Sr. No. Activity Page Number 1. Maternal Health ... - Nrhmharyana.org

IndexSr.No.ActivityPageNumber1. Maternal Health 1-18JSY 19-22Urban RCH 23-24RCH – Child Health Division 25-33Family Welfare 34-35ARSH 36-39Training 40-432. NRHM Part B 44-58IYCFIUD InsertionMenstrual Hygiene SchemeUntied Fund for Sub Centres, Untied Fund for CHCs, Untied Fund forPHCs, Capacity Untied Building Fund of for Members SDHs, Annual of PRIs, Maintenance RKS/SKSs and Grant VHSCs for CHCs,Annual Village Maintenance Health & Nutrition Grant Day for PHCs, (VHND) Annual Maintenance Grant for SCs, Comprehensive Annual Maintenance Best Village Grant for Health SDHs, Scheme Corpus Grants for HMS/SKSsTreatment to Hemophilia PatientsASHA PROGRAMMEComprehensive Best Village Health SchemeContinuing Medical Education (CME)Augmentation of Health Care in Mewat AreaSetting up of Physiotherapy Unit:Cancer Control ProgrammeTreatment to Hemophilia Patients:Planning, Implementation and Monitoring:-Oral Health 59Strengthening Procurement Cell and Regional Drug Warehouses 59-60IEC / BCC Activities 61-64Pre-Natal Diagnostic Technique (PNDT) 653 Immunization 66-774. Disease Control ProgrammesNVBDCP 78-79NLEP 80-82NBCP 84RNTCP 84-90IDSP 91NIDDCP 92National Tobacco Control Programme 925. HMIS 93-966. AYUSH 97-980

APPRAISAL COMMENTS ON RCH II CHAPTER OFNRHM STATE PIP, 2010-11: HARYANAMaternal Health strategiesCommentsState ResponseIndicatorsThe State needs to clarify the unit of the Yes, the unit of the target is in percentage.target. It seems that it is in percentage.The State has not indicated targets and Attached with commentsachievements in the format onMonitorable Indicators circulated to theState.Total Expenditure on MH (strategies Total expenditure on Maternal Healthother than JSY) is only approx. 10percent of the ROP allocation for MH till(Strategies other than JSY including UrbanRCH) is 52.87% till December, 2010.Sep 2010)?MMR (SRS 2004-06) of 162 has shown arise from the previous survey. As per theno. reported by Dists. in the year Apr.2009- Mar 2010- i.e. 164 , the State saysthat it is much lower. However, it islikely that many MDs had not beenreported or audited during this period.MMR as per SRS (2004-06) is 186. 164maternal deaths reported by Haryana fromApril, 2009 to March, 2010 is the number ofthe maternal deaths reported and not theMMR. However, it is quite possible that allthe maternal deaths have not been reported.As on date, there is no mechanism in place toassess the actual MMR in the State. However,all efforts are now being made to ensure thatevery maternal death comes under the radarof State monitoring and is also audited. Acomprehensive policy of maternal deathreporting and review has been introduced andhas been made a part of the SPIP 2011-12.Reporting of maternal deaths has also been1

Based on the analysis of causes of MDsdone by the State, it is not clear from thepie chart whether the 43 % (blue) is“Others” or “Abortion”. If it is Others,then obviously many of the MDs in thiscategory have not been classifiedproperly. Abortion deaths also have notbeen classified.StrategiesFull ANC is just 12.7% and the State hasset the target of 85% for 3+ ANC whichseems unrealistic.linked to the toll free number 102 at theReferral Transport Control Room. A systemof incentivizing the first informant and themembers of the community audit team hasalso been introduced. The State may also goin for external evaluation of actual number ofmaternal deaths in some districts on pilotbasis.In the causes of maternal death 43% is othercauses which include 11% anemia, 4%convulsion, 4% breathlessness, 2% APH, 2%hepatic failure, 10% cardiovascularcomplication including heart problem, 2%caecal perforation, 4% jaundice, 4%miscellaneous causes including renal,diabetes, tuberculosis and typhoid. No deathreported by the district due to abortions.It is not understood as to which sourceindicates the full ANC in Haryana State as12.7%. It is also not clear if the full ANCmeans monthly checkups of a pregnantwoman for the first 7 months of pregnancy,fortnightly checkups in the 8 th month andweekly checkups till the time of deliverythereafter as per the protocol. However, theState has the data of 3 or 3+ ANC availablethrough HMIS. Accordingly the said data hasbeen indicated in the PIP. At present the 3 or3+ ANCs coverage in the State is 78.86% asmentioned in the PIP. Accordingly a target of2

State needs to set realistic targets andaccordingly take steps to improve theservice delivery along with focus onquality of ANC/PNC during VHNDs.IFA consumption is very low 17.1%(DLHS-III). State has target of 95% forIFA consumption which seemsunrealistic.Prevalence of Anaemia among PW ishigh as per NFHS-III data. State shouldtake steps to reduce prevalence ofanaemia.SPIP lacks focus on specific strategiesfor addressing the overall highprevalence anaemia esp. in PW85% has been set for the year 2011-12, whichis not an unrealistic target. This means thatANM at the Sub-centre level should do 3 ormore than 3 antenatal checkups of eachpregnant women including checkup at thetime of registration.State is already taking steps to improve theservice delivery alongwith focus on quality ofANC/PNC during VHNDs. Under the revisedstrategy RCH Outreach camps shall also becarried out on VHNDs. It is proposed toprovide comprehensive ANC and PNCservices by the MOs during VHNDs. IECactivities are already being conducted in theState through community participationprogramme. ASHAs are also beingincentivised and continuously trained formotivating antenatal and postnatal cases tovisit VHNDs.As per HMIS data, consumption of IFAtablets is 85.84% (from April, 2010 toNovember, 2010). Hence the target set isrealistic.State is taking many steps to reduceprevalence of anaemia such as:-o free laboratory investigations therebydetecting anaemia among pregnantwomen and timely iron supplement tocorrect it.o Nutrition counselling especially ofpregnant women, lactating mothers and3

ANC, INC & PNCANCTracking of missed out and left out casesand addressing huge gaps between oneANC and full ANC can be addressed bysetting up an efficient system of MCTS.Establish use of Joint MCH card tofacilitate the tracking of missed and leftout cases in ANC and PNC period.• Micro birth Planning and identification ofreferral transport and facility for deliveryto be focusedadolescent girls on RCH Outreach Campsand VHNDs.o A revised strategy for the convergence ofRCH Outreach camps and VHNDs hasbeen laid down and mentioned in theSPIP. It has been proposed that MedicalOfficer shall conduct the Outreachactivities on VHNDs along with thelaboratory technician. This strategy hasbeen formulated with a clear objective oftackling the anaemia cases especially inpregnant women, adolescent girls andlactating mothers. Besides through schoolhealth interventions also the problem ofanaemia is being addressed for childrenfrom anganwadi centres upto secondaryschools.Yes, noted. The State is trying to put in placean efficient MCTS.The joint MCH card has already beenintroduced in the State.Micro birth planning is being done at theSub-centre level. Right at the time ofregistration of pregnancy/1 st ANC, thereferral transport voucher is given to apregnant woman assuring her a free referral4

with SACSFunds should also be kept for activities onSupportive Supervision /Monitoring ofservices in Operationalized facilities• Salaries of contractual staff should bebudgeted under Infrastructure and HumanResourceblood storage facilities in the GovernmentInstitutions are already being supervisedand administered by SACS.Funds for each district have already beenearmarked in the SPIP for activities onSupportive Supervision/Monitoring ofservices in Operationalized facilities.It has been rightly put up as per theinstructions of the GoI in the revised formatof PIP.• Permissibility of lump sum budgets in caseactivities are not indicated ,may bereviewed by NRHM FinanceBSCs at FRUsHow many of the 60 BSC refrigeratorspurchased in 2008 have been installed?Detailed policy for hiring of specialists andfor payment of salary/compensation hasbeen given in the SPIP. A provision oflump-sum budget has been made to avoidparking of huge sums, which are required tobe made available on the basis of the strictcalculations of salary/compensation.All 60 Blood Storage Refrigerators havebeen installed.Equipment & DrugsWhy does this have to budgeted separately The cost for essential medicines and supplyas “costs for IDs and C-sections”? These for IDs and C-Sections have beencosts should be budgeted under the activitywise functional heads e.g. cost for essentialmedicines, supplies etc.separately mentioned in order to project aproper perspective of demand, procurementand supply to the procurement division.InfrastructureThe State to clarify whether Delivery hut Delivery Hut Sub Centre is not6

S-C is synonymous with MCH level 1 S-C?If it is in a rented building, how will itqualify as MCH Centre Level 1?24x7 PHCsTargets for 2011-12 (24x7 PHCs) notindicatedsynonymous with MCH Level 1 SubCentre. This means that all Delivery HutSub-Centres have not been designated asMCH Level-I. Only those Delivery Hut SubCentres have been designated as MCHLevel-I, where a minimum of 3 or morethan 3 deliveries are taking place everymonth. Adopting this criterion even thoseSub Centres have been designated as MCHLevel-I, which are not yet accredited asDelivery Huts. Process to accredit theseSub Centres as Delivery Huts shall beinitiated in 2011-12.At Level 1 MCH centres basic deliveryservices and basic new born care cornersshall be provided. MCH centres Level 1 inrented building will qualify as MCH facilityif building is sufficient, suitable and easilyapproachable. It is not understood as to whya rented building cannot qualify as MCHLevel-I Sub Centre, if the requisite 24x7service delivery in MCH centre is beingprovided.Yes. No targets have been indicated for24x7 PHCs because 297 out of 343 PHCsare already functioning as 24x7PHCs/Designated MCH Centres. With thenew concept of MCH centres introduced inthe State, the State shall first endeavour tostrengthen those facilities (PHCs) which7

Salaries of contractual staff should bebudgeted under Infrastructure and HumanResource and not under MHHR placement should be need based and asper laid down Guidelines.Dai may be used to provide such services,provided she is not misutilised at suchfacilities for primarily giving delivery careFunds should also be kept for activities onSupportive Supervision /Monitoring ofservices in Operationalized facilitiesMCH CENTRES OPERATIONALIZATIONOperationalise Sub-centres. Does thismean operationalisation of the stand aloneSCs (proposed in 2010-11 as deliveryhuts?Do all the Delivery Huts fall in thecategory of “146 Level 1 with warmers??”have been designated as MCH centres ofvarious levels.It has been rightly put up as per theinstructions of the GoI in the revised formatof PIP.Yes, HR placement is need based and as perlaid down guidelines.Yes, it is being ensured that Dai is not usedprimarily for delivery care.Funds have already been earmarked in theSPIP for Supportive Supervision/Monitoring of services in Operationalizedfacilities.There is a mismatch in the comments.While the heading mentioned is “MCHCentres Operationalization”, the budgetmentioned is Rs.65.00 Lacs for“operationalization of Sub Centres”. It isclarified that operationalization of SubCentres is a separate head in the SPIP and isdistinct from MCH centres. This budget isearmarked for 260 Sub Centres, which haveto be made functional as Delivery Huts.All the Delivery Huts do not fall in thecategory of 146 Level 1 with Warmers. 215out of existing 406 Delivery Huts aredesignated as Level 1 MCH Centres. Out ofthese only 3 Delivery Huts are designated8

as Level 1 with WarmersINSTITUTIONAL DELIVERY INCLUDING JSY(Detailed Comments on JSY will be given by Nodal Officer JSY)As per? CRS? HMIS data , there is a Yes, districts Jhajjar, Mewat and Palwalsteady increase in ID rate at DistrictHospitals (8.66 %), in CHCs(71.09%) andPHCs (54.35%) and also in sub-centresand delivery huts (22.21%). However, theDists. Of Jhajjar, Mewat and Palwal stillhave ID rates

Benefits under JSY should be as per GoInorms.JSY deliveries should be co-linked withservice provision and facility upgradationand budgeted accordingly.Tertiary facilities are overloaded so microplan should promote primary andsecondary health facilities for availingservices.There should be no duplication inbudgeting under 2 different schemesSAFE ABORTION SERVICESThe trends for MTP services given in thewrite-up indicates declining numbers in theGovt. sector between 2009 to 2010.State/UT should plan for operationalisingCAC services at FRUs and MVA/MA at24x7 PHCs as per the GOI GuidelinesPost the trained service providers atfacilities with the required drugs andequipment, particularly for MVA andMMAfacilities due to space constraints or due toheavy patient load, or, many times, due toresistance by the mother and the familymembers. However, it is ensured that themother and the child are discharged fromthe health facilities after they are fullystabilized.Yes, these are as per GoI norms.Yes, noted.Yes, constant efforts are being made to doso.Yes, there is no duplication. The JSY StateScheme is being budgeted under the StateBudget.Yes, noted.Noted.Noted.10

Activate all DLCs for Accreditation ofPrivate providersShould not impose restrictive regulationson the accreditation processRTI/STI SERVICESSocial Marketing of Sanitary Napkinsshould be reflected in the ARSHcomponent and not under the RTI/STIcomponent of MH.Target of the no. of facilities to beoperationalized for RTI/STI services hasnot been mentioned by the State.There is no budgeting for operationalisingstrategies for tackling RTI/STI as perNational Guidelines at SDHs, CHCs andPHCsNoted.Noted.The scheme of social marketing of sanitarynapkins has been mentioned in the ARSHcomponent as well. This scheme findsmention at length under the RTI componentof Maternal Health because the scheme hasbeen introduced to promote menstrualhygiene is unquestionably not only inadolescent girls, but in women as well.Menstrual hygiene is a big step to controlRTI.450 facilities.Training budget of Rs.34.35 Lacs hasalready been projected in the NRHM PIPunder SIHFW.As the basic infrastructure is alreadyavailable so no additional budget provisionhas been made for the same.IEC and job AIDS activities have beenprojected under BCC.A budgetary provision of Rs.8 Lacs* willbe made under mentoring and supportivesupervision (RTI/STI services) underNRHM.11

State /UT should plan for RTI/STI servicesat FRUs and 24x7 PHCs, in convergencewith the SACS in using their trainingresources, counselors at ICTCs, and forestablishing blood safety etc.Color coded RTI/STI drugs kits are to besupplied by NACO for sub-district level.State may indicate whether RTI/STI drugshave been provided in the sub district levelfacilities.REFERRAL TRANSPORTHow are the funds for referral transportunder JSY being utilized? Duplicationshould be avoided.There is a need for assured referral linkageboth from the beneficiary/ community tothe facilities , between the facilities and fordrop back home. Have the necessaryprovisions been made by the State?Scaling of referral is needed, however thecost incurred and physical output is to beevaluated before scaling up.Has there been an assessment of the*TA/DA for District Level STI mentors (Rs.4.60 Lacs),Deputy Civil Surgeons NRHM (Rs.1.10 Lacs) and StateRCH/MH Officers (Rs.2.30 Lacs)District level trainers trained by SACS willfurther train sub-district health providers.ICTC services are being provided at 63FRUs and 23 PHCs (24x7). Services ofthese ICTC counsellors will be utilized forSTI/RTI control NRHM.In its AAP 2011-12, SACS has put forth toNACO an expected kit requirement for 1Lac colour coded RTI/STI drug kits forfacilities under NRHM.STI/RTI drugs are already in process ofdistribution to sub district facilities. DeputyCivil Surgeons (NRHM) are responsiblepersons for the same.There is no duplication. With the freereferral transport facility being in place, thefunds for referral transport under JSY arenot being utilized.Yes, all the necessary provisions havealready been made by the State.This has already been done. Cost factor andthe physical output is being continuouslyevaluated.Yes, the outcomes of the referral transport12

outcomes of the RT scheme?Out of the MDs and Infant and Childdeaths reported through 102, how manyreviewed, and whether any action taken?MATERNAL DEATH REVIEWMaternal death review both for facility andcommunity based can be implemented asper GoI guidelines. These guidelines havebeen reproduced by the State in thewriteup.As already commented in the section onindicators, the State needs to do a betterindepth analysis of the causes of MDs, toactually identify the medical and othercauses (as 43 % deaths have beenclassified as “Others”).MATERNAL HEALTH TRAINING(E) Blood Storage Training:o The State has not provided details/ targetsfor BSCs training.o Targets vs. achievements from the last yearhave not been mentioned.schemes are being assessed on a regularbasis. There is a comprehensive monitoringmechanism in place.Out of 12 maternal deaths reported through102, 5 maternal deaths have been audited.Districts have been asked to expedite theaudit of the remaining 7 maternal deathsreported through 102.The GoI guidelines have been substantiallymodified to cater to the State‟s needs.These have been incorporated into SPIP asthe State specific model and also for theguidelines of the Civil Surgeons and theProgramme Managers, as the SPIP is ahandy guidebook for them.Already done and commented upon.o 10 Medical Officers have been trained in2010-11.o Target 2010-11: Training of MedicalOfficers 21. Training of LTs 43.o Achievements 2010-11: 10 Medical Officerstrained and 18 LTs trained.13

