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ANNUAL REPORT

2008-09

Ministry of Health & Family Welfare


Welfare
Government of India
New Delhi
CONTENTS
PART-I DEPARTMENT
EPARTMENT OF HEALTH & FAMIL
EALTH Y WELF
AMILY ARE
ELFARE

Chapter Page No.


Introduction 1
1. Organization & Infrastructure 5
2. NRHM, Health & Population Policies 23
3. Funding for the Programme 51
4. Maternal Health Programme 61
5. Child Health Programme 69
6. National Programmes under NRHM 83
7. Information, Education and Communication 117
8. Partnership With Non-Government Organisations 123
9. Family Planning 127
10. Training Programme 137
11. Research 149
12. Other National Health Programmes 151
13. Medical Relief and Supplies 165
14. Quality Control In Food & Drugs Sector, Medical Stores 193
15. Medical Education, Training & Research 203
16. Facilities For Scheduled Castes and Scheduled Tribes 315
17. Use of Hindi in Official Work 319
18. International Co-Operation for Health & Family Welfare 321
19. Activities In North East Region 327

PART-II DEP ARTMENT OF AYURVED


EPARTMENT A, YOGA-NATUROP
YURVEDA ATHY, UNANI, SIDHA &
TUROPA
HOMOEOP
OMOEOPA ATHY (A YUSH)
(AYUSH)
Overview 349
1. Organization 353
2. National Policy 355
3. Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) 359
4. Education 363
5. Research and Development 385
6. Increasing the Availability of Medicinal Plants for Raw Material 403
7. Standardization and Quality Control of ASU&H Drugs 411
8. AYUSH Pharmaceutical Industry 417
9. Information Education and Communication 419
10. International Cooperation 427
11. Mainstreaming of AYUSH in National Health Care 433
12. Information Technology 435
13. Gender Issues 437

PART-III DEPARTMENT
EPARTMENT OF HEALTH RESEARCH
EALTH 439

PART-IV DEPARTMENT
EPARTMENT OF AIDS CONTROL 449

ANNEXURE PART-I MINISTRY OF HEALTH & FAMIL


EALTH Y WELF
AMILY ARE
ELFARE

 Organisation Chart of Department of Health and Family Welfare 486


 Organisation Chart of DGHS 498
 Organisation Chart of Department AYUSH 500
 Organisation Chart of Department of Health Research 502
 Organisation Chart of Department of AIDS Control 503

ANNEXURES PART-II DEPARTMENT


EPARTMENT OF AYUSH
AYUSH
Annexure-I List of publications made by various organization under the 507
Department of AYUSH during the last one year / distributed by AYUSH.
 Central Council for Research in Yoga and Naturopathy
 Central Council for Research in Homoeopathy, New Delhi
 Morarji Desai National Institute of Yoga
 Central Council for Research in Unani Medicine

Annexure-II Department of AYUSH Eleventh Plan Outlay 518


Annexure-III Scheme-wise Tenth Plan Outlay and Expenditure 519
Annexure-IV Summary of Infrastructure Facilities under AYUSH 521
Annexure-V State-wise Number of AYUSH Registered Practitioners as on 1.1.2008 522
Annexure-VI State-wise number of AYUSH Registered Practitioners per 523
Lakh Population as on 1.1.2008
Annexure-VII State-wise/System-wise Number of Hospitals with their 524
Bed Strength under AYUSH as on 1.4.2008

Annexure-VIII State-wise/System-wise number of 525


Dispensaries under AYUSH as on 1.4.2008
Part - I

Department of
Health & Family Welfare
ANNUAL REPORT 2008-09

Introduction
India has made substantial progress in health the community in the Public Health Systems. Through
determinants over the past decades. The critical the process of decentralised Integrated Planning and
indicators of health, including Infant Mortality Rate, inter-sectoral convergence, the states are able to
Maternal Mortality ratio, Disease prevalence, address the expectations of the citizens and lead the
morbidity as well as mortality rates have shown country towards a healthier future.
consistent decline over the years. These
In partnership with States and through state led
achievements are the cumulative result of several
innovations, NRHM is rapidly expanding accessible,
interconnected changes. The improved coverage
affordable and accountable quality care to every
and efficiency of Public Health Delivery System as
household in the country. More than 6.28 lakh ASHAs
well as expanding private health sector have
and Link Workers are connecting households to
contributed in equal measures to ameliorating the
health facilities. States across the country are
sufferings associated with adverse health events.
reporting significantly higher utilization of outpatient
The over all economic upturn as well as improvement
services, diagnostic facilities, institutional deliveries
in collateral determinants of health has assisted
and inpatient care. Large scale demand side financing
the country to achieve critical milestones like
under the Janani Suraksha Yojana has brought poor
elimination of Leprosy and reduction in the burden
households to public sector health facilities on a scale
of Tuberculosis. never witnessed before. More than 2.97 lakh Village
India is in the midst of an epidemiological and and Sanitation Committees have been made
demographic transition largely on account of the functional to bring about community ownership and
significant progress in improving life expectancy at planning in health sector. Rogi Kalyan Samitis set at
birth, in reducing mortality due to Malaria, as well as various levels have been made the custodians of
in reducing infant and maternal mortality over the the untied funds and annual maintenance grant for
last few decades. This adds to the already daunting health facilities. Untied funds at various levels have
challenge of reaching quality health care to every introduced functional flexibility in proper upkeep of
household in the country. health institutions ensuring the availability of the
quality services to the citizens. Detailed integrated
The National Rural Health Mission (NRHM) is a District Health Action Plans have been prepared in
major flag ship programme of the Ministry. Over the over 541 districts, and convergence of key health
last three years of implementation, the NHRM has and health related initiatives is being ensured through
brought about comprehensive rejuvenation of Public the District Health Missions and the State Health
Health System in the country. This rejuvenation has Missions.
addressed the fundamental issues encumbering the
Quarterly reporting on flagship programmes as
health system. The Central Government has
“Bharat Nirman Quarterly Reports”
substantially increased the financial support to the
health sector. The funds are being utilised through The Ministry of Health & Family Welfare has launched
the process of decentralised planning and a web based Health MIS (HMIS) portal in March 2008
implementation to ensure the ownership of respective to facilitate data capturing at the District level. The
state Governments in the reform process. At the same portal captures physical and financial performance
time, the community based monitoring and proactive under the NRHM from the States. The Ministry hopes
roles to Village Health & Sanitation Committees and to fully operationalise the HMIS by the end of June
Rogi Kalyan Samitis has restored the confidence of 2009.

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ANNUAL REPORT 2008-09

Reproductive and Child Health Programme is a require focused attention for the country. Kala-azar
major component of NRHM and aims at reduction & Lymphatic Filariasis have been targeted for
of Infant Mortality Rate to 30/1000, Maternal Mortality elimination by 2010 & 2015 respectively and the goal
Ratio to 100/100000 live births and Total Fertility Rate of elimination must be achieved to make our country
to 2.1. These targets are to be achieved by 2010. free from these diseases affecting the health of large
Against these goals, IMR of 55/1000 live births, (SRS population.
2007) MMR of 254/100000 live births (SRS 2006)
HIV situation in the country is assessed and
and Total Fertility Rate of 2.8 (SRS 2006) have been
monitored through regular annual sentinel
achieved.
surveillance mechanism established since 1992. The
Rapid urbanization has led to rapid increase in the third phase of National AIDS Control Programme
number of urban poor, majority of whom live in slums. (NACP) was launched in June 2007. The overall goal
In order to improve the health status of the urban of NACP-III is to halt and reverse the epidemic in
poor particularly the slum dwellers and other India over the next 5 years. Considering that more
disadvantaged sections by facilitating equitable than 99% of the population in the country is free
access to quality health care with the active from infection, NACP-III will place the highest priority
involvement of the Urban Local Bodies (ULBs) in on preventive efforts while, at the same time, seeking
cities with population of one lakh and above and State to integrate prevention with care, support and
Capitals, the National Urban Health Mission treatment. Building up of a strong Strategic
(NUHM) has been planned. The NUHM would be Information Management System and strengthening
covering 21.07 crore urban population with a special the Surveillance and Research components to
focus on 6.25 crore urban poor living in slums and provide evidence for planning and implementation
beyond, spread over 430 cities. The proposed will be given major thrust during NACP-III. National
financial outlay is Rs.6207.84 crore in the XIth Plan. AIDS Control Programme is currently focusing on up-
scaling of services to improve coverage and to
The Integrated Disease Surveillance Project improve the quality of services provided.
(IDSP) launched in 2004 with the objective to detect
and respond early to warning signals of disease Tuberculosis is a major public health problem in
outbreaks, has established an IT network in 317 of India. About 3.25 lakh persons are estimated to die
of TB every year in the country. The Revised National
the 400 sites with the help of NIC and ISRO
TB Control Programme (RNTCP), using Directly
connecting all States, District HQ and Government
Observed Treatment Shortcourse (DOTS) strategy,
medical colleges and certain national institutions
with the objective of curing at least 85% of new sputum
involved in disease surveillance and response. In
patients put on treatment and detecting at least 70%
addition, a 24x7 Call Centre set up in February 2008
of such patients is being implemented in the country
receives disease alerts from all over the country on
in a phased manner from 1997 and the entire country
toll free number 1075 and a total of 34,459 calls have
has been covered by March 2006.
been received till March 2009.
As part of the continued efforts to achieve leprosy
Prevention and control of vector borne diseases
elimination in six States/UTs viz, Bihar, Chattisgarh,
such as Malaria, Filaria, Kala-azar, Japanese
West Bengal, Jharkhand, Chandigarh and D&N
Encephalitis, Dengue & Chikungunya has a direct
Haveli as well as to provide support for Disability
link with economic & social development of the
Prevention and Medical Rehabilitation for these
community. The malaria incidence in the country
States, and 29 States/UTs which have achieved
was brought down from 6.4 million cases in 1976 to
leprosy elimination, support is being provided for
1.86 million cases in 2003. Since then it has been
Reconstruction Surgery (RCS).
kept below 2 million cases. However, malaria still
continues to be a major public health problem in many Cancer is a major public health concern in India and
tribal areas as well as hilly and forested areas which has become one of the ten leading causes of death

