 x 11 55,000

03 Training for Para medical staff-Block level 4,000 x 153 612,000

04 Training for Drug Distributors 1,25,000 x 50 62,50,000

05 Honorarium for Drug Distributors 1,25,000x100 1,25,00,000

06 Honorarium for Supervisors 15,000x100 15,00,000

07 POL and mobility for state and districts and TA/DA for officers monitoring activities

15,00,000

08 IEC/ BCC activities-

a. Message though FM Radio in 11 Dist: 7,50,000

b.Scrolling messages through TV channels 15,00,000

c. Video spots 1,00,000

d. Kitty shows in schools 10,000 x11 1,10,000

e. Media workshops at state and district level 10,000 x 12 1,20,000

f. Sensitization workshops for elected representatives and community leaders

12,000 x 11 1,32,000

g. Mic announcement 5,00,000

h. Essay and quiz competition in schools and colleges 5,000 x 11 55,000

i. Awareness Rally 2,0000 x 11 2,20,000

j. Cinema Slides 50,000

k. Printing of IEC materials and Forms 20,00,000

l. Newspaper advertisement 10,00,000

09 Morbidity Management and Mapping of Lymphydima Cases and Hydrocel Operation

11,00,000

10 Preparation of Microplan Dist; Co-Ordination Committee Meeting RRT Meeting etc.

5,50,000

11 MDA Assement by Medical College/ICMR Institution

9,000 x 11 99,000

12 Pre MDA Parasitological Survey 1,000 x 88 88,000

13 Additional Support for IEC, mobility, contingencies for MDA program

- 30,00,000

3,38,51,000

Action Plan for Dengue and Chikungunya 2009 - 10

1. Situation analysis of the Disease

Dengue Cases Reported during 2004 – 2008

2004 2005 2006 2007 2008 (prov)

No Dist

Case Death Case Death Case Death Case Death Case Death

1. Thiruvananthapuram

319 0 482 0 621 0 298 0 502 1

2. Kollam 28 0 36 2 77 1 67 4 12 0

3. Pathanmthitta 52 1 25 0 24 0 12 0 4 0

4. Alappuzha 22 1 43 1 15 0 13 1 9 0

5. Kottayam 33 2 23 0 8 0 47 4 20 0

6. Idukki 51 0 77 0 19 1 18 0 5 0

7. Ernakulam 55 2 135 4 58 0 25 1 102 1

8. Thrissur 37 1 31 0 68 0 88 0 10 0

9. Palakkad 22 0 6 0 18 2 5 0 7 0

10. Malappuram 33 0 10 0 5 0 6 0 7 1

11. Kozhikode 4 0 21 0 13 1 43 1 26 0

12. Wayanad 37 0 3 0 2 0 27 0 8 0

13. Kannur 25 0 41 0 20 0 20 0 16 0

14. Kasaragod 12 0 95 0 11 0 8 0 6 0

Total 730 7 1028 7 959 5 677 11 734 3

Chikungunya Cases Reported during 2007 and 2008

No. of Cases Sl.

No. District

2007 2008

1. Thiruvananthapuram 1208 124

2. Kollam 918 1

3. Pathanmthitta 3456 0

4. Alappuzha 1848 2

5. Kottayam 10662 1

6. Idukki 538 0

7. Ernakulam 1882 4

8. Thrissur 333 36

9. Palakkad 269 109

10. Malappuram 1886 421

11. Kozhikkod 840 557

12. Wynadu 60 37

13. Kannur 77 90

14. Kasargod 75 23413

Total 24052 24795

Detailed Situation Analysis on the Status and Specific Constraints for implementation of the Dengue & Chikungunya control programme.

Case management

The recorded incidence of Dengue is low in all Districts except Trivandrum.

So the clinical experience of doctors in management of this disease is limited

in the remaining 13 districts. This can be addressed only through adequate

training. In Trivandrum District, refresher courses are necessary.

Strengthening of referral services

Referral services are required in Dengue when the clinical condition worsens,

platelet count progressively decreases or the Hematocrit progressively

increases. Usually patients are referred to centers with facility for platelet

transfusions. The critical points in this chain are quality controlled facilities

for platelet counting, transportation facilities for the sick patient and

component transfusion facilities within the District. Out of these, the weakest

link in Kerala is good laboratories with platelet counting facilities. In fact, a

laboratory based surveillance system (involving both Government & Private

labs) for patients with decreasing platelet counts would be highly relevant in

Kerala. The IgM detection after 7 days is of limited use in patient care.

Patient transportation facilities in dengue affected areas are relatively good.

Component transfusion facilities are not uniformly available within the state.

It is being addressed under the Blood Safety Officer.

Epidemic preparedness and rapid response

The annual Contingency plan to deal with emergency hospitalization is

prepared at the State RRT meeting to be held in the month of February. It

would be a general plan for all usual needs of the state. Dengue is an

important component within the plan. Most of the general arrangements like

drugs, IV fluids, and smaller instruments are regularly arranged from

dedicated funds. But there is no facility for Vacutainers for obtaining dengue

diagnostic test samples, Laboratory test equipment and supplies for

measuring arterial blood gases and pH, Portable X-ray, ultrasound equipment

and Central venous pressure monitoring kits. These would be additionally

required for at least three hospitals.

Case reporting

Fever alert surveillance

Fever Alert Surveillance has been implemented through all field staff of the

Health Department. They include all JHI [MPW (M)] and all JPHN [MPW (F)].

They regularly report these details both through the NVBDCP (MF 11) and

through the IDSP system. Currently, NRHM has undertaken a comprehensive

computerization program with connectivity up to PHC level. It is expected

that this would ease the data transmission problems felt at the peripheral

levels of the Health System. Data transmission and analysis from District

upwards is already computerized under the IDSP program. In Kerala, we

have an additional "Daily" surveillance System, wherein, telephonic and email

communications from about 750 institutions (Mostly government hospitals

and few private hospitals) are consolidated at 14 District Medical Offices and

is transmitted to the State Headquarters by around 5.30 pm every day

(including holidays). Any unusual event or pattern change gets recorded in

this system on a regular basis. This has been continuing since 2003 (Originally

30 major institutions per district).

In the induction trainings for ASHA, Fever alert surveillance had been

included. The ASHA reports her findings to the nearest Field Worker or PHC.

This arrangement has been preferred as immediate local action is a priority

over every thing else in the early phases of any outbreak. Deployment of

ASHA has not been completed throughout the state but it is fast progressing.

The Anganwadi worker (AWW) also reports to the most nearest field staff.

Kerala has strong Media presence. The potential of Media in disease

surveillance is yet to be tapped.

90% of the current surveillance reports of Dengue cases originate from the

laboratory. So they are "Confirmed" cases. The system of clinic/casualty/in-

patient based reporting of "Probable" cases is extremely weak. Therefore,

information on DF/DHF/DSS are lacking in the Kerala's reports. Correction

of this major lacuna would be a long drawn out process. This seems to affect

reporting of Mortality due to Dengue also. As the chances of death are more

in the early days of the disease (when IgM is still not positive), deaths may be

under reported due to the absence of serological evidence.

Involvement of Private sector in sentinel surveillance

District No. of Private Sector Reporting units registered under IDSP

Trivandrum 7

Kollam 15

Pathanamthitta 17

Alleppey 0

Kottayam 13

Idukki 41

Ernakulam 24

Trichur 33

Palakkad 14

Malappuram 0

Kozhikode 6

Wayanad 12

Kannur 8

Kasargode 0

Private sector participation in case detection of Dengue is relatively good in

the Districts of Trivandrum, Pathanamthitta, Kottayam, Ernakulam and

Trichur. But this is mostly limited to reporting of positive cases as and when

they occur. Technically, this is not true surveillance as they are not

enthusiastic about "Nil" reporting.

There are 12 private Medical Colleges in Kerala. Very few of them currently

report communicable disease data.

Sentinel Surveillance sites with laboratory support

Advanced diagnostic facilities could not be made functional at Kerala State

Institute of Virology and Infectious Diseases till now. This has to be taken as a

priority in 2009-10.

Eleven Sentinel Surveillance Sites with laboratory support has been identified.

Majority of the cases reported are from these institutions. But NIV Kits has

been supplied to only 4 institutions.

The pro-active inter-epidemic period surveillance as proposed in the "Long

Term Action Plan for Prevention and Control of DF/DHF/DSS and

Chikungunya in India" is yet to start. Most of the cases detected are through

passive case detection. The inter-epidemic surveillance system can be taken

up in this year, provided additional IgM kits from NIV become available on

time.

Kits received from NIV (2008) Balance Sl. No.

Name of Institution

DEN CHIK DEN CHIK

1

Kerala State Institute of Virology, Alappuzha

15 (not used) 15 (not used) 15 15

2 Govt. Medical

College, Kozhikode

18 (Defective 6 - replaced) (Balance 6)

20 (Balance - 8) 6 8

3 Govt. Medical

College, Kottayam 11 (balance 8) 12 (balance 8) 8 8

4 Govt. Medical College,

Trivandrum 19

16 (5 damaged) (Balance 6)

0 6

Total received 69 63 29 37

Defective 6 5

a. Capacity for Data Analysis: There is a need for improving the data analysis capabilities of Deputy DMOs, District Malaria Officers, Biologists/Entomologists, Technical Assistants and Health Supervisors and Health Inspectors. Many of the deficiencies of the system are related to lack of Data Analysis capabilities.

b. Integrated vector management (IVM) (for transmission risk

reduction):

Entomological Surveillance including larval surveys

The primary impediment noted in the implementation of the Entomological

Surveillance is the difficulty in monitoring the field activities of about 3000

MPW (M) spread throughout the state.

