Tamil Nadu - National Rural Health Mission Program Implimentation ...

PRESENTATION TO NATIONALPROGRAM COORDINATIONCOMMITTEEOnState PIP of Tamilnadu for 2011-121 st April, 2011

Vision‘Healthy People – Now and in the Future.’

Goals‣ To provide accessible and affordable health carebased on people’s need‣ To deliver high quality of health services‣ To improve the long term health status of thepopulation‣ To improve the management of health services andmake them more accountable to the people.

Seven Strategic Directions‣ Create a patient friendly health care system‣ Strengthen primary health with focus on wellfunctioning referral systems and continuing care in thecommunity‣ Make prevention a public priority‣ Build partnerships for health‣ Ensure smooth, efficient and equitable fund flow andassess the cost effectiveness of health programmes‣ Build a sustainable health workforce‣ Implement innovations and accept change

FINANCIAL OVERVIEW

Position of Increase in Budget Allocationover 2009-2010Rupees in croreDetails 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11TotalHealthBudget1652.24 1951.55 2286.14 2741.08 3390.69 3888.90% ofincrease18 17 20 24 14

State Share as per ROP 10-11 (NRHM)State Share 115.87Rupees in CroreCredit from State fund 130.10Release by 31.3.2011 31.90Total State share*(* including short release of 2008-10)162.00

OUTLAY FOR 2011-12BUDGET HEADAll NRHM programmes excludingTreasury MechanismROP 2010-11(in Crores)Proposed asper GOIresourceenvelope (inCrores)532.65 515.88Infrastructure (Treasury Mechanism) 222.43 249.54GOI resource envelope 755.08 765.4215% State Shares 115.87 135.07Total resource envelope 870.95 900.49Less Treasury Mechanism 222.42 249.54Total 648.53 651.95Less Plus polio operating cost 9.36 9.36Proposed Budget 639.17 642.59

NRHM BUDGET ABSTRACT 2011-12Sl. No. Details Amount in Crores1 Part A - RCH Interventions 227.932 Part B - NRHM Additionalities 338.583 Part C - Strengthening of Immunization 3.764 Part D - Disease Control Programme 60.91GRAND TOTAL 631.20

New Scheme Proposed after Sub Group(subject to approval NPCC)Sl.No.1234DetailsStrengthening of Central Drug ControlLaboratoryPilot project on management of childrenafflicted with Muscular Dystrophy disorderSupport to NVBDCP for commodityassistanceManagement of the children withdevelopmental disorders (pilot project)Amount in Crores2.171.254.541.04Total 9.00

Strengthening of Central Drug ControlLaboratorySl.NoDescriptionsQuantityPrice( in Lakhs)1.Ultra High performance liquidchromatograph with aulosampler, PDAdetector, system controller, lab solutionsoftware etc.,4 Nos. 1432.Liquid chromatograph mass spectromet6erLCMS 2020 with UFLC as front end andnitrogen generator1 No. 75Total 217

Project on Screening and awareness buildingin families afflicted with Muscular DystrophySl.No1 Staff Cost for the Projecta. Diagnostics,b. Registry,c. Counseling Care services.2 ConsumablesActivitiesTotal(Rs inLakhs)a. Duchene Muscular Dystrophy Probands - 300/year 33.35a. Spinal Muscular Atrophy Probands-200/year 8a. Carrier screening 3.6530

Project on Screening and awareness building infamilies afflicted with Muscular DystrophySl.NoActivities3 Institutional Strengtheninga. Multidisciplinary care for the affected children 20Children/ month.Total(Rs inLakhs)a. Travel Expenses 10a. Maintenance 1a. IEC activities - Networking, Out reach services, Awareness 5programmesa. Stationeries and Communications 6a. Unforeseen Expenses 1.5a. Institutional Over Head Charges(12% of recurring 15expenses)Total 125.512

Screening and early intervention forchildren with developmental disorders(NIMHANS project)Sl.No1Components (Pilot project Dindigul)Strengthening of Infrastructure for Establishment ofearly intervention centers in the districts (Rs.5 Lks x4 centres)Total (INR)(Rs. In Lakhs)2 Training 7.703 Stationery and Consumables 2.004 Mobility Support 25.56205Staff Remuneration for Psychiatrist , Psychologist ,Social Worker and Special Educators45.28Total 100.54

Committed/ Uncommitted details underNRHM as on 31.3.2011Name of theProgrammeOpeningBalance as on1.4.2010ReceiptfromGOIReceiptfromStateShare15%TotalExpenditure2010-11ClosingBalance as on31.3.2011Committed for2011-12UncommittedRCH Flexible Pool 158.94 163.08 322.02 148.91 173.11 173.11 -NRHM Flexible Pool(includes,convergence,Innovation, NGO,innovation,recommendation fromother prog.)287.56 193.34 162.02 642.92 287.86 355.06 355.06 -Immunization ( from4.93 12.49 17.42 11.51 5.91 5.91 -the RCH Flexible Pool)NVBDCP 2.56 2.38 4.94 2.56 2.38 2.38 -

Committed/ Uncommitted details underNRHM as on 31.3.2011Name oftheProgrammeOpeningBalance ason 1.4.2010ReceiptReceiptfrom GOIfromStateShare15%TotalExpenditure2010-11ClosingBalance as on31.3.2011Committed for2011-12UncommittedRNTCP 3.66 8.00 11.66 9.71 1.95 1.95 -NPCB 16.88 21.89 38.77 24.20 14.57 14.57 -NLEP 0.75 1.15 1.89 1.65 0.24 0.24 -IDSP 0.73 1.28 2.00 1.03 0.97 0.97 -TOTAL 476.00 403.60 162.02 1041.62 487.43 554.19 554.19 -