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ANNUAL REPORT 2008-09
in the country. With a total outlay of Rs. 2400.00 crore, infection) have been reported in several countries,
the National Cancer Control Programme (NCCP) is including India. In order to check the entry and spread
proposed to be modified to meet the gap in available of this virus in our country, this Ministry has taken a
cancer care facilities and trained manpower in the number of measures on war footing e.g. streng-
country. The Government has set up the " Health thening of the laboratory facilities and case
Minister's Cancer Patient Fund "(CPF) to provide management facilities, health screening of
financial assistance to Below Poverty Line (BPL) passengers coming from the affected countries,
cancer patients for treatment of this chronic disease, contact tracing and enhanced surveillance,
which is highly expensive and prolonged. stockpiling of essential drugs etc.

Tobacco is the single most preventable cause of death The Transplantation of Human Organs Act was
in the country. The Government of India is taking steps enacted in 1994 to curb commercial transactions in
to ensure effective implementation of the Cigarettes human organs. In the light of experience gathered
and other Tobacco Products (Prohibition of over the last decades, it is now proposed to amend
Advertisement and Regulation of Trade and Commerce, the law to facilitate genuine cases of organ donation
Production, Supply and Distribution) Act, 2003. The and to prescribe harsh punishment for illegal
Ministry of Health & FW has launched the National transactions. A programme to promote organ
Tobacco Control Programme in the 11th Five Year Plan donation will also be launched shortly.
to build capacity of the States for the effective
implementation of the Tobacco Control Act and the With the objectives of creating and expanding health
Framework Convention on Tobacco Control (FCTC). manpower in old age care, promoting relevant
As per Tobacco Control Legislation, 2003, the Rules research to provide for evidence based active and
regarding pictorial warnings of Health Hazards of healthy ageing and integrated, comprehensive and
Smoking has come into effect on 31st May, 2009. quality health care to older people at all levels - in
institutions and community-the National Programme
To address major causes of mortality and morbidity for Healthcare of Elderly is proposed to be launched
in the country in a focused manner, the Government in 2009.
has launched a number of new initiatives. The
pilot programme under the National Programme In order to reduce the gaps in availability of tertiary
on Prevention and Control of Diabetes, healthcare across states, the Pradhan Mantri
Cardiovascular diseases and Stroke last year Swasthya Suraksha Yojana (PMSSY) Phase I has
has been expanded to 10 States and the Programme been launched. This programme envisages setting
aims at using health promotion and health education, up of 6 new AIIMS like Institutions in the States of
advocacy, early detection of persons with high risk Bihar, Chattisgarh, Madhrya Pradesh, Orissa,
factors (at the risk of developing disease) through Rajasthan and Uttranchal and upgradation of 13
opportunistic screening and strengthening of health existing Government medical colleges. GOI has also
systems at all levels to tackle Non-Communicable approved Phase II of PMSSY project to set up 2 AIIMS
Diseases and improvement of quality of care. The like institutions one each in Uttar Pradesh and West
National Programme on Prevention and Control Bengal and upgrade 6 existing Medical College
of Deafness (NPPCD) is addressing the second Institutions.
most cause of disease morbidity - hearing impairment/ Universal Immunization Programme was started
deafness - in the country and covers nearly 80 in 1985-86 to cover six vaccine preventable diseases
districts in 2008-09. in phased manner covering all the districts in the
country by 1989-90. Since 2006, two new vaccines
Occurrence of cases of H1N1 infection (Swine
viz. Japanese Encephalitis (JE) and Hepatitis B have
flu) in the country
been introduced in select district and States. There
Recently, human cases of Swine flu (H1N1 virus is a plan to introduce a combination (pentavalent)

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ANNUAL REPORT 2008-09
vaccine having five antigens DPT-Hepatitis B-Hib National Council for Human Resources in Health as
to immunize children against five vaccine preventable an overarching regulatory body. To deliberate on the
diseases of Diphtheria, Pertussis, Tetanus, Hepatitis issue of setting up of the National Council, a Task
B and Hib disease in some States. Force under the chairmanship of the Union Secretary
for Health & Family Welfare has been constituted.
Revival of Vaccine producing units in the Public
The Task Force is expected to submit its report by
Sector -Vaccine producing units in the Public Sector
31st July 2009.
will be revived to support the Immunisation
programme. The action plan for revival of production During the year 2008-09, concerted efforts were made
of DPT group of vaccines at CRI Kasauli is already towards the implementation of the newly enacted Food
being implemented Safety and Standards Act, 2006 which seeks to
integrate the various existing laws on food. In this regard,
Nursing plays an important role in the health care
the Food Safety and Standards Authority of India
delivery system. In order to strengthen and expand
(FSSAI) was established for effective implementation
Nursing Services to provide Health Services to the
of the new Act.
rural people, Government of India has taken Nursing
as a priority programme in the 11th Plan. A new Health relief activities in cyclone (AILA) affected
scheme namely Human Resource (Health) Services areas of West Bengal -The cyclonic storm (AILA)
which inter alia include upgradation/strengthening struck the State of West Bengal on 25th - 26th May
of Nursing Services at a cost of Rs. 200 crore during 2009 affecting about 39 lakh people from 19 districts.
the 11th Plan period has been approved. The Public Health Teams of the Ministry were deputed
to the worst affected areas for rapid health
To meet shortage of doctors and specialists,
assessment. Medical teams were also mobilized
comprehensive changes in four regulations of
from Railways, ESIC and the Army, apart from
Medical Council of India (MCI), relating to under-
graduate/postgraduate medical education, starting neighbouring States. These teams are monitoring
of new medical colleges and minimum requirement the situation.
qualification for teachers have been approved by Achieving an acceptable standard of health for
the Ministry and awaiting notification by MCI. A new general population has been the objective over the
centrally sponsored scheme with 75% plan era in the Health sector. In line with this
assistance from the Centre for strengthening objective, there has been a steady increase in
and up gradation of state government medical allocations made for this Sector from very beginning
colleges for increasing seats in PG courses and of the Plan era. Allocation for Health & Family Welfare
starting new PG courses has been formulated. For during 10th Plan was of the order of Rs.37,153 crores.
this purpose, an amount of Rs. 1350 crores has been This has been substantially enhanced to Rs.1,40,136
earmarked in the 11th five year plan. crores during the XIth plan. We hope that substantially
enhanced funding along with rationalisation of
National Council for Human Resources in Health -
policies and systemic corrections initiated under
In order to reform the current regulatory frame work NRHM would help establish a robust Public Health
and enhance the supply of skilled personnel, the System which would respond to the expectations of
Government of India has proposed to set up a the citizens of India.