The second one is the difficulties of implementing these activities in the urban

area on a regular basis.

In order to address both these issues, it is felt that attention should be focused

at the most important phases of the program. The social mobilization and

involvement of community based organizations (including Faith based

organizations) is to be tuned to these phases of operation.

Inter-sectoral convergence:

Kerala has made great strides in Decentralized planning. The government

gives great importance to local level planning. 30% of the Developmental

expenditure has to be compulsorily spent on health issues. At the grass roots,

the PHC Medical Officer is the designated "Implementing Officer" for all

health programmes of the Panchayat. The Implementing officer has to

conceptualize projects based on the needs of the panchayat and the needs

expressed at the Grama Sabhas. It has been observed that many panchayats

had implemented innovative projects through this mechanism. But this is not

the uniform pattern throughout the state.

There is a need to transplant best practices and provide technical guidance at

the panchayat level. It is inconceivable to implement a mass program in

Kerala other than through this Decentralized Planning process. Adequate

powers are given to the Director of Health Services to guide the technical

aspects under the Decentralization Powers Act, 2000.

Supervision and Monitoring

The field activities related to the Vector borne diseases are mainly done by

Junior Health Inspector [MPW (M)]. It has been observed that there are some

deficiencies in the method of monitoring their work. These are being

corrected at the administrative level.

The State Entomology team is engaged in the monitoring of the Entomology

activities. Teams with members from RRT, Medical Colleges, PEID Cells and

experts are constituted when outbreaks occur. At the District and sub district

levels, Technical Assistants, Health Supervisors and Health Inspectors are

involved in supervision.

II. Prioritization of Areas if any, including the criteria of prioritization.

1. Infrequent cases of Chikungunya are now reported from the previously

affected areas. So, the potential for spread to the remaining unaffected areas still persist. Most of the remaining unaffected areas lie along the shoreline of north Kerala. This area forms a priority area.

2. As dengue is reported from Trivandrum area in very high numbers even in the usual lean season, this area forms the priority area for it. Ernakulam has the second priority.

III. Strategy and innovations proposed

Case Management

i. There are good case management skills in Trivandrum District, especially in Medical College Hospital, Trivandrum (Medicine, Pediatrics & Infectious Diseases Units) and KIMS Hospital (Private corporate hospital). This is evidenced by the low mortality in-spite of the high incidence. In order to improve the case management, these practical skills has to be shared with clinicians and Nursing staff throughout the state.

Referral Services

ii. Capacity building of Ambulance staff in government and private sector.

iii. Arrangement of advanced care facilities in District and few

Sub-district hospitals. Level II ICU facilities needs to be arranged in at least three districts. They include facilities for centralized oxygen supply, laboratory test equipment, supplies for measuring arterial blood gases and pH, portable X-ray, ultrasound equipment and central venous pressure monitoring kits.

Fever Alert Surveillance

iv.Necessary trainings for ASHA have already been done and they are also involved in reporting fever cases. But careful handholding is necessary in the initial stages. The mechanisms already kept in place for this purpose (eg., Block Coordinators) need close supervision. Special capacity building session for Block Coordinators and District Program Managers is proposed on supervisory aspects of ASHA. The outcome of this capacity building would be monitored through normal administrative measures and specialized mid-term evaluation of ASHAs activities.

v.An untapped source of information for early detection is the media

reports. About five local language and four English language papers circulate in every district. Multiple local editions of each of these newspapers are available in every district. All papers cover local news on page 2 and 3. Every district has multiple local television channels also. It is hopped that tapping this source would be relevant in Kerala where literacy and paper reading habit is very high. A meeting with Press Council of Kerala, Newspaper managements, Visual Media companies and various staff associations is proposed to chalk out the modalities of this type of

surveillance. At least 4 sessions held in different districts may be necessary for this purpose.

vi.The strengthening of clinic/casualty/ward based reporting of

"Probable" cases is an important priority. Health access is relatively better in Kerala and services of specialists are widely available. A specialty based surveillance system involving Physicians, Pediatricians and Infectious disease specialists is proposed. It is to be operated through the corresponding specialty based professional organization. The data generated would be aggregated at the District Medical Office and analyzed regularly by the staff at the office and the nearest Medical College. Both the government sector and private sector would be seamlessly tied together for the success of the project. Similar arrangement would be taken up for improving the laboratory based reporting also [Specialists - MD (Microbiology), MSc (Medical Microbiology & MSc (Microbiology)].

vii.A special drive is proposed for improving reporting of Vector Borne

diseases from at least 10 largest hospitals of each district.

viii. NABL/NABH Accreditation: A few of the major private institutions in Kerala are accredited with the Quality Council of India. It is a prestigious certificate and the hospitals take great pains to maintain it. The current guidelines do not have any criteria on the Public Health commitments of the hospital/laboratory. It is proposed that NVBDCP take up the matter with BIS/QCI so that regular transfer of Public Health relevant data to the corresponding District Medical Office (on forms designed by the District Medical Office) be an essential criteria for accreditation and its maintenance.

Brief Plan for the proposed Inter-epidemic surveillance system:

Time of Operation: Inter epidemic period of the District (As determined from the previous two years data)

Area of Operation

Description Percentage of Samples*

Time & interval of serum collection

A New area (Block/Municipality/Corporation) newly affected in the previous two years

50% In the month prior to the traditional increase in endemic cases and two months following the traditional decrease in endemic cases, Single day (per week for four consecutive weeks) collection at

multiple GP sites (Government & Private) distributed over the entire area

B High incidence in the past many years

20% In the month prior to the traditional increase in endemic cases. Single day (per week for four weeks) collection at multiple GP sites (Government & Private) distributed over the entire area

C Areas not reporting cases in the past many years

30% Few sites (CHC/BPHC/Taluk, District or General Hospitals) in Medicine & Pediatric wards. Serum collection spread throughout the year especially for non-specific fevers.

*- Percentages are arbitrarily fixed for the current year. Distribution may be changed in future years with greater experience. Estimated test kit requirement for Inter-epidemic surveillance – 7000 Tests (7000/98 = 72 kits). Only NIV supplied kits would be used for this purpose. It would be preferable to limit the sample testing to few scientific institutions like NIV, Alleppey unit, Medical Colleges and KSIVID. Health Department can do the serum collection efficiently throughout the state and transport them to these designated labs according to a mutually agreed schedule.

Entomological Surveillance including larval surveys

Based on the year to year analysis of the epidemiological data and the

expected climatic changes in each district, 4 timed and supervised

Entomological Surveillance (including larval surveys) is proposed to be held

in every district. These activities would be monitored and evaluated from the

state level.

The 4 schedules would be:

Sl. No.

Timing Usual Month

Priority areas

Remarks Action

1 Peak of Dry Season

May Water shortage areas

Most breeding related to water storage for household use.

Demonstration of better water storage practice

2 Beginning of Rainy Season (work starts 3 days after the rain starts)

June and November months

Entire state

Geometric progression of breeding places. Container strategies to be implemented

Removal of all containers as far as possible. Larvicides/fish in the non-removable sources.

3 End of Rainy season

September and December (exact timing would be highly variable)

Entire State

Clean-up to decrease the potential spread during the next year from eggs.

Removal of all containers as far as possible especially those with water from the last showers.

4 One month following the end of rains (Linked to Inter-epidemic surveillance)

Jan 15 to February 15

Areas reporting increased vector borne diseases in the lean period

Source usually not easily visible, like inside the air conditioner, behind the fridge, etc. Requires more technical support.

Search and destroy specific persistent sources in and around the houses.

(Additional surveillance activities may be needed in specific areas. They would be conducted as and when necessary as decided by the district administration)

The work division would be in line with the ward division of the panchayats.

The findings of each ward survey would be discussed at the corresponding

Local Self Government and general plan for the entire local body would be

prepared at local body level. The date for discussion at the local body would

be decided centrally at state or district level. The roles and responsibilities of

ASHA, SHG members, students, technical staff, etc would be decided at these

conferences. The funds under WH & S committee and other decentralized

funds would be used for this purpose. Each activity would be for short

duration and designed to have high impact within a given ward. The State

Entomology team would give technical support to the programme.

Human Resource Development through capacity building

Capacity for Data Analysis: Trainings on Data Analysis are proposed to be

arranged through the State Public Health Training School, Trivandrum with

the help of faculty from various Medical Colleges in Kerala. It would be given

to Deputy DMOs, District Malaria Officers, Biologists/Entomologists,

Technical Assistants, Health Supervisors and Health Inspectors.

The general needs of capacity building include:

Category Syllabus No. of Batches which

can be trained in 2009 -

10 (25 persons per batch,

25% from private sector)

Doctors, Nurses Surveillance, Management of clinical cases (WHO Guidelines, Experience sharing of clinicians from Trivandrum region)

4 - 2 day duration

Laboratory staff Hematocrit, Platelet count, IgM Elisa and surveillance.