REPRODUCTIVE ANDCHILD HEALTH

MMRTamil Nadu- MMR trendsSource DPH & PMYEARUptoJan. 2011

SERVICES OVERVIEWS.No.INDICATOREXPECTED /PLANNED2010-11REPORTED%ACHIEV.1Institutionaldelivery1080647898860(Upto Jan.2011)99.2%(Upto Jan.2011)2 Full Immunisation 10.97 Lks. 9.55 Lks. 95%3 Sterilisation 365000 298904 89.3%4 IUD insertion 390000 316126 88.4%

FacilityMATERNAL HEALTHCum.target(2012)Cum.Progresstill Mar‘11IncrementalTarget(10-11)Progress10-11tillMar’11Incr.Target(11-12)FRU – DH 30 30 - -FRU – SDH, etc. 130 130 - -FRU – CHC 256+40 248 117 4824x7 FACILITIES 1283 1283 50Sub-centres conductingdeliveries, with adequateinfrastructure, incl. LRSub-district facilitiesproviding safe abortionservicesSub-district facilitiesproviding RTI/ STI services- - - - 31665 665 - 481770 1770 -50 NewPHCs

JANANI SURAKSHA YOJANA (JSY)Target‘10-11Achv.‘10-11(till Dec)Proposed‘11-12Budget‘10-11(Rs. lakh)Exp. ‘10-11(till Dec)(Rs.lakh)Budget‘11-12(Rs.lakh)Home Deliv. 2500 168 1821Inst. Deliv.RuralInst. Deliv.Urban322300 215869 328148138000 57174 1260543529.83 1742.49 3215.58C-sections 2135

MATERNAL DEATH REVIEW‣ Audit of Maternal Death since – 2004 throughVerbal autopsy format.‣ No. of maternal deaths reported in 10-11 - 726‣ No. of maternal deaths analysed in 10-11 - 598

Maternal Death Analysis-2010-2011 (CauseWise)Endocrine disorders1%Anaemia5%Liver disorders3%Infectious diseases4%Other medicalconditions Abortions1% 1%Obstructed labour/rupture uterus2%Heart diseasescomplicatingpregnancy7%Sepsis related topregnancy and childbirth5%Complications ofanaesthesia andsurgery1%Sudden deaths22%Post partumHaemorrhage (PPH).25%Hypertensivedisorders ofpregnancy20%

Maternal Death Analysis-2010-2011 (CauseWise analyses for 2 districts)ObstructedLabour/ruptureuterus11%Suddendeaths11%Sepsisrelated topregnancy andchildbirth17%Anaemia11%DharmapuriInfectiousdiseases11%HypertensivedisorersofPregnancy28%PostPartumHaemorrhage(PPH)11%Infectiousdiseases7%SuddendeathsSepsis 13%related topregnancy andchildbirth7%Liverdisorders7%Anaemia13%SivakasiHypertensivedisorersofPregnancy40%PostPartumHaemorrhage(PPH)13%

Maternal HealthOngoingScheme24 Hours delivery care services in 1539PHCsProvision of Second Medical Officer inPHCs with Single DoctorPerformance based incentive to the Staffnurse and VHN.Maternal Anaemia Control ProgrammeRs. in Lakhs3281.76728.46164.18235.57(Reflected underNRHM budget)Gestational Diabetes Control Programme 153.9Hiring of Anaesthetist and Obstetricians forProviding EmOC Services433.43

Maternal HealthOngoingSchemeIntegration of 399 ICTC Establishedunder TANSACS in Block PHCFeeding and Dietary Charges toAntenatal/Postnatal MothersAmount inLakhs1394574.63Mobile Medical Units in 385 bocks 2972.20Operationalisation of blood storagecentres in all CHCs and Conduction ofCommunity Blood Donation Camps22.8Janani Suraksha Yojana 3215.588

Maternal HealthNewSchemeInfection Control Menstrual Hygiene –provision of sanitary napkins to PostnatalmothersMCH Centres Operationalisation –Provision of Staff and Equipments to 42Level II MCH Centres and 31 Level IMCH CentresAmount inLakhs394.03366.66

Child Health - INFANT MORTALITY RATEUIP,1985CSSM,1992RCH,1997NRHM,2005140.0120.0100.080.060.040.020.00.0127121113 110Combined81779180104 9365 6057Urban5355 54 42 39Rural5549 3935 333738 34 303531 3031262828261971 1976 1981 1986 1991 1996 2001 2006 2007 2008 2009Source: SRS

CHILD HEALTHFacilityCum.target(2012)Cum.progresstill Mar‘11Incremental Target(10-11)Progress10-11 tillMar’11Incremental Target(11-12)SNCU – DH 43 25 31 15 18NBSU – SDH,CHC, etc.NBCC – DH,SDH, CHC, PHC,etc.NBCC – Subcentre42 - - - 421539 - - - 11831 MCHcentre- - - 31NRC Nil Nil Nil Nil Nil

CHILD HEALTHEstablishment of 41 Neonatal Intensive Care Units in MedicalColleges and large CEmONC centres

CHILD HEALTHOngoingSchemeComprehensive intervention to reduceneonatal deaths in districts with high IMR inall districts – 41 NICUsHiring of Pediatricians for provision ofEmergency Newborn Care servicesAmbulance services for the emergencytransport of mothers and childrenTraining of Medical Officers inUltrasonogram for prenatal screeningEstablishment of Early Intervention centersin 2 Districts ( Pilot Project)Amount inLakhs916.56184.68(Carried over from2010-11)38.04300.00(Carried over from2010-11)100.05(Carried over from2010-11)