NARESH DAYAL
Date : 11-07-2009
Secretary (H &FW)
New Delhi
Ministry of Health & Family Welfare

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ANNUAL REPORT 2008-09

Chapter 1

Organization & Infrastructure


1.1 Introduction the respective State Governments and the Department
of Health & Family Welfare only facilitates the States
In view of the federal nature of the Constitution, in availing of external assistance. All these schemes
areas of operation have been divided between Union aim at fulfilling the national commitment to improve
Government and State Governments. Seventh access to Primary health care facilities keeping in
Schedule of Constitution describes three exhaustive view the needs of rural areas and where the incidence
lists of items, namely, Union list, State list and of disease is high.
Concurrent list. Though some items like Public Health,
The Union Ministry of Health & Family Welfare
hospitals, sanitation, etc. fall in the State list, the items
comprises the following departments, each of which
having wider ramification at the national level like
is headed by a Secretary to the Government of India:-
population control and family welfare, medical
education, prevention of food adulteration, quality  Department of Health & Family Welfare
control in manufacture of drugs etc. have been
 Department of AYUSH
included in the Concurrent list.
 Department of AIDS Control (Created in
The Union Ministry of Health & Family Welfare is
December, 2008)
instrumental and responsible for implementation of
various programmes on a national scale in the areas  Department of Health Research
of Health & Family welfare, prevention and control of
Organograms of the above Departments of Health &
major communicable diseases and promotion of
Family Welfare ,Department of AYUSH , Department
traditional and indigenous systems of medicines.
of AIDS Control and Department of Health Research
Apart from these, the Ministry also assists states in
are at Annexure (Part-I) at the end of the Annual
preventing and controlling the spread of seasonal
Report.
disease outbreaks and epidemics through technical
assistance. Directorate General of Health Services (Dte.GHS) is
an attached office of the Department of Health &
Ministry of Health & Family Welfare incurs expenditure Family Welfare and has subordinate offices spread
either directly under Central Schemes through its all over the country. The DGHS renders technical
two departments, including the attached offices of advice on all medical and public health matters and
DGHS and its various subordinate offices, or by way is involved in the implementation of various health
of grants - in - aids to the autonomous/statutory schemes.
bodies etc. and NGOs. In addition to the 100%
centrally sponsored family welfare programme, the
1.2 Minister in Charge
Ministry is implementing several World Bank assisted The Ministry of Health and Family Welfare is headed
programmes for control of AIDS, Malaria, Leprosy, by Union Minister of Health and Family Welfare, Shri
and Tuberculosis and Blindness in designated areas. Ghulam Nabi Azad since 29th May, 2009. He is
Besides, State Health Systems Develoment Projects assisted by the Ministers of State for Health and
with World Bank assistance are under implementation Family Welfare-Shri Dinesh Trivedi and Shri S.
in various states. The projects are implemented by Gandhiselvan.

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ANNUAL REPORT 2008-09

Union Minister of Health and Minister of State for Health Minister of State for Health
Family Welfare and Family Welfare and Family Welfare
Shri Ghulam Nabi Azad Shri Dinesh Trivedi Shri S. Gandhiselvan

1.3 Administration and improved working environment. Two conference


halls have been modernized and one mini conference
In order to fulfill Government's commitment to provide hall has been newly built.
better health care facilities, the Department has taken
new initiatives and steps to ensure that the 1.6 Central Health Service
Government policies and programmes are
implemented in a time-bound and efficient manner. The Central Health Service was restructured in 1982
It has enforced discipline and accountability amongst to provide medical manpower to various participating
its officers and staff. units like Directorate General of Health Services
(DGHS), Central Government Health Service
As part of responsive administration, Director (CGHS), Government of National Capital Territory
(Administration) attends to service related grievances (GNCT) of Delhi, Ministry of Labour, Deptt. of Posts,
of the staff in the Department of Health and Family Assam Rifles, etc. Since inception a number of
Welfare. Secretary(Health and Family Welfare) also participating units like ESIC, NDMC, MCD, Himachal
gives personal hearing to staff grievances. Pradesh, Manipur, Tripura, Goa, etc. have formed
their own cadres. The latest in the list of institutions
For quick and timely redressal of public grievances, which has gone out of CHS cadre is JIPMER,
Shri P A Sawant, Director (Welfare & PG) in the Pondicherry which has become an autonomous body
Department is functioning as nodal officer. Under w.e.f. 14th July, 2008. Recently, Ministry of Labour
Secretary (welfare and PG) assists him in the matter. (Labour Welfare Organization) and Assam Rifles
1.4 Healthy Lifestyle Centre (YOGA & which is under the Ministry of Home Affairs have also
opted out of CHS partially. At the same time units
GYM)
like CGHS have also expanded. The Central Health
A Healthy Lifestyle Centre (Yoga & Gym), funded by Service now consists of the following four sub cadres
WHO has been functioning in the Ministry since 28th and the present strength of each sub-cadre is as
November 2005. The officers and staff of the Ministry under:
have been availing this facility
i) General Duty Medical Officer sub-cadre - 3137
1.5 Modernization of Office ii) Teaching Specialists sub-cadre - 778
The work relating to modernization of office premises iii) Non-Teaching Specialists sub-cadre - 784
continued in 2008-09, during which period, about
10 rooms have been upgraded, creating more space iv) Public Health Specialists sub-cadre - 079

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ANNUAL REPORT 2008-09
In addition to the above there are 19 posts in the During the year, the following number of promotions
Higher Administrative Grade, which are common to were effected in various sub-cadres of the Central
all the four sub cadres. Health Service.

S.No. Particulars GDMO Non-Teaching Teaching Public Health

1. Medical Officers (Rs. 8000-13500) 18 - - -


Promoted as Senior Medical
Officers (Rs. 10000-15200)

2. Senior Medical Officers 18 05 - -


(Rs. 10000-15200) Promoted as
Chief Medical Officers
(Rs. 12000-16500)

3. C.M.O. promoted to CMO (NFSG) 137 - - -


Rs. 12000-16500 to
Rs. 14300-18300) (Regular)

4. C.M.O. promoted to CMO (NFSG) 01 - - -


Rs. 12000-16500 to
Rs. 14300-18300) (Regularised)

5. Specialist Gr. II/Asstt. Prof. to - 05 - -


Sr. Scale to Sr. Administrative
Grade (Rs. 10000-15200 to
Rs. 12000-16500)

6. Specialist Grade II (Senior Scale)/ - 37 - -


Associate Professor
(Rs. 12000-16500) to
Specialists Grade I/Professor
(Rs. 14300-Rs. 18300)

7. Specialist Grade I (Professor)/CMO - 17 03 -


(NFSG) (Rs. 14300-18300) to
SAG/Director Professor

Chief Medical Officer (NFSG) (Rs. 14300- Promotion orders have been issued for the regular cadre
18300) to Senior Administrative Grade of the CHS doctors and is under issue for the regularized
(Rs. 18400-22400) (Regular & Regularized) cadres of the CHS doctors.

Proposals Approved by Government during the for the RRs for the post as also the filling up
Year: the post as a one time exemption has been
sent to the UPSC for their concurrence after
i) Creation of the posts of Special DG: The which the approval of the ACC would be taken.
Government approved the creation of two
posts of Special DG, (Health Services) in the ii) Enhancement of the age of super-
scale of pre-revised Rs. 26000/- (fixed) and annuation of Teaching Specialists: In June
orders were issued in April 2008. Proposal 2008 the government approved the
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ANNUAL REPORT 2008-09

enhancement of age of superannuation of approved the appointment of retired GDMOs


Medical Teaching Specialists of the Central of CHS on contract basis in CGHS
Health Service and other medical institutions dispensaries subject to the following terms
under the Ministry of Health and FW from 62 and conditions:
years to 65 years. This would be applicable
to all the Teaching Specialists of the Central a) The contract will be for one year
Health Service as also the Medical Teaching extendable by another one year
Faculty in AIIMS, New Delhi, PGIMER, b) Retired GDMOs will be engaged on a
Chandigarh, NIMHANS, Bangalore, consolidated amount of Rs. 25,000/- p.m.
NEIGRIHMS, Shillong, RIMS, Imphal, AIIH &
PH, Kolkatta and LGBRIMH, Tezpur. c) All appointees shall be below the age of
65 years.
iii) Extension of DACP Scheme upto SAG
level: Government approved the extension vi) Increasing the remuneration of
of Dynamic Assured Career Progression contractual employees: The contractual
(DACP) Scheme upto Senior Administrative employees appointed under the Government
Grade (SAG) in respect of all Medical and of India were in receipt of a lump sum amount
Dental doctors including doctor of the Central of Rs. 26000/ p.m. However, having
Health Service under the Ministry of Health consideration to the fact these contract
and Family Welfare. employees supervise the work of the Junior
and Senior Residents and the pay of these
iv) Posting of doctors to Andaman & Nicobar
Resident has been substantially increased
Islands: The Andaman & Nicobar
as a result of the recommendations of the
Administration had formed their own service
6th CPC, it has been decided that the pay of
known as Andaman Health Services.
contractual employees be raised to Rs.
However, despite best efforts on their part
47500/- plus DA.
the vacancies of Specialists (Non-Teaching)
Sub-Cadre could not be filled and that Other Service related matters
Administration has sought assistance from
this Ministry to fill up the posts. Accordingly, i) Special efforts for obtaining ACRs:
from August 2008 onwards General Duty One of the major component cadre
Medical Officers with requisite PG management of CHS is to ensure timely
qualification are being deputed to the A & N submission of ACRs by all participating
Islands for a period of 90 days in Specialities units in respect of CHS officers working
of Medicine, Radiology, ENT, Skin and under them. In order to catalyze the
Obstetrics & Gynaecology. By the end of system of collecting of ACRs Nodal
March 2009 it is expected that 21 officers Officers had been appointed during 2006
would have completed their tenure of 90 days for three or four participating units in a
each in the Islands. The Andaman and particular territory. These Nodal Officers
Nicobar Administration has also been advised were required to coordinate with
to tie up with some of the well known hospitals individual units for collection and
like Lifeline/Apollo Hospitals for better patient submission of ACR to the Ministry in time.
care through the system of telemedicine. In It has been observed that the system has
the case of Lakshadweep Islands the system borne fruits and there is a quantum jump
of rotational transfer of Specialists for a in timely submission of
period of 90 days is still continuing.
ii) the ACRs by the participating units.
v) Contractual appointments of retired Further, it was noticed that one of the
GDMOs: The Government of India has participating units, namely GNCT Delhi