o Planning for BSCs should be linked withtraining and FRU Operationalisation.o No budget has been earmarked. Pleaseensure establishment of BSCs and itslinkages with trained manpower,equipments and infrastructure.(G) RTI/STI TrainingState has planned RTI/STI training nodetails are provided.Trained service providers and supply ofdrugs to be linkedRTI/STI training should be as per GoIguidelines on RTIs/STIs and planned inconvergence with the SACS.Trained persons should be posted at thefacilities strengthened for RTI/STI.Budget should be kept for the monitoringof the trainingMATERNAL HEALTH PROCUREMENT• While provisioning for drugs, account maybe taken of central supplies of RCH Kits.• Comments on NRHM Support for freedrugs and supplies for LSCS and NormalDeliveries, given under FacilityOperationalisationOUTREACH ACTIVITIES: VHNDs/OthersVHND should be used for tracking lost/o Linkages with Operationalisation of FRUsand BSCs will be taken into account beforeestablishing BSCs.o Budget for training Rs. 3.84 lacs and forconsumables Rs. 2.50 lacs in 2010-11.o Budget for training Rs. 4.14 lacs and forconsumables Rs. 1.25 lacs in 2011-12.CTP of STI/RTI training is attached atAnnexure 1.Drugs will be supplied at facilities havingtrained service providers.RTI/STI training will be done as per GoIguidelines on RTIs/STIs and are beingplanned in convergence with the SACS asper CTP enclosed.Trained persons will be posted at thefacilities strengthened for RTI/STI.Budget for the monitoring of the traininghas been kept in the training plan bySIHFW.Already Commented UponNoted14

missed cases for ANC/PNC. Linking withthe MCTS and use of joint MCH card andSafe Mother Booklet is advisedHow will it be ensured that MOs actuallyreach all ORs. Who will be providingregular services at PHCs on the days whenMOs are involved in OR sessions.?Regular ongoing monitoring of VHNDsshould be done and funds may be kept forthis.It is not clear from the budget sheet if theamt. of 62.80 lakhs reflected against RCHOutreach Camps is the same as the 62.80lakhs reflected in the write-up against thebudget for Participation of 434 PHCs?In good functional PHCs, 2 MOs and 1Dentist are posted. MOs will prepare theiradvance tour programme and circulate copyto the concerned ANM, ASHA andChairman of VLC Committee and also toCivil Surgeon Office in advance. At PHCswhere 2 doctors are posted, when 1 doctoris away for Outreach sessions the otherdoctor will look after the services at PHCs.At PHCs where only 1 doctor is posted thenpharmacist, LHV and staff nurses willprovide the services. Moreover, the OPDservices are provided in the Outreachsessions as well.Regular ongoing monitoring of VHNDs isbeing carried out by way of various formatsand field visits by the district officers.Funds have been earmarked for monitoring.Now with the changed strategy, the VHNDswould get monitored by the MOs‟involvement in Outreach sessions andVHNDsYes, the amount of Rs.62.80 Lacs is forOutreach camps. This has been calculatedon the basis of participation of 434 PHCs.15

100/= per VHND can be sourced fromVHSC fundNo, every year the State is making separatebudgetary provision for VHNDs.Incentive for Staff Nurses and ANMs in difficult areas.Difficult Area Allowances may be budgeted Noted.under NRHM additionalitiesJachcha Bachcha Scheme (State initiative)• What are the outcomes of Jaccha Baccha Outcome of Jaccha Baccha Scheme isscheme. Has the State done any reflected in the increase of Govt.assessment?Institutional Deliveries specially at SubCentre, PHC and CHC level.• Why is a per case differential incentiveproposed for the service provider for thedelivery of a male child /female child? Theincentive is proposed for SBA trainedDifferential incentive proposed for theservice provider for the delivery of a malechild/female child is to promote genderequity and women empowerment. It can beservice provider? State may like to taken as a celebration for birth of a femaleelaborate on the objective?child, which is extremely important in thesocio cultural context of Haryana State.• Incentives to service providers should be Jaccha Baccha Scheme is a holisticlinked to benchmarks of performance , oncompletion of a range of activities toapproach which ensures the entire gamut ofmaternal and child health services includingdeliver services of qualityantenatal care, institutional deliveries,postnatal care and neonatal care. Incentiveis paid to the service providers only oncompletion of a range of activities todeliver services of quality and bench marksof performance have also been fixed.Incentive to DAIs (Traditional Birth Attendants)-• The State seems to have taken a good Yes, noted.initiative of using the Dais as a communityresource, however TBAs / Dais are not to16

e promoted as a primary provider fordelivery services and hence no training tobe given to them for conducting deliveriesas per GOI policy.• It is not understood why the AYUSH wingshould recommend training of TBAs asSBAs. The TBA cannot be trained in SBAskills. Funds should not be earmarked forthe same.• They may be suitably trained e.g.topromote ID and mobilize PW for ID ,orescort the PW for ID ,or as an assistant toANM to help her in sundry jobs at the subcentre.Any clinical role is to bediscouraged.• Incentives whether to ASHAs or Daisshould be linked to benchmarks ofperformance on a range of activities andnot on a per case basis.Human ResourcesPlacing of HR should be linked to the caseloads and location of facilities, and assuredavailability of drugs and supplied.Policy of rational deployment of serviceproviders after training to be enforced.PPP/Innovations/OthersDelivery Hut Scheme (Special State Scheme):-The State needs to clarify whether thedelivery huts are synonymous with MCHLevel 1 sub-centres?Noted.Noted.Incentive to ASHAs have been discussed atlength under ASHA programme.Yes, noted.Yes, noted.Replied already in previous paras.17

Is the appointment of the 3 rd ANM in placeof the Male Worker? Was this approved inROP of 2010-11?3 rd ANM is an additional staff support onlyfor 3 Delivery Huts/Sub-centres, which areperforming exceptionally well. It is not inthe place of male worker. This wasapproved in ROP of 2010-11.18

J a n a n i S u r a k s h a Y o j n aCommentFull ANC in the State has increased from 13.3 % (DLHS-III) to 42.9 % (CES-2009) which is almost a threefold increase; similarly the State has improved itsperformance w.r.t institutional delivery i.e. from 46.9 % (DLHS-III) to 63.3%(CES-2009).Comment State has reported an expenditure of 185.52 lakhs against an approval of Rs. 699lakhs i.e. an expenditure of 26.5 % till November 2010 which is very low. Stateneeds to explore the reasons for such a low rate of utilization of JSY budget andtake corrective steps to improve its financial performance.Reply:- Expenditure of 48.77% is reported till December, 2010.Comment State has not provided progress under institutional and home deliveries for 2011-12.Reply:-Breakup of projected institutional deliveries and home deliveries for JSYbeneficiaries is as follows:-Institutional DeliveriesHome Deliveries156339 24306The projection shows 6% increase in institutional deliveries over last year.Comment JSY estimates for 2011-12Home deliveries:Eligibility- BPL pregnant women aged 19 years of above upto two live births.Haryana has provided clear estimates for rural and urban home deliveries i.e.130283 and 65142 respectively and proposed a budget of Rs. 195.42 lakhs; byadding the total live births in BPL and SC. However, home delivery benefitunder JSY is only applicable to BPL pregnant women and not to the SC categorywomen. Thus the State needs to project the home delivery benefit only for theBPL category women which come to Rs. 112.97 lakhs for 22595 eligible BPLcategory women (considering 20% home deliveries). State needs to revise itsbudget accordingly19

Reply:-CommentRevised budget for home deliveries is as follows:-Total Number of expected Live births in BPL population 169970158004+11966 (Mewat)Approximate number of deliveries with 1 st and 2 nd children 121529(71.5% of 169970)No. of BPL Home Deliveries (20% of 121529) 24306Budget required (24306 x 500)Rs.121.53 LacsBudget for institutional deliveriesTotal Number of expected Live births in BPL and SC 273321populationApproximate number of deliveries with 1 st and 2 nd children 195425(71.5% of 273321)Approximate No. of Urban Deliveries (1/3 rd of 195425) 65142Approximate No. of Rural Deliveries (2/3 rd of 195425) 130283Approximate No. of Urban Institutional Deliveries52113(80% of 65142)Budget required (52113 x 600)Rs.312.68 LacsApproximate No. of Rural Institutional Deliveries104226(80% of 130283)Budget required (104226 x 700)Rs.729.58 LacsBudget for care by ASHA for institutional deliveries Rs.312.68 Lacs(200 x 156340)TotalRs.1476.47 LacsState Level administrative expenses (1% of the total) Rs.14.76 LacsDistrict Level administrative expenses (4% of the total) Rs.59.06 LacsTotal 1550.29Lump-sum budget provision for higher incentive for Rs.50.00District MewatGrand Total 1600.29However, the budget proposed is 60% of 1600.29 i.e. Rs.960.17 LacsInstitutional deliveries: State has provided clear estimations for institutional20

deliveries.Eligibility for Rural Institutional deliveries: All SC/ST women upto 02 livebirths and all BPL pregnant women aged 19 years or above upto 02 live birthsare entitled for Rs. 700 and ASHA for Rs. 200/-to facilitate institutionaldeliveries as per JSY guidelines.State has proposed Rs. 729.58 lakhs for 104226 ID in rural areas@ Rs. 700 per delivery.Eligibility for Urban Institutional deliveries: All SC/ST women upto 02 live births andall BPL pregnant women aged 19 years or above upto 02 live births are entitled for Rs.700 and ASHA for Rs. 200/-to facilitate institutional deliveries as per JSY guidelines.State has proposed Rs. 312.68 lakhs for 52113 ID in urban areas@ Rs. 600 per delivery.The State has budgeted Rs. 312.68 lakhs as incentive for ASHA for promotion ofinstitutional delivery in rural and urban areas @ Rs. 200 per delivery for 156340institutional deliveries.State has budgeted Rs. 77.51 lakhs towards administrative expenses.Proposed package of Rs. 1400 per institutional delivery per beneficiary in Mewat for anamount of Rs. 50 lakhs is not recommended for approval since JSY is a CentrallySponsored Scheme and guidelines as regards eligibility for Low Performing States andHigh Performing States are approved by the CCEA; as such any modification in thescheme requires approval from MSG of NRHM. State may fund this activity from itsown resources.Reply:-The matter was discussed in the sub group meeting. It was conceded by the GoI team thatMewat is a high focus district and should be treated at par with low performing States forJSY purposes. The State repeats its request for higher incentive under JSY for DistrictMewat.However, while computing the budget State has targeted all the institutional deliveriesinto government health facilities although as per the figures provided by the State 36%deliveries are in the Private sector which are not entitled for JSY benefit. State isrequested to revise its JSY budget as per the comments given above.21

Reply:-Noted. However, the State has already asked for only 60% of the total budget requiredunder JSY. This takes care of the 36% institutional deliveries in the private sectors. Thusthere is no surplus projection of JSY budget.State has proposed a budget of Rs. 1006.73 lakhs for 2011-12 which is 44 % higherthan the last year’s approval (Rs. 699 lakhs). State needs to modify its target forhome deliveries, urban & rural institutional deliveries and administrative expensesas per comments above and revise its budget accordingly.State needs to adhere to JSY guidelines while disbursing funds to eligible pregnantmothers and ASHA.There is a mismatch between the data reported by the State on Ministry‟s HMIS Webportal and the data reported in physical form to the Ministry. State needs to ensureaccuracy of data reported to MOHFW.NotedState needs to incentivize eligible beneficiaries under home delivery category as per JSYguidelines.NotedRecent visits of GOI members to the State revealed poor implementation of JSYguidelines in terms of display of beneficiaries‟ names at facilities, micro birth planning,grievance redressal system, payment of JSY incentives through account payee cheques,monitoring and physical verification of beneficiaries by district and State level authoritiesState needs to ensure 48 hour stay at facility, display of beneficiaries‟ names at facilities, microbirth planning, grievance redressal system, payment of JSY incentives through account payeecheques, monitoring and physical verification of beneficiaries by district and State levelauthorities etc.Reply:-Noted. Necessary action will be taken to remove the deficiencies22

URBAN RCHCurrent Status:2 Urban RCH hospitals have been set up in Faridabad which are functioning as full fledgedFRUs and cater to 10 lakh slum dwellers of the city.50 urban RCH centres have been set up in 21 districts of the State and 36 urban RCH centresare in the process of being set up.11 urban RCH centres are in the process of being converted into 24x7 delivery centres.Strategies for year 2011-12:Strengthening of all the 86 Urban RCH centres will be taken up in the year 2011-12.To convert the 11 urban RCH centres into 24x7 delivery centres two additional staff nursesand a night sanitary worker per centre will be recruited.New born corners will be set up in the given 11 RCH centres as per the strategy given underthe “Child Health” component.Performance appraisal system for the urban RCH centres shall be developed during the year2011-12 to ensure assured level of service delivery at these centres.Two new Urban RCH centres to be setup in the District Jhajjar and Hisar.Budget Proposal:The total budget proposed under Urban RCH for year 2011-12 is Rs 1316.39 lakhs.It includes the salary of contractual staff of the Urban RCH centres, the cost of drugs andother office equipment.Comments:The PIP does not include any provisions for recruitment of link workers and constitution ofMASs/SHGs.Reply:-According to the present design of the Urban RCH Scheme, the 2 ANMs posted in the UrbanRCH centres are required to carry out the extension work in Urban and Peri Urban Slums. They arerequired to act as link workers as well as extension workers. For the OPD activities, there is aprovision of 2 Medical Officers in each Urban RCH centre. Besides there is 1 pharmacist and 1laboratory technician in each Urban RCH CentreNo additional budget has been proposed for BCC/IEC activities in the urban areas.No funds have been earmarked for Monitoring & Evaluation activities in the budget.No funds have been allocated for conducting outreach health camps and immunization sessions.Reply:-23

A lump-sum budget provision of Rs.50,000/- per Urban RCH centre was made for procurementof miscellaneous items. The activities mentioned in the note of the GoI have now been listed forbudgeting from the said lump-sum budget grant.Out of the Rs 1084.06 lakhs approved for Urban RCH in the year 2010-11, only Rs 248.1lakhs have been spent till Sept 2010. The State may be asked to accelerate the expenditureand furnish the physical and financial reports urgentlyReply:-Till December, 2010, 69.95% expenditure is reported.24

RCH CommentsReply on CHILD HEALTH (comments from Child Health Division, MoHFW, GoI)Achievements 2010-11Proposed Target2011-12ProposedBudgetApproved Comments Reply1. IndicatorsIMR 51 (SRS 2009) 45 N/A N/A 54 (SRS 2008),decreasedNMR 34 (SRS 2008) Target notprovidedU5M 65 (SRS 2008) Target notprovided2. IYCFTarget notStrategiesprovidedExclusive breastfeedingrate up to six months is9.4% (DLHS 3)Complementary feedingrate at 6-9 months is 74.1%(DLHS 3)Breastfeeding initiationwithin 1 hour of birth is17.4% (DLHS 3)ASHAs are being givenincentive of Rs 25 for BFpromotion after makingthree post natal visits, IECthrough “Pakhwara”approach by SMS3. Diarrhoea Management StrategiesTreatment Not provided Target notprovidedN/A 34 (SRS 2007), static Target: 30N/A Data N/A Target: 62N/A N/A Data N/A (DLHS 2)Budget notproposedN/AData N/A (DLHS 2)17.4% (DLHS 2), staticWhat is the state‟sstrategy??Data not availableIYCF will beimplemented throughYasodha scheme in 3districts under FBNC.District level seminarswill be conducted allover the state forimplementation of IMSAct and promotion ofIYCF. In the home basesPNC, there are provisionfor birth preparednessvisit in 8 th month and 6PNC visits to everynewborn during whichearly and exclusivebreastfeeding would bepromoted throughcounselling.25

ORS usageIEC/ Awareness/Care seekingAchievements 2010-1131.7% children withdiarrhoea in the last 2weeks received ORS(DLHS 3)82.0% children withdiarrhoea sought treatment(DLHS 3)Proposed Target2011-12Target notprovidedTarget notprovidedZinc utilization Not provided in PIP Target notprovidedReferral Not provided in PIP Target notprovidedProposedBudgetBudget notproposedBudget notproposedBudget notproposedBudget notproposedApproved Comments ReplyN/A 32.3% (DLHS 2),decreasedN/A 78.4% (DLHS 2),increasedORS packets alreadyprovided through Kit„A‟ & „B‟. Target is toimprove the use of ORSusage to 80%. ORS is apart of Essential drug listof the State.IEC will be done withother child healthactivities.N/A N/A Camps will be organizedand zinc will bedistributed during thepeak season in districtsreporting high no. ofdiarrhoea . Zinc is a partof Essential drug list ofthe State.N/A N/A There is provision forfree transportation ofinfant till 28 days afterbirth and on paid basisfor other cases.4. ARI Program StrategiesTreatment atHSC/PHCData not available-childrenwith ARI in last 2 weeksgiven treatment (DLHS 3)8.3% Children sufferedfrom ARI in last 2 weeks(DLHS 3)Target notprovidedBudget notproposedN/AData not available10.8% (DLHS 2),decreasedUtilization ofCotrimoxazole is beingimproved in ARI cases.Inj. Ampicillin &Gentamycin is providedat all Health facilities fortreatment for ARI.Budget for purchase ofthese medicines in26