CHILD HEALTHExpansionNewSchemeNew born care Units @ Rs.80000per kit x (208 + 118) PHCs indistricts)Strengthening of the Existing NICUof the 2 Tertiary care centersStrengthening of EMRI Vehicle withNeonatal support system for 29districtsEssential New Born Care Services atCHCs – NBSUsAmount in Lakhs260.8042.3387( budgeted underNRHM – EMRIScheme)72.27(budgeted underOperationalisation of42 MCH Centres)

FAMILY PLANNING‣ Key issues in operationalization of fixed day Sterilizationservices Non availability of PS trained doctors in all facilities with theatres. Shift over to local anesthesia based tubectomy services to reduceneed for anesthetist in .backward districts.‣ Steps taken Mobile team has been formed to operationalize all theatres fortubectomy services. 2011-12 Mini-lap training will be conducted to train serviceproviders at PHC, CHC and Sub-District Hospital. Private service providers also hired to perform sterilization Focus on higher order birth pockets

FAMILY WELFAREOngoingSchemeAmount in LakhsNSV – Fixed Day Camp88.20(funds available)Mobility Support for FW Surgical team 11.52FW Operation theatre Maintenance /Contingencies45.95Provision of Diet charges for thesterilisation acceptors at PHCs and100Health Posts.Utilization of Services of NSV acceptorsas counselors6.40IUCD update training18.80 (budgetunder training )IEC activities for 2011-12 206.07Sterilization compensation 2895

FAMILY WELFARENewSchemeAmount inLakhsReview meeting on FP performance 1.2Monitoring and supervisory visits 2.56Performance based rewards to institutions 5Printing of EC register and supervisor charges onEC enumeration75.12Orientation workshop on technical manuals on FP 5.53TOT on Mini Lap,Mini Lap training for service providers106.702(budget undertraining )Purchase of Tubectomy kit 75Repair of Laparoscopes 27.61Family Planning Counselors in 110 Post PartumCenters ( Contractual Salary of Staff )41.28

ARSH & SCHOOL HEALTH (SHP)‣ Implemented through 14 Medical colleges by establishing TeenClinics‣ Third year MBBS students and Nursing students are trained inAdolescent health.‣ Biannual deworming and weekly supplementation of Irontablets on every Thursday to school and non school going girls.

ARSH & SCHOOL HEALTH (SHP)Preliminary work done for introduction in 10 districts will beexpanded throughout the state in 2011-12– HEAL modules for Class VI, VII, VIII,– New school health card– First aid module and kit deworming twice a year– Support for hiring doctors / transport students referral– Training will be given to Medical Officer for 3 days andVHN / SHN for 5 days for ARSH in MSHP districts

ADOLESCENT HEALTHOngoingExpansionNewSchemeTeen health clinics have been establishedthrough 14 Medical collegesAdolescent anemia control programmeWeekly supplementation of IFA tabletsand De wormingImplementation of ARSH strategy in thestate – State Level WorkshopARSH training to Medical Officer andHealth Workers-(extended to remaining32 HUDs)Scheme for Promotion of MenstrualHygieneAmount inLakhsCarried over from2010-11312.26( budgeted underNRHM drug budget)3220.01(Budgeted underTraining)2093.88(Subject to provisionby GOI)

URBAN HEALTHSchemeAmount in LakhsUrban Health Centre strengthening in60 municipalities with less than 1Lakh population725.16(Carried over from2010-11)OngoingUrban Health Programme throughMedical Colleges88.20(Carried over2010-11)

TRIBAL RCH12 Tribal Mobile Medical Units to reach the remote andinaccessible districts.Birth waiting room in 15 PHCs in the foothills of tribal villagesFeeding and Dietary charges for 7 Days for AN Mothers andone attender for 20 Tribal PHCs.1639 Village Health Volunteers (ASHA) placed in 13 tribalDistricts. Training of VHV completed. Drug kit issued.

TRIBAL HEALTHOngoingExpansionNewScheme1639 ASHAs to function as the Village HealthVolunteer (VHV) in Tribal areasEstablishment of birth waiting room atthe Tribal 15 PHCsFeeding and Dietary charges for ANMothers in 35 PHCs12 Mobile Medical Unit in tribal areas (PhaseI)8 Mobile Medical Unit in tribal areas (PhaseII)EMRI in Tribal Districts (Supply of 4 wheeldrive vehicles for 24 identified unreachableblocks)Amount in Lakhs454.80(Under NRHMflexipool)7598.1113.0438.88276(Under NRHM - EMRIscheme)

GENDER & SEX RATIOState Level Nodal Department – Directorate of Medical &Rural Health ServicesAdvisory Committees have been formed to superviseimplementation of PNDT act.StateDistrictLevelAppropriate authorityDirector of Medical & Rural HealthServicesDistrict CollectorSub districtRevenue Divisional Officer

GENDER & SEX RATIOBlocks with declining sex ratio at birth have been identified.IEC activities against foeticide/infanticide problems areongoing in the problem districts .Focussed IEC activities to improve sex ratio in all the blocksidentified with

GENDER & SEX RATIOACTIONS INITIATED AGAINST THE OFFENDERSNumber of cases for non registration 70Revealing of Sex 1Violation of Section 22 ( issue ofAdvertisements )1PRESENT STATUS OF THE CASESJudgement delivered 62Cases under Trial 10

INFRASTRUCTURE- RCHSchemeAmount inLakhsOngoingRepairs renovation and extension of ANward, PN ward, OT, labour ward etc.2100Rent charges for the HSC (2202) with outown building264.24