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ANNUAL REPORT 2008-09
was found wanting in submission of ACRs (iii) RTI: The number of RTI cases received
in time. Accordingly, the matter was taken in this Division is 113.
up at the highest level in GNCT by
addressing a suitable letter to the Chief (iv) Court Cases: There were 83 CAT/Court
Secretary, GNCT, Delhi explaining the cases pending in various CAT/Courts in the
poor position of submission of ACRs by beginning of financial year 2008-09. But due
that Government. The response to that to vigorous efforts by the CHS Division, 19
letter has been very good and cases have been disposed off by the courts
encouraging as hundreds of ACRs have and only 64 cases are pending in courts.
been received in respect of CHS officers (v) Deputation of GDMO with PG
working under GNCT, Delhi. It is in the Qualification: The CHS Rules provide for
fitness of thing that the letters are 100 posts to be filled on deputation. It has
received from various hospitals under accordingly been decided to allow GDMO
GNCT, Delhi intimating the submissions Sub-Cadre of CHS with PG qualification in
of ACR to the Secretariat in Delhi for any Specialty to apply to the posts of
further follow up. In order to give fillip to Specialists in any of the three Specialists Sub
the on-going efforts, team of officers of Cadre i.e. Teaching, Non Teaching and Public
CHS Division have been constituted for Health on deputation basis.
visit to various participating units of the
CHS throughout the country. Non Medical Scientists

A proposal has been mooted to amend the ISP Rules,


iii) Formation of the Delhi Health Service:
90 to incorporate provisions for inclusion of more
The formation of the Delhi health Service
posts within its ambit as also to exclude some of the
was going on since 2006. The UPSC
posts outside its purview.
have now approved the Delhi Health
Service Allopathy Rules on 14th Draft COS Note has also been circulated among
November 2008 and have requested the concerned Departments calling for their comments
GNCT of Delhi to issue the Notification on the proposal for amendment of UPSC(Exemption
within a period of ten weeks. Special from Consultation) Regulations, 1958 under Ministry
efforts had been taken by this Ministry to of Health and Family Welfare with a view to do away
expedite the formation of the Delhi Health with the requirement of consultation with the UPSC
Service in order to gauge the number of in the matter of in-situ promotion upto S.IV level.
doctors that would be remaining in the Action has also been taken to fill up three out of the
CHS after the formation of the Delhi Health six vacant posts at S-V level.
Service and JIPMER which has already
Dental Posts:-
been declared as an autonomous
organization in July 2008. During the year 2008-09 six posts of Dental Surgeons
under Ministry of Health and Family Welfare have
Tentative figures indicate that the strength of Central
been filled up on regular basis. Orders for promotion
Health Service in each of the sub-cadres would be
of three Dental Surgeons as Junior Staff Surgeons
as follows:
and placement of two Dental Officers in the NFSG
Teaching Sub Cadre 241 were issued.

Non-Teaching Sub Cadre 598 A proposal for giving the benefit of DACP to the Dental
Officers from a retrospective date i.e. the date from
Public Health 75 which it was made applicable to CHS Officers, has
GDMO 2175 been submitted to the COS for its consideration.

9
ANNUAL REPORT 2008-09

The process has also been initiated to amend the Computerization of Central Govt. Health
Dental Posts Recruitment Rules, 1997 to bring them Scheme (CGHS)
in conformity with the changes that have since taken
CGHS is high on the agenda of the Government with
place.
the ultimate objective to provide effective, timely and
Seniority Lists hassle free healthcare to the CGHS beneficiary. The
computerized system is aimed at computerizing all
The grade-wise seniority lists of doctors belonging functions of the dispensary such as Registration,
to the four sub-cadres of CHS have been posted on Doctors' prescription, Pharmacy Counter, Stores,
the website of Ministry of Health & FW and is being Laboratory & Indent. The system has been
regularly updated. successfully implemented in the CGHS dispensaries
of Delhi/NCR a year before. Now the 102
1.7 E-Governance Initiatives of the dispensaries outside Delhi in 6 locations namely
Ministry of Health & FW Mumbai, Pune, Nagpur, Chennai, Hyderabad and
Health Informatics Division of National Informatics Chennai are under implementation.
Centre provides MIS and Computerization support The system requires robust internet connectivity in
to Ministry of Health & Family Welfare. More than the CGHS dispensaries to access the computerized
1200 PCs of the Ministry are connected to the Local web based system work. The broadband connectivity
Area Network (LAN), which in turn, connected to currently provided in the dispensaries is being
NICNET through RF Link and leased line circuits. upgraded to the Managed Leased Data Network
Salient features of the some of the projects handled (MLDN) which will provide dual use of Leased Line
by NIC are as follows: and Broadband connection and can be monitored
remotely, the implementation of which is under
Web Page of the Ministry of Health & Family completion. The similar MLDN network is also under
Welfare : implementation in 110 locations in CGHS
dispensaries of NCR region and 6 aforesaid
The updation of Website of the Ministry of Health &
locations outside Delhi/NCR.
Family Welfare http://mohfw.nic.in and various other
websites under the ministry is done on a regular basis, The introduction of plastic cards for every individual
as and when the information is provided by the users. CGHS beneficiary with the barcode number is under
Critical information such as Bird Flu, notifications of implementation. Hence every beneficiary will have
the CGHS, Tenders under the Ministry, Sanction to carry plastic card in place of the CGHS Index Card
Details of the Principal Accounts Office & Public (which was the family card). The distribution of plastic
Expenditure Management, etc are such areas where cards has already started and is likely to complete
regular updation takes place. by this year.

Network Maintenance and email, internet More modules have been introduced in the
usage computerized system. The pilot implementation of
claims processing of individual beneficiaries,
NIC provides new LAN connections; network based diagnostic centers, permissions etc is underway. The
Anti-virus solution in addition to maintaining existing URL of the site is http://cghs.nic.in . .
network users. At present over 1200 LAN nodes have
FSSAI Web portal
been provided in the Department of Health & Family
Welfare and about 100 LAN nodes are there at IRCS Food Safety & Standards Authority of India (FSSAI)
Building at Dept of AYUSH. The email and internet has been established under the Food Safety and
usage has grown significantly and officials prefer Standards Act, 2006 as a statutory body for laying
email communication over other means. down science based standards for articles of food