Achievements 2010-11Proposed Target2011-12ProposedBudgetApproved Comments ReplyGeneral Drug Budget.These medicines are partof EDL.Referral Not provided in PIP Target notprovidedIEC/ Awareness/Care seekingChildren with ARI soughttreatment 88.1% (DLHS 3)5. Vitamin A supplementation StrategiesImprove Vit A 46.3% children aged 9coverage / biannual months and above receivedroundsat least one dose of Vit. A(DLHS 3)Target notprovidedTarget notprovidedIEC Not provided in PIP Target notprovidedSupply 673577 (out of 1039000)given preventive Vit Asolution (Nov 2010) asmentioned in PIP page 113Chapter 2 part A6. IFA supplementation StrategiesImprove Coverage 82.5% children under 5with anaemia 6 to 35months (NFHS 3)Target notprovidedTarget notprovidedBudget notproposedBudget notproposedBudget notproposedBudget notproposedBudget notproposedBudget notproposedN/A N/A There is provision forfree transportation ofinfant till 28 days afterbirth and on paid basisfor other cases.N/A 78% (DLHS 2),increasedN/A 42.2% (DLHS 2),increasedIEC will be done withother child healthactivities.Vit „A‟ supplementationis being improvedthrough IBSY (Schoolphase & Anganwariphase). Budget proposedin IBSY (school health).Vit „A‟ is part of Kit „A‟& „B‟ and part of EDL.N/A N/A IEC will be done withother child healthactivities.N/A N/A Adequate supply of Vit„A‟ is there in state. Partof immunization strategyto provide preventiveVit „A‟ dose to everychild as per schedule.N/A83.9 (NFHS 2), slightlyreducedApart from regularsupply of IFA throughRCH kits, prophylaxis &27

Achievements 2010-11Proposed Target2011-12IEC Not provided in PIP Target notprovidedSupply534779 children given iron Target nottablets (small) from Apr- providedNov 2010 HIMS1021540 bottles of IFAsyrup distributed Apr-Nov2010 HIMS7. Facility based Newborn Care StrategiesSNCU2 established Mewat and(infrastructure, Faridabad and 6 will beequipment, HR, established by March 2011capacity building, (Target 10)utilization,protocols)NBSU(infrastructure,equipment, HR,capacity building ,utilization,protocols)NBCC(Infrastructure,equipment, HR,ProposedBudgetBudget notproposedBudget notproposed11 Rs 55 lacs isproposed forSNCURs 36 lacs isproposed for0 (Target 30) 36 NBSUN/A297 (Target 81 with warmerand 161 without warmer)mentioned page 114Total 40190 with warmerand 311 withoutRs 552 lacs isproposed forequipments for@ Rs 25 lac perSNCU and Rs 4lac per NBSUand Rs 0.87 lac28Approved Comments ReplyN/AN/Atreatment was providedto all anaemic childrenscreened during IBSY inschool & Anganwariphase.N/A N/A All children diagnosedfor Anaemia are beinggiven IFA tablets.Adequate supply isbeing ensured. BudgetRs. 3.0 crore providedby WCD dept. of Stateunder “Curb Anaemia”scheme for purchase ofIFA and is also part ofASHA kit.May beapprovedN/AN/A

capacity building ,utilization,protocols)Achievements 2010-11chapter 4 part AProposed Target2011-12warmerAs mentionedpage 126 chapter4 part A11 urban RCHcentres whichcould not beupgraded asNBCCs in 2010-11 would becovered in 2011-12ProposedBudgetper NBCC withwarmer and Rs0.17 lac perNBCC withoutwarmerRs 463.456 lacsfor staff salariesRs 11.76 lacs forsupport forcomputer, printerand consumablesApproved Comments Reply8. Malnutrition management StrategiesUnderweight/stunte Wasted 19.1% childrend/wasted(NFHS 3)16.7% as mentioned in PIPpage 113 (Chapter 2 part A)WHO growth charts forgirls & boys is incorporatedin MCH card this year soANM can identifymalnourish children forreferral & treatmentTarget notprovidedNRC 49 Target notprovided9. Training StrategiesIMNCI1441 ANM/ASHA/LHVstrained in IMNCI.Implementation started inRs 22.656 lacsfor new bornsurvival kitBudget notproposedBudget notproposedRs 5 lacs forIncrease3 times in 1 st IMNCI bookletsnewborns visited printing of 5000N/A Data N/A (NFHS 2) Workshop on WHOgrowth chart beingcoordinated by WCDdept. and proposed totake up monitoring onWHO growth chart.Counter foil of growthchart would now bemaintained even byANMs in Sub-centresN/A N/AMay beapprovedN/A29

F-IMNCIAchievements 2010-1113 districts.Total births: 29965Newborn visited with 24hours: 25730Newborns visited 3 times in10 days: 19297Total 522 MO/SNs trained(Target 3083)Training load for IMNCItrained 2125 and nontrainedis 928.Proposed Target2011-12week to 80%1625 ANMs andLHVs would betrained (65batches)Total 1600672 (42 batchesIMNCI trained)and 928 (58batches non-IMNCI trained)ProposedBudget@ Rs 100 perbooklet and Rs 1lac for printing of1000 IMNCISupervisorybooklets @ Rs100 per bookletRs 10.5 lac forsupportivesupervision isproposed @ Rs50000 for 21districtsBudget notproposedApproved Comments ReplySubject todiscussionKindly clarify exactnumber ofMO/SN/ANM/LHVsplanned to be trained in2011-12Budget & manpowerproposed under Traininghead by SIHFW,Haryana under head11.5.1.5.a & bNSSK1276 MOs and SNs trained(Target 2880)620 ANMs and LHVstrained (Target 4604)1600 MOs/SNsand 1312 ANMand LHVsplanned to betrained asmentioned page137 chapter 4,part A1600 (50 batches)1313 (41 batches)Target mentionedis 2496 asmentioned pageBudget notproposedSubject todiscussionKindly clarify exactnumber of ANMsplanned to be trained in2011-12Budget & manpowerproposed under Traininghead by SIHFW,Haryana under head11.5.5.1.2 & 11.5.5.1.430

HBNC10. Pre- ServiceIMNCIStrategies11. VHNDsStrategiesAchievements 2010-11ASHA module 6 th and 7 thstarted in 5 districts of thestate- Will beConducted in 3medical collegesVHNDs held 44745(planned up to Nov 2010were 48943)12. MCH centre StrategiesLevel III 16 identified as Level 3MCH CentresLevel II 70 identified as Level 2MCH CentresLevel I 146 identified as Level 1with warmer MCH centres463 identified as Level 1MCH centres13. Free Referral Free referral servicesTransport for provided to allsick new born malnourished and sickand children children14. Planning for HFD: 1Proposed Target Proposed2011-12 Budget137 chapter 4,part AHBPNC Each ASHAimplementation would be paid Rswill be done in 200 forall districts conducting 7Remaining 16 Home visitsdistricts would becovered forASHA module6 th and 7 thTarget notprovidedAll remainingdistrict hospitalswill be convertedto Level 3 MCHcentresTarget notprovidedTarget notprovidedTarget notprovidedBudget notproposedBudget notproposedRs 42 lacs isproposedBudget notproposedApproved Comments ReplyN/AIt has been mentionedthat budget forincentives is budgetedunder ASHA PIPN/A N/A Budget proposed underTraining Head.N/A N/A Budget proposed underMaternal Health.Subject todiscussionDetails of utilization of2010-11 budget andutilization for MCHCentres level 1,2 and 3is required1. Expenditure ofRs. 7249462/-has been donetill Jan 11.2. Equipments hasbeen ordered forvarious level ofhealth facilities(MNCH centres)N/A N/A All sick new born up to28 days are allowed freereferral transport in theState.31

HFD15. InnovationsAdvanced lifesupport trainingof MOsTraining ofPaediatrician, MOand SNs on NNFmodelChild SNCUhelplineYashoda healthvolunteer forIYCFAchievements 2010-11MewatNot provided in PIPProposed Target2011-12Target notprovided- All MOs andPaediatricians ofSNCU will betrained(Paediatricadvance lifesupport andNeonataladvanced lifesupport): 2batches with 20participants eachof NALS andPALS20 Doctors and80 SNs forobserver shipTarget for SNCUnot providedMobile phonesfor 4 consultantsof PGI CHD andRohtak and fundsfor mobilecharges8 YashodaProposedBudgetBudget notproposedseparatelyRs 2.1 lacs isproposed (Rs1.05 NALS & Rs1.05 lacs PALS)Rs 0.8 lac for 2state levelworkshop, Rs 7.8lac for 15 daysobserver shiptraining and Rs15 lac for SNCUtrainingRs 20000 (@ Rs5000 per mobile)and Rs 24000 (@Rs 500 per monthfor 4 mobiles)Total Rs 15.2lacsApproved Comments ReplyN/AMay beapprovedSubject todiscussionSubject todiscussionSubject todiscussionSubject toN/AN/APlease check previousyear ROPState should bear thecost of communicationand prioritize interests ofNRHMIs it supported by anyDevelopment partner(e.g. NIPI)All 21 districts to beupgraded for SNCUs.Target for SNCU hasbeen provided in PIP.There is no provision inState budget to providethis expenditure.Yes, the Yashoda yojnais supported by NIPI &NNF32

Verbal deathautopsy16. IEC Budgeton Childhealth17. Impactassessment (M& E)Achievements 2010-11Proposed Target2011-12volunteers to beemployed andDeployed in 3district hospitalsviz. Ambala,Panchkula andFaridabad (8hours shifts)Trainedsupervisor(retired nurse)work as YashodasupervisorTraining forYashodas andSupervisorsProposedBudget(Rs 100 perdelivery wouldbe paid toYashoda asincentive andRs 7500 permonth to trainedsupervisor)Rs 20000 trainingcost for 1 batchRs 21 lac isproposed forincentives toASHA and fieldverification andmeetings ANDRs 10 lacs fortraining andlogistics- - Rs 42 lacs isproposed- Rs 10 lacs wasallocated toschool of publichealth PGIChandigarhRs 10.5 lacs isproposedApproved Comments ReplydiscussionSubject todiscussionMay beapprovedSubject todiscussionBudget approved was Rs 850.51 lacs for 2010-11; expenditure till Sept 2010: Rs 17.92 lacs (2.1%)Is the training approvedby GOI?Budget breakup fortraining and logistics notprovided in PIP (Kindlycheck budget sheet formaternal health)N/AImpact assessmentreport of 2010-11 notprovidedThe training is to beapproved by GOIThe training for infantdeath audit is plannedwith trainings forMaternal deaths audit.Therefore not budgetedunder child health.Funds proposed in PIP isonly for Infant deathinvestigation & meeting.The modalities havebeen identified.Research teams forassessment are beingmade. The reporting willbe received during FY2011-12. Negotiationfor budget is going on.33

Family Welfare:S. No. Comments by Govt. of India Reply1 In the PIP (Page NO. 234) the State has mentionedthat training in Minilap is planned to increase theservice providers base; however, same has not beenreflected under training budget. The State may notethat minilap tubectomy is important because of itslogistical simplicity and requirement of only MBBSdoctors and not post graduate gynecologists/surgeons. The State may plan and budgetaccordingly.2 The state may assess the availability and budget forTOTs for NSV, laparscopic and minilap.3 The State has budgeted Rs. 88.36 Lakhs (A.3.3) asmobility support for monitoring. This seems to bevery high. The state may rationalize the budget.4 The State has not planned for accreditation of privateproviders for IUD insertion services. The State mayassess the availability of private facilities at districtand below level and if required the State may planand budget for the same.MTP and Minilap Tubectomy training areintegrated in the State of Haryana and assuch no additional Funds/Budgets arerequired for this purpose.TOTs for NSV and laparoscopic are alreadytrained and complete in Haryana. Noseparate funds are required for this purpose.17 Batches of 4 Doctors each will be trainedin NSV technique. A sum of Rs. 234175/-has been earmarked in training budget head11.6.3.2 for this purpose. The cost of eachtraining is Rs. 13775/-Mobility Support for Rs. 88.36 lacs hasbeen rationalize and reduce to Rs. 44.18 lacswhich is reflected in PIP budget sheet.Private Hospitals are not very keen inproviding IUD insertion services. They areprovided Copper-T free of cost by theDepartment but in actual practice theycharge money from beneficiaries and so notsubmit monthly reports. As such not muchcan be done and no additional budget isrequired for this purpose.34

5 State has budgeted compensation to ASHAs forensuring retention of IUD by clients – 3500 IUDinsertions @ Rs. 100 per month for 12 month. TheState may note that, follow-up for IUD retentionshould be at 3 months, 6 months and one year andRs. 100 may be proposed as an incentive to ASHA atthe end of one year and not on monthly basis. Budgetmay be revised accordingly.6 There is no information on utilization of privatefacilities for FP Services; private sector contributiontill 2009-10 is rather low (14.9% out of totalsterlization). This could be due to low data coverage.State may look at gathering data properly fromprivate facilities.Regarding compensation to ASHA workers,whole thing has been misread andmisinterpreted by GOI teams. Rs. 100/- permonth for 12 months has not beencalculated by the Department. This amounthas been proposed as incentive to ASHAworkers for motivation the IUD case,bringing her to health facility and gettingthe IUD inserted to her. Practically it notpossible to check the retention at 3 months,6 months and 12 months as it is humiliatingfor the beneficiaries to undergo three pervaginal examination. Budget does not needrevision as it is estimated that on an average3500 ASHA worker will being 12 cases in ayear. Maximum 42000 IUD cases can bemotivated by ASHA workers in a year. Asum of Rs. 42.00 lacs as proposed earlier issufficient.Regarding utilization of Private facilities forFP services due consideration will be givento the views express by GOI teams.However no extra budget is required for thispurpose.35

Comments of ARSH Activities1. Regarding the achievements and expenditure details is as under: -Check-List for ARSH Activities (Table 1)S. No. Activity Status1.2.1-day State Orientation Workshop forARSHState level Training of Trainers(3days)Workshop for Deputy Civil Surgeons conducted on29.09.10 and 9 participants attended the workshopfrom 9 districts covering ARSH Programme.Conducted in 2009-10, 188 Block ExtensionEducators and Counselors from SACS trained in TOTfrom 25 th May to 16 th June 2010.3. Printing of training Modules Available Training Modules were distributed.4. IEC for ARSH1. For Youth- Phone-in-Programme wasconducted on 20.01.11 on the AdolescentHealth.2. Pakhwaras – one 15 days programmefrom 1 st Jan to 15 th Jan in convergencewith HSACS in more than 6000 villages.3. Youth Festivals – 18.5. Helpline for ARSH To be started soon.6.Convergence with other programmes/departments (WCD, SACS, MoYAS,HRD)SACS – 1. Under Adolescent Education Programme(AEP)2. Counselors of SACS are trainers for training ofPEs. PEs for AEP and ARSH are also same in thevillages.WCD - Convergence under SABLA being planned.7. Other activities (pls specify)Establishment of AFHC (Adolescent Friendly HealthClinics) at 1-GH, 1-CHC and 2-PHC of a District,named as “Mitrata Clinics”. 36 clinics already startedfunctioning w.e.f. Dec. 2010.Detail report still awaited. Details will be sent afterconsolidation.Physical and Financial achievements till date (Table 2)36

Name of theDistt.AFHSStarted(4 PerDistt.)AdolescentattendingAFHS ClinicsTrainingof PEsMeetingof PEsYouthFestivalsFundsutilizedTill DateM FBhiwani Yes 244 Nil Nil Rs.27400/-Gurgaon YesJind Yes 230 4 Nil Rs.21800/-Sonepat Yes 162 2 Rs.152700/-Kurukshetra Yes 190 1 2 Rs.85585/-Panchkukla YesRewari Yes 84 Nil 2 Rs.79400/-RohtakYamunaNagarYesYes 77 93 250283 (PEs) + 3by LHVRs.38200/-* The detail report still awaited. Details will be sent after consolidation as AFHS clinics programmestarted in Dec. 2010.2. Achievements of PEs programmeThe response is provided in Table No. 23. Status of expenditure on ARSH and achievements of activitiesThe response is provided in Table No. 24. Training status(Table 3)Name of the Distt.Training StatusMOPEsRohtak 7Rewari 8 84Jind 8 230Sonepat 8 162Gurgaon 6Kurukshetra 9 190Yamuna Nagar 8 250Bhiwani 7 244Panchkula 637