Other ActivitiesOngoingSchemeInnovation – Female foeticide preventionthrough scan centre auditHMIS-Health management informationsystem to monitor the new born and childcare services in Institute of Child Health,Chennai - Tertiary Care PaediatricInstitution, Contractual Salary for SystemManagersAmount inLakhs57.7556

Other ActivitiesNEWSchemeBirth and death Registration-Printing ofCirculars, Strengthening of SBHI withComputer Infrastructure, Documentation ofRCH/NRHM & Public Health ActivitiesAmount inLakhs10.1Anti shock garments NASG - Preventionand Control of Post Partum Hemorrhagesto tackle Maternal Deaths14

TRAININGS.No.TRAINING 10-11Target10-11Achiev.11-12Target1 SBA - SN 1200 473 25972 SBA – ANM/LHV3 BEmOC – MO 4246(PHC MO &DUTY DOCTORS OFDH)4 CEmOC, incl.c-section –MO397 487will be takenup in 201132 8 + 9 (4 thbatch ongoingsince 07.03.11)53075 LSAS – MO 96 43 966 MTP – MO 480 (MVA)7 RTI/ STI – MO 468 32232

TRAININGS.No.TRAINING 10-11Target10-11Achiev.8 RTI/ STI – SN 156 1359 RTI/ STI – LT 156 12711-12Target10 IMNCI – ANM 15772 5887 2861311 IMNCI - AWW12 F-IMNCI - MO 3890 (ExcludesAdministrative MOs)13 F-IMNCI – SN 5629 (ExcludesAdministrative S/N)14 NSSK – MO15 NSSK – SN16 NSSK – ANM/ LHV2399 34083507 6442NSSK included in F-IMNCI

TRAININGS.No.TRAINING 10-11Target10-11Achiev.11-12Target17 Lap Ster. 28 22 100team18 Minilap Ster. 66419 NSV 50 13 6020 IUD – MO 2480 157721 IUD – SN 2480 234022 IUD – ANM/ LHV 7440 5297462023 ARSH – MO 600 269924 ARSH – ANM 2220 264 8085

TRAINING(CONTD.)State and district training sites – AvailableTrainers for various trainings – AvailableKey issues and Steps taken– Trainee selection for multiskilling trainings based on willingness andselection after counselling only. Hence, about 50 % utilisation is seen .Hence, the doctors willing to undergo the trainings are selected andposted against specialist posts in FRUs. For other trainings there are generally no issues. Post training placement EmOC & LSAS Trained Medical Officers are either working in FRUs orattached to nearby FRUs. Now as the selection is mostly from FRUs,placement will not be an issue of concern.

TRAINING(CONTD.) Now for NICU centres, the Medical Officers & Staff Nurses areexclusively selected, trained and posted. Staff Nurses have been recruited from Jan-2011 as there was someadministrative delay and now there are about 2500 new SNs toundergo SBA training.For all the Skill based trainings there is a district level specialist nodalofficer coordinating and monitoring quality of training programme andits implementation at field level ensuring skills utilisation along with thestate level & district level master trainers and the district administrators. The Regional Training Institutes conduct the knowledge based trainingsand with the District & Block level training teams formed in each HealthUnit District monitor the quality of training and skills utilisation.

TRAINING(CONTD.)The State Monitoring officers of the Health Directorates and the SixSupportive Supervision teams formed under the State Health Society aremonitoring the training programmes and their implementation during theirfield visits.8 training institutes Institute for Vector Control and Zoonoses, Hosur Institution of Public Health, Poonamallee Health and Family Welfare Training Centre, Egmore , Madurai &Gandhigram Health Manpower Development Institute, Salem & Villupuram Regional Training School, Thiruvarankulam10 Rural health training centres located in the PHCs where the ANMtrainees are being trained will be strengthened.Amount requested for strengthening training institutes – Rs. 500 lakhs.

RCH TRAININGTraining On Going ExpansionChildHealthMaternalHealthFW•F - IMNCI Training•Laparoscopy Training•NSV Training• IMNCI Supervisor and functionaries• Home Based New Born Care training• Pre - IMNCI training• SNCU• SBA training• EmOC training• LSAS training• AMTSL• BEmONC training(3rd spell)• MVA• Contraceptive update• PP IUCD• MinilapOthers• HMIS Training•ASHA Training• ARSH training• Integrated Refresher training

NRHM TRAININGTraining On Going NewNRHM• Blood Storage training• Managerial skills tomedical officers• AYUSH• Accounts training• Tally ERP 9 training• Refresher training• Refresher training• Biomedical waste management• VHWSC training• Quarterly regional review cumtraining• Training programme onepidemic prevention, investigation, control & managementBUDGET FOR TRAININGRCH - Rs.1579.56 LakhsNRHM - Rs.709.29 Lakhs

RCH- BUDGET ABSTRACTSl. No Name of the Activity Amount in croresA RCH1. Maternal Health 96.852. Child Health 9.903 Family Welfare 4.954 Adolescent Health 0.035 Tribal Health 3.256 Innovation /PPT/NGO 0.717 Infrastructure Strengthening 23.648 HMIS 0.649 Training 15.7910 BCC –IEC 1.5011 Procurement 9.5712 JSY 32.1513 Sterilization Compensation 28.95Grand Total 227.93

IMMUNISATION

IMMUNISATIONIndicators Target (10-11) Progress 10-11Target(11-12)No. of immunisation sessions 192678 188725 192678Training of MOs * * 4300Training of HW * * 20800Training of cold chainhandlers* * 3000Review meetings 4 4 4* Proposed during 2011-12 as training are planned once in two years

Mechanism for alternate vaccine deliveryThe State conducts immunization sessions in all Govt. institutions(PHCs, GH, Medical College Hospitals, Urban Health Centres etc.)Alternate vaccinators are engaged only in few urban slums. Theamount already sanctioned during 2009-10 under alternate slumvaccinators are now being utilized. Hence, no funds are proposed inthe PIP 2011-12Outreach sessions are conducted only for remote and inaccessibleareas by using MMU vehicles. Hence, no funds are projected.