2 - 4 day duration

Field staff Basic Entomology principles, communicating the findings at the panchayat and local field utilization of available resources.

30 - 3 day duration

Field supervisory staff

Basic Entomology principles, supervision techniques.

20 - 3 day duration

Legal fraternity Sample laws implemented in other states and countries.

2 - 1 day duration

Library Development:

Reference books on Vector Borne diseases are not available in the Directorate

Library. There is an urgent need to buy the latest reference books on case

management, outbreak management, entomology, epidemiology, etc.

c. Inter-sectoral convergence: Development of Public Health Projects for

inclusion into the 2009 - 10 decentralized planning process is an immediate priority. Discussion meetings need to be arranged for this purpose at different levels to support the planning process.

d. Operational research:

There are a number of research priorities for the state in the region of

vector borne diseases. These are expressed in different forums but never get conceptualized into actual field based studies. These research questions arise on the background of the public health management experience of the Department. Such questions can be addressed in the participatory environment of Medical Colleges, Research institutions and Health Services Department.

It is proposed to conduct three brain storming conferences to identify

and conceptualize the Departmental Research Priorities.

The following are already selected and ready for immediate implementation:

A. Introduction to the Science of Medical Entomology from Class V to MSc (Zoology/Environmental sciences/Biotechnology) & BEd/Med.

Introduction of the science of medical entomology into the school and college

Encephalitis cases 2007&2008

Year Month Cases Death

2007 January 4 1(65 F)

2007 February 2

2007 March 5 2(30F,24F)

2007 April 1

2007 May 2

2007 June 4 3(55F,89M,62M)

2007 July 21 12(15F,77F,55M,42M,40F,35M,60M,68F,49M,1.6F,7.6M)

2007 August 11 7(63F,72F,67F,65M,58M,80F)

2007 September 3 1(60F)

2007 October 3 2(58M,45F)

2007 November 3

2007 December 1

2008 January 2 2( No details)

2008 February Nil

2008 March 2 2(41F,48M)

2008 April 1 1(39F)

2008 May 1 1( No details)

2008 June Nil

2008 July Nil

2008 August 1 1(41M)

2008 September Nil

2008 October 1

2008 November Nil

Total 68 34

syllabus would be a long term investment relevant to Kerala. In view of the

high literacy and almost universal school enrolment, the benefit is expected to

last another 50 years.

Previously, VCRC, Pudicherry had conducted a course on MSc (Entomology).

So, along with educationists, if we could design a proposed syllabus for Class

V to MSc (Zoology/ Environmental sciences/Biotechnology) & BEd/MEd,

then the Department could try to introduce it into the curriculum. This

measure is expected to modify the social acceptance of vector control

measures in the long term.

At least 4 sessions of discussions would be necessary. The participation of

VCRC, Pudicherry is very critical. The issue has already been discussed with

the Director of the institute and it is understood that they are interested in

collaboration.

B. Serosurveillance: Discussed in detail under the Japanese Encephalitis section. II. Qualitative evaluations of the current BCC strategies using the help of MSW

professionals can help us in fine turning our strategies. Two evaluations (one in north Kerala and one in South Kerala) would need to be done.

Action Plan for Japanese Encephalitis 2009 - 10

Situation Analysis of the Disease

Report from STATE PEID Cell, Thiruvananthapuram I. Specific Constraints for implementation of the program

a. Case Reporting: The case reporting system is very weak for this

disease. In Kerala, due to the good health access almost all cases of Encephalitis are treated by specialists like Pediatricians, Physicians and Neurologists. Most of the cases report either to the private hospitals with specialists or Medical Colleges. On analysis of the surveillance reports of the well reported communicable diseases, it is seen that relatively few reports originate from the above points.

b. Offering a diagnostic facility of a treatable condition like Herpes

Encephalitis also along with Japanese Encephalitis would greatly improve the case reporting pattern.

c. Ventilator facilities are not available in district hospitals.

II. Strategy and Innovations proposed. a. Full scale ICU facility with ventilator support is proposed for one

district hospital.

b. Field surveillance: ASHA has been taught to report "Fever with altered sensorium" also.

c. Hospital Based Surveillance: Speciality based surveillance including

Neurologists also is proposed.

d. A special drive is proposed for improving reporting of Vector Borne diseases from at least 10 largest hospitals of each district.

e. The Forest Department has identified the usual Migratory Bird

homing sites. These sites could be taken as priority areas for entomology studies.

f. Pig Serological surveillance

g. The general needs of capacity building include:

Category Syllabus No. of Batches which can be trained in 2009 - 10 (25 persons per batch, 25% persons from Private sector)

Doctors, Nurses Surveillance, Management of clinical cases

2 day duration

Field supervisory staff Basic Entomology principles, supervision techniques.

5 - 3 day duration

h. Sero-surveillance on Japanese Encephalitis and Dengue

In Kerala, we have started the Japanese Encephalitis vaccination. During

the Technical meetings held prior to the vaccination in Alleppey, many experts

had opined that the basic serology pattern in the community has to be

documented prior to vaccination. Unless it is done, it may not be possible to

know the effectiveness of the vaccine at a later time. (This information is

permanently lost once the vaccination has been done) As standard guidelines for

this purpose are not available, it is necessary to design the method. Many

informal discussions were done. SCTIMST, AMCHSS has been approached

informally for study design and VCRC-Kottayam unit helped us in identifying

the appropriate serological tests. Dr. Sunija, Director PH Lab and Dr. Sarada,

Microbiologist, Medical College, Trivandrum gave valuable suggestions. It is

estimated that about 7000 blood samples selected at random from the

community, has to be properly collected and stored for this purpose. This

massive collection can be done by the Department of Health Services. Our staff

would be able to do it with some field level training on the special methods to be

followed for research studies. We need help in analyzing the samples as the tests

involved are of specialized nature. As the mandate of VCRC is in vector borne

diseases, collaboration with them would highly benefit the state. VCRC in turn

would be able to use the information in their studies on the mosquitoes. The

stored serum can be used for sero-surveillance of Dengue, Chikungunya,

Hepatitis (A, B, C & D), Chicken pox, Rubella, Leptospirosis, etc. The routine

immunization programme can also be analyzed. (Advanced countries use this

method for analyzing their vaccination programmes). The help of VCRC can be

used in Japanese Encephalitis, Dengue and Chikungunya. One scientist from

Rajiv Gandhi Institute of Biotechnology has expressed interest in Hepatitis C. We

plan to request the help of NIV, Alleppey unit for all other diseases (except

Leptospirosis).

Currently the study proposal is being finalized. It would be submitted to

NVBDCP research funding separately.

Detailed budget statements

Dengue/Chikungunya

I Strengthening Surveillance

No. of Batches

Days of training

Cost per batch

Total cost Remarks

1 Use of Media in Disease

Surveillance 4 1 20000 80000 One batch in each zone

2 Speciality based surveillance 5 1 5000 25000

3 Augmenting Surveillance in 10 largest hospitals in each district 14 1 40000 560000

4 Inter-epidemic surveillance system 350000

For transportation of samples, containers, small instruments, etc. (would become operational only if NIV supplies the required number of Kits)

5 4 timed and supervised

Entomological Surveillance 800000

POL, TA/DA, Stationery, Printing

Sub Total. [Grant-in-AID for Strengthening surveillance] 1815000

II Training

No. of Batches

Days of training

Cost per batch

Total cost Remarks

1 Nurses 14 2 30000 420000

Each batch to have 25 persons. 25% seats for private sector. Conducted at District level.

Case Management Training

Doctors 14 2 30000 420000

Each batch to have 25 persons. 25% seats for private sector. Conducted at District level.

2 Capacity for Data Analysis

4 2 40000 160000

Each batch to have 25 persons. Conducted at District level.

3 Training for Laboratory staff 2 4 60000 120000

Each batch to have 25 persons. 25% seats for private sector. Conducted at District level.

4 Training for Field Staff 30 3 20000 600000

Each batch to have 25 persons. Conducted at District level.

5 Training for field supervisory staff 20 3 20000 400000

Each batch to have 25 persons. Conducted at District level.