Total 67(Table 4)Sr. No.Name of the Distt.Planning for 2011-12 (will be extended to all the 21Districts)MOANM/LHV/PEs1 Ambala 8 2502 Bhiwani 8 2503 Faridabad 8 2504 Fatehabad 8 2505 Gurgaon 8 2506 Hisar 8 2507 Jhajjar 8 2508 Jind 8 2509 Kaithal 8 25010 Karnal 8 25011 Kurukshetra 8 25012 Mewat 8 25013 Narnaul 8 25014 Palwal 8 25015 Panipat 8 25016 Panchkula 8 25017 Rohtak 8 25018 Rewari 8 25019 Sirsa 8 25020 Sonepat 8 25021 Yamunanagar 8 250Total 168 5250* ANM / LHV will be trained in ARSH along with other trainings conducted at Distt. level. ARSHtraining module will be distributed to them after TOT.AFHS ClinicsTotal District Hospital: 21District hospital with AFHS clinic: 9 per district = 36Planned AFHS clinic in DH in 2011-12: 84(Table 5)38

NameofDistrictPHC withAFHS clinicAFHS at CHClevelAFHS at GHlevelRohtak 2 1 1Rewari 2 1 1Jind 2 1 1Sonepat 2 1 1Gurgaon 2 1 1Kurukshetra 2 1 1Yamunanagar 2 1 1Bhiwani 2 1 1Panchkula 2 1 1AFHS clinicsplannedfor2011-12All the 21districts willhave 4 AFHSclinics.Total AFHS Clinics established in 2010-11 – 36AFHS Clinics Planned for 2011-12 – 845. The linkages with ICTC counselors have already been established. Medical Officers alreadyconducting outreach for Adolescent and school children under “Indira Bal Swasthya Yojna”.719812 number of Adolescent were screened for diseases deficiency and disability in the year2010-11 under “Indira Bal Swasthya Yojna”, the programme will continue. Children with anemiaand other diseases were given appropriate medicines or referred to higher institutions fortreatment.6 Caseloads at the functional clinics and classification of services sought by AdolescentFrom “Indira Bal Swasthya Yojna”, it was seen that most of the Adolescents had problems relatedto Malnutrition, Skin disorders, Taboos related to reproductive and sexual health (specially ingirls a problems related with menstrual cycle).7. Scheme for promotion of Menstrual Hygiene.The scheme for promotion of menstrual hygiene has been taken up separately under Mother andChild Health. Details have been provided under that section.8. ARSH component for Urban RCHARSH component for Urban RCH will be included in coordination with Urban RCH facilitiesfunctionally.39

Comments on Training PIP 2011-12TRAININGSComprehensive Training PlanComprehensive Training Plan (CTP) for 2011-12 of Haryana State for trainings underNational Rural Health Mission has been included in the PIPA separate chapter on Training and Capacity Building for the trainings under RCH hasbeen included in the PIP with specific budget heads.Differential planning for High Focus Districts (11 districts) and budget allocation to thesehave not been indicated in the PIP. Differential planning for High Focus districts andbudget allocation to these has been clearly indicated in Annexure 3e.Strengthening Of Training InstitutesThe state‟s proposal is to equip new conference room with video conferencing facility inthe FY 2011-12 to make training more participative & interactive in an effort to makeSIHFW a „State of the Art Institution‟ with connectivity of SIHFW with 21 DTCs.Renovation of RHFWTC: The State has proposed that the hostel of RHFWTC is a veryold building and needs repair and renovation so that the participants get goodaccommodation within the campus at nominal charges. No new funds have beenproposed for the renovation of RHFWTC for want of SOEs and UCs of the fundsreleased during the previous 2 years. Renovation is in process.Other Trainings and CoursesPIP states that SIHFW is sponsoring clinicians for the PDC course being conducted atNIHFW New Delhi.40

SIHFW is also sponsoring clinicians to undergo short courses in management beingconducted at other training institutes like, HIPA, PGIMER Chandigarh, GMCH Sector -32 Chandigarh.Maternal HealthRemarksThe training load for MTP of MOs is given as 185 in chapter 4 " Maternal Health" on pageno. 89, However the training load for the same has been mentioned as 120 in the table"Comprehensive Training Plan on page no. 303, state needs to clarify the actual training load.The training load of 120 provided in the Comprehensive training plan is as per the actualtraining load obtained from all the 21 districts of Haryana.Combined load and achievement has been given for SBA and IMEP training, State needs toprovide the segregated load and achievement for 2010-11. IMEP has been integrated withSBA training since 2008-09. Therefore, the load and achievement have been combined.Child HealthRemarksThe training achievement for FIMNCI TOT, FIMNCI and IMNCI plus Immunization ofMOs for the year 2010-11 has not been provided, but training load and budget have beenmentioned. No training has been planned for 2011-12. The load of ToT F-IMNCI havealready been completed. 104 ToTs are available in the State. A total of 621 MOs and SNshave been trained in F-IMNCI till Q-III of FY 2010-11. IMNCI training for MOs was notapproved in the ROPs of PIP received from GOI. Therefore, not conducted. IMNCI traininghas been imparted to 1441 ANM/SN/ASHAs. In total 7216 ANM/SN/ASHAs have beentrained in IMNCI till date, out of which, 3563 are ANMs. The plan of FIMNCI and IMNCIfor FY 2011-12 is as under:-BudgetHeadName ofTrainingCategory ofParticipantsTrainingloadTrainedtill dateTrainingload to becovered in2011-12Amount inRs.11.5.1.2 IMNCItraining forANMs/LHVsANMs/LHVs4989 3563 1625(65B) 7839650.0041

BudgetHeadName ofTrainingCategory ofParticipantsTrainingloadTrainedtill dateTrainingload to becovered in2011-12Amount inRs.11.5.1.5.aFIMNCItrainingfor IMNCItrainedMOs/SNs/PHNsMOs/SNs/PHNs2125 522 672(42B) 2314200.0011.5.1.5.bFIMNCItrainingfor IMNCInontrainedMOs/SNs/PHNsMOs/SNs/PHNs928 0 928 (58B) 5917160.00Family PlanningRemarksThe training achievement has not been provided for the trainings Minilap and MTP for MOs.Progress so far indicates that 231 MOs have been trained in Minilap and 202 MOs have beentrained in MTP.Disease Control ProgramRemarksIn PIP 2011-12 on Page no. 658 the training load for RNTCP training for MO has beenmentioned as 210, however the training load for the same has been given as 300 inComprehensive Training Plan on page no.308, State needs to clarify the actual training loadfor 2011-12. As received from DD (RNTCP).No training achievement has been provided for the training NVBDCP and RNTCP Retrainingfor MO for the year the year 2010- state needs to clarify about the inclusion ofbacklog of the year 2010-11 in the training load for the year 2011-12. As received from DHS(Malaria) & DD (RNTCP)42

FEEDBACKThe trainings as proposed in various sections have been identified and presented in theproposed CTP and attached as a separate file for review, providing additional informationas indicated and confirm. (Proposed CTP for 2011-2012) the state needs to complete themissing information.There is also need for a calendar to ensure coverage of the identified training load for allthe training included in their PIP43

NRHM Part BSr. Name of the Main Name of the Sub Comments/Observations of the Reply/Justification of the StateNo. Component Component MoHFW (GoI)1 Child Health IYCF What is the state‟s strategy? ASHA will take care of this activity duringPNC visits and during Home Based PostNatal Care (HBPNC) protocol.BCC activities are already being conductedby the SMS Groups under IEC Strategy.2 Family Planning IUD Insertion State has budget for 3500 IUD Under State strategy, ASHAs have to carryinsertions @ Rs. 100 per month for 12 out the follow-up of IUD retention for amonth; state may note that, follow-up maximum of 6 months.for IUD retention should be at 3Payments to ASHAs are being made after 6months of IUD retention and not on monthlymonths, 6 months and one year and Rs.basis.100 may be proposed as an incentive toASHA at the end of one year and noton monthly basis. Budget may berevised accordingly.3 NRHM Part-B:ARSH4.1 NRHM Part-B:Untied FundsMenstrualHygiene SchemeUntied Fund forSub CentresThe scheme for promotion of menstrualhygiene may please be budgeted as perthe operational guidelines.Two districts will be supplied packs ofnapkins through the tender route.The budgeting for the other districtsmay be done accordingly.The state has proposed an amount ofRs. 263 lakhs for 2630 SCs under thecurrent plan. Whereas the Core Activity44The operational guidelines have not yetbeen received. Therefore, the budget hasbeen proposed as per the ongoing Schemeon Social Marketing of Sanitary Napkinsalready operational in the State.Budget will be revised, if need be, as andwhen the clear guidelines for launching thenational programme are received by theState.Presently 2630 SCs are functional in theState. The funds have been proposedaccordingly in the current PIP. The Core

Sr.No.Name of the MainComponentName of the SubComponent4.2 Untied Fund forCHCs4.3 Untied Fund forPHCsComments/Observations of theMoHFW (GoI)Sheets RHS/MIS data for MissionFlexi-pool under NRHM reports thenumber of existing SCs as 2565.The clarity on the latest number offunctional SCs is required from thestate.The utilisation of untied fund for SCsfor the FY 2010-11 is 43.45 %.The state is also requested to givereasons for low utilisation of thesefunds.The state has proposed an amount ofRs.51 lakhs for 102 CHCs.Whereas the Core Activity Sheets RHS/MIS data for Mission Flexipool underNRHM reports the number of existingCHCs as 93.The clarity on the latest number offunctional CHCs is required from thestate.The utilisation of untied fund for CHCsfor the FY 2010-11 is 46 %.The state is also requested to givereasons for low utilisation of thesefunds.Reply/Justification of the StateActivity Sheet RHS/MIS data might havenot been updated. Hence there is a gap inthe figures.The utilization of untied funds of the SCsgenerally picks up in the III and IVQuarters. Budget Utilization will certainlyincrease substantially.Presently 102 CHCs are functional in theState. The funds have been proposedaccordingly in the current PIP. The CoreActivity Sheet RHS/MIS data might havenot been updated. Hence there is a gap inthe figures.The utilization of untied funds of the CHCsgenerally picks up in the III and IVQuarters. Budget Utilization will certainlyincrease substantially.The state has proposed an amount of Presently 343 PHCs are stand-alonefunctional in the State. The funds have been45

Sr.No.Name of the MainComponentName of the SubComponent4.4 Untied Fund forSDHs5.1 NRHM Part-B:AnnualMaintenance GrantAnnualMaintenanceGrant for CHCsComments/Observations of theMoHFW (GoI)Rs. 85.75 lakhs for 343 PHCs. Whereasthe Core Activity Sheets RHS/MIS datafor Mission Flexi-pool under NRHMreports the number of existing PHCs as437.The clarity on the latest number offunctional PHCs is required from thestate.The utilisation of untied fund for PHCsfor the FY 2010-11 is 39.40 %.The state is also requested to givereasons for low utilisation of thesefunds.The state has proposed an amount ofRs. 11 lakhs for 22 SDHs.The clarity on the latest number offunctional SDHs is required from thestate.Are these SDHs calculated as CHCs inthe current plan?The State has proposed an amount ofRs. 102 lakhs for 102 CHCs. Whereasthe Core Activity Sheets RHS/MIS datafor Mission Flexi-pool under NRHMreports the number of existing CHCs ingovernment building as 85.46Reply/Justification of the Stateproposed accordingly in the current PIP.The Core Activity Sheet RHS/MIS datamight have not been updated. Hence there isa gap in the figures.The utilization of untied funds of the PHCsgenerally picks up in the III and IVQuarters. Budget Utilization will certainlyincrease substantially.Presently 22 SDHs are functional in theState. The funds have been proposedaccordingly in the current PIP. The CoreActivity Sheet RHS/MIS data might havenot been updated. Hence there is a gap inthe figures.The SDHs are an independent entity. NoCHCs have been considered as SDH in theState.Presently 102 CHCs are functional in theState. The funds have been proposedaccordingly in the current PIP. The CoreActivity Sheet RHS/MIS data might havenot been updated. Hence there is a gap inthe figures.Most of the non-government CHC buildings

Sr.No.Name of the MainComponentName of the SubComponent5.2 AnnualMaintenanceGrant for PHCsComments/Observations of theMoHFW (GoI)As the support of AMG is given only tothose health facilities which arefunctioning in government building, theclarity on the latest number offunctional CHCs in governmentbuilding is required from the state.Also the state is requested to clarifywhether the SDHs are included in thiscategory of CHCs?The utilisation of Annual MaintenanceGrant for CHCs for the FY 2010-11 is40.77 %. The state is also requested togive reasons for low utilisation of thesefunds.The State has proposed an amount ofRs. 1071 lakhs for 343 PHCs. Whereasthe Core Activity Sheets RHS/MIS datafor Mission Flexi-pool under NRHMreports the number of existing PHCs ingovernment building as 306.As the support of AMG is given only tothose health facilities which arefunctioning in government building, the47Reply/Justification of the Stateare being used without any rent payment, asthe same belong to the Village Panchayats.It is extremely important to maintain thesebuildings in order to keep them fullyfunctional. It should be appreciated thatPanchayats come forward to give theirbuildings to the Health Department. TheGovernment can not avoid the responsibilityof bearing the cost of maintenance of thesebuildings. Moreover, it is not possible forthe Government to create its owninfrastructure on such a large scale in a shorttime. Therefore, the demand of AMG for allthe buildings is justified and must beaccepted.No SDH is included in the category ofCHCs.The utilization of AMG of the CHCsgenerally picks up in the III and IVQuarters. The budget utilization willcertainly increase substantially.Presently 343 PHCs are functional as standalonePHCs in the State. The Core ActivitySheet RHS/MIS data might have not beenupdated. Hence there is a gap in the figures.Most of the non-government PHC buildingsare being used without any rent payment, asthe same belong to the Village Panchayats.It is extremely important to maintain thesebuildings in order to keep them fullyfunctional. It should be appreciated that

Sr.No.Name of the MainComponentName of the SubComponent5.3 AnnualMaintenanceGrant for SCsComments/Observations of theMoHFW (GoI)clarity on the latest number offunctional PHCs in governmentbuilding is required from the state.The utilisation of Annual MaintenanceGrant for PHCs for the FY 2010-11 is21.61 %. The state is also requested togive reasons for low utilisation of thesefunds.The state has proposed an amount ofRs. 263 lakhs for 2630 Sub Centres.Whereas the Core Activity SheetsRHS/ MIS data for Mission Flexi-poolunder NRHM reports the number ofexisting Sub centres in governmentbuilding as 1502.As the support of AMG is given only tothose health facilities which arefunctioning in government building, theclarity on the latest number offunctional Sub centres in governmentbuilding is required from the state.The utilisation of Annual MaintenanceGrant for Sub centres for the FY 2010-48Reply/Justification of the StatePanchayats come forward to give theirbuildings to the Health Department. TheGovernment can not avoid the responsibilityof bearing the cost of maintenance of thesebuildings. Moreover, it is not possible forthe Government to create its owninfrastructure on such a large scale in a shorttime. Therefore, the demand of AMG for allthe buildings is justified and must beaccepted.The utilization of AMG of the PHCsgenerally picks up in the III and IVQuarters. The budget utilization willcertainly increase substantially.Presently 2630 SCs are functional in theState. The Core Activity Sheet RHS/MISdata might have not been updated. Hencethere is a gap in the figures.Most of the non-government SC buildingsare being used without any rent payment, asthe same belong to the Village Panchayats.It is extremely important to maintain thesebuildings in order to keep them fullyfunctional. It should be appreciated thatPanchayats come forward to give theirbuildings to the Health Department. TheGovernment can not avoid the responsibilityof bearing the cost of maintenance of thesebuildings. Moreover, it is not possible forthe Government to create its owninfrastructure on such a large scale in a short

Sr.No.Name of the MainComponentName of the SubComponent5.4 AnnualMaintenanceGrant for SDHs6 NRHM Part-B:SKS Corpus GrantCorpus Grants forHMS/SKSsComments/Observations of theMoHFW (GoI)11 is 16.52%.The state is also requested to givereasons for low utilisation of thesefunds.The state has proposed an amount ofRs. 22 lakhs for 22 SDHs. The clarityon the latest number of functionalSDHs is required from the state. Arethese SDHs calculated as CHCs in thecurrent plan?The proposal for untied fund is notseparately mentioned for SDHs.Confusion regarding the exactfunctional SDHs should be clarified bythe state.The state has proposed an amount ofRs. 102 lakhs for 102 CHCs. Whereasthe Core Activity Sheets RHS/MIS datafor Mission Flexi-pool under NRHMreports the number of existing CHCswhere RKS is registered as 93.As the support of RKS is given only tothose health facilities where RKS areregistered, the clarity on the latestnumber of CHCs in with registered49Reply/Justification of the Statetime. Therefore, the demand of AMG for allSC buildings is justified and must beaccepted.The utilization of AMG of the SCs generallypicks up in the III and IV Quarters. Thebudget utilization will certainly increasesubstantially.Presently 22 SDHs are functional as anindependent entity in the State and theAMGs have been proposed accordingly inthe current PIP.No CHC is included in the category of SDH.Proposal of the untied funds for the SDHshas also been made in the current PIP.The total budget projected is Rs. 22.00 lacs.Presently 102 CHCs are functional in theState. The funds have been proposedaccordingly in the current PIP. The CoreActivity Sheet RHS/MIS data might havenot been updated. Hence there is a gap inthe figures.100% RKS/SKSs have been registered atCHC level and budget has been proposedaccordingly in the current PIP.No SDH is included in the category ofCHCs.