10
ANNUAL REPORT 2008-09
and regulating manufacturing, processing, distribution, regulation of these cases is carried out by the State
sale and import of food so as to ensure safe and and District Appropriate Authorities through the online
wholesome food for human consumption. The web system. The training has been successfully
portal of the FSSAI has been designed and launched. completed for State and District Appropriate
The complete System Requirements Study is Authorities in most affected States where the ratio of
underway. The URL of the site is http://fssai.gov.in. Females to Males is alarmingly low. The training is
underway to cover all the States and UTs.
Intra-Health Portal for the Ministry:
Computerisation of Medical Stores Organization
NIC had initiated the development of a portal for the
(MSO) and General Medical Stores Depots
Ministry of Health and Family Welfare. The services
(GMSDs)
like Pay slips, user profile, Birthday Greetings, File
Movement System, Project Monitoring System, News, The MSO is a premier organization of the MoHFW,
Events, Notices and Circulars, Photo of the week etc which is involved in procurement and supply of
have been incorporated. File Movement system is medicines to the Central Govt. hospitals across India,
being accessed by various sections of the CGHS, Para-military forces. MSO does it through its
Department of AYUSH & Department of Health & 7 GMSDs located across India. Inventory
Family Welfare. The portal URL is http:// management is therefore very vital for the MSO so
intrahealth.nic.in. This portal can become an effective that the medicines are supplied to the indenters in
tool for the users to communicate within the Ministry time after proper quality check.
and share the files, documents, notifications, circulars
etc. The web based Inventory management system for
the MSO & GMSD has been implemented on a pilot
Grant-In-Aid (GIA) and Utilization Certificates basis. The full cycle implementation is underway with
(UC) monitoring system various stack holders such as indenters, suppliers;
Labs etc are to be provided with the connectivity to
The web based system has been launched in the
be part of the online system.
Ministry and all the Pay & Accounts Offices of the
ministry use it centrally. Now it's possible to track the Integrated Diseases Surveillance Project (IDSP)
status of GIA and UCs division wise, institution wise,
state wise. It can become more useful when all the Integrated Disease Surveillance Project (IDSP) is a
divisions in the Ministry start using this system. The decentralized, State based Surveillance Program of
URL is http://mohfw.nic.in/uc/super/login.asp. MOHFW covering the whole country. It is intended to
detect early warning signals of impending outbreaks
PNDT Web Portal and help initiate an effective response in a timely
manner.
Pre-Natal Diagnostic Techniques (PNDT) has been
established under the Pre-Conception and Pre-Natal NIC has been entrusted with the turn key
Diagnostic Techniques (Prohibition of sex selection) responsibility of establishing the ICT infrastructure
Act, 1994. The Web portal was launched in April 2008 at around 800 sites including 604 Districts, 35 state
during the launch of the Save the Girl Child capitals, 147 Medical colleges, 12 ID hospitals and
Campaign by the Hon'ble Prime Minster of India. The central offices in Delhi.
portal provides all the necessary information about
the Act and its implementation. A web based MIS has The ICT infrastructure has so far been made
also been developed through which all the hospitals functional at around 85 % of the total locations. The
and diagnostics centers such as Ultra Sound Clinics work is in progress in the states of Bihar, Jharkhand
and Labs involved in pre-natal examinations are and UP which joined later in IDSP. This ICT network
required to submit the online form F against each enables enhanced Speedy Data Transfer, Video
case reported with them. The monitoring and Conferencing, Discussions, Training e-learning for

11
ANNUAL REPORT 2008-09

outbreaks and program monitoring under IDSP. Video From the academic year 2009-10 onwards, the
conferencing is being used regularly for discussions computerized Seat Allotment will be done in the cities
between states and Central Unit during outbreaks of New Delhi, Mumbai, Chennai, Kolkatta and Shillong
and for monitoring if IDSP implementation and through VC based counselling. Also, reservations
Training. A 24X7 call center with toll free telephone for OBC and PH merit holders in addition to SC/ST
no 1075 accessible from BSNL/MTNL telephone from category merit holders is being introduced from the
all states is in operation since February 2008. This academic year 2009-10.
receives disease alerts from anywhere in the country
and shares the information with the respective State/ ehospital@NIC:
District Surveillance Units for verification and initiating
NIC had developed work flow based Hospital
appropriate actions wherever required. During the
Management Information System (HMIS) thro' Tripura
last 10 months of operation, 29,548 calls were
State Unit. Presently, this software had been
received at 1075 during last 10 months of which 68
were Health Alerts resulting in 7 outbreak alerts. implemented and successfully running in G.B. Pant
Hospital, Agartala. Various customized versions of
Development of OncoNET India: a computer this software are running in number of government
network of 125 Cancer Centers: Hospitals, to name a few, ESIC Hospital, Basai
NIC is proposing to outsource the development of Darapur, Delhi, Bhagwan Das Memorial Hospital,
OncoNET to a vendor and has developed a business Shillong, Indira Gandhi Medical College, Nagpur etc.
model for implementation of the project. The vendor This software had been demonstrated to the officials
would set up the medical equipment (viz. Digital of Ministry of Health & Family Welfare and Dr. Ram
Microscope and X-Ray scanner) at the centres to Manohar Lohia Hospital. The proposal pertaining to
facilitate transmission of patients' EMR; in addition the implementation of this software at Dr. Ram
the network would facilitate scheduling of Manohar Lohia hospital had been approved by the
appointments, management/treatment and follow up Ministry.
visits. The vendor would be using telemedicine
Health Management Information System
software indigenously developed by NIC. RFP for bids
for the same would be released shortly. The Ministry has recently launched a dedicated
Computerised Medical Seats Allotment System: Health Management Information System (HMIS) portal
for all Public Health related information in October
In compliance of the Hon'ble Supreme Court of India, 2008. The HMIS portal captures data to be collected
Directorate General of Health Services allot 15% as per the revised HMIS formats on a web-based
undergraduate medical/dental seats and 50% system at the District level and also enables
Postgraduate recognised/approved MD/MS degree/
information to be entered for each facility. The
diploma seats and MDS seats. Towards this,
application would facilitate timely and accurate
Computerised Medical Seats Allotment System is
collection, capturing and dissemination of data. The
implemented by NIC and operational for the last 15
portal would help in converting the data locally into
years.
useful information, management indicators, district
Earlier, the Post Graduate/Under Graduate Medical/ profiles, trends which could be displayed graphically
Dental Seats Allotment was done only at New Delhi. in reports.
From the academic year 2007-08, Undergraduate
medical/dental seats counselling was provided The portal would be generating unique analytical
through Video conferencing based counselling in the reports using Data Warehousing platform for fine
cities of Puducherry and Kolkatta in addition to New tuning policy initiatives. Information could be made
Delhi. Also, reservations for SC/ST category merit available quickly and regularly to decision makers
holders had also been implemented from the and other users in the form of specific and tailored
academic year 2007-08. monthly, quarterly and annual reports.

12
ANNUAL REPORT 2008-09

1.8 Accounting Organisation Officers (PAOs) and 138 Drawing & Disbursing
Officers (DDOs) in the field.
General Accounting Set up
In addition there are Fourteen encadred posts of
As provided in Article 150 of the Constitution, the the Accounts Officers located at various places.
Accounts of the Union Government, shall be kept in There is a common Internal Audit wing for both
such form as the President of India, may on the Departments, which carry out the inspection of all
advise of Comptroller & Auditor General of India the Cheque Drawing and Non-Cheque drawing
prescribe. The Controller General of Accounts DDO's, Pr. Accounts Office and all the PAOs. There
(CGA) in the M/o Finance shall be responsible to are 5 Field Inspection Parties located at Delhi,
prepare and compile the Annual Accounts of the Chandigarh, Mumbai, Kolkatta and Bangalore.
Union Government to be laid in Parliament. The CGA
performs this function through the Accounts wing in Accounting Functions in the Ministry-
each Civil Ministry. The Officials of Indian Civil
The Accounting function of the Ministry comprises of
Accounts Organization are responsible for
various kinds of daily payments and receipts,
maintenance of Accounts in Civil Ministries. The
compiling of daily challans, vouchers, preparation of
administration of Accounts Officials in all Civil
daily Expenditures Control register etc. Monthly
Ministries is under the control of the office of the
expenditure accounts, monthly receipts and monthly
CGA. However, the Railways, P&T and Defence
net cash flow statements are being prepared for
Ministries have independent Finance and Accounts
submission to Ministry of Finance through the CGA's
services and are submitting accounts to the CGA
office. The Pr. Accounts Office prepares Annual
through the heads of their accounting organizations.
finance Accounts, Annual Appropriation Accounts,
The Secretary of each Ministry/Department is the Chief Statement of Central Transactions, Annual Receipts
Accounting Authority. This responsibility is to be Budget, Actual Receipts and Recovery statement
discharged by him through and with the help of the for each grant of the Ministry. The head wise
Chief Controller of Accounts (CCA) and on the advise appropriation accounts are submitted to the
of the Financial Advisor of the Ministry. The Secretary Parliament by the CGA along with the C&AG's report.
is responsible for certification of Appropriation In addition, the Pr. Accounts office also issues orders
Accounts and is answerable to Public Accounts of placement of funds to other civil Ministries, issued
Committee and Standing parliamentary Committee on advices to Reserve Bank of India (RBI) for release
any observations of the accounts. The Chief Controller of loans/grants to State Governments and LOC to
of Accounts is submitting Internal audit observations the accredited Bank of the Ministry for placing funds
and matter related to financial discipline directly to with DDOs.
the Secretary in respect of each Department and its
Apart from General Accounting functions, the
subordinate organizations. The Annual Review Report
Accounts wing also gives technical advices of various
of the Internal Audit is also subject to scrutiny by the
Budgetary, Financial and Accounting matters.
CGA and Ministry of Finance.
The Accounting wing also function as a coordinating
Accounting Set Up in the Ministry-
agency on all accounts matters between Ministry and
The Ministry of H&FW has two departments i.e. Office of the Controller General Accounts & the
Department of Health & Family Welfare and Comptroller and Auditor General. Similarly it
Department of Ayush (Ayurveda, Yoga, Unani, Sidha coordinates on all budget matters between Ministry
& Homeopathy). There is a common Accounting Wing and the Budget Division of the Ministry of Finance.
for both the departments. The Accounting wing is
1.9 Implementation of RTI Act, 2005
functioning under the supervision of a Chief
Controller of Accounts supported by a Controller of The Law Commission of India's 179th Report and
Accounts (CA), Dy. CA and eleven Pay & Accounts Reports of number of Committees and Councils

