Presentation on NRHM, Assam

National Rural Health Mission, AssamDepartment of Health & Family Welfare

Govt. of Assam

Dated 20th November, 2012

District Monitoring Programme

NRHM, A paradigm shift Promoting equity and excellence for ‘ Health for All’

The Mission:

Providing affordable, accessible, equitable quality healthcare especially for those residing in rural areas, the poor, women and children

Focus Areas and priorities:

1. Improving the health status of pregnant women and children especially in rural areas

2. Stabilizing population by promoting family planning

3. Restructuring public health governance through community and PRI involvement, addressing resource shortages in terms of providing additional required manpower and increase public spending in healthcare

NRHM, A paradigm shift Promoting equity and excellence for ‘ Health for All’; cont.

Objective of the Mission: Reduction in Infant Mortality Rate (IMR) and Maternal

Mortality Ratio (MMR)

Universal access to public health services.

Prevention and control of communicable and non-communicable diseases, including locally endemic diseases

Access to integrated comprehensive primary healthcare

Population stabilization, gender and demographic balance.

Revitalize local health traditions and mainstream AYUSH

Promotion of healthy life styles

2001-03 2004-06 2007-08 2007-09(AHS 2010-11)

0

100

200

300

400

500

600

490 480

390 381

Trend of MMR in Assam

Year

MM

R pe

r 1,0

0,00

0 Li

ve B

irth

Trend of Maternal Mortality Ratio (MMR) in AssamTotal 99 point drop of MMR

during NRHM period which is the highest drop in the country

during NRHM period

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10

20

30

40

50

60

70

80 76 76 76 75 7470

67 66 68 67 66 6461

5855

71 72 70 68 66

60 58 58 57 55 5350

4744

TREND OF INFANT MORTALITY RATE (IMR)

AssamIndia

Year

IMR

per 1

,000

Liv

e Bi

rth

Total 2 point drop 1997 to

2001 Total 7 point drop 2001 to 2006 Total 12 point

drop 2006 to 2011

Monitoring Checklist

Improve coverage, accessibility and quality of antenatal care (ANC)

Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Coverage of ANC Registration

% of ANC Registration against Expected number of pregnant women for the year 2012-13

District100% of expected pregnant women during the period

All Health Block100% of expected pregnant women during the period

Early Registration of pregnancy

% Pregnant Women Registered for ANC within 1st Trimester against Total ANC Registration in 2012-13

District100% of total pregnant women registered for ANC during 2012-13

All Health Block100% of total pregnant women registered for ANC during 2012-13

Improve coverage, accessibility and quality of antenatal care (ANC)

Monitoring Required Monitor able Indicators Level of

Monitoring Expected Level of Achievement

Coverage of 3 or more ANC

% of 3 ANC against Total ANC Registration

District100% of total pregnant women registered for ANC during 2012-13

All Health Block100% of total pregnant women registered for ANC during 2012-13

Coverage of TT% of pregnant women received TT2 or Booster against Total ANC Registration

District100% of total pregnant women registered for ANC during 2012-13

All Health Block100% of total pregnant women registered for ANC during 2012-13

Updation of MCP Card, MCH Register during service delivery

During visit of Health Facility

All Registers and MCP card to be updated at the time of Service Delivery

Mamoni – Cash assistance to pregnant women @Rs 1000/- in two installments during 2nd and 3rd ANC. To provide nutritional support

to pregnant women (under Assam Bikash Yojana)

Monitoring Required

Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Spot payment at Sub Centre during 2nd & 3rd ANC

% of Pregnant Women received “Mamoni” cheque on Spot during 2nd & 3rd ANC during 2012-13

District100% of total pregnant women registered for ANC during 2012-13

All Health Block100% of total pregnant women registered for ANC during 2012-13

During visit of Health Facility

100% of total pregnant women registered for ANC during 2012-13

Record Maintenance

Whether Records of beneficiaries are maintained properly or not

During visit of Health Facility

Beneficiary payment records to be maintained properly

Village Health & Nutrition Day (VHND). One VHND organized in each village every month. To

provide Antenatal care, post natal care, routine immunization and counseling services to pregnant women,

infant, children and adolescentMonitoring Required Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Status of VHND organized