6 Training for Legal fraternity 2 1 20000 40000

Sub Total. [Grant-in -AID for

Training] 2160000

III IEC/BCC

1 Library Development 300000

2 Inter-sectroal convergence

meetings 100000

3

Qualitative evaluations of current BCC strategies

100000

4 Posters 5000 nos. Unit cost

Rs 10. 4 types 200000

5 Hordings. 140 nos. Unit

cost Rs. 8000. 1120000

6

Newspaper advertisements 17 dailies, 20 x 20 cm Column per cm

- Rs 45000. 700000

7 TV Advertisement 25 sec

duration 2 times 260000

8

Radio 25 seconds 20 times Unit cost = Rs 7000/ per

advt. 140000

9 Health Camp 75 camps

Unit cost 5000. 375000

10 Village level camp 700

camps Unit cost = Rs 1000. 700000

Sub Total [Grant-in -AID for IEC/BCC] 3995000

IV Operational Research

1 Brainstorming sessions on Departmental Research 30000

Priorities

2

Discussion on introduction of Science of Medical Entomology into syllabus 40000

Sub Total [Operational Research] 70000

V NRHM Flexi pool

1

Advance care facilities in District and few Sub-district hospitals esp Centralized Oxygen

supply 4 hospitals 2000000 NRHM Flexi pool

2

Supervisory trainings to Block Coordinators and

District Program Managers to monitor ASHAs activities 28 1 5000 140000 NRHM Flexi pool

Sub Total. [NRHM Flexi pool] 2140000

Total [Dengue/Chikungunya] 10180000

Japanese Encephalitis Remarks

I Fogging Machines

700000

II Physiotherapy equipments

75000

III IEC Material

1 Posters 2500 nos. Unit cost Rs

10. 25000

2 Hordings. 20 nos. Unit cost Rs.

8000. 160000

3

Newspaper adverisements 4 dailies, 20 x 20 cm Column per

cm - Rs 45000. 200000

Sub Total [IEC Material] 385000

IV Training

1 Speciality based surveillance 5 1 5000 25000

Each batch to have 25 persons. 70% seats for private sector. Conducted at District level.

2 Entomological and serological surveillance at Migratory Bird

Homing sites 14 10000 140000

Each batch to have 25 persons. Conducted at District level.

3 Pig Serological surveillance 10000

4 Capacity for Data Analysis 2 2 40000 80000

Each batch to have 25 persons. Conducted at District level.

5 Training for Laboratory staff 2 4 60000 120000

Each batch to have 25 persons. 25% seats for private sector. Conducted at District level.

6 Training for Field Staff 3 3 20000 60000

Each batch to have 25 persons. Conducted at District level.

7 Training for field supervisory

staff 3 3 20000 60000

Each batch to have 25 persons. Conducted at District level.

Sub Total [Training] 495000

V Technical malathion 200000

VI ICU Facility 2000000 NRHM Flexi pool

Total [Japanese Encephalitis] 3855000

Quarterly Activity Plan

I II III IV

Apr - Jun Jul - Sept Oct - Dec Jan - Mar

Doctors 5 5 4 Case Management Training Nurses 5 5 4

Use of Media in Disease Surveillance 1 2 1

Speciality based surveillance 1 1 2 1

Augmenting Surveillance in 10 largest hospitals in each district 5 5 4

Inter-epidemic surveillance system: As per trends in each district over the past 2 years.

Brief plan included in the Action Plan

4 timed and supervised Entomological Surveillance

Timed according to the plan included in the Action Plan

Capacity for Data Analysis 2 2

Training for Laboratory staff 1 1

Training for Field Staff 15 15

Training for field supervisory staff 10 10

Training for Legal fraternity 1 1

Inter-sectroal convergence meetings 3 3 3 3

Brainstorming sessions on Departmental Research Priorities 2 2

Discussion on introduction of Science of Medical Entomology into syllabus 1 1 2

Qualitative evaluations of current BCC strategies 1

Japanese Encephalitis

Speciality based surveillance 2 3

Entomological and serological surveillance at Migratory Bird Homing sites Continuous activity

Pig Serological surveillance Continuous activity

Budget Proposal 2009 – 10

Activities 2008 - 09 2009 - 10

Malaria

DBS

Salary for contractual MPW - - Operational Expenses - - Spray wages - 300000 TA/DA for contractual Staff - - ASHA incentives - - ASHA Facilitator incentives - -

Trainings • MPW • ASHA • Spray workers • FTD • Health Supervisors • Lab technicians • Medical Officers • Community Volunteers

other than ASHA

-

2240000 560000 - -

240000 240000 400000

280000

IEC / BCC - 1360000 GFTAM – Not Applicable

World Bank – Not Applicable Total for Malaria 5620000

Filaria

Drugs Training 6977000 IEC / BCC 6537000 Preparatory activity 3337000

Drug distributor’s honorarium 14000000 Total (Filaria) 16294000 30851000

Dengue/Chikungunya 2008-09 2009-10

Grant-in-AID for Strengthening surveillance - 1815000 Grant-in -AID for Training - 2460000

Grant-in -AID for IEC/BCC - 3695000 Cost of test kits to ICMR - 0 Operational Research - 70000 Total Dengue/Chikungunya 8040000

JE

Fogging Machine - 700000 Physiotherapy equipments - 75000 Ventilator - 0 Elisa Kits - 0 IEC Material - 385000 Training - 495000

Technical malathion - 200000 Total JE 1855000

Grand Total 4,63,66,000.00

PART –G

NLEP (NATIONAL LEPROSY ERADICATION PROGRAMME)

Situational Analysis

By March 2007 the patient load was 0.83 lakhs with Prevalence Rate

0.72/10,000 population.

New Case Detection rate 12.07/ 1,00,000 population.

Elimination level with Prevalence Rate less than 1/10,000 population

achieved in Kerala by December 2005

Leprosy is a disease with long incubation period, slow in

progressing and associated with high level of Social stigma So strict

surveillance need to be maintained for New case detection and

treatment to avoid recurrence of the situation. There is no tool to

prevent disease occurrence in Leprosy. So the programme has to keep

ready with quality service provisions for each patient.

Activities Proposed for 2009-10

I. Anti Leprosy Service Initiatives

A Project named ‘Poornatha – 2009’ is to be launched on Anti

Leprosy Day January 30th to make Kerala - a Leprosy-free State by

2012.

The activities to be taken are,

1. IEC Campaigns to spread awareness about the disease in areas

where migrant population is more.

2. Developing a suitable referral system for providing the benefit to

difficult to diagnose cases at PHC level and also to cases which

needed specialized services

3. Giving more attention to disadvantaged groups like females,

scheduled Tribes, scheduled Castes etc.

4. Validating new cases to avoid wrongly diagnosed cases

5. Organizing Skin camps for detection of new cases

6. Doing Contact Surveys for newly detected cases.

7. Involving Panchayat leaders, NGOs and other agencies for

motivating the patients.

The goal of the project is to minimise the burden of Leprosy and

to provide access to quality Leprosy Control Services for all affected

Communities following the principles of equity and Social justice and

to make Kerala a Leprosy – free State

II. Provision of High quality Leprosy Services.

i. Skin Camps along with NRHM Arogyamelas

ii. Referral Services for Complicated cases

iii. Ulcer Care Camps in Leprosy Sanatoria on regular basis with a team

of Specialist doctors.

III. Enhanced Disability Prevention and Medical Rehabilitation

(DPMR)

i. Camps, with the help of Department of Physical Medicine,

periodically.

ii. Providing Aids and appliances, free of cost

iii. Reconstructive Surgery Camps

IV. IEC activities

To reduce stigma and discrimination against leprosy patients.

Messages. a. Leprosy is curable through MDT

b. Join hands for a Leprosy-Free India

c. Early detection and early treatment to prevent

Disabilities

V. Capacity building

a. Training of newly appointed Doctors of Health Services

b. Orientation Training for Medical Officers of Health Services

c. Trainers Training on Disability Prevention

d. Training of General Health Care Staff

e. Training of Lab Technicians

f. Training of private practitioners with the help of IMA

g. Training of Pharmacists on MDT

h. Training of Prevention of Disabilities (P.O.D) to Medical officers of

Health Services

i. CME on Prevention of Disabilities to post graduate students of

Orthopedics, Physical Medicine, Surgery and Dermatology

j. Workshops on Disability Prevention and Medical Rehabilitation for

Doctors of private and Govt Sector

k. Sensitisation of ASHAS, Kudumbasree workers and Anganwadi

workers on NLEP

VI Monitoring and supervision

District Nucleus to be strengthened for monitoring and Supervision.

VII. Financial position

During the last 3 years the State has received Rs.96.72 lakhs and expended Rs.109.67 lakhs as shown below.

Year Receipt (Rs) Expenditure(Rs)

2005-06 27,64,000 31,20,131

2006-07 61,67,000 66,97,784

2007-08 7,41,000 11,49,212 TOTAL 96,72,000 1,09,67,127

Current Year (2008-09)

Receipts : During current financial year we have received Rs.33.70 lakhs from Government of India.

Expenditure: During 2008-09, Rs.34.60 lakhs was expended as noted

below.

Fund transferred to District Leprosy Offices 28.00 lakhs Fund released to NGOs 05.90 lakhs Expenses at State Leprosy Office 0.70 lakhs

TOTAL 34.60 lakhs

Following activities are pending completion for which an amount of Rs.67.13 lakhs is required.

Sl.No. Details (Rs. In lakhs)

1. Capacity building 18.00

2. Leprosy day activities 1.50

3. DPMR Activities 19.00

4. IEC Activities 20.00

5. Review meetings 2.00

6. 1st installment of grant-in-aid to NGOs (2008-09)

6.63

TOTAL 67.13

There is a bank balance of Rs.25.30 lakhs only with State Society. The

shortage of funds is proposed to be met from the 2nd installment of grant

expected to receive from Government of India shortly.