Status of Cold chain maintenanceFor proper maintenance of Cold Chain System, the State hasestablished 1947 vaccine storage points at PHCs, Municipalities,urban centres etc. with total installation of 5511Cold ChainEquipments.One Refrigeration Mechanic is posted at each district for attendingpreventive maintenance and repair work. The is break down rate0.8% as against the allowable percent of 2.However, the post of one Cold Chain Officer and 8 posts ofRefrigeration Mechanic are vacant for which funds support arerequired to fill up the post on contractual basis (proposal submittedunder NRHM Additionality.

Supervision and monitoringThe Joint Director (Immunization) as State Programme Officer is monitoringImmunization programme under the head of Director of Public Health andPreventive Medicine. One Deputy Director at each district is supervisingImmunization activities assisted by Asst. Director (SBHI) and District Maternal andChild Health Officer.Weekly review meetings are conducted at PHC level with all field functionaries byMedical Officers on Tuesday of every week. Monthly review meeting on 1st Fridayof every month is conducted with all Medical Officers at the districts by the DDs.Similarly, State level meetings are conducted with all district officers to review theprogress of Immunization Programme During 2010-11, 4 State level reviewmeetings are conducted.

IMMUNISATIONSL.NoAActivityStrengthening of ImmunisationRI strengthening project (Reviewmeeting, Mobility Support, Outreach Services etc)Amount in(Lakhs)287.89B Salary of Contractual Staffs 38.4C Training under Immunization 20.91D Cold chain maintenance 29.245Total 376.445

MISSION FLEXIPOOL

CORE ACTIVITIESPatient Welfare Society (PWS) GrantsUnitAmountin lakhsGovt. District . HQ Hospital 30 x 5 150Taluk / Non Taluk Hospital- sub District /Area hospitals231 x 1 231Primary Health Centre 1539 x 1 1539Institutions under DME control17 x 1012 x 5 2355 x 1Urban health centers 60 x 1 60Total 2215

CORE ACTIVITIESAnnual Maintenance GrantsAnnual Maintenance Grants for PHC (AMG)– 1524 PHCs with own buidlingUnit cost1524 x0.5Amountin Lakhs762Annual Maintenance Grants for CHC (AMG) 450 x 0.5 225Annual Maintenance Grants for HSC (AMG)6510 x0.1651Total 1638

CORE ACTIVITIESUntied FundsUnitAmount inlakhsUrban health centers 60 x 0.25 15Untied funds to HSCs 8712 x 0.1 871.2Untied funds to PHCs/CHCs1539 x0.25384.75Untied funds to Sub District Hospitals 231 x 0.5 115.5District Head Quarters Hospital 30 x 1 30Village Health and Sanitation Committee 1515.80Health Melas 312TOTAL 3244.25

ASHAs‣ Total Number of ASHAs in the State – 2650 - Phase I‣ Population Per ASHA – 500 to 1000‣ Drug KitsAmount proposed per kit – Rs.600/kit- 4200 - Phase II Total Number of Kits to be procured for the year 2011-12 - 6850Total Amount proposed – Rs.41.1 Lakhs‣ Expenditure on Selection, TrainingTotal amount proposed for training of ASHA - Rs.31.84 Lakhs (Rs.368.52 Lakhs isavailable from the previous year allocations for this scheme)Amount proposed per ASHA – Rs.7500‣ Total amount proposed for paying incentives – 334.23 (Rs.433.23 Lakhs availablefrom the previous year allocations )‣ Non monetary incentives (like uniforms, Umbrella etc) proposed for ASHA –Rs.10.42 Lakhs for VHV bags.

Strengthening Existing ActivitiesOngoingName of the ActivityVHV- (ASHA) -(2650+4200 VHVs)-Performance based Incentives and drug kitsStrengthening of FRU infrastructure- Civilworks, Equipments to DMS Institution,Outsourcing of housekeeping and sanitation in4 Govt hospitalsStrengthening of PHC infrastructure -Infrastructure upgradation in PHCs to cope upwith additional service demands, QualityCertification of 30 PHCs, Equipments to PHCsAmount inLakhs385.752000.002650.00

FREE & ASSURED REFERRAL – (EMRI - 108)FacilityNo. Of districts having referral transport /EMRINo. of high focus districts having referraltransport / EMRICall centre at State/ district level (give no.s)Status 2010-11(till Feb. 11)32NILProposed2011-1224 TribalEMRI and 29New BorntransportOne central EmergencyResponse CentreNo. of ambulances (including for EMRI) 415 200Whether ambulances fitted with GPS (Y/N) No -

FREE & ASSURED REFERRAL – (EMRI - 108)FacilityStatus 2010-11(till Feb. 11)1. Number of Calls received 80331521.1 Number of calls attended 77850512. Total number of cases transported 5219342.1 Number of pregnancy related calls attended 1176353. Total no. of patients using referral transport interfacility transfer383244. No. of sick newborns using referral transport 5891Total annual running costAverage cost per tripAverage distance travel per trip4145.62 Lks.Rs.79433.21 K.M.