% of VHND organized against Target

District100% of VHND targeted during 2012-13

All Health Block100% of VHND targeted during 2012-13

Involvement of ASHA, AWW, PRI members in VHND

  During visit of Health Facility

ASHA, AWW & ANM should present in VHND, presence of PRI member is desirable

Operationalization of 24X7 PHC with New Born Care Corner (NBCC). To conduct round the clock normal delivery

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

Functional status of Labour Room and Newborn Care Corner (NBCC)

Delivery trend compared to last year

District 1.1 X last years figure for same period

Health facility 1.1 X last years figure for same period

Whether Doctor and GNM stay at the Hospital Campus

% of Docotor & Nurses stay in the Hospital Campus

During visit of Health Facility

100% of all Doctors & Nurses in position

Whether Night Delivery conducted or not

No of Night Delivery conducted

During visit of Health Facility More than 0

functional Status of NBCC

No of Newborn treated in NBCC

During visit of Health Facility More than 0

Operationalization of FRU (First Referral Unit) - To facilitate round the clock C-section, assisted and normal delivery

with Blood Storage/ Blood Bank facility

Monitoring Required Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Facility to conduct Round the clock C-section delivery

C-Section delivery trend compared to last year

District 1.1 X last years figure for same period

During visit of Health Facility

1.1 X last years figure for same period

Whether both Gynecologist & Anesthetist in position

During visit of Health Facility

At least one Gynecologist and one Anesthetist should be in position

Functional Status of OT and Blood Storage/ Blood Bank

Functional Status of OT and Blood Storage/ Blood Bank

During visit of Health Facility

At least one Surgery per week

Average No of Blood transfusion done per month

During visit of Health Facility

Functional Blood Bank/ Blood Storage Unit - Availability of Blood Unit & transaction

Delivery at Sub Centre by Rural Health Practitioner (RHP). To facilitate normal delivery in the village level (Sub Centre)

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

Functional status of the Sub Centre

Average No of Delivery conducted per month by the RHP at the Sub Centre

During visit of Health Facility

On an average Minimum 3 Delivery per month

Whether RHP resided in the Sub Centre village

Whether RHP resided in the Sub Centre village

During visit of Health Facility

To reside in the Sub Centre village

Janani Surkasha Yojana (JSY). Cash assistance to Mother (@Rs 1,400/- for women from Rural area and Rs. 1,000/- from

Urban area) & ASHA Incentive to promote Institutional Delivery

Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Status of JSY payment during discharge

% of Mother received JSY payment against total Delivery (excluding paying cabin and Pvt. Hospital Delivery)

District 100% of all elegible beneficairies

Health facility 100% of all elegible beneficairies

Status of JSY Incentive paid to ASHA

% of ASHA incentive under JSY paid

District20% to 40% against total amount paid to Mother under JSY

Health facility20% to 40% against total amount paid to Mother under JSY

Mamata Kit – Baby kit provided if Mother stay for 48 hrs after delivery To ensure 48 hrs stay of Mother & baby after

delivery to ensure post natal care (PNC)

Monitoring Required Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of providing Mamata kit

% of Mothers stay at Hospital at least for 48hrs after delivery

District 100% of all deliveries

Health facility

100% of all deliveries

% of Mothers received “Mamata kit” against Mothers stay for 48 hrs after delivery

District 100% of all deliveries

Health facility

100% of all deliveries

Supplementary Nutrition (Mother Horlicks). To provide supplementary Nutrition to Mother after Delivery

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

Status of providing Mother Horlicks

% of Mothers received “Mother Horlicks” after delivery

District 100% of all deliveries

Health facility

100% of all deliveries

Implementation of Janani and Sishu Suraksha Karyakram (JSSK).

Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of Achievement

Status of Free transportation from Home to Hospital, Hospital to Hospital and Hospital to Home (Adarani)

% of Pregnant Women/ Mothers received free transportation from Home to Hospital

District100% of pregnant women reported at Hospital

During visit of Health Facility

100% of pregnant women reported at Hospital

% of Pregnant Women/ Mothers received free transportation from Hospital to Hospital

District 100% of Referred cases

During visit of Health Facility

100% of Referred cases

% of Pregnant Women/ Mothers received free transportation from Hospital to Home (Adarani)

District 100% of Hospital Deliveries

During visit of Health Facility

100% of Hospital Deliveries

Status of free treatment to Pregnant Women and Children

% of Pregnant women, Mother and Children received free treatment

District100% of pregnant womenand children reported at Hospital

During visit of Health Facility

100% of pregnant womenand children reported at Hospital

Implementation of Janani and Sishu Suraksha Karyakram (JSSK).

Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of Achievement

Status of availability of Drugs & Consumable for Normal Delivery and C-Section delivery

Availability of Drugs & Consumable for Normal Delivery and C-Section delivery

DistrictList of items available in CS Kit and Delivery kit enclosed

During visit of Health Facility

List of items available in CS Kit and Delivery kit enclosed

Reimbursement claim by Hospital under JSSK

Total amount of Reimbursement made to Hospital under JSSK

DistrictTotal expenditure incurred and claimed

During visit of Health Facility

Total expenditure incurred and claimed

Status of free diagnostics facility including Laboratory test, USG, etc

% of Pregnant Women/ Mother received free diagnostics facility

District100% of pregnant women reported at Hospital

During visit of Health Facility

100% of pregnant women reported at Hospital

Implementation of Janani and Sishu Suraksha Karyakram (JSSK).

Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Status of free test for Blood Transfusion

% of Pregnant Women/ Mother received free Blood Transfusion Facility against Total Pregnant Women/ Mother provided Blood Transfusion

District100% of pregnant women reporting blood transmission

During visit of Health Facility

100% of pregnant women reporting blood transmission

Status of availability of IEC material on JSSK

Hoarding on JSSK During visit of Health Facility

Should be installed at prominently visible location

Operationalisation of Newborn Stabilization Unit (NBSU)

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

To provide services to sick and low birth weight children

Functional status of NBSU

During visit of Health Facility

Should be made functional if construction completed i.e., admission made

Operationalization of Special Care Newborn Unit (SCNU)

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

To provide special care to sick and low birth weight children to reduce Infant Mortality

Functional status of SCNU

District Hospital

Should be made functional if construction completed - No of admission and Survival rate > 90%

Routine Immunization Programme

Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

To provide vaccine to children under National Routine Immunization Schedule to protect the children from different diseases

% of Fully Immunized Children

District 100% of childen

All Health Block 100% of childen

Health facility 100% of childen

BCG to Measles Drop Out Rate

District 0%

All Health Block 0%

Health facility 0%

Mother & Child Tracking System (MCTS)

Monitoring Required

Monitor able Indicators Level of Monitoring Expected Level of

Achievement

Status of implementation of MCTS

% of Pregnant Women Registered in MCTS against expected no of pregnant women registered ANC during the period

District 100% of all Pregnant Women Registered

All Health Block 100% of all Pregnant Women Registered

Status of implementation of MCTS

% of Children Registered in MCTS against expected no ofLive Birth during the period

District 100% of all Child Born

All Health Block 100% of all Child Born

Sterilization. Permanent method of limiting for population stabilization in order to reduce Total Fertility Rate (TFR)

Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

Status of Male Sterilization

% of Male Sterilization conducted against Expected Level of Achievement

District 100%

Status of Female Sterilization

% of Female Sterilization conducted against Expected Level of Achievement

District 100%

Status of Sterilization Failure / Death case and insurance claim status

% of Compensation amount paid against Sterilization Failure / Death case and insurance claim

