NATIONAL RURAL HEALTH MISSION (NRHM) on 30 TH OCTOBER 2008 PRESENTATION ON

NATIONAL RURAL HEALTH MISSION (NRHM)

on30TH OCTOBER 2008

PRESENTATION ON

NATIONAL RURAL HEALTH MISSION

• NRHM launched by Hon’ble Prime Minister on 12/4/2005.

• Aimed to ensure affordable, quality health care to the poorest

house holds in remotest areas.

• Special focus on 18 low performing States which have weak

public health indicators and weak infrastructure.

• Punjab is among the nine high performing States- Punjab,

Haryana, Gujarat, Maharashtra, Karnataka, Kerala, Tamil

Nadu, Andhra Pradesh, West Bengal.

04/18/23 2

• Universalized access to quality health care especially to rural poor

with focus on women and children.

• Reduced infant mortality rate and Maternal Mortality Rate.

• Ensuring population stabilization & gender equity.

• Prevention and control of communicable and non-communicable

diseases.

• Access to integrated comprehensive primary health care.

• Mainstream AYUSH- Integration of AYUSH with mainstream health

institutions .

• Promotion of Healthy life style.

• Emphasis on potable drinking water, hygiene, sanitation and

nutrition.

NRHM OBJECTIVES

304/18/23

Community Partnership

Village level planning

ASHA

Village Health & Nutrition Days

Village Health & Sanitation Committees

Increased involvement of PRIs

System strengthening

Infrastructure development

Monitoring through computerisation

Improved financial management & Human Resource

Public Private Partnership

Telemedicine

Mobile units for un reached

Intra & inter sectoral convergence

24-Hour- delivery services

Emergency Obstetric Services

Specialist Services – On call/contract

Immunization strengthening

IMNCI

Adolescent health

Family welfare services

KEY COMPONENTS OF NRHMImproved services

Accessibility, Approachability and Quality

NRHM STRATEGIES

• Decentralization of the process of health planning and management from Village to District level.

• Involvement of PRIs and Village Health & Sanitation Committees.

• Up-gradation of existing health institutions from Sub Centres to District Hospitals as per Indian Public Health Standards (IPHS).

• Flexible financing- untied funds for filling up the gaps in infrastructure and other related activities.

• Manpower requirement- recruitment of doctors, and paramedical staff in relation to Woman & Child Health.

• Improved management through capacity building- provision of computers, computer operators, establishment of State, District and Block Programme Management Units (PMUs).

• Integration of AYUSH with the mainstream health institutions including recruitment of Ayurvedic/Homeopathy doctors at PHC and CHC level.

• Intersectoral Convergence with Nutrition, water and sanitation programmes.

• Promotion of Public Private Partnership for achieving public health goals.

BLOCKLEVEL

HOSPITAL

30-40 Villages

Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics

AmbulanceTelephone

Obstetric/Surgical MedicalEmergencies 24 X 7

Round the Clock Services;

BLOCK LEVEL HEALTH OFFICE –--------------- Accountant

CLUSTER OF GPs – PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization

Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;

Round the Clock Services; Drugs; TB / Malaria etc. tests

GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

VILLAGE LEVEL – ASHA, AWW, VH & SC

ASHAs, AWWs in every village; Village Health & Nutrition DayDrug Kit, Referral chains

100,000 Population

100 Villages

5-6 Villages

Accredit private providers for public health goals

Health Manager

Store Keeper

NRHM – ILLUSTRATIVE STRUCTURE

NRHM FIVE COMPONENTS

(PART- A)

RCH AND RELATED ACTIVITIES

(RCH FLEXI POOL)

(PART- A)

RCH AND RELATED ACTIVITIES

(RCH FLEXI POOL)

(PART- B)

INITIATIVES UNDER NRHM OTHER THAN RCH

(MISSION FLEXI POOL)

(PART- B)

INITIATIVES UNDER NRHM OTHER THAN RCH

(MISSION FLEXI POOL)

(PART- C)

IMMUNIZATION STRENGTHENING

PROGRAMME

(PART- C)

IMMUNIZATION STRENGTHENING

PROGRAMME

(PART- D)

NATIONAL DISEASE CONTROL PROGRAMMES

(PART- D)

NATIONAL DISEASE CONTROL PROGRAMMES

(PART- E)

INTER SECTORAL CONVERGENCE

SCHEMES

(PART- E)

INTER SECTORAL CONVERGENCE

SCHEMES

INSTITUTIONAL ARRANGEMETS UNDER NRHM

STATE LEVEL

• State Health Mission chaired by Hon’ble Chief Minister.

• State Health Society chaired by Chief Secretary.

• Merger of all vertical societies into State Health Society.

• Signing of MoU with GoI.

DISTRICT LEVEL

• District Health Mission chaired by Chairman Zila Parishad.