Budget Proposal for the year 2009-10

A. Contractual Services (Rs in Lakhs)

1) BFO @ 14300 x 12 1.72

2) DEO @ 8000/pm 0.96

3) Drivers @ 4500/15 0.54

Total 3.22

B. Office expenses 1) SLS @ 50,000/yr for rent,

Electricity, miscellaneous 0.50

2) DLS @ 15,000/yr for rent,

Electricity, miscellaneous 2.10

3) SLS equipment maintenance Cost 0.50

Total 3.1

C. Consumables

1) SLS @ 30,000 for stationary 0.30

2) DLS @ 15,000/yr/Dt 2.10

Total 2.4

D. Capacity building 1) 4 days training of newly

appointed 25000/10 batches

30 each batch 2.5

2) 4 days training to Hs/Hw

20,000/batch/30 batches

30 / batch 6.00

3) 5 days training to

District Hospital Lab

technician 14/batch

single batch - 1 lab technician / District

@ Rs. 20,000/batches 0.20

4) 2 days training to

Dermatologists, private practitioners

102500/ 40 batches 25 in each batch 4.10

5) 2 days refresher

course for MOs Rs. 10,000/40 batches

20 in each batch 4.00

6) CME on DPMR 25000 x 4 2.00

Total 18.8

E. Communication for Behavioural change IEC Activities for State Level 6.10 1) wall painting - 200 x 25/14-districts 0.70

2) Rallies @ 5000 x 2 x 14 1.40

3) Quiz @ 3000 x 4 x 14 Districts 1.68

4) Folk shows/magic shows @

6000 x 8x14 districts 6.72

5) IPC workshop @ 4x10,000x14 5.60

6) Orientation workshop for

NGOS, kudumbasree @

25,000x4x14 districts 14.00

7) Meeting of opinion leaders

10,000 x 2 x14districts 2.80

8) Sensitisation of ASHA @

2000 x 100 batches 20/each batch 2.00

Total 41.00

F. POL/vehicle operation & hiring

1 vehicle at State level 1.00

2 at District level 40,000 x 2 3.92

Total 4.92

G. Project – Poornatha 2009-

For Leprosy free State Kerala 25.00

H. DPMR Supportive Medicines DLS

50,000 /District x 14 District 7.00

MCR footwear @Rs. 300 x 100 / 14 district 4.20

Aids & appliances

10,000 / D t/ 14 1.40

Support to institutions conducting RCS

50,000 / Institutions-(4) 2.00

RCS – 5000/RCS x 25 pts/yr 1.25

Printing form 0.30

Lab equipments/ Reagents 3.00

Total 19.15

VIII Urban Leprosy Control programme 20.40

IX NGO – grand in aid SET Scheme 13.26

X Review meeting /6 Review meeting every 2 months (20000x6) 1.20

Workshops 25,000 x 2 0.50 Total 35.36 Grant Total for the year 2009-10 152.95

For Leprosy –Free State- Kerala POORNATHA - 2009

INTRODUCTION

Leprosy has become the least priority disease now a day which

actually needs top priority because our aim is to eliminate Leprosy in 2012. So the case finding activities need improvement. Most of these cases are detected in Arogyamela, RCH camps. OP clinic and other Medical Camp. This clearly indicates the hidden cases in community. So the surveillance activities are to be strengthened. For this we have to find out hidden cases as early as possible & start treatment. Message should be “Leprosy free State Through Early Detection and Early Treatment”.

OBJECTIVES

To identify the new cases of Leprosy in Kerala and Start

appropriate treatment by conducting screening camps and field surveys.

METHODOLOGY Study design - Action Research Study setting 4 Districts in Kerala State Viz, Tvpm,

Pathanamthitta, Waynad & Palakkad

Study population - People residing in all the 4 districts of Kerala

Study period - From January 15th 2009 to May 31st 2009.

HUMAN RESOURCE & MATERIALS

HUMAN RESOURCE

1 teams allotted per panchayath. Each team consists of two groups. 1 technical / medical group & 1 organization group

• Medical group consists of 1. Medical Officer, Primary Health Centre, 2. One Asst. Surgeon 3. Health Inspector & Leprosy Health Inspector 4. Junior Public Health Nurse 5. Junior Health Inspector 6. Pharmacist 7. ASHA workers

8. One driver 9. One Lab technician for taking skin specimen 10. One anganwadi worker (all from corresponding PHC of Panchayath). One dermatologist has to be recruited to the medical group from outside

• Organizational group consists of 1. Panchayat President 2. One Member of Local Self Government 3. One local leader,

Team leaders -> MO, PHC & Panchayat President.

• 5 teams allotted for covering 98 Panchayaths in Palakkad

• 4 teams allotted for covering 78 Panchayats in Thiruvananthapuram

• 2 teams allotted for covering 25 Panchayats in Wynadu

• Another team for monitoring & evaluating the program consisting of selected health inspectors allotted per district. 1 Health Inspector will monitor the activities of around 5 panchayaths. Thus a team of 20 His for Palakkad, 15 for Thiruvananthapuram, 10 for Pathanamthitta, 5 for Wynad.

Materials

Drugs required for screening camp, lab equipments for collecting skin

specimen, vehicle for conveyance, banners, posters, notices and other IEC materials, venue for conducting camps with facilities for collecting & storing specimens

Strategies

1. Training for stake holders 2. IEC activities 3. Conducting screening camps in every Panchayat for detecting Leprosy cases 4. Confirmation of cases, categorization, registration & initiation of treatment for +ve cases

5. Survey conducted in working places & 25 houses around +ve case (50 houses if density populated)

6. Follow up of patients on treatment 7. Follow up of suspected cases

Activities 1. Protocol & activities should be discussed among District Leprosy

Officers and District Panchayath Presidents of all 4 districts 2. Training of Trainers for Medical Officers and Orientation for

Panchayat Presidents by DLOs & Jilla President (2TOTS for Palakkad)

3. Training for Health Inspector, Junior Health Inspector, Junior Public Health Nurse , ASHA by Medical Officers & Panchayat President

4. Training for Lab technicians (at least & per team) One training for 20 Lab technicians

5. House to House visit by trained field workers esp in high risk houses & areas

Objectives of visit

1. Creating awareness regarding Leprosy.

2. Removing stigma

3. Regarding complete care of disease

4. Informing about screening camps & free drugs supply

5. Early registration for camps.

6. Mobilization of community

7. Ensure community participation

6. Other IEC activities

State & District level

• Proper message of campaign should be covered in newspapers,

TV, FM Radios & Mobile phones

• Posters, Banners, Stickers

• Bit notices

Panchayat level

• Mike announcements

• Posters & Banners – 1 week before camps in Public places

• Distribution of notices 2 days before in schools

• Messages through religious institution

• Arrange venue

7. Conducting Screening camps – 112 days from February 8th to May

31st

• 5 teams allotted for Palakkad

Time – schedule – every 5th day (from 8-12 pm)

• 4 teams for Tvpm, every 5th day (from 8-12 pm)

• 3 teams for Pathanamthitta, every 5th day (from 8-12 pm)

• 2 teams for Wynad, once in every 12th day (from 8-12pm)

Follow-up camps in one of the previous venues from 1-2 pm by

dermatologist to see suspected cases detected through field surveys

Working pattern

• All teams will conduct camps on the same days, same time in

adjacent Panchayat as mentioned above

• Camp may be inaugurated by MP/MLA/Mayor/Municipal

Chair person/Block Resident etc….. Representatives of the

supporting agencies should be invited

• Registration

• All suspected cases should be seen by dermatologist

• Collection & storing of split skin specimen

• Maintain OP & Lab register

Outside camp venue:- Mobilization of people to camp by ASHA, ward

Member & local leaders

Report should be sent after every camp

8. Follow up

• Confirmation of diagnoses by pathologist

• Surely conducted in 25 houses around +ve case & among his close

contacts at home & working place by concerned PHC for early

detection (Challenge is dt IP is 2-5 years)

9. Start Treatment for + ve cases after categorizing & registration

10. Follow up done by Health workers for Pts on Tx & Monthly report sent to

DLO

11. Follow up of suspected cases every 6 months for minimum of 5 years for

signs & Symptoms & reported to DLO

PART – H

NBCP (National Blindness Control Programme

Introduction

National Programme for Control of Blindness (NPCB) was launched in the

year 1976 as a cent percent Centrally Sponsored Programme with the goal of

achieving a prevalence rate of blindness to 0.3% of population. The first

programmed strategy of the programme is

• Strengthening service delivery

• Developing human resources for eye care

• Promoting outreach activities and public awareness

• Developing institutional capacity

The implementation of the programme was decentralized in 1994-95 with formation of district blindness society in each districts of the country.

Situation Analysis

The estimated number of blind population in India is about 12 million. The

main causes of blindness is Cataract, Refractive Error, Glaucoma, Corneal

blindness and other congenital and neurological diseases and Metaboills

diseases like diabetic Retinopathy, Cataract is the major causes of blindness

emphasis is given for cataract detection and treatment. The target for cataract

surgery for the year 2009-10 is 1,00,000.

As in India, cataract is the main cause of blindness in Kerala also. This is

about 2.5 lakhs to 3.0 lakhs blind people in Kerala. There are about 25 to

30,000 corneal blindness cases in Kerala.