District 100%

Family Planning Method

Activity Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

IUCD Insertion. Temporary Method of spacing

Status of IUCD Insertion

% of IUCD insertion conducted against Expected Level of Achievement

District 100%

OCP/ CondomStatus of Oral Contraceptive Pill (OCP) distribution

No of Oral Contraceptive Pill (OCP) distributed

During visit of Health Facility

More than 0

Temporary method of spacing / ECP

Status of Condom distribution

No of Condom distributed

During visit of Health Facility

More than 0

Status of Emergency Contraceptive Pill (ECP) distribution

No of Emergency Contraceptive Pill (ECP) distributed

During visit of Health Facility

More than 0

Involvement of ASHA Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Training Status of ASHA

% of ASHA completed 6th & 7th Module of Training

District 100% of ASHAs in position

Timely payment of incentives to ASHA

% of ASHA Incentive paid for Full Immunization @Rs. 250/-

District 100% of Fully Immunized Infant

All Health Block 100% of Fully Immunized Infant

% of ASHA Incentive paid for Full ANC @Rs. 100/-

District 100% of ANC Registered

All Health Block 100% of ANC Registered

Adolescent Clinic. Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

AchievementFunctional status of Adolescent clinic

Functional status of Adolescent clinic

During visit of Health Facility

Records to be maintained properly

Untied, Maintenance and RKS fund to HospitalsFor smooth running of the hospitals, Untied, Maintenance

and RKS fund is provided to each health facility.

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

Utilization status of Untied, Maintenance & RKS Fund

Utilization status of Untied, Maintenance & RKS Fund During visit of

Health Facility

Should be properly and fully utilized and maintaining of documents

Type Untied Fund Maintenance Fund RKS Fund

DH - - Rs. 5,00,000SDCH Rs. 50,000 Rs. 1,00,000 Rs. 1,00,000CHC Rs. 50,000 Rs. 1,00,000 Rs. 1,00,000PHC Rs. 25,000 Rs. 50,000 Rs. 1,00,000SC Rs. 10,000 Rs. 10,000 -VHSNC Rs. 10,000 - -

Construction of New Health Facility. - To meet up the gap of Health Facility as per populations norms

Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

Status of construction of District Hospital

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of new Model Hospital (CHC)

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of New PHC

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of Riverine PHC

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Construction of New Health Facility. - To meet up the gap of Health Facility as per populations norms

Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

Status of Construction of Sub Centre

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of Labour Room

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of Ward

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of up gradation of CHC to IPHS standard

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of NBSU

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Construction of Doctors’ and Nurses’ quarter. To ensure residential facility of Doctor, Nurse and paramedical staff in

order to operationalize 24X7 facilityMonitoring Required Monitor able Indicators Level of

MonitoringExpected Level of Achievement

Status of construction of Rural Health Block Pooling Complex (RHBPC)

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of construction of Doctors’ and Nurses Quarter

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Status of Construction of Boundary Wall

% of Civil Works Completed District 100%

Status of Construction of ASHA Waiting Shed

% of Civil Works & Electrical Work Completed and being utilized

District 100%

Health Manpower position. To ensure services to the rural people

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of availability of critical manpower in the health facilities

Status of availability of critical manpower in the health facilities

District 100%

Mobile Medical Unit (MMU) - Hospital on wheel. To provide health care services to remote areas

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of utilization of District level and Sub Divisional MMU

Average no of camps organized by MMU every month

District 25 camps per month

Rational use of MMU so that needy people are served first

Average patients treated per camp by MMU

District Around 100 patient per camp

Status of Sub Divisional level MMU

After how many days, the same camp (locality) visited by the MMU Unit

District Every month

Boat Clinic - Hospital on boat.To provide health care services to riverine and char areas

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of utilization of Boat Clinic