Sr.No.Name of the MainComponent7 NRHM Part-B:Panchayati RajInitiativesName of the SubComponentCapacityBuilding ofMembers ofPRIs, RKS/SKSsand VHSCsComments/Observations of theMoHFW (GoI)RKS is required from the state.Also the state is requested to clarifywhether the SDHs are included in thiscategory of CHCs?The utilisation of RKS Grant for CHCsfor the FY 2010-11 is 44.75 %. Thestate is also requested to give reasonsfor low utilisation of these funds.A lump sum budget of Rs. 50 Lakhs isproposed for the FY 2011-12 for thecapacity building of members of theSwasthya Kalyan Samitis (SKS), PRIsand Village Health & SanitationCommittees (VHSCs) to be done onpilot basis in five districts of Haryanai.e.. Bhiwani, Jhajjar, Mewat, Palwal& Narnaul.- According to the PIP, Chapter-4(Part-B, under B.8, i.e. PRI), thebudget for this activity has beenreflected in the component B.3.4. butaccording to budget sheet thiscomponent B.3.4. reflects AMG forSDH which doesn‟t include thebudget for Capacity Building of PRIsand members of SKS/VHSC.- According to Chapter-1(OutcomeAnalysis), the budget for PRI has notReply/Justification of the StateThe budget utilization picks-up in the IIIand IV quarters.This is a clerical error. The budget hasbeen rightly booked under B.8.2 and notunder B.3.4.The budget for the capacity building andtraining of the PRI/VHSC/SKS memberswas projected in the State PIP of the lastyear as well @ Rs. 10.00 lacs, which wasdully approved in the RoP received from theGoI. Due to the lesser sanctions by the GoIon the overall budget projection of the Statein the year‟s PIP some re-appropriation ofbudget was made by the State keeping inview the high priority areas.It was without saying that there is a need forthe capacity building of the communitymembers for enhanced communityparticipation in the health programme.Therefore, a lump sum budget demands @Rs. 50.00 lacs has been made in the StatePIP of the current year.It is not possible to give a detailed break-upof the proposed amount at this stage as the50

Sr.No.Name of the MainComponent8 NRHM Part-B:VHND9.1 NRHM Part-B:New initiatives/New InnovationsName of the SubComponentVillage Health &Nutrition Day(VHND)ComprehensiveBest VillageHealth SchemeComments/Observations of theMoHFW (GoI)been approved for both the previousyears (FY2009-10 & 2010-11)- We may ask the state to provide : Justification of the amount 50 lakh. Detailed break-up of proposedamount. For IEC, there is a separate budgetproposal, so the amount for theIEC cannot be proposed here. The proposed amount may notbe approved.The proposed budget of Rs 75 lakhs forVHND is booked under MaternalHealth Component No. A 1.3.2.There are 6280 VHSCs in the State,VHN day is required to be conductedonce a month by each VLC-cum-VHSC in their village on rotation.State may be asked to provide details: Which activities they have plannedto do? Where to spent the money, as forconducting activities under VHND,like immunization, they get thevaccines from DH, ASHA‟s get theincentives.The state has asked 25 lacs rupees forcomprehensive best village healthscheme. The scheme is generally runReply/Justification of the Statetraining module has not yet been finalized.The budget proposed is only for the capacitybuilding and trainings and not for IEC. Themention of IEC material in the write-up isstrictly in respect of the IEC/trainingmaterial to be provided to the trainees andnot for general IEC purposes.The proposed amount should therefore beapproved.Celebrations of the VHNDs have beenconverged with the RCH Outreach Campsin the current PIP. Therefore, the budget hasbeen reflected under Maternal Health.Strategy for celebration of the VHNDs andthe activities to be planned are wellillustrated in the write-up of the current PIP.The budget projected for the VHNDcelebrations is for the miscellaneousexpenses incurred on organizing theVHNDs which also includes the expenditureon light refreshments for the pregnantwomen. Mothers and children who come toparticipate.The expenditure details are being collected.It is towards the end of the year that theperformance of the villages can be evaluatedand the selection for the reward can be51

Sr.No.Name of the MainComponentName of the SubComponent9.2 Treatment toHemophiliaPatients10 NRHM PART B:ASHAASHAPROGRAMMEComments/Observations of theMoHFW (GoI)by rural division in most of the states.So state may be asked for theclarification regarding coordinationwith Rural division that whether thereis coordination between 2 divisions ornot regarding the scheme.Also the expenditure details forFY2010-11 are sort.The state has proposed Rs 15000 perepisode of hemophilia. They may beasked for the justification of the costingper episode. Also, the disease burdenneeds to be detailed by the state.Comments from the NHSRC:The ASHA section has been drafted wellwith a lot of detailing on the strategies.Gaps in the programme have been clearlyidentified and action to be taken on thesame has been outlined. The followingare some observation andrecommendations for the consideration ofthe state:State has so far trained 42% ASHAsin module 5. The training of allASHAs in Module 5 needs to becompleted at the earliest.The PIP mentions that the Module VI52Reply/Justification of the Statefinalized.Requisite details are already given in thewrite-up.100% ASHAs will be trained up to theModule-V by the end of the current FY.Further training under new strategy, i.e.Home Based Post Natal Care (HBPNC)(Module VI-VII modified) will also becompleted under Phase-I up to the ASHAslevel in the State by end of the current FY.Brief strategy under the modified version ofModule VI-VII has been incorporated in thecurrent PIP and detailed Modules will beshared with the MoHFW.Though, the State is providing trainingsunder HBPNC, still the NHSRC modulesVI-VII will also be utilized for furthercapacity building of the ASHAs. Therefore,the State will send the Master Trainers for

Sr.No.Name of the MainComponentName of the SubComponentComments/Observations of theMoHFW (GoI)and VII have been modified. Themodified versions may be shared withMoHFW to ensure that they have thespecific skills in place for preparingthe ASHAs for post partum car.The plan of the state and the effortsput for training 14000 ASHAs inappreciable. However, in the absenceof full time trainers, it would be achallenge to do so. The state needs toput in place full time trainers in placefor achieving this task.It is not clear from the PIP, if NGOshave been involved in supporting andhandholding the ASHAs.The PIP states that ANMs would beutilised for supporting the ASHAs.Since the ANMs are alreadyoverloaded with their own extensivetasks, it will be good to involveNGOs in this area.State needs to put in place urgently,ASHA support structure at the state,district and sub district level forstrengthening the programme andensuring that it is sustainable.Many new ASHAs have beenReply/Justification of the Statethe State ToT.BTFs are in place as the full time trainersfor ASHAs in the field; still specific fulltime trainers are being identified for futuretrainings.Currently NGOs are not being involvedunder the ASHA trainings in the State.To provide support to the ASHAProgramme, a Community Processes Unithas been set-up at the NRHM State HQincorporating 2 MOs from the field andState NGO Coordinator. The CommunityProcesses Team is looking after the ASHAProgramme under direction of the DirectorNRHM.Additionally, 04 posts of the Managers(Community Processes) have been proposedin the current PIP to be appointed at theRegional level to extensivelymonitor/supervise and support the ASHAProgramme in the State.Modular Trainings for newly appointedASHAs and provision of Refresher /Orientation for low performing ASHAshave already been made by the State in thecurrent PIP.53

Sr.No.Name of the MainComponentUpgradation ofCHCs, PHCs, Dist.Hospitals to IPHSName of the SubComponentComments/Observations of theMoHFW (GoI)reportedly appointed to fill the gap ondormant / non performing ASHAs.An orientation and training planneeds to be prepared for the newASHAs. State may start the trainingof the new ASHAs with the 5 th , 6 thand 7 th module instead of startingfrom Module 1.An amount of Rs. 500 lakhs are proposedduring the current plan for up gradationof CHCs, PHCs, Dist. Hospitals to IPHS.Further details on this plan are requiredfrom the state with DPR (DetailedProject Report) with the strategy andtime schedule details of up gradationactivities. As per ROP FY 2010-11 theamount approved for up gradation ofCHCs, PHCs, Dist. Hospitals to IPHSwas 200 lakhs out of which only 38.45lakhs has been utilised till September2010. The state is requested to givedetails on the status of up gradationactivities for the year 2010-11and thereason for low utilisation.Reply/Justification of the StateRs. 500.00 lacs is demanded for makingprovision of essential equipments and theirmaintenance in the District Hospitals, CHCs,PHCs and Sub Centres with the view to fillthe gaps. This amount also include for makingprovision of critical manpower and specialistson contractual basis. The utilization ofNRHM funds for the year 2010-11 was slowbecause the State Govt. had spent a sum ofRs. 100.00 crores from the State Budget forupgradation of District Hospitals as per IPHSthat include machinery, equipments,infrastructure and manpower. It is expectedthat the State will utilize the entire fund. Thebudget has been reflected in Component No.B.16.1.5 (Procurement)ComprehensiveBest Village HealthSchemeThe state has asked 25 lacs rupees forcomprehensive best village healthscheme. The scheme is generally runby rural division in most of the states.So state may be asked for theThe scheme is implemented through VillageHealth and Sanitation Committee which is apart of Village level committee of Womenand Child Department. The detail feedback isreceived from SMS (Shaksar Mahila Smooh)54

Sr.No.Name of the MainComponentName of the SubComponentComments/Observations of theMoHFW (GoI)clarification regarding coordinationwith Rural division that whether thereis coordination between 2 divisions ornot regarding the scheme.Also the expenditure details forFY2010-11 are sort.Reply/Justification of the Stateof WCD and ASHA. However, the during theyear 2010-11 the scheme could not beimplemented in the effective manner. Hence,the expenditure under this head wasnegligible.ContinuingMedical Education(CME)Augmentation ofHealth Care inMewat AreaThe state has proposed 5 lacs rupees forCME. The state needs to give the properplan and location (whether it is ingovernment institute, within governmentstructure or in corporate scenario) toconduct CME.The state needs to justify the need ofspecial immunization strategy and thecompleted budgeted plan along withtime line and with the immunizationstatus of the area.Also, the state needs to justify thehigh costing of this activity. Also thejustification regarding hiring 111MPHW (big number) is sort.State has proposed the activities in and withinthe Govt. structure.A sum of Rs. 34.56 lacs is demanded forspecial immunization strategy in the MewatDistrict as it is a most backward district inthe State.111 Nos. of Multi Purpose Health Worker(Male) is demanded in the Mewat Districton the basis of advice received fromMinistry of Health & Family Welfare, GoI.Also, the state has mentionedconsolidated budget of 145.6 lacsrupees for Augmentation of HealthCare in Mewat Area in detailedsummary while in budget sheet, theyhad proposed rs 180.22 lacs. So thestate needs to clarify this as well.The Total budget of augmentation of healthcare in Mewat is Rs. 180.22 Las instead of145.60 Lacs.55

Sr.No.Name of the MainComponentSetting up ofPhysiotherapyUnit:Cancer ControlProgrammeTreatment toHemophilia Patients:Name of the SubComponentComments/Observations of theMoHFW (GoI)The state has proposed 28.80 lacsrupees for physiotherapy units. Thestate needs to mention the alreadyexisting physiotherapy units in thestate and the burden of diseases suchas paralysis, Cerebral Palsy and Orthocases.State may be asked to provide thedetails of expenditure onPhysiotherapy units in Chapter-1(Outcome Analysis), details are notgiven.As per the guidelines, the NonCommunicable diseases are not under theambit of NRHMThe state has proposed Rs 15000 perepisode of hemophilia. They may beasked for the justification of thecosting per episode.Also, the disease burden needs to bedetailed by the state.Reply/Justification of the StateThe State Govt. has Physiotherapy Units in its20 District Hospitals. District Hospitalsnamely Gurgaon, Faridabad, Panchkula,Bhiwani, Sonepat, Rothak and Hisar had beenupgraded as per IPHS with modernphysiotherapy units. A sum of Rs. 28.80 Lacsis demanded for hiring of Physiotherapistsunder NRHM. The expenditure uptoDecember 2010 is Rs. 3.31 Lacs.Cancer care unit in GH Gurgaon was startedas innovative scheme under NRHM toprovide cancer care services to the needypatients of the area. Trained on co surgeonalongwith his dedicated team is deliveringthese services. Provision for honorarium tothe paramedical staff and medical staff wasmade under it and mentioned in the PIP 2010-11 and 2011-12 also. To supplement the Stateefforts provision for honorarium to thesupplementary staff may be made. It is anongoing activity.The details have been given in the write up.There are 400 patients till December, 2010 inthe State, out of which 254 are registered withDepartment and smart card has been issued tothem.56

Sr.No.Name of the MainComponentPlanning,Implementation andMonitoring:-Name of the SubComponentComments/Observations of theMoHFW (GoI)In the financial year 2011-12proposed amount for planning,implementation and monitoring is981.77 lacs. Out of this stateproposed Rs.108.24 lacs forcommunity monitoring. but did notmention activities which they wouldlike to do for planning, andimplementation.State should give all details ofnumber of workshop, conferencesand other activities with therespective time frame.Reply/Justification of the StateThe activity is an overlapping activity andbudgetary provision has been made underrespective components. So no budget is proposedunder this component. This activity will be takenin an integrated manner for monitoring of variousprogrammes under NRHM.57

Comment : Oral HealthIEC: the state has already asked the budget for IEC activities under an independent head.Reply: Compliance has been made.Comments: Strengthening Procurement Cell and Regional Drug Warehouses:-Reply: In the Financial year 2011-12 a sum of Rs. 243.97 lacs is proposed for strengthening ofexisting infrastructure of warehouses and construction of new warehouses. The breakup is asunder:Sr. At State HQ Unit + Amount Requirement ofNo.funds1 Director, IPD 1x12x90000 10800002 Sr. Consultant Equipment 1X55000X12 660000Procurement & Maintenance3 4 No. Bio Medical Engineers (one 4 X 20000 X 12 960000each at Divisional level)4 Pharmacist 2 X 10500 X 12 2520005 Computer Assistant cum Data Entry 2 X 9000 X 12 216000OperatorAt Each District HQ6 Renovation of warehouse and4200000purchase of tool kits @ Rs.2.00 lacsper district.7 Additional Pharmacist 10500X 12 X 21 26460008 2 Computer Assistant 8800 X 2 X 12 X 4535200219 21 Bio Medical Engineers 16500x21x12 415800010 Purchase of 6 nos of Computer & 50000x6= 300000Accessories11 TA/DA of Bio Medical Engineers 62400012 Training and Capacity Building @210000Rs. 10000/- per district13 Software Development integrated2000000with PromisA. Total Amount 21841200New Posts Proposed for setting up of Procurement Wing1 Procurement Officer (Doctor) 1x40000x9 36000058

Sr. At State HQ Unit + Amount Requirement ofNo.funds2 Assistant (Procurement) 1x9400x9 846003 Computer Operator cum RecordKeeper (Procurement)1x8000x9720004 Logistics Officer 1x25000x9 2250005 Assistant (Logistics) 1x9400x9 846006 Account Officer (Logistics) 1x20000x9 1800007 Section Officer (Logistics) 1x12000x9 1080008 Two Computer Operators cum 2x8000x9Record Keeper (Logistics)144000Drug & Pharmaceuticals9 Doctor 1x30000x9 27000010 Two Pharmacists 2x9400x9 169200Equipment11 Bio Medical Consultant 1x25000x9 22500012 Bio Medical Engineer 1x18000x9 16200013 One Doctor 1x35000x9 31500014 Assistant (Quality Control) 1x9400x9 8460015 Computer Operator cum RecordKeeper (Quality Control)1x8000x972000B. Total Amount in 2556000C. Construction of 5 nos. of12500000Warehouses (Projected in(Projected inInfrastructure)InfrastructureHead)Grand Total (A+B) 24397200A sum of Rs. 243.97 Lacs is required for maintenance and strengthening of procurementand maintenance wing of NRHM that include implementation of ProMIS. 5 nos. of new DrugWarehouses shall be constructed at the cost of Rs. 125.00 lacs during the financial year 2011-12.The budget for which is projected in the Infrastructure Head.59