Cataract Surgery Performance in 2007-08 and 2008-09 till December2008

2007-2008 2008-2009 till December

Target 1,00,000 1,00,000

Achievement 91,890 76,659

Percentage 91.89 76.66

School Eye Screening Performance in 2007-08 and 2008-09 till

December2008

2007-08 Particulars

Target Achievement

Achievement till December 2008

No. of children examined

3,00,000 6,67,002 13,70,271

Eye Banking Performance in 2007-08 and 2008-09 till December2008

2007-08 Achievement till

December 2008 Particulars

Target Achievement Target Achievement

No. of cornea collected

2000 2088 3000 595

Objectives

1. Target for cataract surgery - 1,00,000 2. School Eye screening

Students to be screened - 3,00,000 Detection of refractive errors - 21,000

Free spectacles to be provided - 6,300 3. Cornea collection - 30,000 4. Setting of vision centres - 40 5. Setting of eye donation center - 1 6. Strengthening of Eye Bank - 1 7. Strengthening of Eye care hospitals of NGOs- 2

1. Cataract Operation

Cataract operations are done in government hospitals, private

hospitals and also by NGOs. NGO’s are given grant-in-aid for conducting eye camps for the rural population. More emphasis is given for the quality of surgery. Strict measures are taken for post operative follow up and visual acquity assessment.

2. School Eye Screening

Training is given to teachers for conducting preliminary screening

of children. These screened children were examined by Ophthalmic assistants in that area and those with refractive errors and other diseases like Vit-A deficiency were re-examined by Opthalmic surgeons in the Mobile Ophthalmic Units by conducting eye camps in the periphery. Spectacles were prescribed for children with refractive errors. Measures are taken to provide free spectacles for poor children (BPL).

3. Setting of Vision Centres

40 vision centres are started in State now. Opthalmic Assistant in CHC will visit our vision centre a week and attached to mini PHC, glaucoma screening, Diabetic retinopathy screening are started now and to be enhanced next year

4. Eye Donation and cornea transplantation to be enhanced next year

Mass awareness classes about eye donation through identified PHCs/ CHC and eye donation information centers.

Fortnight celebration of eye donation (28th August to 8th September)

all over state.

Awareness classes to be conducted in Higher Secondary Schools-as they are the people to be motivated to give the eyes of their parents.

Meeting & seminars in District levels & Block levels all over state.

Painting competitions and essay competitions through voluntary organisations like Lions club, Rotary club.

Print notices & book texts to be issued through PMOA’s about eye donation of occupational hazardous injuries of eyes.

5. Strengthening of Eye care hospitals and NGOs

MGM – Hospital Kallada (Kollam) and Renjini Eye Hospital, Ernakulam are proposed this year.

Activities

1. To organize screening camps for identifying those requiring

cataract surgery and other blinding disorder. 2. To organise transportation and to conduct free cataract surgery for

the poor in government facilities or NGOs supporting the programme.

3. To involve voluntary and private hospitals providing free/ subsidized eye care services and identify NGO facilities that can be considered for non-recurring grant under programme.

4. To organize screening of school children for detection of refractive error and other eye problems and provide free glasses to poor children.

5. To promote eye donation. 6. To provide grant-in-aid to voluntary organisation for promoting

free cataract surgery. 7. To provide grant-in-aid to Eye Banks of NGO for cornea collection. 8. To plan and organise training programmes 9. To prepare Blind Register.

Work Plan -2009-10 1. Conducting eye camps by mobile ophthalmic Units in the periphery

for detection of cataract and other blinding disorders. 2. Promote cataract surgery in Government sector by finding more

equipments and man power. Buy already 14 microscopes in the year. A scan Keratometer, flash autoclave in all district and sub district hospitals and Yag lasers in district hospitals yet to be bought.

3. Eye donation-To increase the number of eye donation by increasing awareness among population and to strengthen the infrastructure of Eye Donation centres and Eye Banks.

4. School Eye screening –Regular screening of school children for early detection of Refractive errors to prevent amblyopia and to provide free spectacles for poor children. Squint screening and referring cases of squint for surgery and financial assistance for surgery of poor patients.

5. Willing Ophthalmologists to be send for S.I.C.S, Pediatric Ophthalmology and glaucoma training.

6. Participation of Voluntary Organisations – To ensure active participation of voluntary organisations in NPCB activities.

7. Diabetic retinopathy screening and glaucoma screening stand in vision centre none.

FINANCIAL POSITION

Previous year:

During 2007-08 an amount of Rs.158 lakhs was received from

Government of India and Rs.165.67 lakhs has been expended on

various activities.

Current Year (2008-09):

The receipt from Government of India was to the tune of Rs.260.92

lakhs of which 251.60 lakhs has been rebased to 238 lakhs Blindness

Control Societies. As of 24.01.2009, there is a bank balance of Rs.120

lakhs with State Society including bank interest and carried outward

balance; Orders have already been placed with Kerala Medical Services

Corporation for the procurement and supply of 12 nos of operating

microscopes at a total cost of Rs.48 lakhs. Procurement is expected

before the close of current financial year.

The balance would then be Rs.72 lakhs for which payments of

grant-in-aid to NGO’s are pending. Payment to NGOS was delayed

since irregularities were noticed in the claims preferred by some

NGOs. However, instructions have been issued to all DBCS’s to effect

payment during the current financial year itself, after due verification

of the records of the NGO’s.

BUDGETARY REQUIREMENTS -2009-2010 STATE OF KERALA

A. Kerala State Blindness Control Society – State Ophthalmic Cell

1. Remuneration of Contractual Staff

Budget Finance Officer (13000 x 12) 1,56,000

Administrative Officer (11000 x 12) 1,32,000

Data Entry Operator (6500 x 12) 78,000

Administrative Assistant (5500 x 12) 66,000

Peon (3000 x 12) 36,000

Driver (3500 x 12) 42,000 TOTAL 5,10,000

2. POL and Maintenance of vehicle 30,000

3. Telephone charges 20,000

4. IEC 50,000

5. Contingencies 30,000

6. Office Expenses 24,000

7. Special Programmes 40,000

8. Repair of equipments 50,000

9. Training 50,000 TOTAL 2,94,000

B. Budgetary requirements 2009-10 for District Blindness Control Societies

1. Honorarium to be paid to Member Secretary and other staff appointed in the District (35000 x 14)

4,90,000

2. Procurement of goods, procurement of consumables like IOL, Suture materials, viscoelastic sustains, Medicines by DBCS (50000 x 12 x 14)

84,00,000

3. POL and maintenance (POL to DBCS vehicles, hiring of vehicles, maintenance of vehicle (10,000 x 12 x 14)

16,80,000

4. IEC activities (50000 x 14) 7,00,000

5. Grant-in-aid to voluntary organisations (including pending cases and non recurring grain-in-aid to 2 NGOs)

3,50,00,000

6. Funds for development of vision centres 15,00,000

7. Contingencies (10000 x 12 x 14) 16,80,000

8. Training (75000 x 14) 10,50,000

9. School Eye Screening (150000 x 14) 21,00,000

10. Purchase of Major Ophthalmic equipments 2,50,00,000

TOTAL 7,76,00,000

Total Budgetary Requirement

KSBCS - 8,04,000

All DBCS - 7,76,00,000

TOTAL - 7,84,04,000

PART –I

RNTCP (REVISED NATIONAL TUBERCULOSIS CONTROL

PROGRAMME)

Objectives:

1. To achieve and maintain a cure rate of at least 85% among newly detected

infectious (new sputum smear positive) cases, and

2. To achieve and maintain detection of at least 70% of such cases in the

population

Section-A – General Information about the State

1 State Population (in lakh) please give projected population

for next year

34557000

2 Number of districts in the State 14

3 Urban population 8243218

4 Tribal population 568474

5 Hilly population 1916094

6 Any other known groups of special population for

specific interventions

(e.g. nomadic, migrant, industrial workers, urban

slums, etc.)

459180

(These population statistics may be obtained from Census data /State Statistical

Dept/ District plans)

No. of districts without DTC: Nil

No. of districts that submitted annual action plans, which have been

consolidated in this state plan: 14

Organization of services in the state:

Please indicate number of TUs of each type

Please indicate no. of DMCs of each type in the

district

S. No.

Name of the District

Projected Population (in Lakhs)

Govt NGO Public Sector*

NGO Private Sector^

1 Trivandrum 3510886 6 39 2 5

2 Kollam 2804750 5 25 0 15

3 Alappuzha 2285104 4 24 0 3

4 Pathanamthitta 1336729 2 17 1 6

5 Kottayam 2119640 5 28 1 13

6 Ernakulam 3362917 7 32 1 16

7 Idukki 1224965 4 22 0 6

8 Wayanad 853789 3 12 1 0

9 Thrissur 3229483 5 30 0 8

10 Palakkad 2840518 6 39 0 1

11 Kozhikode 3124264 5 26 0 4

12 Malappuram 3939539 7 34 0 4

13 Kannur 2618333 5 23 0 16

14 Kasaragode 1306083 3 11 0 0

Total 34557000 67 362 6 97

*Public Sector includes Medical Colleges, Govt. health department, other Govt.

department and PSUs i.e. as defined in PMR report

^ Similarly, Private Sector includes Private Medical College, Private Practitioners,

Private Clinics/Nursing Homes and Corporate sector

RNTCP performance indicators:

Plan for the next year

Name of the District (also indicate if it is notified hilly or tribal district

Total number of patients put on

treatment*

Annualised total case

detection rate

(Per lakh pop.)