13
ANNUAL REPORT 2008-09

working on this subject sensitized the Government Apart from dealing with disciplinary cases of the
of India to enact a specific law on the right to Department of Health & FW, the vigilance cases
information. Likewise in May 2005 the Right to involving officials of Directorate General of Health
Information Act (22 of 2005) was passed by the Services and CGHS are also dealt with by the
Parliament. Vigilance Division. The machinery mainly handles
the vigilance inquiries/ disciplinary proceedings in
The Right to Information Act, 2005, enacted with a
respect of doctors and non-medical/technical
view to promote transparency and accountability in
personnel borne on the Central Health Service
the functioning of the Government by securing to
working in various hospitals, and CGHS/ P&T
the citizens the right to access the information under
Dispensaries and other Institutions like Medical
the control of public authorities, have already come
into effect w.e.f. 12.10.2005. Stores Organization, Port Health Organization,
Labour Welfare Organization etc.
Under the Right to information Act, 2005, 35 Central
Public Information Officers( CPIOs) and 13 Appellate During 2008-09, 17 charge sheets for major penalty
Authorities( A/As) have been appointed in the Ministry and 3 charge sheets for minor penalty for alleged
of Health & Family Welfare(Department of Health & irregularities including unauthorized absence were
Family Welfare). issued. Penalty was imposed in 5 cases and charges
were dropped in 7 cases. 2 officials/ officers have
All CPIOs including autonomous organizations/PSUs been placed under suspension during the year. In 3
were requested for placing all obligatory information cases, sanction for prosecution was issued.
pertaining to their Division/programme, under Section
4(i) of the RTI Act, 2005 in the Website of Ministry Central Vigilance Commission's guidelines for using
and the same has been done. Now RTI/Request/ information technology in vigilance administration are
Appeal Management System (RRMS) is under being implemented and major initiatives have already
implementing stage. Under this system CPIOs and been taken to use information technology as a tool
Appellate Authorities (including autonomous to usher in e-governance, minimizing the manual
organizations) would create computer Based interface etc. In the CGHS, the entire process
management of RTI requests and appeal. starting from registration of patients to maintenance
of personal records, patients' prescriptions,
Applications under the Act for seeking information
investigation advices, distribution of medicines and
from general public are accepted at Facilitation
raising indent to local chemists has been
Centre, near Gate No.5, Nirman Bhavan & at
computerized leaving little scope of corruption.
Coordination-II ( CDN-II) Section, Room No. 215A,
Similarly, e-submissions, standard operating
'D' Wing, Nirman Bhawan, New Delhi. Applications
procedures have been introduced in the Central
are also accepted by post through Receipt & Issue
(R&I) Section. During 2008-09 1681 applications Drugs Standard & Control Organization. An official
and 268 appeals have been received which were website has been launched giving all important
replied to in time, Annual return for the year 2008- information, including status of applications for
2009 has also been sent to CIC. licenses etc. Initiatives of these nature are bringing
in the much desired transparency in the functioning
1.10 Vigilance of the schemes/ organizations.
There is Vigilance machinery functioning for the 1.11 Activities of the Complaint
Department of Health & Family Welfare under a Joint Committee on Sexual Harassment
Secretary working as Chief Vigilance Officer (CVO) of Women Employees
on part-time basis. The CVO is assisted by a
Director/Deputy Secretary and an Under Secretary. In pursuance of the direction of Hon'ble Supermen
A Vigilance Section with a Section Officer with Court in their judgment in the case of Vishakha and
supporting staff functions as a part of this set-up. other Vs. State of Rajasthan and Others, a Complaint

14
ANNUAL REPORT 2008-09
Committee has been constituted in the Department Therefore the committee decided not to
of health and Family Welfare to look into the pursue the case further in the absence of
complaints of sexual harassment of women employees support form the complainants.
in the Department. The SHC is chaired by Mrs. Ganga
As per directions, the Committee is also looking into
Murthy, Economic Adviser and has four members Smt.
the matters relating to appropriate conditions i.e.
Aparna Sharma- Member, Mr. J.P. Pandey-member,
Hygiene conditions that have an impact on health of
Smt. Manorama Bawa-NGO Member and Mrs. Rekah
the women employee of the department.
Chauhan-Member Secretary.

Three complaints of sexual harassment were


1.12 Public Grievance Cell
referred to the Committee durin the year 2008. The Public Grievance Redressal Mechanism is
brief of each case is given below: functioning in the Ministry of Health and Family
Welfare as well as in the attached offices of the
1. Programme Division Incharge of NIB vide
Directorate of Health Services and the other
letter dated 12.4.2007 referred to the Sexual
Subordinate Offices of CGHS ( both in Delhi and
Harassment Committee(SHC) complaints
other Regions), Central Government Hospitals and
received from two Junior Scientist of NIB,
PSUs falling under the Ministry for implementation of
namely Mrs. E. Madhu and Mrs. Ajanta Sarkar
the various guidelines issued from time to time by
about inappropriate and harassment meted
the Government of India through the Ministry of
out by Dr. V.K. Kashyap, Director, NIB.
Personnel, Public Grievances and Pensions.
Subsequently, on 27.04.2007, the case of Dr.
Achala Prasad, Scientist Grade III of NIB was Ms. Shakuntala D. Gamlin, Joint secretary in the
also sent. The SHC deliberated on the Department of Health has been designated as Nodal
complaints and held Eleven Meetings for the Officer for Public Grievances relating to the
purpose of deposition by the complainants Department. Shri P.A. Sawant, Director in the
and the respondents. A report was submitted Department of Health has been working as Public
to Secretary (HFW) on 5.9.2008. Grievance Officer. Similarly other organizations under
2. In another case, a complaint was received the Ministry have also senior level officials functioning
form Dr. Punita k. Sodhi working as assistant as Public Grievance Officers.
Professor in Ophthalmology in Lady Harding
Director (A&V), Directorate General of Health Services
Medical College against Dr. K. P. S. Malik
and Director (EMR), Directorate General of Health
HOD, Ophthalmology, Safdarjung Hospital. In
Services are functioning as Public/ Staff Grievance
this case the complainant was requested to
Officer of the Directorate general of Health services.
approach to SHC of Lady Harding Medical
College in connection with her complaint. The number of Grievance petitions received/
disposed of and pending during 2007 and 2008 are
3. Complaint from the students namely Km Anju
as follows:
(M. Sc.-Microbiology) of IAMR, Ghaziabad,
Kum. Payal Tyagi (M.SC.-Biotech) of ITS, Year Opening Grievance Grievance Pending
Ghaziabad, Kum. Ekta Singh (M.Sc.-Biotech) Balance petitions petitions
of ITS, Ghaziabad and Kum. Monica Sharma received disposed
(M.Sc.-Bilotech) of ITS, Ghaziabad was during the of during
received against Dr. G.N. Singh, Director CIPL year the year
and others. Notices were issued to the
2007 104 155 135 124
complainants for their deposition but they
neither attended the meeting nor gave 2008 124 183 205 102
anything in writing to the committee.

15
ANNUAL REPORT 2008-09

1.13 Information & Facilitation Centre the challenges posed by rapid urbanization, degraded
environmental conditions / poor health indicators of
To strengthen the Public Redressal Mechanism in urban poor population, inadequacy and sub optimal
the Ministry of Health &Family Welfare an Information functioning of urban primary health infrastructure and
& Facilitation Centre is functioning adjacent to Gate overcrowding at secondary level, multiplicity of
No.5, Nirman Bhawan. The facilitation center service providers with weak interdepartmental
provides the following information to public: - coordination, heterogeneity and need for different
1. Circulars/ Booklets/ Pamphlets/ Posters/ NGO strategies to reach to different section of population;
sub optimal utilization of the strengths of private and
Guidelines and forms for public use.
charitable service providers, weak community
2. Receipt of Application under Right to capacity, clearly pronounce the need of different set
Information Act 2005 of strategies for meeting the above challenges.