Comments for IEC / BCC Activities1. Regarding the discrepancy in the budget, it is clarified that budget required for integratedBCC is as under: -Sr.No.Budget HeadINTEGRAGED BCCUNDER NRHMB 12 Strengthening ofBCC/IEC unit at Statelevel12.1 a) Integration ofBCC/IEC unit atState/District/Village.12.1.1 Administrativesupport for BCCdivision12.1.2 CreativeDesigning for IECmaterial.12.1.3 • Hiring BCCConsultant (1)12.1.4 • Editor (1) forNewsletter• Junior Editor (1)12.1.5• ComputerAssistants (2)12.1.6• Graphics Designer/ DTP Operator12.1.7 (1)• Office Helper (1)-5 lacs5 lacsRate40000 X 1225000 X 1215000 X 1212000 X 2 X1218000 X 12Quarter1 (Rs. inlacs)1.251.251.200.750.450.720.54Quarter2(Rs. inlacs)1.251.251.200.750.450.720.54Quarter3(Rs. inlacs)1.251.251.200.750.450.720.54Quarter4(Rs. inlacs)1.251.251.200.750.450.720.54Financialallocation(Rs. InLacs )5.05.04.803.001.802.882.1612.1.812.2 Development of StateBCC strategy12.3 BCCs activities for allHealth Programme bySMS at Village level.6000 X 12 0.18 0.18 0.18 0.18 0.72- - - - - -52.01 52.01 52.01 52.01 208.07560

Sr.No.Budget HeadINTEGRAGED BCCUNDER NRHMRateQuarter1 (Rs. inlacs)Quarter2(Rs. inlacs)Quarter3(Rs. inlacs)Quarter4(Rs. inlacs)Financialallocation(Rs. InLacs )10.5012.3.1 Contingency for Districts Rs.50000/-per distt.12.3.2 Support for District Rs.50000/- 2.625 2.625 2.625 2.625 10.50Supervision.per Districtfor 21district12.3.3 Quarterly review meeting 50000 X 4 0.50 0.50 0.50 0.50 2.0of Dy. Civil Surgeons atState LevelPrinting of EducationMaterial12.4 Flips Charts / Booklets 6.25 6.25 6.25 6.25 25.0012.4.1 Posters 5.00 5.00 10.0012.4.2 1) External Evaluation forimpact assessment by anagency.12.5 Mass Media12.5.1 News PaperAdvertisementAt State levelAs per detailedcalendar.(Annexure ‘D’)5 lacs 5.00 5.050 lacs 12.5 12.5 12.5 12.5 50.0012.5.2 Radio PublicityTo cover all 70 lacs 17.5 17.5 17.5 17.5 70.0programs12.5.3 Preparation ofDocumentaries/VideoCDs10 lacs 10.0 10.0To cover allprograms12.6 Bimonthly Newsletter 2 Lacs X 8 4.0 4.0 4.0 4.0 16.0012.7 Plays by SMS Groups 20.825 10.41 10.41 20.825and ARSH PEs12.8 Miscellaneous 10 lacs 2.5 2.5 2.5 2.5 10.061

Quarter Quarter Quarter Quarter FinancialBudget HeadSr.1 (Rs. in 2 3 4 allocationINTEGRAGED BCC RateNo.lacs) (Rs. in (Rs. in (Rs. in (Rs. InUNDER NRHMlacs) lacs) lacs) Lacs )12.9 IEC of AYUSH 58.0012.10 IEC for improving Sex21.00ratioTotal Budget forIntegrated BCCactivities552.260The budget for IEC activities for specific programmesThe activity detail and budget is also being projected in respective programme heads12.11 Specific IEC of differentprogrammes (Disease ControlProgrammes)12.11.1 TB Control Programme As givenby TBOfficer12.11.2 IDSP As givenby SSUIDSP12.11.3 Immunization/Child Health/School Health/ARSH12.11.4 Leprosy Control Programme As givenby SLO12.11.5 Blindness Control Programme As givenby DD,12.11.6 Malaria/Dengue (VBD ControlProgramme)BlindnessAs givenby DD,Malaria28.0827.17584.3710.0030.0032.16The final modified budget for integrated BCC is Rs.552.260 Lacs.62

2. As per your comments the revised requirement for staff under BCC head is as under: -Sr.No.12.1.312.1.412.1.512.1.612.1.712.1.8Budget HeadINTEGRAGED BCCUNDER NRHM• Hiring BCCConsultant (1)• Editor (1) forNewsletter• Junior Editor(1)• ComputerAssistants (2)• GraphicsDesigner / DTPOperator (1)• Office Helper(1)Rate40000 X 1225000 X 1215000 X 1212000 X 2X 1218000 X 126000 X 12Quarter1 (Rs.in lacs)1.200.750.450.720.54Quarter2(Rs. inlacs)1.200.750.450.720.54Quarter3(Rs. inlacs)1.200.750.450.720.54Quarter4(Rs. inlacs)1.200.750.450.720.54Financialallocation(Rs. InLacs )4.803.001.802.882.160.18 0.18 0.18 0.18 0.72Total 15.363. Regarding funds for supervisory visits, it is clarified that as the number of units to besupervised is more than 6000, it was envisaged that all the Deputy Civil Surgeons will beencouraged to conduct regular visit to the SMS group. However the amount for thesupervisory visit is being reduced from Rs.1.00 Lacs to Rs.50000/- per distt. Thebudget have been modified accordingly.4. The expenditure incurred under BCC Head is 14173000/-. As the payments for RadioJingles and Phone-in Programme are pending. We expect to spend almost 70 to 80% ofthe sanctioned budget for BCC by 31 st March 2011. However, budget for SMS group hasbeen worked out on the basis of savings amount from the previous year budget.63

Pre-Natal Diagnostic Technique (PNDT)The para wise comments on the recommendations of Govt. of India team are as under:-PNDTActivitiesThe state has proposed budget forPNDT activities under 2 heads. Ithas proposed 30 lacs rupees forthe BCC activities and awarenessgeneration programmes whereasunder independent PNDT head,the State has asked for 90.13 lacswhich includes BCC/IECactivities as well.As declining sex ratio is themajor concerns for Haryana thebudget may be approved but theState might ask for theclarification regarding 2 overlapping budget heads.Proper time line could have beenmentioned against each budgetedstrategy.Under the PNDT Head, the State has asked forRs. 90.13 lacs which includes a special Savethe Girl Child Campaign of Rs. 30.00 lacswhich includes involvement of legislators,Govt. officials, NGO‟s, Media, Dharm Gurusand important personalities of Haryana on amassive scale. Rs. 21.00 lacs has been reflectedfor BCC activities and awareness generationprogrammes under BCC Head and includesMass-Media like Radio Jingles, T.V. Spots,newspaper advertisements, wall writing etc.Time line for each activity is as under:-Operationalization of PNDT Cell 1 stQuarter.Training of Distt. Nodal Officers 2 nd &4 th quarter.BestVillage Scheme in the district 3 rdquarter.Printing of Annual Report 3 rd quarterSave the Girl Child Campaign 2 nd & 3 rd64

Reply on comments on ImmunizationSl.No.Activities( Asproposed by theState)1 Mobility Supportfor supervision@ Rs. 50000 perdistrict (21)and Rs.1.00 lakh for statelevel officers2 Cold chainmaintenance 1.Maintenance of 5WICs and 1 WIF@ Rs. 10,000 perWIC/WIF; 2.Maintenance ofApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments11,50,000 7,30,000 5,22,446 17,80,000 11,50,000 6,30,000 Funds may beapproved as per GOInorms.5,09,000 4,69,000 1,82,245 5,33,500 4,73,500 60,000 Since the expenditureof last year i.e. for 9months is approx38% and projection offund for this activityis higher than the lastyear and GOI norms.ReplyImmunizationcoverage in urbanslums is low becauseof lack of manpower& infrastructure inurban areas,therefore, there wasneed for urban RInodal officer whowill be responsiblefor urban microplanning,hiring ofANMs, vaccinedelivery &monitoring ofsessions. Hence,mobility support forurban RI nodalofficer may beapproved. Sum ofRs. 630000/-is forurban strategy.Utilization till Jan2011 is Rs. 183875and the funds wouldbe utilized, hence,the projected amountof Rs. 533500/- maybe approved.65

Sl.No.Activities( Asproposed by theState)Cold Chain at 21district HeadQuarters @Rs.10,000/-eachdistrict; 3.Maintenance ofcold chainequipments @ Rs.500/- per CHC &PHC (527)3 Focus on slum &underserved areasin urbanareas:(i.e1485*10sessions*350)4 Mobilization ofchildren throughASHA or othermobilizers@ Rs. 150 permonth per perworker for foursession in 2465 SCper monthApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-1266JustifiedNotJustifiedCommentsHowever, Funds maybe approved as perGOI norms.Additional fund canbe considered later ifstate has more than90% expenditure.39,48,000 0 7,95,070 51,97,500 51,97,500 0 This may be agreedto.1,77,48,000 1,77,48,000 71,88,436 2,11,63,500 1,77,48,000 34,15,500 Since the expenditureof last year for 9months is approx40%. Therefore, fundto the extent of lastyear may beapproved.Reply1. The no. of subcentreshasincreased from2465 to 2630,therefore,additional fundsis required forthe sessions tobe held in thesesub-centres.2. This year, it isplanned thatapproximately1485 sessionswill be held inurban areas,which requires

Sl.No.Activities( Asproposed by theState)5 AlternativeVaccine Deliery inother areas @ Rs.50 per session forfour sessions in2630 SCs and 1485urban centresApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments59,16,000 63,28,000 27,09,040 70,54,500 70,54,500 0 May be agreed to.Replymobilizationsupport.Therefore, theincreased fundsfor the abovemay beapproved.3. However, thetotal funds hasbeen reducedand in case ofbetter utilization, it would be reappropriatefromoverall saving67

Sl.No.Activities( Asproposed by theState)6.1 ComputerAssistants supportfor State level @Rs. 15000 perperson per monthfor 1 personsApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments21,60,000 1,80,000 15,28,870 1,98,000 1,80,000 18,000 The state hasprojected fund @Rs.16500/C.A forstate level. However,fund may beapproved as per GOInorms. States shouldhave uniformity onpayment forComputer Assistantsunder variousprogrammes. Lastyear, U.T ofChandigarh hadrequested for increasein salary of ComputerAssistant as theComputer Assistant inHaryana was gettinghigher salary. Theywere informed thatthe salary componentof contractual staffunder NRHM invarious programmesReplyThe computerAssistant at statelevel is working forlast 9 years and hasgot a wealth ofexperience anddedication towardsprogramme. He isonly assistant withthe Child healthbranch which islooking afterprogrammes ofChild Health,Immunization, NeonatalUnits, PulsePolio, MMU,Referral Transportetc. Also the highrate of inflation maybe considered.Therefore, theproposed budget inthe PIP may beapproved68

Sl.No.Activities( Asproposed by theState)6.2 ComputerAssistants supportfor District level @Rs. 10000 perperson per monthfor one computerassistant in each21districts7 Printing anddissemination ofImmunization cards,tally sheets,monitoring formsetc. @ Rs. 5beneficiaries for1209000beneficiariesReview meetings8.1 Support forQuarterly Statelevel reviewmeetings of districtApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments22,68,000 25,20,000 25,20,000 0 depends on the workallocation/locationwhere he is working.There are no fixednorms for the salaryto the staff. It is thediscretion of theconcerned StateGovernment to decidethe salary to the staffon the basis ofexisting condition.Present request ofHaryana may beexamined in the lightof reply given to U.Tof Chandigarh.32,75,000 32,50,000 21,00,000 52,00,000 52,00,000 0 Since this is wellwithin GOI norms,this may be agreed to.1,50,000 1,50,000 62,494 1,50,000 1,50,000 0 May be agreed to.However, expenditureof last year for 9months is approxReply69

Sl.No.Activities( Asproposed by theState)officer @ Rs.1250/-/participant/day (CMO/DIO/DistCold chain Officer)for 30 participantsper meeting.8.2 Quarterly reviewmeetings exclusivefor RI at districtlevel with one BlockMos, CDPO, andother stake holders@ Rs. 100 perparticipants for 20participants perdistrict for 21districts8.3 Quarterly reviewmeetings exclusivefor RI at blocklevel @ Rs. 50/- PPas honorarium forASHAs and Rs. 25per persons formeeting expensesfor ASHAsApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustified1,68,000 1,68,000 1,68,000 1,68,000 0Comments39,00,000 39,00,000 1,47,515 0 0 0 No fund projected. The reviewwould be carriedout in themonthlycoordinationmeeting ofASHAExpenditureunder this headwas actually reappropriatedandused for trainingof Health20%.Reply70

Sl.No.Activities( Asproposed by theState)ApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedCommentsReplyWorkers andCold Chainhandlers trainingTrainings9.1 District levelOrientationtraining includingHep B, Measles &JE(whereverrequired) for 2days ANM, MultiPurpose HealthWorker (Male),LHV, HealthAssistant(Male/Female),Nurse Mid Wives,BEEs & other staff( as per RCHnorms)9.2 Three day trainingincluding Hep B,Measles &JE(whereverrequired) ofMedical Officers ofRI using revisedMO trainingmodule)10,00,000 0 9,94,676 0 0 0 No fund projected.8,00,000 19,89,000 31,50,000 31,50,000 0 May be allowed.NIHFW may becommunicated fortraining details.This fund is projectin the PIP for HealthWorkers training andmay be approved inhead 9.171

Sl.No.Activities( Asproposed by theState)9.3 One day refreshertraining of districtComputerassistants onRIMS/HIMS andimmunizationformats for 26persons9.4 One day cold chainhandler’s trainingfor block level coldchain handlers byState and districtcold chain officersfor a batch of 25-30per batch.9.5 One day traning ofblock level datahandlers by DIOsand District coldchain officersMicro planning10 To develop subcentreand PHCmocroplans usingbottom-upplanning withparticipation ofANM, ASHA andAWW @Rs. 100/-per sub-centreApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustified30,000 30,000 30,000 30,000 00 0 5,25,000 5,25,000 0Comments1,20,000 0 0 0 0 No fund projected. Will be clubbedwith DIOs reviewmeeting in 2011-123,80,000 9,85,000 13,600 5,22,000 1,00,000 4,22,000 Since the expenditureof last year for 9months is approx 2%i.e very low.Therefore, a tokenprovision of Rs.1.00lakh may beapproved.ReplyThe micro-planningexercise has startedin the M/o March2011 for next yearand the expenditureunder this head willbe done in the M/oMarch 11. Also thestress was given on72

Sl.No.Activities( Asproposed by theState)(2630);Consolidation ofmicro plan atPHC/CHC level@Rs. 1000/- prblock (110);Consolidation ofmicroplan atDistrict level @ Rs.2000/per district(21)11 POL for vaccinedelivery from Stateto district andfrom district toPHC/CHCs @ Rs.50000 per districtfor 21 districts.12.1 Consumables forcomputerincluding provisionfor internet accessfor RIMs Rs. 400per month perdistrict for 21districts.ApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-1273JustifiedNotJustifiedComments21,00,000 10,50,000 4,75,131 12,50,000 12,50,000 0 Since the expenditureof last year for 9months is approx45% and state hasprojected amount forthis activity is lowerthan GOI. Therefore,it is well within GOInorms, this may beagreed to.1,06,000 1,00,000 41,393 2,07,000 1,05,600 1,01,400 Fund may beapproved as per GOInorms.Replymicro-planning inthe recently heldmeeting of DIOs.Therefore, thebudget may beapproved.At present, noservice providerprovides broadbandservices @ Rs. 400/-per month. Also,there is additionalexpenditure onstationary etc.Therefore, the fundsprojected may beapproved.