FREE & ASSURED REFERRAL – (EMRI - 108)‣ The referral services are free for PW and sick newborns.‣ Second referral is being provided but there is no drop backfacility.‣ IEC provided for dissemination of services.‣ Source of funds for the budget – NRHM – 60%,- State Share – 40%

Strengthening Existing ActivitiesEMRIAmount inLakhsTotal Budget (Proposed by EMRI) 10561OngoingNRHM share (capital cost (excluding civilworks) + 60% of recurrent cost)State Funding (Civil works cost +40 % ofrecurrent cost)Budget sanction required under NRHMFlexipool :5412.485148.525412.48

Strengthening Existing ActivitiesOngoingAmount inName of the ActivityLakhsNew Buildings for 6 PHCs in rented buildings 150.00Human ResourceSalary of Staff of 116 new PHCs and4454.25Salary of Staff of 125 upgraded PHCsStrengthening Dental Services in the ExistingDental units (148 Upgraded PHCs and 22 Taluk 421.60and Non Taluk Hospitals)Bio Medical waste management(Payment to CTFoperators –301 secondary care hospitals and 275.75130 upgraded PHCs )Correction of refractive error in School children- 252.63

Strengthening Existing ActivitiesOngoingAmountDrug kits to health institutionsin LakhsDrug kits to CHCs, PHC, HSCs etc 1050Drugs for Anemia & Deworming – AdolescentAneamia, Maternal Anemia – Iron Sucrose,699.53Deworming tablets for Adolescent and drugs forMSHP and ICDSGestational Diabetes 153.9MCH Centres (42) 42MCH Centres (31) 15.5Mobile Medical Unit Drugs to PHCs 385Disposable syringes 200Total 2545.93

Strengthening Existing ActivitiesOngoingName of the ActivityMainstreaming of AYUSH( 300 PHC-Phase-1 & 144 PHCs –Phase-2 and31 Yoga and naturopathy Maternity Centers)Support to Research group focus research inAIDS under ISM MedicineAmount inLakhs1230.1410.00Down’s Syndrome –PPP with NGO 40.08ISO – Quality Certification-support to theestablished 48 ISO PHCs for quality management 57.6servicesSupport Strengthening for NVBDCP under NRHMAdditionalties-Dengue & Chikungunya Control in 246.68Mpty with less than one Lakh populationBCC/IEC activities 200.00

Expansion of Ongoing activitiesName of the ActivityModified School Health Programme to 20DistrictsAmountin Lakhs1194.17ExpansionStrengthening Dental Services in 60 CHCs 112.8ISO Certification of 30 PHCs in tripartitearrangement with NHSRCCommunity Action for Health- 446 Panchyatarea in 6 districts150207.59

NEW ACTIVITIES OF 2011-12NewSCHEMEMCH Centres Operationalisation• Level 1 MCH centres-31•Level II MCH Centres-42• Budget proposed for Repairs / Renovation worksStrengthening of TRAINING centres•Strengthening of 8 training institutes•Establishing skill labs and ANM training centre•Strengthening of DTT at 42 HUDs•Strengthening of 10 RHTCs as ANM training centresImmunization - Construction of warehouse•Construction of Ware House to store DryImmunization stock at 10 WIC at the district level andone at the state levelAmount inlakhs1465.22500145

NEW ACTIVITIES OF 2011-12NewSCHEMEPENGAL NALAMUDAN - Goals• Spread awareness regarding risk for breast andcervical cancer.•Detect and treat early asymptomatic andundiagnosed cases especially those at high risk.Establishing Elderly Clinic with Physiotherapy inUG PHC (CHC)A Pilot project in coordination with PPP in 15Upgraded PHCs (CHCs) with 3 centres each in the5 districts.Amountin lakhs271.4230

NEW ACTIVITIES OF 2011-12NewSCHEMEAmount inlakhsEMRI• Strengthening of existing EMRI with neonatal supportsystem in 29 district.363•EMRI in 24 tribal blocksSHDRCThe SHDRC, through its indicators will primarily focuson Preventive & Corrective Actions, Epidemic Response, 200Resource Planning, Policy Analysis, Health SystemResearchStrengthening of HMIS in PHCs 582.21Establishment of Central Tissue Bank -at King Instituteof Preventive Medicine and Research, Chennai*263.56* Yet to be decided

INFRASTRUCTURERs in lakhsActivity SC PHC/CHC DH/SDH/OthersNo Amount No Amount No Amount1600New Const. 0 0 216 2160Up-gradation31MCH334.6342 MCH210PHCs1130.59210017NICU176.85Sub-Centre rentNo. of SC Amt @ SC Amt proposed in PIP2202 Rs 1000 per month 264.24Amount proposed for other activities Rs in lakhsHospital Strengthening Mobility Support Others (pl specify)Equipments-200 0 Out sourcing -200

Research studiesName of Study Estimated Cost Proposed InstituteMMU Under Progress IIT, ChennaiAnemia in PregnancyEconomic Implications ofimproved PHCperformanceSafe Abortion &Maternal death due toabortionUnder ProgressUnder progressUnder ProgressSRM Medical College(Community MedicineDepartment)NIE, ChennaiCHAD, Vellore

Procurement of DrugsKITSNOS AMOUNT inLakhsDrug kitsSpecial Kit to PHCs/CHCs 1539 500.00Special Kit to HSCs (Minor ailments/school 10658 550.00health)Drugs for AnemiaIFA – adolescent 314680000 251.74Maternal Anaemia - Iron sucrose 500000 230.76Deworming – AlbendazoleAntenatal mothers 961535 4.81Adolescent girls 12103080 60.52MSHP 20000000 100.00ICDS 10340000 51.70