3. Information and Guidelines to avail the grant Aim:


from Health Minister's Discretionary fund and
The proposed National Urban Health Mission aims
Rashtriya Arogya Nidhi.
to improve the health status of the urban poor
4. Guidelines and instructions regarding issue particularly the slum dwellers and other
of NOC to Indian Doctors to pursue higher disadvantaged sections by facilitating equitable
medical studies abroad. access to quality health care with the active
involvement of the Urban Local Bodies (ULBs) in
5. Petitions/ Complaint/ Suggestions on public cities with population one lakh and above and State
Grievances are received at the Centre. Capitals. The NUHM would be covering 21.07 crore
6. Information and guidelines relating to CGHS urban population with a special focus on 6.25 crore
urban poor living in slums and beyond, spread over
and Query regarding work of Drugs Controller
430 cities.
General (India) Office
Core Strategies:
7. Query regarding WHO's WHO in the Ministry
personally and on Telephone (i) Improving the efficiency of public health
system in the cities by strengthening,
During the year 5,000(approximate) queries were
revamping and rationalizing urban primary
received at the Information & Facilitation Centre,
health structure
which were disposed of to the satisfaction of all
concerned. (ii) Partnership with non government providers
for filling up of the health delivery gaps
1.14 National Urban Health Mission
(iii) Promotion of access to improved health care
Context:
at household level through community based
Rapid urbanization has led to rapid increase in groups (Mahila Arogya Samittees) and Urban
number of urban poor population, majority of who Social Health Activist (USHA)
live in slums. The need for improving the delivery of
(iv) Strengthening public health through
health care for the urban poor has been recognized
preventive and promotive action
by the National Health Policy (2000), the National
Population Policy (2002) and the Eleventh Five Year (v) Increased access to health care through risk
Plan. pooling
However, policy prescriptions have not optimally (vi) IT enabled services (ITES) and e-
translated into focused strategies for improving the governance for improving access improved
health status of the urban poor. On the other hand surveillance and monitoring

16
ANNUAL REPORT 2008-09
(vii) Capacity building of stakeholders one Male Health Worker and one LHV for six such
Sub-Centres. Sub-centres are assigned task relating
(viii) Prioritizing the most vulnerable amongst the to maternal and child health, family welfare, nutrition,
poor immunization, diarrhea control and control of
(ix) Ensuring quality health care services. communicable diseases programmes and provided
with basic drugs for minor ailments needed for taking
Financial Allocation: care for essential health need for women and
children. The number of sub-centres functioning in
The proposed financial outlay of the National Urban
the country present as on March, 2007 is annexed.
Health Mission is Rs. 5249 Crores of which an
estimated allocation of Rs.4495 crores would be from Govt. of India bears the salary of ANM and LHV
the Central Government for a period of 4 years (2008- besides rent liability and contingency whereas, the
2012) and State/ULB share would be Rs. 754 crores, salary of the Male Health Worker is borne by the
to enable adequate focus on urban health. This State Governments. 8669 new Sub-Centres have
would be supplemented by remaining balance of been approved to be established in 15 States/UTs
Rs.958.84 crores i.e. outlay for the Centrally during X Plan period, out of which 6457 have been
Sponsored Scheme (CSS) - Urban Health Centres set up all over the country.
(UFWCs. and UHPs) which is through the Treasury
route. Thus the total outlay for NUHM would be Rs. Expenditure per annum for the existing Sub-
5249 crores and the remaining balance of Rs. 958.84 centres
crores. Item Amount
1.15 Rural Health Services Salary of ANM and LHV As per State Govt. pay scale

The health and family welfare programme in the Rent 3000


country is being implemented through primary health Medicine To be supplied under RCH
care system. In rural areas, primary health care Programme
services are provided through a network of 145272
Contingency 3200
Sub-centres, 22370 Primary Health Centres and
4045 Community Health Centres as on March 2007 Voluntary Worker Rs.1200/- as honorarium
based on the following population norms:
Under NRHM Sub-centres are being strengthened by
Centre Population Norms provision of untied funds of Rs.10,000/- per year which
Plain Hilly/Tribal is operated by the ANM and the Sarpanch, supply of
Area area allopathic and indigenous medicines and provision of
an additional worker (male multipurpose worker or
Sub-Centre 5000 3000
additional ANM), Annual maintenance grant of
Primary Health 30,000 20,000 Rs.10,000/- is also made available to every Sub-centre
Centre (PHC) to undertake and supervise improvement and
maintenance of the facility. Upgradation of existing Sub-
Community Health 1,20,000 80,000
centres, including building for Sub-centres functioning
Centre (CHC)
in rented premises and setting them up as per 2001
census has also been envisaged under NRHM.
Sub-Centre
Primary Health Centre (PHC)
Sub-centre is the first peripheral contact point
between Primary Health Care system and the PHC is the first contact point between village
community. It is manned by one Female (ANM) and community and the Medical Officer. It is manned by

17
ANNUAL REPORT 2008-09

a Medical Officer and 14 other staff. It acts as a @ Rs.20 lakh per CHC has already been provided
referral Unit for 6 Sub-Centres and has 4-6 beds for under the initiative and more funds are being
patients. It performs curative, preventive, promotive provided every year as requested by the States in
and Family Welfare services. There are 22370 PHCs their annual Programme Implementation Plan under
functioning in the country. NRHM.

The PHCs are being strengthened under NRHM to Strengthening of the Sub-Divisional /Sub-
provide a package of essential public health District and District Hospitals
programmes and support for outreach services to
For upgradation of District Hospitals to IPHS, the
ensure regular supplies of essential drugs and
States/UTs other than NE Sttes have been released
equipment, round the clock services in all PHCs
funds @ Rs.20.00 lakhs as an initial amount for 498
across the country, upgrading single doctor PHC to
District Hospitals and @ Rs.one crores per DH in the
2 doctors PHC by posting AYUSH practitioners at PHC
NE States for 69 District Hospitals.
level, provision of 3 Staff Nurses in a phased manner.
The States/UTs have to incorporate their proposals Indian Public Health Standards (IPHS)
and requirement of funds in their Annual Programme
Implementation Plans under NRHM. Untied Grant of Indian Public Health Standards (IPHS), which detail
Rs.25,000/- per PHC for local health action and the specifications of standards to which institutions
Annual Maintenance Grant of Rs.50,000/- per PHC of primary health care would have to be raised to so
through PHC level Panchayat Committee/Rogi that the citizen is confident of getting public health
Kalyan Samiti to undertake and supervise services in the hospital that can be measured to be
improvement and maintenance of physical of acceptable standards. Indian Public Health
infrastructure have been provided. Standards (IPHS Sub-centres, PHCs, CHCs, Sub-
divisional/Sub-district Hospitals and District Hospitals
Community Health Centre (CHC) lay down Standards not only for personnel and
physical infrastructure, but also for delivery of
CHC is established and maintained by the State
services, and management. A system of performance
Governments and as per standards it is supposed
bench marks will be introduced to concurrently assess
to be manned by four Medical specialists i.e.
the adherence of public hospitals to IPHS, in a
Surgeon, Physician, Gynecologist and Pediatrician
transparent manner.
supported by 21 paramedical and other staff. It has
30 in-door beds with one OT, X-ray, and Labour room Each Hospital would, as part of IPHS, be required to
and Laboratory facilities and serves as a referral set up a Rogi Kalyan Samittee (RKS)/Hospital
centre for 4 PHCs. It provides facilities for emergency Management Committee), which will bring in
obstaetrics care and specialist consultations. Indian community control into the management of public
Public Health standards lays down that this CHC is hospitals. Guidelines for setting up of Rogi Kalyan
to be manned by 6 Medical Specialists including Samiti have been circulated to all State/UTs. Based
Anaesthetics and an eye surgeon (for 5 CHCs) on the registration details of RKSs set up by various
supported by 24 paramedical and other staff with States/UTs, funds @ Rs. one lakh per PHC, CHC,
inclusion of two nurse midwives in the present system Sub-divisional/Sub-district Hospitals and @ Rs.5.00
of seven nurse midwives. At present 4045 CHCs lakhs per District Hospital have been released for
are functioning in the country. RKSs to these States/UTs. The objective is to provide
sustainable quality care with accountability and
For Upgradation of CHCs as per the Indian Pubic
peoples participation alongwith total transparency.
Health Standards (IPHS). State/UTs have been
requested to carry out the facility survey of all CHCs Mobile Medical Units/Health Camps
so as to gauge the exact requirement of funds in
terms of upgrdation of the facility as far as manpower, With the objective to take health care to the door
building, equipments etc. if concerned. Initial funds step of the public in the rural areas, especially in