Sl.No.Activities( Asproposed by theState)ApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments12.2 Contingency/4,000 0 0 0 0 No fund projected.Consumable atstate level @ Rs.5000 per month.Injection safety 0Reply13.1 Red/Black plasticbags etc. @ Rs.2/bags/session for 4session in 2465 SC13.2 HubCutter/Bleach/Hypochlorite solution/Twin bucket @ Rs.900 perPHC/CHCper year14 Contruction &Repair of WasteDisposal pits atPHCs@Rs.5000*441State specificrequirement.20,000 19,000 42,356 6,40,100 6,40,100 0 May be agreed to.2,59,000 2,59,000 63,9332,07,000 2,07,000 60,0500 0 0 22,05,000 8,82,000 13,23,000 Fund may beapproved as per GOInorms (i.eRs.2000*441).However, state shouldgive justification forprojecting the largeamount against theGOI norms, so that itcan be furtherexamined andadditional fund couldbe considered.At the present rate ofRs. 2000/-, none ofthe DIOs agreed tothe construction ofPits. The minimumrequirement as perestimates is Rs.5000/- per PHC/CHC. Hence, budgetmay be approved.74

Sl.No.Activities( Asproposed by theState)15 Printing ofTracking bags @Rs. 150 per bag for2500 bags16 Supportivesupervision forpoor performingdistrict @ 50000*317 AEFI & VPDsensitizationworkshopsApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments0 75,000 28,550 3,75,000 0 3,75,000 Since we have alreadyapproved fund forPrinting anddissemination ofImmunization cards,tally sheets,monitoring forms,tickler bags, etc,(Sl.No.7), this activitymay be includedtherein.0 0 0 1,50,000 0 1,50,000 Since we have alreadyapproved fund forMobility support forsupervision,(Sl.No.1), this activitymay be includedtherein.0 0 0 1,60,000 0 0 Since we have alreadyapproved fund fortraining (Sl.No.9),this activity may beincluded therein.ReplyAlready theexpenditureprojected is less ascompared torequirement and itcannot be includedin the printingbudget as it is aseparate itemaltogether. So, maykindly be approved.The plan is to sendadditionalsupervisors fromother districts/ state /partner agencies foradditionalsupervision in poorperforming districtslike Mewat, Palwal 7Faridabad. May beapproved.This is a specificworkshops plannedfor AEFI & VPDsensitization and isseparate from thetrainings at Sr. No.9. Hence, budgetmay be approved.75

Sl.No.Activities( Asproposed by theState)18 Mewat & PalwalStrategyApprovedPIP during2009-10ApprovedPIP during2010-11Expenditure during2010-11 (tillDec' 10)Projectedoutlay forthe year2011-12JustifiedNotJustifiedComments0 0 0 4,96,800 1,00,000 4,96,800 The state has notfurnished details ofthis activity.However, a tokenprovision of Rs. 1.00lakh may beapproved. Thisactivity should not becovered on the otherproposed activities.Details may beprovided for itsspecification.TOTAL 4,39,46,000 3,99,09,000 1,69,55,805 5,36,75,900 4,66,24,200 69,91,700ReplyDetails have beenprovided in Part Cunder Mewat &Palwal Strategy.Special strategy isrequired for thesetwo districts whereevaluated coverageas per DLHS-3 is12% and 18%respectively.76

Part D Disease Control ProgrammesNVBDCP1. Haryana is low endemic for malaria, during 2010, a total of 18276 malaria cases werereported with 657 Pf case with no deaths. ABER is less than 10. Though the malariacases have reduced significantly from 31747 in 2009 to 18276 in 2010. However, thenumber of P.f cases have increase from 525 to 657.Reply It is submitted that during the years 2009 & 2010, there is a significant decrease inMalaria incidence as compared to previous years but the PF cases have increased. Thereare only main two districts in the State (one is Karnal and the second is Yamuna Nagar).In district Yamuna Nagar, there is migratory population working in Crasher Zone fromUP & Bihar which is a Pf prone area. In district Karnal, there was flood in some areasdue to that the water remained stagnated. The second reason was that there was lack ofsurveillance due to shortage of Workers. Though, all the vacant posts were filled bynewly recruited MPHWs but all these workers were transferred from there and theseareas remained without surveillance that caused increase of cases. These vacancies wereagain tried to be filled up through outsourcing policy on contract basis but permission ofthe same was not granted. Strict instructions to Civil Surgeons to Karnal andYamunanagar have already been issued by the Directorate.2. During 2010, 807 confirmed dengue cases were reported with 17 deaths. However, outof 807 cases 597 were reported from Gurgaon distt alone.Reply Although, 807 cases including 597 cases from District Gurgaon alone have been reportedduring year 2010 but keeping in the view the incidence of the adjoining States; theincidence in the State is much lower. 75% cases in state are from NCR region. Reason forthe same is the frequent visit of the people of these areas to Union Territory, Delhi.3. To keep a watch on malaria and large incidence of dengue during 2010, it is veryessential to monitor the surveillance of these diseases regularly by strengthening theexisting surveillance system by filling up various vacant posts.Reply During the year 2010, 790 posts of MPHW (Male) & 63 posts of LT (Malaria) have beenfilled and a request to fill up the 390 posts of MPHW (Male) has already been sent toHaryana Staff Selection Commission.4. Action plan made for the control of Vector Borne Diseases should be specific and timebound clearly mentioning by whom, when and where various activities will be carriedout. Rapid response teams should be constituted and should be in ready position to tackleany possible outbreak of any vector borne diseases in the area.77

Reply Rapid response team has already been constituted at State Head Quarter as well asDistrict Head Quarter.5. Entomological surveillance should be strengthened and monitored at state HQs level byfilling the post of State Entomologist/Asstt. Entomologist by coordinating with variousBiologists working in the districts.Reply Regular Entomological Surveillance System was intensified through regular tours in theareas by the existing Entomological Staff. The Entomological surveys were carried outand necessary directions were issued to the concerns. The Government has also beenrequested to create some new posts of various Entomological Staff i.e. StateEntomologists, Biologists, Zonal Entomologists, Insect Collectors and Field Workers.6. The state may prepare proposal keeping in mind the allotted grant.Reply PIP – 2011 for NVBDCP has been prepared keeping in view all the facts and figures andas per guidelines of Govt. of India.78

NLEPThe following points have been point out in the meeting of PIP under National LeprosyEradication Programme.1. Comments on new initiatives submitted by the Statea. Salary of contractual staff under NLEP is very low in comparison to other programmesdue to which many workers have left the job & shifted in other Programme. Salary ofcontractual staff must be equal to other programmes.Comment – Not budgeted in the PIP. But the state may propose for the same underNRHM.The following budget is required under NRHM additionalities for salary of contractual staff ofNLEP:-S.No. Name of the post1. Surveillance MedicalOfficer2. Budget & FinanceOfficerCumAdministrative OfficerNo.ofPostBudgetRequired(Per month asper NRHM)BudgetfromNLEP(Permonth)AdditionalBudgetrequiredfromNRHM(Per month)TotalBudgetrequired forthe year2011-121 25,000/- 20,000/- 5,000/- 60,000/-1 18,000/- 15,000/- 3,000/- 36,000/-3. Data Entry Operator 1 8,800/- 8,000/- 800/- 9,600/-4. Administrative Assistant 1 8,000/- 7,000/- 1,000/- 12,000/-5. Para medical Worker 21 8,000/- 6,000/- 2,000/- 5,04,000/-6. Drivers 12 6,500/- 4,500/- 2,000/- 2,88,000/-Total Budget required9,09,600/-from NRHMaddittionaliites79

. In Haryana State additional charge of NLEP has been given to District TB Officers. OneState Coordinator must be provided to Haryana State to coordinate.Comment – The state needs to specify the duration and the purpose for the positionrequested. Request may be sent to the division which could explore possibilities of hiringone from other sources.Reply: - Coordinator is required for the period of 3-5 years for technical support asDistrict Leprosy Officer post is not sanctioned at the District nucleus. However DistrcitTB Officers have additional charge of NLEP. Proposal will be sent to GOI at earliest.c. TOT for LTs from Haryana State must be conducted at Central level. So that furthertrainings of LTs may be done inour State.Comment – the state needs to send a request to the division and CLTRI for the same.Reply: Request will be sent to Central Leprosy Division at earliestd. All physically & financially guidelines is not mentioned in Programme ImplementationPlan 2007-12. In next PIP i.e. 2012-17 all the guidelines must be mentioned.Comment – Noted.e. There must be a provision of increment of 5-10% per year on salary of contractual staffon basis of experience.Comment – Not as per PIP guidelines. May be budgeted under NRHM.Reply: There are following staff is working under NLEP from more than 5 Years underNLEP or complete the five years in the financial year 2011-12:-S.No.Name of the post1. Budget & FinanceOfficerTotal Salary per Increment Total BudgetPost month required from required s for theNRHM per year 2011-12monthfrom NRHMadittionliites aditionalitiesfunds1 18,000/- 900/- 10,800/-80

2. Para Medical 4 8,000/- 400/- 19,200/-Worker3. Drivers 11 6,500/- 325 42,900/-Total Budget 16 72,900/-RequiredTotal Budget required from NRHM aditionalities in contractual Services is9,09600/-+72,900/= 9,82,500/- rounded off 10 lacs5. The state has nil involvement of NGOs and this need to planned by the State.Reply: At present no NGO is come forward under NLEP. In the financial year 2011-12efforts will be intensified to involve NGOs.81

NBCPPART D:- NPCBRemarksThe state may provide a detailedactivity outline and also previousyears overall performance of theprogramme and also thoseagencies/NGOs empanelled todeliver services in the programmealong with their monitor ableindicators.The data on service provision, No. ofCataract operated patients, SchoolChildren with refractive errors, andthose who were provided free glass,annual collection of eyes and alsothose utilized needs to be provided.Role of NGOs, MMUs, ASHA, andintegration with school healthprogrammes needs to be outlined.AnswerIn 2009-10 the State has achievedcataract surgeries 137188 (110%) against the targetof 125000 Out of which % of IOL was 98%.During the same year teachers were 10357 trained,children screened 1319768, children with refractiveerrors 28810, free glasses to children 15215, campsat fixed facility 1068, camps for screening ofschool children 2809, camps for screening of +50population 2403 and spectacles to post operativepatients 7137. Total eyes were collected in all theeye banks and eye donation centres were 1663,used for keratoplasty 772, eyes sent to other eyebanks were 254, used for research purpose 89,eyes unfit for use 535 and eye pledge for eyedonation 1992. Eyes collected under Nehru DrishtiYojna were 18 till 31st March, 2010.In 2010-11 the State has achieved cataractsurgeries 79124 (66%) till Jan, 2011 against thetarget of 125000 Out of which % of IOL was 99%.During the same year teachers were 2261 trained,children screened 328545, children with refractiveerrors 9816, free glasses to children 3392, camps atfixed facility 313,NGO‟s are actively participating inperforming Cataract surgeries and also encouragedto adopt villages to provide surgical treatment,follow up and screening eye camps. In the comingyear more NGOs will be encouraged and involved.District Education Officer and Teachers througheducation department will be requested to organizeschool eye care programme and ensuring supply offree glasses to children with refractive errors incollaboration with Health Department.The system strengthening aspect ofthe programme has been lackingwhich state may please address in theMore intensified training will be taken upfor Phaco surgery for eye surgeons and training forMedical Officers, Ophthalmic Assistants, StaffNurses.82

RemarksAnswerPIP.Camps for screening DiabeticRetinopathy, Glaucoma etc and earlydetection may also be incorporated inthe PIP and information on No. offacilities where laser treatment isbeing provided.Camps for screening of school children1426, camps for screening of +50 population 415and spectacles to post operative patients 2307.Total eyes were collected in all the eye banks andeye donation centres were 1014, used forkeratoplasty 522, eyes sent to other eye banks were308, used for research purpose 66, eyes unfit foruse 454 and eye pledge for eye donation 966. Eyescollected under Nehru Drishti Yojna were 146 till31st Jan., 2011.Part D: RNTCPOverall RemarksREVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME(2011-12)S. No. Comments/Remarks Reply1 The state is performing moderately -60% New Smear Positive CaseDetection Rate and 85% success rate innew smear positive patients.(i)2 The STO has additional charges ofNLEP and Blindness ControlProgramme.3 9 districts - Panchkula, Yamuna Nagar,Palwal, Kaithal, Rewari, Jhajjar,Fatehabad, Mewat & Panipat do nothave a sanctioned post of DTO.Efforts are being made to strengthenthe involvement of General HealthSystem in RNTCP.(ii) Involvement of Big Hospitals ofPrivate sector in RNTCP with OPDmore than 60-100 per day.(iii) Opening of 3 more TU‟s and 27DMC‟s as per GOI norms and inaccordance with projected population,2011.STO & DTO are having the same charges ofTB & Leprosy.Although there is no sanctioned post ofD.T.O. in 9 districts but the charge of DTOhas been allotted to other officer/MO-TC toensure the functioning of RNTCPProgramme.4 None of the 21 DTO‟s in the district - STO & DTO are having the same charges83

are full time. All the DTO‟s haveadditional chrge of Leprosy and HIVprogramme besides few other charges.5 HR vacanciesi. 1 DOTS Plus site MO-of TB & Leprosy.(i) Will be required for additional DOTSPLUS Site in IInd Phase of DOTS PLUSimplementation. (At present one regularM.O. has been deputed in functional DOTSPLUS Site at PGIMS Rohtak).(ii) Sanctionedii.14 Sr. DOTS Plus TB HIVSupervisor.6 The programme is not being reviewedby the CMO during the monthlymedical officers meeting leading to lowpriority of the programme by thegeneral health staff.7 Participation and involvement ofGeneral Health system paramedicalstaff under the programme is suboptimal.Most of the supervision andmonitoring of TB patients on treatmentis done by the contractual programmestaff.CMO, SMO, PMO and MS of GHregarding awareness of objectives underRNTCP will be Sensitized.Higher Authorities to direct CMOs toreview RNTCP during monthly clinicalmeeting on priority basis.To increase the participation andinvolvement of General Health System inRNTCP, the following actions will be taken:All General Hospitals will be involvedin RNTCP as DMC and DOT centresand their involvement regarding referralof chest symptomatics, suspectsexamined, positivity rate and patientsput on DOTS will be monitored.co-ordinate will be made with ESIauthorities for its involvement as DMCand DOT centers and to function as perGOI guidelinesDy. CMO‟s will be involved insupervision under RNTCP of theirrespective blocks. For this purposeforms given in internal evaluationformat for DMO and DOT center can beutilized.NRHM Report will be analyzedmonthly and be reviewed by higherauthorities.More ASHA‟s as DOT provider underRNTCP will be involved. Timelyprovision of honorarium to ASHAs asDOT Provider will be ensured.84

8 Infrastructure – State has 223 DMCsand 47 TUs which are 27 and 3 less,respectively, as per population normsfor the state.MPHW (M) and (F) will be motivatedand sensitized for referral of chestsymptomatic cases, diagnosis, treatmentof TB patients and for strengthening thesupervision of community volunteers intheir respective areas by health workers.LT not posted in DMC‟s will be mademore accountable for sputum smearmicroscopy for better implementation ofthe National programme as per GOIguidelines.Monthly PHI level reports will be filledby LT and Pharmacist of PHI regularly(not by STS/ STLS in some cases) andMO-PHI to check the report to knowthe situation of drugs, lab consumablesand microscopy activities etc. beforesigning.Urban slums to be covered with DecentralizedDOT Network.Designated trained MO-TCs not to bechanged frequently.Sanction & Budget has been given toDistrict Sirsa & Faridabad for openingof one TU in each district. There is planone more TU in district Gurgaon in2011-12.Budget has been allotted to Distt.Faridabad for DMC Pali, Distt. Karnalfor DMC Jundla, Distt. Panchkula forDMC in Urban slum, District Sirsa forDMC at Rori ,Distt. Mewat for DMC atMandikhera.Comments on the activity-wise budget proposedS.No.Category ofExpenditureEstimatedBudgetApproved BudgetJustification/RemarksReply o ncomments1 Civil works 3184100 3133100Laboratory2materials4697435 4697435One time cost of 1 DPS, 2 DTCs, 1TU, 20 DMCs, up gradation of 10DDS for SLD and maintenance costfor STDC/IRL/STC/SDS, 12 DTCs,49 TUs and 223 DMCs approved.Approved 100% of the estimatedbudget in view of DP--85

S.No.Category ofExpenditureEstimatedBudgetApproved Budget3 Honorarium 2648000 26480004 IEC/ Publicity 3020300 1208120Equipment5maintenance1932500 14227506 Training 2139085 1818222Vehicle7maintenance2350000 20000008 Vehicle hiring 6421000 22345009 NGO/PP support 4244046 25464281Miscellaneous 4990850 42422230Contractual 1services 138920350389203501Printing 3815850 17171332Research 1 andstudies 3Medical 1Colleges 40 0 03108800 3108800Justification/Remarksimplementation in the state,although it's above the revisedfinancial normsApproved 100% of the estimatedbudget in accordance to expenditurelast 4 quartersUtilized only 8 % of the plannedbudget, approved 40% of theestimated budget.Approved 74% of the estimatedbudget.Approved 80% of the estimatedbudget in accordance to revisedfinancial norms.Approved 85% of the estimatedbudget in accordance to revisedfinancial normsUtilized Rs 11.82 lacs against theplanned budget approved 35% ofthe estimated budget. More may besanctioned in accordance toexpenditure pattern in initial 2quarters of FYUtilized Rs 1.22 lacs against theplanned budget approved 60% ofthe estimated budget.Approved 85% of the estimatedbudget in accordance to revisedfinancial norms and expenditurelast 4 quarters.Approved 100% of the estimatedbudget in accordance to expenditurelast 4 quartersUtilized Rs 5.92 lacs against theplanned budget approved 45% ofthe estimated budget.Approved 100% of the estimatedbudget, OR funds subject toapproval from STF/ZTF/NTF/CTD.Approved 3 new 2 wheelers and 5two wheelers against condemnedvehicles in accordance to revisedfinancial norms.Approved 5 office equipment setsagainst the condemned officeProcurement –vehicles 1Four 5 wheeler 0 0Two Wheeler 400000 400000 -Procurement1–equipment454000 360000Reply o ncomments-Revised asperapprovalRevised asperapproval- Revisedas perapprovalRevised asperapprovalRevised asperapprovalRevisedas perapprovalRevised asperapproval-Revised asperapproval--Revised asper86