Procurement of DrugsOther drugsKITSNOSAMOUNT inlakhsGestational Diabetes 1539 153.90MCH Centres (42 x Rs. 1.00 Lakh) 42 42.00.MCH Centres (31 x Rs. 0.50 Lakh) 31 155.00Mobile Medical Unit Drugs to PHCs 385 385.00Disposable syringes 20000000 200.00Total 254593700

PROCUREMENT - EQUIPMENTSPROCUREMENTTribal HealthProcurement of furnitures for birth waitingroomsNo. of unitsUnitcostRs. In lakhs15 476000 71.4Child Health - Equipments 0New born care unit in PHCs 326 80000 260.8Equipments to NICU 2 342500 6.85Family Welfare 0Purchase of Tubectomy kit 1500 2500 37.5Maternal Health - Drugs and Supplies 0Lab reagents for MMU 385 25000 96.25Procurement of Sanitary Napkins 19701480 2 394.02Equipments to MCH centre -level 1 31 100000 31Equipments to MCH centre -level 2 42 300000 126

Monitoring & Evaluation (M&E)‣ District monthly consolidated reports so far manually collectedfrom all the facilities and uploaded in the NRHM portal by thedistricts‣ By way of data integration, we are generating PHC/CHC facilityreport from Jan’ 11and ready for uploading.‣ Training for Dt/PHC staff started from 30th of Mar’11‣ Database for SDH/DH/TH is not available in the state HMISportal

Monitoring & Evaluation (M&E)‣ Hardcopy of reports are in use in the above type offacilities‣ Training for such facilities is proposed to be taken up duringApl/May’11 to introduce NRHM web portal for uploading‣ Exploring the mode of data capturing from Private Hospitalsfor data integration is under process‣ Complete shift is expected from July’11 onwards

MOTHER CHILD TRACKING SYSTEM‣ Strengthening of IT infrastructure at PHC and district level (Budget requested)‣ Training of staff at all level for smooth flow of information with quality isplanned‣ Strengthening the PICME and its utilisation- drive organized for completingbacklog of child data‣ Use of work plan/due list as data entry/review format planned to be pilotedin 3 districts shortly.‣ Issues such as migration tracking, off line data entry, sms prompt underdiscussion with NIC technical experts

CAPACITY BUILDING‣ To enhance analytical capabilities skill developmenttraining already planned for state and district levelofficials during 2011-12 using available funds.‣ To improve data quality and completeness necessarytraining/review would be imparted to districts on prioritybasis.‣ Training on data integration will increase the datacompleteness

NRHM Initiatives – Budget abstractSl.Amount inName of the ActivityNocroresB NRHM Initiatives1 ASHA Incentives 3.852 Village Health Sanitation Committee 15.153 Untied Funds 14.164 Annual Maintenance Grants 16.385 Corpus Grants to HMS / RKS 22.156 Hospital and PHC Infrastructure Strengthening 46.507 New Constructions/ Improvements / MCH centres 17.608 EMRI 57.759 Human Resource 40.4910 Training 7.09

NRHM Initiatives – Budget abstractSl.Amount inName of the ActivityNocrores11 Dental services 6.4112 Establishing elderly clinic with physiotherapy 30.0013 Bio Medical waste management 2.7514 Correction of refractive error in School children 2.5215 Mainstreaming of AYUSH 12.3016 General drugs & supplies for health facilities 25.4517 Modified School Health Programme 11.9418 Nalamana Thamilagam 2.7119 Down Syndrome 0.4020Support to Research group focus research in AIDSunder ISM Medicine0.10

NRHM Initiatives – Budget abstractSl.Amount inName of the ActivityNocrores21 ISO quality certification 2.0722 Community Monitoring 2.0723 IEC-BCC , Health Mela-NRHM 5.1224 Strengthening of Training Institutes 5.0025 Establishment of SHDRC 2.0026 Support Strengthening under NVBDCP 2.8427 Support strengthening under IDSP 2.1428 Strengthening of HMIS Infrastructure in PHCs 5.8229Central Tissue Bank at King Institute of PreventiveMedicine and Research, Chennai2.63*30 Support Strengthening under Immunisation 2.38Total NRHM Part B 338.17

RNTCP

Name of thedistrict/districtsDistricts with Poor to moderateNSP CDR/performance*TreatmentSuccessRate (TSR)moderateperformance< 50-59% 80-85%coimbatore 55% 87%kanyakumari 55% 87%salem 52% 82%tanjavur 58% 81%tirunelveli 51% 86%tiruppur 55% NAerode 61% 80%madurai 67% 80%theni 68% 83%Dindigul 71% 84%Reasons Proposedfor poor solutionsperforman /Activities ince PIPConstraints

Districts with Poor to moderateperformance*Name of thedistrict/districtsNSP CDR/TreatmentSuccessRate (TSR)Reasons Proposedfor poor solutionsperforman /Activities ince PIPConstraintspoor performancenilgris 23% 88%dharmapuri 43% 94%krishnagiri 44% 90%nagapattinam 45% 86%cuddalore 46% 94%perambalur 46% 79%pudukottai 47% 85%tiruvarur 48% 85%Lack ofawarenessamong thePublicImprove theACSMActivities inall Districts

Status of IRL and DOTS PlusDistrictsImplementing DOTSPlus/ProposedDistrictsalreadyimplementingDistrictsproposedfor 2011-12Status of IRL andservices offeredSolidCultureLiquidcultureLPADOTSPlusSiteNo ofPatientsproposed toPut onDOTS Plus (2011-12)HumanResourcestatus forDOTS Plus26 5 YES NO NOGHTMThambaram-DOTS Plus/HIVTB supervisors-Filled in alldistrict, MedicalOfficer forDOTS Plus sitesvacantandData entryoperator DOTSPlus sites-Vacant