• District Health Society chaired by Deputy Commissioner.

• Rogi Kalyan Samities in District/Sub Divisional Hospitals.

• Merger of all vertical societies into District Health Society.

..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM

BLOCK LEVEL

• Block Health Committees at Block PHC.

• PHC Management Committee at PHC level.

• Rogi Kalyan Samities.

VILLAGE LEVEL

• Village Health & Sanitation Committees in each village.

• Accredited Social Health Activist (ASHA) for every 1000

population.

India Punjab Best State

Birth Rate(SRS 2006)

23.5 17.813.414.9

Manipur Kerala

Death Rate(SRS 2006)

7.5 6.84.5 4.7

ManipurDelhi

Life Expectancy at birth 62.15 68.25 73.5 Kerala

Sex Ratio (Census 2001)

933 8761001 1058

PondicherryKerala

IMR(SRS 2006)

57 441115

ManipurKerala

TFR (SRS 2005) 2.9 2.1 1.7 Kerala

Maternal Mortality Ratio (SRS 2005) 301 178 110 Kerala

Ante Natal Care (at least 3 checkup) (%) (NFHS III)

50.7 72.5 96.5 T.Nadu

Institution Delivery (%) (NFHS III) 41 53 100 Kerala

Contraceptive Use (%) (NFHS III)

56 63.3 73 HP

Vaccine coverage (%) (NFHS III)

44 60 81 T.Nadu

HEALTH INDICATORS

IndicatorsAt the start of RCH

SRS 1998-1999

Present Status

2007-2008

Target by 2009-2010

Total Fertility Rate 2.5 2.1 1.8

Infant Mortality Rate(per 1000 live births)

49 44 <30

Maternal Mortality Ratio(per 100000 live births)

199 178 <100

Institutional Deliveries37.5%

(NFHS II)52.5 80%

ANC Check-up with 03 contacts

58.4%

(NFHS II)72.5 100%

TARGETS FOR PUNJAB

HEALTH INSTITUTIONS

INSTITUTIONSPUBLIC SECTOR

PRIVATE SECTOR

MEDICAL COLLEGES 3 5

DISTRICT HOPITALS 20

983SUB DIVSIONAL HOSPITALS 42

COMMUNITY HEALTH CENTRES 128

PRIMARY LEVEL HEALTH INSTITUTIONS(PRIMARY HEALTH CENTRES/ CLINICS/ POLY-CLINICS/ DISPENSARIES)

1823 3046

SUB CENTRES AT VILLAGE LEVEL 2858 --

TOTAL = 4858 4034

NRHM

OVER THE YEARS

A sum of Rs. 336.25 crore has been received from GoI from 2005-06 to 2007-08 against which a sum of Rs. 309.29 crore has been spent. The plan for the current year 2008-09 is for Rs. 210.70 crore (Rs. 180.00 crore GoI + Rs. 30 crore GoP).

Up-gradation of Institutions• District Hospitals – 5 District Hospitals are being upgraded at a cost of Rs 13.00 crore

by adding 230 beds in the current year. The Hospitals are – Gurdaspur (100-150 beds), Ludhiana (100-130 beds), Mohali (70-130 beds), Patiala (MKS) (154-250 beds) & Bathinda.

• Construction of Mother and Child Hospital at Fatehgarh Sahib which was lying suspended for 2 years would be resumed at a cost of Rs. 7 crores.

• Sub Divisional Hospitals – 4 Sub Divisional Hospitals are being upgraded at a cost of Rs.6.50 crores in the current year. The Hospitals are Batala (50-80 beds), Pathankot (100-130 beds), Nabha ( 100-130 beds) & Patti (50-80 beds) at a cost of Rs. 2.50 crore.

• PHCs at Adampur & Rural Hospial Morinda are being upgraded at a cost of Rs. 1 crore.

• CHCs – Community Health Centre at Dhakoli (Zirakpur) will be constructed at a cost of Rs. 2.50 crore.

• 75 PHCs for 24 hour delivery upgraded during 2007-08 and 26 being upgraded 2008-09.

• 50 CHCs for Emergency Obstetric care upgraded during 2007-08 and 10 being upgraded 2008-09.

• A sum of Rs. 10.00 crore has been earmarked from ACA of 2008-09 for setting up of Urban Healthcare Centres in Municipal Corporation town, Bathinda.

Equipment and Furniture

• Equipment and Furniture worth Rs. 6.5 crore to be provided to CHCs as per IPHS Norms

Drugs

• Drugs and consumable Rs. 3.60 crore provide to CHCs, Rs. 4.84 crore provided to PHCs and Rs. 6.00 crore provided to SHCs. - Total Rs. 14.44 crore

Rogi Kalyan Samities

• In the year 07/08 Corpus Grant of Rs. 5 lac for 20 district hospitals, 1 lac each for 42 Sub Divisional Hospitals and Rs. 1 lac each for 100 CHCs was provided.