S.No.Category of Estimated ApproveReply o nJustification/RemarksExpenditure Budget d Budgetcomments6 equipment sets and 1 for State. approvalTotal (A)7045706082326316Additionality1funds from7NRHM (B)TOTAL (A+B)5348000 3858000Rs.74315060/- OnlyAdditionality Funds from NRHM-Details of the activities for which Additionality Funds areproposed to be sought.ExpenditurReply on commentsSr.e planned ApprovedJustification/Acitivity / Item for next AmountNoRemarksFinancial (Rs)Year (Rs)12345A. Equipments forIRL KarnalNew Generator setof 125 KVAcapacityAudio-Visualsystem withprojector for trainingLaminar flow forMedia preparationBio-safety cabinetClass-II2000000 2000000100000 100000200000300000May beapprovedMay beapprovedEquipmentssupplied byCTD. Hencestate to justifytherequirementsfor the same.Equipmentssupplied byCTD. Hencestate to justifytherequirementsfor the same.6 Hand driers 20000 20000May beapproved7 Voltage Stabilizers 50000 50000 May be -New Generator of 125KVA capacity isrequired for BSL-3 (negative pressure )laboratory proposed byCTDrequired for IRL Karnalfor trainings ofLTs/STLSsAs per IRL, LaminatorFlow has not beenreceived.Budget required forrepair, replacement ofparts and AMC/CMCfrom originalmanufacturers of oneunit which has becomenon functional due tofailure of control boardand display unit.-87

Additionality Funds from NRHM-Details of the activities for which Additionality Funds areproposed to be sought.ExpenditurReply on commentsSr.e planned ApprovedJustification/Acitivity / Item for next AmountNoRemarksFinancial (Rs)Year (Rs)8910for 3 Phase supplyB. Civil Works ,HRand MiscellaneousItems for IRLKarnal-Estimateamount forrenovation of wholeIRL KarnalProvision of threeclean rooms for LPAtechnologyProviding 3 LA‟s inIRL Karnal7800001000000 1000000288000 288000approvedDetailedproposal to begiven to CTDMay beapprovedApprovedsubject to thecondition thatsubsequentlythe statewould be ableto take upthese expenseson it‟s own.DetailedEstimate/proposal fromIRL Karnal will beforwarded by the stateto CTD.Required as per CTDPolicy for LPATechnology for all IRLsRequired as per CTDPolicy111213C. Equipments atSTDC, Panchkula-Diesel generatorset/Inverter forSTDCPhotostat Machinefor STDC/state TBCellD. Additional DOTSPlus site-Provision400000 40000080000 - -210000May beapprovedTherequirementRequired for STDC,Panchkula due tofrequent organization oftrainings ofRNTCP/otherprogrammesBudget was previousincluded in RNTCPhead.Very much need of 1Photostat machine atState TB TrainingCentre as the old onehas completed life ofmore than 10 years andis not functional. Maybe provided underNRHM Additional tieshead if not approvedunder RNTCPDetails will be sent indue course of time after88

Additionality Funds from NRHM-Details of the activities for which Additionality Funds areproposed to be sought.ExpenditurReply on commentsSr.e planned ApprovedJustification/Acitivity / Item for next AmountNoRemarksFinancial (Rs)Year (Rs)of funds foradditional DOTSPlus site as indoorcharges of MDR-TBPatients(70 Patients)not clear.Further detailsrequired.finalization of locationof DOTS PLUS Site.Salary of RNTCP staff is very low due to which trained and experienced staff has left the14 job and shifted in other programmes. An additional increment of 5-10% on the basis ofexperience should be provided to Contractual RNTCP staff like NRHM/other programme.Total 5348000 385800089

Part D: IDSPComments form GOITraining: The state has asked Rs. 8, 17,000 for all thetrainings. However, it is not mentioned how manypersons will be trained. All information must be givenby the state before calculating the budget.Human Resource: The state has asked Rs 14,000 forData manager at State and District level. As per IDSPguidelines Data Managers may be paid Rs. 14,000 atSSU and Rs 13,500 at DSU instead of Rs. 14,000.Remuneration suggested for other contractual staffmay be accepted.Operational Cost: The State has asked for Rs. 13.30Lakh at State and District level for mobility support,Rs.17.56 Lakh at State & District level for printing ofreporting forms and reports. The state has asked for Rs10.58 Lakh at State & District level for Reviewmeeting & Rs 10.70 Lakh for field visits.As per the IDSP guidelines, for operational cost thereasonable amount may be Rs 15000/unit(SSU/DSU)/month which includes transport,broadband, printing of reports and fonnats, collectionand transportation of samples and other miscellaneousexpenses. The expenditure may be restricted to thisamount.Laboratory: Two priority district labs are identifiedunder IDSP (Kamal & Hisar) for strengthening. Forthese labs, an amount of Rs 2 lac each may beaccepted. In addition the State has proposed Rs 2.57crore for strengthening of five labs. This may be donefrom NRHM funds other than IDSP.IEC-BCC: The state has asked for Rs 27.18 Lakh inIEC- BCC activities. As per IDSP guidelines no budgetis provided under IDSP for lEC- BCC activities. Thesemay be done from other NRHM funds (not fromIDSP).Furniture & Fixture: The state has asked for Rs.23.75 Lakh at State & District level in Furniture &Fixture head. As per the IDSP guidelines purchasingfurniture fixture, Renovation & Office equipments isnow not allowed under IDSP. These may be done fromother NRHM funds (not from IDSP).Corrections and JustificationsThe detailed information about traininghas been updated according to Guidelinesprovided, persons to be trained has beenincluded in PIP.The budget has been revised according tothe comments.The budget has been revised according toComments.The budget for strengthening of fivedistrict Labs is included in Chapter 8 ofState PIP and will be drawn from NRHMfunds accordingly.The Budget will be drawn from IEC-BCCcomponent of NRHM funds under StatePIP.The budget for furniture and fixture isincluded in Chapter 8 of State PIP and willbe drawn from NRHM Flexi-pool fundsaccordingly.90

NIDDCPComments from GOIDetails of conducting urine analysis could be provided andthe analysis of the reports that were collected by MPHWscould be provided by the stats in the PIP.Budget has been proposed for conducting survey in twodistricts of the state.STK has been supplied to MPHWs. A total of 1,00,000 Salttesting Kits (STK) were received in 2009-10.Corrections and JustificationsReports attached in the PIPBudget has been proposed forconducting survey in four districtsof the state.Stock of STK is almost Nil , so25000 Kits may be supplied.National Tobacco Control ProgrammeComments From GOIThe Over all budget is Rs. 39.72 Lakhs andstate may please consider revising the budget.Corrections and JustificationsThe total proposed budget under NTCP for theyear 2011-12 is 39.72 lakhs and is sufficientfor implementation of the program as discussedin PIP.91

Response to comments HMIS & MCTS-Sr. Description of Comment by Sub-No. Group on PIP 2011-121. (a) Data Entry Status on HMISPortal“The State has shown regularity inMonthly reporting on HMISmonthly report on the Web portalfrom all Districts. As the statealready have infrastructure andpersonnel at place at the facilityonwards, it should take steps toinitiate facility level data uploadedon the HMIS Portal for bettermonitoring and strengthening ofHMIS portal as a single window forreporting for all the programmes.The Annual, Infrastructure, FMRand NVBDCP data should also bereported on a regular basis on HMISportal. The Annual Format needs tobe uploaded at the beginning ofevery year”2. Notification of Nodal M& Eofficer(s)Response from StateState has already proposed to rollout facility levelHMIS in phase manner . From April‟2011 , HMISwill be rollout upto Block(CHC) level whereinfacility level data will be captured in the webportal. Necessary training & capacity building ofstaff is being initiated in the month of March-April2011. Data has already provided to GOI forcreation of facility master ( upto Sub-Center).Through Quarterly, FMR and annual Reports isbeing uploaded in the web portal withinconsistency, steps will be taken to improve thequality of data captured in these reports. Effortswill also be taken towards the capacity building ofstakeholders in understanding these formats aswell as defining person(s) responsible for theseformats to facilitate regularity in reporting.State has already notified Nodal M&Eofficer(s) at State & District level both for HMIS& MCTS .At state level , Director (MIS & Admn. ) isoverall responsible officer for HMIS, he isassisted by Dy. Director (M&E), AD(demo) andHMIS Data manager and at district level Dy. CivilSurgeon, NRHM is the nodal M&E officer .Similarly Nodal officers for MCH tracking atdistrict has also been notified .At State level Director (Admn.) is thenodal officer and Deputy Director Child Health isthe alternative nodal officer whereas at districtlevel Dy. Civil Surgeon Family welfare is NodalofficerOnce facility level rollout of HMIS &MCTS initiated, SMO/MO in-charge of concernblock(CHC) will be designated / notified as nodal92

-Sr.No.Description of Comment by Sub-Group on PIP 2011-12Response from Stateofficer for the HMIS & MCTS tracking. He/ Shewill be assisted by PHN/LHV and Informationassistant. Similarity at PHC level MO I/c will benotified as Nodal M&E officer assisted byAccounts cum Information Assistant.3. Facility Level rollout of HMIS“HMIS Data in the state has shownencouraging results. As the HMISdata is already available at the blockand facility level, state can initiatefacility based data entry in HMISPortal of the Ministry.”4. Clear Cut Policy for HMIS &MCTSThe state needs to mention a clearcut strategy for both HMIS & MCTSfor implementation of the same.5. The state should focus onintegrating resources acrosshealth program for optimumutilization of resources andmanpower. There should not beduplication of manpower orinfrastructure.6. Budget Allocationa) 1.1 Strengthening of M&E/HMIS -(a)“ Revisit and integrate theHR requirement acrossprogrammes “ HR Cost24.72 Lakh at SPMU7. b) 1.1 Strengthening of M&E/HMIS –(b)Permissible subject to facility basedreporting on the HMIS and MCTSportal of the Ministry HR Cost389.08 Lakh for DPMU , BPMUand PHC level8. 1.2 Mobility for M&E officers(Field visits )Noted , same has already incorporated inthe PIP 2011-12 .Clear cut policy for HMIS & MCTS hasbeen incorporated in the PIP contents.State has already taken into the account ofintegrating resources across health programmes foroptimum utilization of resources and manpower.There is no duplication of manpower andinfrastructure across progammes. Manpowerrequired is minimum for effective rollout offacility based HMIS and MCTSManpower projected in minimal and is integrationof HR across progammes has already taken intoaccount . To facilitate smooth implementation ofMCTS in the state , provision for engaging oneno. Sr. Programmer with dot net experience andone no. Database Administrator (DBA) has beenmade for managing online application (customization as per state requirement anddatabases maintenance of MCTS for 9 months).Facility based rollout has already planned out forFY 2011-12Nothing to be responded93

-Sr.No.Description of Comment by Sub-Group on PIP 2011-12Mobility Support 7.38 LakhResponse from StatePermissible10. 1.4 M&E Studies & reviewmeetingsRs. 19.90 LakhPermissible11. 2.1 a) Procurement of HW &SW and other equipments forSPMU – Servers Rs. 5.50 lakh“Revisit as Servers are beingcentrally procured by MoHFW”12 2.1 b) Procurement of HW &SW and other equipments forDPMU/BPMURs. 44.50 lakh“ Give deployment details ofexisting H/W and S/W vis-a-visnew requirement”13 2.2 Internet Connectivity Rs.50.20 LakhGive justification14. 2.4 Operation Cost ( Media &Consumables )Rs. 149.55 LakhGive justification15. 3. Operationalising HMIS atSub-District LevelNothing to be respondedServers mentioned in PIP are to be used asProxy & SAN (backup) Server (including system& application software) Cost estimates are Rs.3.00 lakh. Similarly 2.50 Lakh has beenprovisioned at Mission directorate (SHS) , forrenewal of annual rental of Internet lease line plusup-gradation of necessary system software formanning UTM for shared internet access ( 30-35concurrent users ). However expenditure will beincurred judiciously.As most of the hardware provided at CHC& District level is old and obsolete( purchasedduring 2004-05) and need immediate replacement .A provision of Rs. 2 lakh per district & 2.50 FORSHS has been made for procurement of 2desktops and establishing LAN connectivity forsharing internet and other resources at DPMU .However expenditure will be incurredjudiciously.As Common Service center (CSC) inHaryana has not yet made functional and SWANconnectivity is yet to be provided , BSNL‟s CSCBroad Band CSC 999/-PM un-limited has beenadopted to facilitate integrated internet and e-mailfacility in the health facilities . Provision of Rs.10,000/- per facility per annum has beenprovisioned for 502 facilities ( 21 CMO offices+21 DHs+18 SDHs+111 CHCs and 331 StandalonePHCs . This is required to facilitate rollout ofHMIS & MCTS upto Facility level.As state as already provided Computer upto PHClevel , A lump sum amount @ 30,000/- PA perfacility has been provision for facilitatingnecessary printing for reporting and generatingwork plans for 502 facilities upto PHC level.Nothing to be responded94

-Sr.No.Description of Comment by Sub-Group on PIP 2011-12Response from StatePermissible16. 3.1 Printing of New Registers /FormsPermissible17. 3.2 Operationalising/Printing ofthe HMIS formats - Printing ofNew Registers / FormsPermissible18. 3.2.3 Training of StaffPermissible19. Operationalising MCHTrackingNothing to be respondedNothing to be respondedNothing to be respondedNothing to be respondedPermissibleThough , sum of Rs.1114 lakh say Rs.11.14 crores would be required forstrengthening HMIS & MCTS in the state during 2011-12. Keeping in view thefinancial envelop given to state and availability of funds under mission flexi-pool, itis proposed that a sum of Rs. 400.00 lacs should be marked for allocation underHMIS/MCTS for FY 2011-12.95

AYUSHSr.No.CommentsReply of the Department1. The PIP mentions about trained dais (pg .719). The purpose of dai training and planfor utilization of the dais as well strategiesfor placing them in the facilities, along withthe expected roles may be outlined in thePIP.2. Role of AYUSH doctors may be expandedfor providing support in RCH. Withappropriate capacity building these MOscould become an asset even in the RCHprogramme.The department has proposed trainingprogramme for 240 trained dais posted inAYUSH dispensaries so that their servicescould be utilized in nearby delivery huts inaddition to their present duties. The detailtraining programmes has been included inPIP.In PIP 2011-12 the role of AYUSH doctorshave been indicated as follows:-1.OPD/IPD at PHCs, CHCs and DHs2. Panchkarma facalities at DHs.3.Propagation of curative and preventiveaspects of AYUSH systems of medicines,daily and seasonal regimens, utilities oflocal medicinal plants and healthy life styleetc.4.Support in RCH and other National HealthProgrammes.3. State needs to report on utilization ofAYUSH services in HMIS.4. A situational analysis of AYUSH in theState, status of current programme andoutcome analysis needs to be include in PIP5. The manpower component may be soughtand approved under NRHM flexipool notunder RCH Flexi pool.6. State should clarify the Physical units andrate of salary of AYUSH MO andThe AYUSH Doctors shall reports theiractivities and achievements to the AYUSHheadquarter as well as to the in-charge ofPHCs/CHCs/DHs so that it could becompiled by the staff working atPHCs/CHCs and DHs under HMISprogramme.The Situational analysis of AYUSHactivities has been included in the PIP 2011-12.The manpower under the programme ofmainstreaming of AYUSH has already beenapproved under NRHM flexipool.The physical units established under theprogramme of mainstreaming of AYUSH96

Paramedics.7. AYUSH doctor‟s remuneration should beat par with allopathic doctors.8. State should clarify the activities underhead of Staff at Headquarter for AYUSH.9. State may seek the financial assistanceunder NRHM flexi pool not under RCHflexi-pool and also mentioned the details oftraining activities to be undertaken .10. State may seek the financial assistanceunder NRHM flexi pool & The IECprogrammes may be supported underNRHM Flexipool.11. State should clarify the activities other thanHR under the head of mainstreaming ofAYUSH.12. The State may seek financial assistance forsupport of collocation at PHCs, CHCs andDHs and sent the monthly progress reportfor the financial support provided to thePHCs, CHCs and DHs.13. The UT may seek financial assistance fromthe Department of AYUSH forestablishment of supply of essential drugs.has already been mentioned in the PIP.The remuneration of AYUSH doctor‟s hasbeen revised at par with allopathic doctors inPIP 2011-12.The officers/officials posted under NRHMprogramme at AYUSH Head Quarter areoverall responsible for reviewing andmonitoring of AYUSH activities,maintaining of accounts pertains to theflexipool and CSS etc.The manpower under the programme ofmainstreaming of AYUSH has already beenapproved under NRHM flexipool. The detailof trainings to be conducted for AYUSHmanpower have been included in PIP 2011-12The budget involved in IEC programmes hasbeen proposed under NRHM Flexipool.The IEC, training and other activitiespertains to the mainstreaming of AYUSH hasbeen clarified in the PIP.The monthly physical and financial progressreport of AYUSH activities is already beingsubmitted to the state NRHM authorities.The essential drugs are being procured andsupplied for AYUSH Wing working atPHCs/CHCs/DHs from CSS.97