Revised National Tuberculosis ControlProgrammeCategory of Expenditure1. Civil works 62.152. Laboratory materials 120.013. Honorarium 29.394. IEC/ Publicity 67.045. Equipment maintenance 24.356. Training 47.977. Vehicle maintenance 75.058. Vehicle hiring 59.509. NGO/PP support 170.4910. Miscellaneous 106.8011. Contractual services 972.6912. Printing 87.0814. Medical Colleges 158.6915. Procurement –vehicles 29.5016. Procurement – equipment 22.55Total 2033.31Amount in Lakhs

Budget heads and Amount proposedSr. No.Budget headsAmount proposed(INR )Amountapproved (INR )1 Civil works 6215600 53722392 Laboratory materials 12001106 94808743 Honorarium 2939963 17639784 IEC/ Publicity 6704100 60336905 Equipment maintenance 2435000 20362506 Training 4797030 47970307 Vehicle maintenance 7505000 57511508 Vehicle hiring 5950800 14419769 NGO/PP support 17049083 6819633

Budget heads and Amount proposedSr. No.Budget headsAmount proposed(INR )Amount approved(INR )10 Miscellaneous 10680606 1068060611 Contractual services97269400 6517049812 Printing 8708606 365761513 Research and studies0 014 Medical Colleges 15869920 1535692015 Procurement –vehicles2950000 016 Procurement – equipment2255000 017 Tribal Action Plan 0 0Total 203331214 138362459

National Vector Borne Disease ControlProgramme (NVBDCP)Sl.No.ActivityAmountin Rs. lakhs1 Malaria 177.602 Filaria 473.123 Dengue / Chikungunya 83.254 Japanese and Encephalitis 38.005 *Decentralized commodities 27.18Total 799.15* During the discussion PIP sub group meeting it was represented by theState that during 2009-10, Rs.453.71 Lakhs was allocated as support forlarvicides out of which Rs.431.44 was utilized. Hence the same allocation ofRS.453.71 may be made for the year 2011-12 (otherwise may be permittedfrom flexipool).

National Programme for Control ofBlindness (PERFORMANCE UP TO Feb 2011)‣ Catops– Govt Sector : 55438– NGO + Private : 391193‣ IOL Implantation : 95%‣ NGO Claims settled upto Feb 2011‣ RIO - Chennai & Ophthal departments ofCoimbatore,Thanjavur &Madurai Medical Colleges upgraded as RegionalTraining Centers.

National Programme For Control OfBlindnessSl.NoActivitiesAmount in Lakhs1 Catops GIA, School Eye Screening , Eye donation 18012 Procurement of Equipments and IOL 3053 Renumeration (DBCS and SBCS 2344 Training, IEC and other activities 855 Medical Colleges@ Rs.40 lakhs Tiruvarur 406 Vision Centre@Rs.50 Thousand 57 Eye Banks@Rs.15 lakhs 308 NGOs Hospital@Rs.30 lakhs ( Nilgiris) 309 Eye Wards & Eye OTs@Rs.75 lakhs 010 Mobile Ophthalmic Units with Tele Network 011 District Hospital@Rs.20 lakhs 4012 Sub District Hospital@ Rs.5 lakhs 513 Ophthalmic Surgeon@Rs.25000/per monthFunds will be carried14 PMOA's@Rs.8000/- Per monthover from 2009-1015 Eye Donation Counsellor@Rs.10000 pmTotal 2575

National Iodine Deficiency DisorderControl ProgrammeS.No Activity Amount in lakhs1 Purchase of MBI kits 10.002 Celebration of Global IDD Day 5.003 Health Education & Publicity 10.004IDD Survey of Districts @ Rs.50,000 perdistrict (5 Districts)2.5TOTAL 27.5

Integrated Disease Surveillance ProjectSl. No.ActivityAmountin Rs. lakhs1 Human Resources 365.92 Training 24.443LaboratorySupport44.004 Scrub Typhus - Kits for Diagnosis 41.26Total 475.6

National leprosy Eradication ProgrammeSL.NOActivitiesAmount inLakhs1 Contractual Services 16.372 Services through ASHA/USHA/ Dais - VHN 3.553 Office expenses & Consumables 10.564 Capacity building (Training) 19.465 Behavioral Change Communication (IEC) 28.006 POL/Vehicle operation & hiring 24.207 DPMR( Disability Prevention & Medical25.75Rehabilitation)8 Drugs, Materials and Supplies 13.809 ULEP (Urban Leprosy Programme) 24.7410 Supervision, Monitoring & Review 4.3011 Cash Assistance 2010 – 11 10.00Total 180.73

PART – D - Disease Control ProgrammesBudget Abstract 2011-12Sl.NoDISEASE CONTROL PROGRAMMESAmount inlakhs1 National Vector Borne Diseases Control (VBDC) 799.152 Integrated Disease Surveillance Programme 475.63 Revised National Tuberculosis Control Programme 20334 National Leprosy Eradication Programme (NLEP) 1815 National Blindness Control Programme 25756National Iodine Deficiency Disorder ControlProgramme28Total (Programmes under NRHM budget) 6091.757National Programme for Prevention and Control OfDeafness (NPPCD)4748 National Tobacco Control Programme 30.59 National Mental Health Programme 670.89Total (Programmes out side NRHM budget) 1175.39Grand Total 7267.14

Priority Projects for Additional ResourcesSl. NoActivitiesBudget Proposedafter Sub GroupMeetingAmount in Lakhs1 Additional Resource Envelope for SDHRC 822.42 Scheme on promotion of menstrual hygiene 2093.88Total 2916.28

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