Untied Fund & Maintenance Grant• Rs. 10,000 as Untied Funds to 12300VHSCs–Rs. 12.30 crore

has been provided each year.• Rs. 10,000 as Untied Funds to 2858 Sub Centre–Rs. 2.85 crore

has been provided each year.• Rs. 25,000 as Untied Funds for 484 PHCs – Total Rs. 1.21 crore

has been provided each year. • Rs. 50,000 as Untied Funds to 128 CHCs - Total Rs. 64.00 Lac

has been provided in 2008-09.• Rs. 50,000 as Annual Maintenance Grant to 484 PHCs – Total

Rs. 2.42 Crore in 2007-08 and to 100 PHCs – Total Rs. 50.00 Lac in 2008-09.

• Rs. 1.00 Lac as Annual Maintenance Grant to 112 CHCs – Total Rs. 1.12 crore

School Health Programme• Under School Health Campaign health checkup of 32,64,826

students of Primary and Secondary level will be done and minor ailments will be treated and referral will be provided wherever necessary. Report from PGI regarding treatments of Congenital Health Disease and Rheumatic Heart Disease among children has been received and proposal is being finalized. A total outlay of Rs. 5.00 crore has been provided for the programme.

Emergency Response Services• 224 Ambulance (56 advance life saving and 168 with basis life

saving equipments) equipped with medical facilities and Medical Technicians are to be deployed in the State with Public-Private Partnership total initial cost will be Rs. 41.00 crore. Recurring cost will be Rs. 25.00 crore per annum.

Mobile Medical Unit• Mobile Medical Unit (Rs. 36.00 Lac each) equipped with one

Male Medical Officer, One Female Medical Officer, Lab Technician, Radiographer and Staff Nurse has been deployed to provide medical services in the rural and remote areas. Total outlay of Rs. 7.00 crore.

Village Health and Sanitation Committees• 11319 Village Health and Sanitation Committees constituted and

provided Rs. 10,000 each per year. ASHA• 13201 ASHA workers selected in the State. They are not paid

given any fixed salary but instead are given cash ncentives on the basis of their performance in child health, family planning and institutional deliveries.

SN Name of the PostSanctioned

PostFilled Vacant

Consolidated Salary PM

Remarks

1 Director Finance 1 1 0 On Deputation

2State Programme Manager

1 1 0 From State Govt.

3Maternal Health Specialist

1 0 1 40,000Services have been terminated

4 Family Welfare Specialist 1 1 0 40,000

5 Procurement Manager 1 0 1 25,000 Candidate resigned

6 Manager (HRD) 1 1 0 20,000

7 Manager (F&A) 1 1 0 25,000

8 Manager (M&E) 1 1 0 20,000

9 State NGO Coordinator 1 1 0 30,000

10Programme Coordinator (ARSH & Gender)

1 1 0 20,000

RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT


PostFilled Vacant


Remarks

11Programme Coordinator (BCC)

1 1 0 20,000

12 Consultant (Admn) 1 0 1 20,000

13 Consultant (M&E) 1 1 0 20,000

14 System Analyst 1 1 0 15,000

15 Accounts Officer 2 2 0 15,000

16 Statistical Assistant 4 4 0 10,000

17 Hardware Supervisor 1 1 0 10,000

18Accountant/ Accounts Clerk

1 0 1 10,000 Not to recruit

19 Accountant-cum-Cashier 2 2 0 10,000

…contd…


PostFilled Vacant


Remarks

20 Computer Assistant 4 4 0 8,000Selection has been done for the vacant position candidate is yet to join

21 Office Assistant 9 9 0 7,000Appointment orders to 4 OAs are being given

22 Graphic Designer 1 1 0 10,000Selection has been done for the vacant position

23 Procurement Assistant 2 2 0 8,000Candidates have been adjusted at State HQ from the districts

24 Drivers 2 0 2 5,000 Action is being initiated

25 Class-IV 3 2 1 3,000Action is being initiated

Total 45 38 7

…contd…


PostFilled Vacant


Remarks

1District Programme Manager

20 17 3 20,000 Selection has been Done.

2 District Accounts Officer 20 20 0 15,000 Selection has been Done.

3District Monitoring & Evaluation Officer

20 18 2 15,000 Selection has been Done.