No of new smear positive cases put

on treatment

*

Annualised New smear positive case

detection rate (per lakh pop)

Cure rate for cases

detected in the last 4 correspon

ding quarters

Annualized NSP case

detection rate

Cure rate

Trivandrum 2733 78 1190 34 79% 70% 85%

Kollam 1833 66 942 34 84% 70% 85%

Alappuzha 1755 77 718 32 84% 74% 85%

Pathanamthitta 878 68 508 39 84% 90% 90%

Kottayam 1777 85 893 43 80% 70% 85%

Ernakulam 2263 106 1124 34 84% 70% 85%

Idukki 662 55 298 25 80% 70% 85%

Wayanad 608 72 249 31 85% 70% 88%

Thrissur 2203 109 1071 34 81% 80% 85%

Palakkad 1974 98 951 32 83% 80% 85%

Kozhikode 2501 81 902 29 84% 70% 85%

Malappuram 2044 57 214 23 85% 70% 85%

Kannur 1662 62 799 30 80% 70% 85%

Kasaragode 895 68 411 35 78% 70% 85%

Total 23788 77 10270 33 84% 70% 85%

* Patients put on treatment under DOTS regimens only are to be included. Section B – List Priority areas at the State level for achieving the objectives planned:

S.No. Priority areas Activity planned under each priority area

1 a)Active support of NGOs with signed schemes; Adherence scheme, Slum scheme

1 b) Decentralised DOT with more community DOT providers and strengthening supervision of the DOT providers with peripheral health workers and supervisors.

1 c) Monitoring co-morbid conditions especially diabetes and facilitating proper management of the co-morbid conditions.

1 d) Early detection of cases by active involvement of private sector

1 Strengthen case holding

1 e) Reduce of Cat II default by giving special attention on cat II patients

1 f) Linkage with NGOs for managing alcoholic patients with proper counselling and tie up with de-addiction programmes

1 a)Improved Private Sector Involvement using the NGO/PP schemes

1 b) Strengthen community participation using Local self governments and NGOs

2 Improving Case Detection

1 c) Social Mobilisation, referral of chest symptomatics by trained Kudumbasree health volunteers and ASHA

3 a) To strengthen DOT by proper decentralisation and supervision of DOT providers

3 b) Early identification of MDR suspects and C&S in the IRL

3 Implementation of DOTS-Plus programme

3 c) Strengthen DOTS-Plus sites

4 a) Training of all untrained MOs & LTs and maximum MPWs.

4 b) update trainings of Trained MOs

4 Training and Re-training

4 c) Re- Training for poorly performing MOs/LTs/MPWs

5 a) Internal evaluations, State level and inter TU evaluation by district team.

5 b) Identified districts will be visited by a team of supervisors for two days under the leadership of STO and DMO, identify issues and help district programme officers to solve them, 3 districts per month.

5 Intensified supervision and monitoring of districts from State level

5 c) Zonal reviews

6 Strengthen ACSM activities 6.a) Facilitate ACSM activities in the districts using additional support from NGOs.

6.b) Patient education using patient education booklets

7 Strengthen TB/HIV collaborative activities

7.a) District coordination committees 7. b) TB/HIV Schemes with NGOs

8 Strengthen health system 8. a) Implementation of Practical approach to Lung Health (PAL)

Priority Districts for Supervision and Monitoring by State during the next year

S No

District Reason for inclusion in priority list

1 Malappuram Large district with low case detection

2 Kozhikkode District with low case detection and low cure rate. A DOTS-Plus site

3 Thrissur District with high defaulter rate and death rate

Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at

the State Level

1. Civil Works

Activity No. required as per the norms in the state

No. already

upgraded/ present in the state

No. planned to be

upgraded during next

financial year

Pl provide justification

if an increase is planned in excess of norms (use separate sheet if required)

Estimated Expenditure on the activity

Quarter in which the planned activity expected to be

completed

(a) (b) (c) (d) (e) (f)

STDC/ IRL

1 1 0 Maintenance works need to be done

40000 3nd qtr 09

SDS 1 1 0 ,, 10000 2nd qtr 09

DTCs 14 14 0 ,, 63000 3rd qtr 09

TUs 73 67 6 263400 4th qtr 09

DMCs 379 362 17 884000 4th qtr 09

TOTAL 1260400

2. Laboratory Materials

Activity Amount permissible as per the norms in the state

Amount actually spent in the last 4

quarters

Procurement planned during the current financial year (in Rupees)

Estimated Expenditure for the next financial year for

which plan is being submitted (Rs.)

Justification/ Remarks for

(d)

(a) (b) (c) (d) (e)

Purchase of Lab Materials

by Districts

4754912

4636789

5431000

6122750

Lab materials for EQA activity at STDC/IRL

510000

71248

500000

525000

As CTD had supplied reagents for C&S, they were not procured at state level, hence less spending.

3. Honorarium

Activity Amount permissible as per the norms in the state

Amount actually spent in the last 4

quarters

Expenditure (in Rs)

planned for current financial year

Estimated Expenditure for the next financial year for

which plan is being submitted (Rs.)

Justification/ Remarks for

(d)

(a) (b) (c) (d) (e)

Honorarium for DOT providers (both tribal and non tribal

districts)

1172018 1616000 1763350 More involvement

of community

DOT providers

Honorarium for DOT

providers of Cat IV patients

320000

These community volunteers are other than salaried employees of Central/State

government and are involved in provision of DOT e.g. Anganwadi workers, trained

dais, village health guides, ASHA, other volunteers, etc.

4.IEC/Publicity:

Permissible budget for State and all Districts as per Norms: Rs.36,67,675/-

Estimated IEC budget for all Districts, as per action plans (please enclose

consolidation summary): Rs.3779350.

Estimated IEC activities and Budget at the State level (excluding districts) for

the next financial year proposed as per action plan detailed below:

Rs.1058500/-

Activities Planned at State Level

No of activities proposed in the next financial year, quarter wise

Target Group/ Objective A

ctivity

(All activ

ities to be planned as p

er local n

eeds,

catering to the targ

et groups sp

ecified)

No. of activ

ities held in last 4 q

uarters

Apr-Ju

n

July-Sep

Oct-D

ec

Jan-Mar

Total activ

ities proposed

during next fin

. year

Estim

ated Cost p

er activity unit

Total ex

penditure fo

r the activ

ity during the next fin

.

Year

Outdoors: - wall 0 - Hoardings 50 - Tin plates in local shops

- Banners 50 30 30 500 15000

-Scroll board

13

Patients and General public / for awareness generation and social mobilization

- others Display boards fixing in Trains

0

20

20

5000

100000

Outreach activities: - Patient

0

Community meetings

0

- Mike publicity

0

- Others State level RNTCP Exhibition

2

1

20000

20000

Puppet shows/ street plays/etc.

72

School activities

2800

Print publicity

50000

Pamphlets 0

Others Printing of time table card& calendar with RNTCP Messages for School Students

0

100000

100000

2 200000

Media activities Radio

360 spots

15

15

15

15

60

1600

96000

Print 2 15 15 15 15 60 1500

90000

Television 31 7 7 7 7 28 6000

168000

Any other activity RNTCP Message dissemination through Televisions installed in the KSRTC bus stations in whole state

0 60 60 60 60 240 625 150000

RNTCP Message dissemination through Televisions installed in the Railway Stations in whole state

0

40 40 40 40 160 800 128000

Sensitization meetings

0 1 1 30000

30000

Media activities- press briefing, meeting etc

2 2 2 5000

10000

Power point Presentations / one to one interaction

0

Information Booklets/ brochures

0

30 30 50 1500

World TB Day activities

1 0 0 0 1 1 50000

50000

Opinion leaders/ NGOs for advocacy

Any other public event

0

Health Care CMEs 0

Interaction meetings

0

one to one interaction meetings

0

Information Booklets

0

providers – public and private

Any other

0

Any Other Activities

0

Total Budget 1058500

5. Equipment Maintenance:

Item

No. actually

present in the state

Amoun

t actually spent in the last 4 quarters

Amount Proposed

for Maintenance during current financial yr.

Estimated Expenditure for the next financial year for

which plan is being submitted (Rs.)

Justification/ Remarks for

(d)

(a) (b) (c) (d) (e)

Computer (maintenance includes AMC, software and

hardware upgrades, Printer

Cartridges and Internet expenses)

17 477806 427000 467000

More computers and other office equipments at two DOTS-plus

sites

Binocular Microscopes (RNTCP)

480

326340

600000

700000

All BMs were not under AMC as they were under

warranty, now all BMs will have to be under AMC, hence the

eligible amount is estimated

STDC/ IRL Equipment

-

-

750000

For AMC of C&S

equipments (15% of cost of equipments)

Any Other (pl. specify)

TOTAL 1917000

No. planned to be trained in RNTCP during each

quarter of next FY (c)

Activity

No. in the state

No. already trained in RNTCP

Q1 Q2 Q3 Q4

Expenditure (in Rs)

planned for current financial year

Estimated Expenditure for the next financial year

(Rs.)