Average no of camps organized by Boat Clinic per month

District 25 camps per month

Average patients treated per camp by Boat Clinic

District Around 80 patient per camp

After how many days, the same camp (locality) visited by the Boat Clinic Unit

District Every month

Sanjeevani – Village Health Outreach Programme. To provide health care service at the door step of the rural people

Monitoring Required Monitor able Indicators Level of Monitoring

Expected Level of Achievement

Status of implementation of Sanjeevani – Village Health Outreach Programme

Average no of camps organized by Sanjevani VAN

District 48 camps per month per van

Average patients treated by each Sanjeevani VAN

District

No of Diabetics, Hypertension, et cases detected

District Every month

Mritunjoy – 108 Emergency Management Services. To provide emergency services at the golden hour

Monitoring Required Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of utilization of Mritunjoy 108 service

Average no of patients transported per month

District Around 90 patients per month

Availability of 108 services

No of PW transported District

State average, 40% of the total transported patients are pregnant women

Status of transportation of Pregnant women and sick children

No of Sick Infant transported District

NCD Screening Programme. To screen adult population (more than 30 years of age) to detect

and timely referral for non communicable diseases like Hypertension, Diabetics etc

(Implemented in Barpeta, Dibrugarh, Jorhat, Kamrup Metro, Kamrup Rural, Lakhimpur, Morigaon, Nagaon, Nalbari, Sivasagar, Sonitpur & Tinsukia)

Monitoring Required Monitor able Indicators Level of

Monitoring Expected Level of Achievement

Status of implementation of NCD screening programme by MPW (Male) by house to house visit

% of MPW(M) trained for NCD Screening Programme District 100%

% of trained MPW(M) screening for Hypertension and Diabetics cases on regular basis

District 100%

No of persons screened District

No of persons detected as Hypertension case District

State average - Around 10% of screened persons deteceted as suspected hypertensive case

No of persons detected as Diabetics case. District

State average - Around 3.5% of screened persons deteceted as suspected Diabetics case

“Majoni” – Social assistance to all the girl child born in the family up to second order is given a fixed deposit of Rs. 5,000/- for 18 years – an initiative by Govt. of Assam. To

promote girl child

Monitoring Required Monitor able Indicators Level of

MonitoringExpected Level of

Achievement

Status of issue of Fix Deposit

% of Fix Deposit issued against no of application form received

District 100%

“Morom” - The Morom scheme provides financial support to indoor patients of Government Health Institutions

Indoor patients admitted to a Hospital will receive Rs. 75/- per day for Medical College, Rs. 50/- per day for District

Hospital and Rs. 30/- per day for SDCH/ CHC/ PHC.For supplementary nutrition and compensation for wage loss during hospitalisation and post hospital expenses

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Status of Morom payment

% of Indoor patient stayed at Midnight received "Morom" fund excluding Delivery cases

During visit of Health Facility

100%

Other Activities Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of

Achievement

For quality health services

Overall cleanliness and Hygiene Issue

During visit of Health Facility

Should be clean and hygenic

Functional Status of Laboratory

During visit of Health Facility Should be functional

Availability of Diet facility During visit of Health Facility Should be functional

Status of Indoor Ward During visit of Health Facility

Should be functional, clean and hygenic

Status of Patient Waiting Area with Drinking Water facility, Toilet, etc

During visit of Health Facility Should be available

Implementation of Bio Medical Waste Management System

During visit of Health Facility Should be available

Availability Free Medicine and proper record keeping of stock

During visit of Health Facility Should be available

Emergency service facility During visit of Health Facility Should be available

Availability Fire fighting measures

During visit of Health Facility Should be available

PPP with Tea Garden Hospital. To provide healthcare services to Tea Garden areas

Monitoring Required

Monitor able Indicators

Level of Monitoring

Expected Level of Achievement

Functional Status of PPP Tea Garden Hospital

Whether all services provided to pregnant women and children

During visit of Health Facility

Should be available

Availability of Doctor and other health personnel

During visit of Health Facility

Should be available

THANK YOU

NRHM, ASSAM