4 Procurement Officer 20 4 16 15,000No further recruitment to be made

5 Maintenance Engineer 20 17 3 12,000 Selection has been Done.

6 Statistical Assistant 20 17 3 8,000 Selection has been Done.

7 Procurement Assistant 20 0 20 8,000

No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification

8 Accountant-cum-Cashier 20 13 7 8,000 Selection has been Done.

9 BCC Facilitator 20 11 9 8,000 Selection has been Done.

Total 180 117 6336 vacancies are not to be filled

RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS

RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS

SN Name of the PostSanctione

d PostFilled Vacant


Remarks

1Block Statistical Assistant 118 93 25* 8,000

*Recruitment in final stage at district level

2Block Accountant cum Cashier 118 102 16* 8,000

*Recruitment in final stage at district level

3. Computer Operator 173 97 76* 5,000*Recruitment in final stage at district level

Total 409 292 117

SN Name of the Post Sanctioned Post Filled VacantConsolidated

Salary PMRemarks

1 Obstetricians 60 29 31*

Rs. 20000/- + Rs. 3000/- HRA+ Rs. 1000/ EmOC + Rs. 500/- per delivery conducted + Rs. 200/ MTP

*Appointment letter to 11 Obst. Are being Issued on 30.10.2008

2 Paediatricians 60 21 39*

Rs. 20000/- + Rs. 200/- per Emergency Case during off duty hours + Rs. 3000/- HRA

*Appointment letter to 12 Paed are being issued on 30.10.2008

3 Anaesthesia 60 38 22Rs. 1500/- on call per case + TA Rs. 6/KM upto 50 KM

*Empanelment for 12 CHCs under process

4 Staff Nurses 300 251 59

Rs. 8500/- + Rs. 1500/- (if accommodation is not provided)

*Recruitment Final stage at district level

5 OT Assistant 50 10 40

Rs. 4000/- + 300/- evey Major OT Case + Rs. 1500/- HRA

Not required to recruit

RECRUITMENT - EmOCs


PostFilled Vacant


Remarks

1 Female Medical Officer 75 24 51*

Rs. 15000 PM + Rs. 500 per Delivery+ Rs. 200/ MTP + Rs. 3000/- HRA

*Appointment letter to 13 FMOs are being issued on 30.10.2008

2 Staff Nurses 225 168 57*

Rs. 5000/- + Rs. 500/- per delivery conducted + Rs. 100/- per delivery assisted and Rs. 1500/- HRA (if accommodation is not provided)

*Recruitment under process at district level

3.Medical Officer Mini PHCs

95 0 95 Rs. 16,000/- PMAppointment letter to 61 MOs are being issued on 30.10.2008

RECRUITMENT - PHCs 24x7 & Mini PHCs


d PostFilled Vacant


Remarks

1 Medical Officer (Male) 20 20 0 22,000 Appointed in August 2008

2Medical Officer (Female)

20 20 4 22,000 Selection at final stage

3 Nurses 20 18 2* 8,000*Recruitment under process at district level

4 Radiographer 20 20 0 8,000 *

5 Lab Technician 20 20 0 8,000*Recruitment under process at district level from July 2008 and reports being received

6 Driver 20 20 0 7,000 *Placement agency hired

7 Helper 20 20 0 4,000 *Placement agency hired

RECRUITMENT - Mobile Medical Unit (MMU)


d PostFilled Vacant


Remarks

1MPHW (Female) for urban slums

230 114 *116 6,000

*Recruitment under process at district level from July 2008 and reports being received

2ANM for vacant sub-centres (2211)

514 0 514 6,000Advertisement given on 23.08.2008 recruitment in final stage

32nd ANM for 954 sub-centres

954 0 954 6,000

Advertisement given on 23.08.2008 recruitment in final stage

RECRUITMENT - ANM for Urban Slum Area & Sub-Centres

• 24-hour delivery services including normal and assisted deliveries

• Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other medical interventions

• New-born Care(*)

• Emergency Care of sick children

• Full range of family planning services including Laproscopic Services

• Safe Abortion Services

• Treatment of STI / RTI

• Blood Storage Facility (*)

• Essential Laboratory Services

• Referral (transport) Services

• Janani Suraksha Yojna

• (*): Critical determinants of functionality

Essential Services to be provided at EmOCs (FRUs)

Essential service package to be provided at 24x7 PHC

• 24-hour delivery services, both normal and assisted (*)• Essential newborn care (*)• Referral for emergencies (*)• Ante-natal care and routine immunisation services for children

and pregnant women (besides fixed day services).• Post-natal care• Early and safe abortion services (including MVA)• Family planning services• Prevention and management of RTIs/STIs• Essential laboratory services• Janani Suraksha Yojna(*): Critical determinants of functionality

Services at Mini PHCs

• Routine OPD• Management of National Health Programmes

– RCH Service

– Immunization Programmed

– National TB Control Programme

– National Leprosy Eradication Programme

– National Vector Borne Disease Control Programme

– Integrated Disease Surveillance Programme

– School Health Programme

• Supervision of services at Sub-Centre Level

THANK YOU

Documents

NATIONAL RURAL HEALTH MISSION (NRHM) on 30 TH OCTOBER 2008 PRESENTATION ON