Justification/ remarks

(a)

(b)

-

-

(d)

(e)

(f)

Training of MO- TCs

67

53

20

30000

45000

Excluding TA/DA

Training of STLS

67+8

53

14

18000

30000

,,

Training of SA

15

7

12

8000

15000

,,

Training of STS + TBHV

67+28

8(TBHVs)

2

15000

20000

,,

Training of Pharmacist

15

15

10

4000

20000

,,

TB/HIV

Training of

67

67

20 17000

30000

,,

MOTCs

TB/HIV

Training of STLS

67

0

37

30

16000

30000

,,

TB/HIV

Training of STS

67 67 10 20000 5000 ,,

67 67

7000

31000

67+8

75

14000

75000

,,

a). MO-TCs

b) STLS(EQA)

c) STS

72

72

42000

,,

d) SA

15

- - 15

12000

,,

e)

TBHV

20

20

6000

,,

f)Pharmacist

15 15 5000 ,,

g) DTO (EQA)

14

14

10000

Any

Other Training

Activity

DRS Training

DTOs

14

-

14

- - 15000

MO TC & DMC MO

119

-

119

75000

LT- DMC

86

86

50000

STLS

34

34

25000

STS

33

33

22000

TOT

AL

563000

Training by district

s

4385160

Training amount is excess of eligible, because a number of re-trainings and

replacement trainings has to be undertaken; training of Medical College

faculty, Private sector, community volunteer etc need to be done. Update

training at various levels needs to be completed.

8. Vehicle Maintenance:

Type of Vehicle

Number permissible as per the norms in the state

Number actually present

Amount spent on POL and

Maintenance in the

previous 4 quarters

Expenditure (in Rs)

planned for current financial year

Estimated Expenditure for the next financial year for

which plan is being submitted (Rs.)

Justification/ remarks

(a)

(b)

(c)

(d)

(e)

(f)

Four

Wheelers

16

14

1355696

1820000

2100000

Two

Wheelers

67

65

898086

1424000

1745000

6 more TUs planned

- hike in POL TOTAL 3845000

9. Vehicle Hiring*:

Hirin

g of

Four

Wheeler

Number

perm

issible

as per th

e

norms in

the

Number

actually

requirin

g

hired

Amount

spent in the

prev. 4 q

trs

Expenditure

(in Rs)

planned for

curren

t

financial

Estim

ated

Expenditure

for th

e next

financial

year fo

r

Justificatio

n

/ rem

arks

(a) (b) (c) (d) (e) (f)

For STC/

STDC

21519

50000

50000

For DTO

126690

59500

143000

For MO-TC

547143

1183364

4291200

To Strengthen MOTC

supervision

TOTAL

4484200

* Vehicle Hiring permissible only where RNTCP vehicles have not been provided

ACTIVITY

No. of cu

rrently

involved in RNTCP

Additio

nal en

rolment

planned for th

is year

Amount sp

ent in the

previous 4 q

uarters

Expenditure (in

Rs)

planned for cu

rrent

financial y

ear

Estim

ated Expenditure

for th

e next fin

ancial

year fo

r which plan is

being submitted

Justificatio

n/ rem

arks

(a) (b) (c) (d) (e) (f)

ACSM Scheme: TB advocacy, communication, and social mobilization

- 23 - - 3050000

SC Scheme: Sputum Collection Centre/s

43 2497350

Transport Scheme:

Sputum Pick-Up and Transport Service

32 1420900

DMC Scheme: Designated Microscopy

Cum Treatment Centre (A & B)

24 2800000

LT Scheme: Strengthening RNTCP diagnostic services

13 1268750

Culture and DST Scheme: Providing Quality Assured

Culture and Drug

Susceptibility Testing Services

Adherence scheme: Promoting treatment adherence

19 1595000

Slum Scheme: Improving TB control in

Urban Slums

4 200000

Tuberculosis Unit Model

TB-HIV Scheme:

Delivering TB-HIV

interventions to high HIV Risk groups (HRGs)

4 665000

TOTAL 13519875

10. Miscellaneous:

Activity* e.g. TA/DA, Stationary, etc

Amount

permissible as per the norms in the state

Amount

spent in the previous 4 quarters

Expenditure (in Rs)

planned for

current financial year

Estimated Expenditure for the next

financial year (Rs.)

Justification/ remarks

(a) (b) (c) (d) (e)

5800000

4260954

4818080

5851000

TA/DA Telephone bills Electricity bills Minor Equipment accessories Potable water Other Facilities for DOT provision Other stationeries etc

TOTAL 5851000 * Please mention the main activities proposed to be met out through this head

11.Contractual Services Category of Staff

No. permissible as per the norms in the state

No. actually present in the state

No. planned to be additionally hired during this year

Amount spent in the previous 4 quarters

Expenditure (in Rs)

planned for

current fin. year

Estimated

Expenditure for the next financial year (Rs.)

Justification/

remarks

(a)

(b)

(c)

(d)

(e)

TB/HIV Coord.

1 0 1 0 216000 300000 Higher salary at par with NRHM contractual

Medical officers

Urban TB Coord.

1 1 0 216000

216000 240000 ,,

MO-STCS 1 0 1 0 216000 240000 ,,

State Accountant

1 1 0 180000

180000 189000

State IEC Officer

1 1 0 180000

180000 189000

Pharmacist 1 1 0 50000 60000 102000

Secretarial Asst

1 1 0 92400 92400 96200

MO-DTC 4 2 2 292240

451200 1020000

STS 74 67 7 5567775

4978280 6704280

STLS 74 67 7 5582730

5241780 6724780

TBHV 48 32 16 2059014

2610875 4058800

DEO 16 16 18 1136169

1214930 1430036

Accountant – 12 14 0 33437 340800 350200

part time 9

Contractual LT

76 63 13 3899835

4428495 6277924 All contractual LTs were not posted for 12 months, hence less

expenditure

Driver 1 1 0 54000 54000 54000

Any other contractual

post approved under RNTCP

IRL Microbiologist

1

1

0

360000

360000

378000

TOTAL 28054220

12. Printing:

Activity Amount permissible as per the norms in the state

Amount

spent in the previous 4 quarters

Expenditure (in Rs)

planned for

current financial year

Estimated Expenditure for the next financial year for which plan is being submitted (Rs.)

Justification/

remarks

(a) (b) (c) (d) (e)

Printing-State level:*

665635 2000000 2000000

Printing- Distt. Level:*

5100000

796079 2660000 2963100

* Please specify items to be printed in this column 13. Research and Studies (excluding OR in Medical Colleges): Any Operational Research projects planned (Yes/No) ___________No___________________________ (If yes, enclose annexure providing details of the Topic of the Study, Investigators and Other details) Whether submitted for approval/ already approved? (Yes/No) _______________________________ Estimated Total Budget ____________________________________________ 14. Medical Colleges

Activity Amount permissible as per norms

Estimated Expenditure for

the next financial year(Rs.)

Justification/ remarks

(a) (b) (c)

Contractual Staff: � MO-Medical College

(Total approved in state __6_ )

� STLS in Medical Colleges (Total no in state _2__ )

� LT for Medical College (Total no in state _24 )

� TBHV for Medical College (Total no in state_15__)

1152000 180000 1170000 1215000

1321000 189000 1872000 1215000

5% increment ,, ,,

Research and Studies: � Thesis of PG

Students � Operations

Research*

100000

100000 1600000

Approved 4 ORs by zonal OR committee

Travel Expenses for attending STF/ZTF/NTF

meetings

175000

IEC: Meetings and CME planned

75000 90000 2 more medical colleges

started in pvt sector

Equipment Maintenance at Nodal Centres

* Expenditure on OR can only be incurred after due approvals of STF/ STCS/ZTF/CTD (as applicable)

15. Procurement of Vehicles:

Equipment No. actually present in the state

No. planned for

procurement this year (only if

permissible as per norms)

Estimated Expenditure for

the next financial year for which plan is being submitted

(Rs.)

Justification/ remarks

(a) (b) (c) (d)

4-wheeler **

2-wheeler 62 70 3500000 Except 4 all other two wheelers are more than 8 yrs old.

** Only if authorized in writing by the Central TB Division 16. Procurement of Equipment:

Equipment No. actually present in the state

No. planned for this year

(only as per

norms)

Estimated Expenditure for the next financial year for which plan

is being submitted (Rs.)

Justification/ remarks

(a) (b) (c) (d)

Office Equipment (Computer, modem, scanner,

printer, UPS etc.)

15

3 150000 62100 (others)

One computer need

replacement and two new computers for DOTS-plus site

Total 212100

Section D: Summary of proposed budget for the state–

Category of Expenditure Budget estimate for the coming FY 2009 - 2010 (To be based on the planned activities and expenditure in Section C)

1. Civil works 1260400

2. Laboratory materials 6647750

3. Honorarium 2083350

4. IEC/ Publicity 4837850

5. Equipment maintenance

1917000

6. Training 4948160

7. Vehicle maintenance 3845000

8. Vehicle hiring 4484200

9. NGO/PP support 13519875

10. Miscellaneous 5851000

11. Contractual services 28054220

12. Printing 4963100

13. Research and studies 0

14. Medical Colleges 6562000

15. Procurement –vehicles

3500000

16. Procurement – equipment

212100

TOTAL 9,26,86,005.00

** Only if authorized in writing by the Central TB Division