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ANNUAL REPORT 2008-09
under-served areas, Mobile Medical Units (MMUs), - Walk-in-interview and contractual
have been provided, one per district under NRHM. appointment of doctors;
The States are however, expected to address the
diversity and ensure the adoption of more suitable - Enhancing the salary for posting in rural
and sustainable model for the MMU to suit their local areas by one-third;
requirements. They are also required to plan for - Increasing the admission capacity in medical
long-term sustainability of the intervention. colleges for Anesthesia;
Two kinds of MMUs are envisaged, one with - Reviving the Diploma Course in Anesthesia;
diagnostic facility for the States other than North-
East States, Himachal Pradesh and J&K. In addition, - To start one year Certificate Course in
for the North- Eastern States, Himachal Pradesh and Anesthesia for Medical Officers working in
J&K, specialized facilities and services such as X- the system at present to be given by National
ray, ECG and ultrasound are proposed to be Board of Examination.
provided in MMUs due to their difficult hilly terrain,
- Recognition of five hundred bedded Hospitals
non-approachability by public transport, long
to provide the facility for conducting the
distances to be covered etc.
above course;
The States are needed to involve District Health
- Hiring of private practitioners on case-to-
Society/Rogi Kalyan Samiti/NGOs in deciding the
case basis.The above recommendation were
appropriate modality for operationalization of the
circulated to All the State /UT Governments.
MMUs. The provision of staff will be considered only
State/UT Governments have taken a number
for the States who will run the vehicles with support
of initiatives to ensure presence of doctors
of NGOs/RKSs and in case of States out-sourcing
in rural areas such as :
the vehicles. States are needed to work out numbers
of mobile dispensaries/health camps as a means of - Compulsory rural/difficult area posting for
mobilizing local communities of health action and for admission to post-graduate courses and as
creating demand a pre-requisite for promotion, foreign
assignment or training abroad ;
Tackling the problem of lack of manpower in
Rural Areas : - Compulsory rotation of doctors on completion
of prescribed tenure as per classification of
The Government is seized of the problem of lack of
locations;
skilled manpower in rural health infrastructure. A
number of new and innovative steps have been taken - Contractual appointment of doctors;
by various State/UT Governments to bridge the gap
between the available and required manpower - Option to forgo non practicing allowance and
especially for ensuring the availability of Doctors in undertake practice without compromising on
rural areas. A Task Group constituted under the assigned duties, as per the service rules;
National Rural Health Mission under the chairmanship offering incentive in form of allowance etc.
of Director General of Health Services has
- Manning of PHCs by NGOs/ Non Government
recommended the following measures to ensure the
Statkeholders
services of doctors in rural areas :
- Involvement of Medical colleges.
- Increase in the age of retirement of doctors
to 65 years preferably with posting near Apart from doctors, steps have been taken to deploy
hometown; contractual manpower in all other cadres ie. ANM,
MPWs, Pharmacists etc. The funds are being
- Decentralization of recruitment at district
released to all States/UTs under NRHM as per their
level;

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ANNUAL REPORT 2008-09

demand reflected in their NRHM PIPs. There has engaging contractual staff under NRHM which is
been significant improvement in manpower after clear from the perusal of following table :

Status of Contractual Manpower Engagement Under the NRHM


Contractual Manpower Status as on 31st August 2008
Sl. No. Name of State Doctors Specialists Staff Nurse ANM Others

1 Bihar 381 2194 5896 0


2 Chhattisgarh 111 0 714 0
3 Jharkhand 2332 0 429 6041 1230
4 Madhya Pradesh 189 0 152 1359 0
5 Rajasthan 1076 3976 1237
6 Orissa 470 721 27
7 Uttar Pradesh 160 6 1829 980 96
8 Uttarakhand 16 2 65 67 6
9 Jammu & Kashmir 161 0 167 295 225
10 Himachal Pradesh 263 13 76 0 408
11 Assam 84 117 223 4088
12 Arunachal Pradesh 57 0 35 20 0
13 Manipur 104 2 108 427 490
14 Meghalaya 12 1 525 753 155
15 Mizoram 21 0 9 230 45
16 Nagaland 83 0 20 199 75
17 Tripura 0 32
18 Sikkim 19 4 17 48 10
19 Andhra Pradesh 146 1050 2775 118
20 Goa 0 0 0 0 0
21 Gujarat 554 865 365 0 480
22 Haryana 0 26 161 2174 260
23 Karnataka 1037 0 1077 370 98
24 Kerala 1104 207 1300 0 49
25 Maharashtra 0 349 549 3782 34
26 Punjab 30 209 0 390
27 Tamil Nadu 2770 0 2138 0 3008
28 West Bengal 0 30 0 51
29 A & N Islands 17 9 21 81 108
30 Chandigarh 0 0 0 30 11
31 D&NH 6 1 15 12 32
32 Daman & Diu 2 7 0 21
33 Delhi 297 29 73 600 155
34 Lakshadweep 7 0 0 6 0
35 Puducherry 7 6 12 77 29
Total 10489 2231 17979 32321 7590

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ANNUAL REPORT 2008-09
Table - 2
Number of Sub-Centres, PHCs & CHCs Functioning
(As on March.,2007)

Sl. No. State/UT State/UT PHCs CHCs

1 Andhra Pradesh 12522 1570 167


2 Arunachal Pradesh 379 85 31
3 Assam 5109 610 100
4 Bihar 8909 1648 70
5 Chhattisgarh 4692 518 118
6 Goa 172 19 5
7 Gujarat 7274 1073 273
8 Haryana 2433 411 86
9 Himachal Pradesh 2071 443 71
10 Jammu & Kashmir 1888 374 80
11 Jharkhand 3958 330 194
12 Karnataka 8143 1679 254
13 Kerala 5094 909 107
14 Madhya Pradesh 8834 1149 270
15 Maharashtra 10453 1800 407
16 Manipur 420 72 16
17 Meghalaya 398 103 26
18 Mizoram 366 57 9
19 Nagaland 397 84 21
20 Orissa 5927 1279 231
21 Punjab 2858 484 126
22 Rajasthan 10612 1499 337
23 Sikkim 147 24 4
24 Tamil Nadu 8683 1181 236
25 Tripura 579 75 10
26 Uttarakhand 1765 232 49
27 Uttar Pradesh 20521 3660 386
28 West Bengal 10356 922 346
29 Andaman & Nicobar Islands 108 20 4
30 Chandigarh 13 0 2
31 Dadra & Nagar Haveli 38 6 1
32 Daman & Diu 21 3 1
33 Delhi 41 8 0
34 Lakshadweep 14 4 3
35 Puducherry 77 39 4

All India 145272 22370 4045

21
ANNUAL REPORT 2008-09

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ANNUAL REPORT 2008-09

Chapter 2

NRHM, Health & Population Policies


2.1 National Rural Health Mission 20,977 Staff Nurses, 8645 Paramedics have
(NRHM) been appointed on contract by States to fill
in critical gaps.
The National Rural Health Mission (NRHM) launched
on 12.4.2004 by the Hon'ble Prime Minister of India, Management Support
is being operationalised throughout the Country with  1588 professionals (CA/MBA/MCA) have
special focus on 18 States which included 8 been appointed in the State and 576 District
Empowered Action Group States (Bihar, Jharkhand, level Program Management Units (PMU) and
Madhya Pradesh, Chhattisgarh, Uttar Pradesh, 3474 Block level Program Management Units
Uttaranchal, Orissa and Rajasthan, 8 NE States, (BPMU) have been established to support
Himachal Pradesh and Jammu and Kashmir. NRHM.
ASHAs/ Link Worker Mobile Medical Units
 Selection of 6, 48,516 ASHAs/Link workers  Funds for one Mobile Medical Unit (MMU) per
have been done in the entire country, out of district released for 318 districts. The states,
which 5, 63,462 ASHAs were given orientation till date has operationalised 243 Mobile
training and positioned in villages. Medical Units with their own funds.
 4.11 lakhs ASHAs have been provided with Immunization
drug kit as well.
 Intense monitoring of Polio Progress -
Infrastructure Services of ASHA useful.
 1.45 lakhs Subcentres in the country are  JE vaccination completed in 11 districts in 4
provided with untied funds of Rs. 10,000 states - 93 lakh children immunized during
each. 3,02,200 Subcentres & VHSC have 2006-07. JE vaccination is being implemented
operational joint accounts of ANMs and in 26 districts of 10 states in 2007. The 11
Pradhans for utilization of annual untied districts of 4 states where JE vaccination was
funds. 25,743 Subcentres are functional with carried out in 2006 have introduced JE
second ANM. vaccine in Routine Immunization to vaccinate
 Out of 4045 Community Health Centres, 2788 new cohort between 1-2 years of age with
CHCs have been selected for upgradation booster dose of DPT.
to IPHS and facility survey has been  House tracking of polio cases and intense
completed in 2698 CHCs. monitoring.
 23,100 Rogi Kalyan Samitis have been  Neonatal Tetanus declared eliminated from
registered at different level of facilities. 7 states in the country.
Manpower  Full immunization coverage evaluated at
 10,948 Doctors and Specialist, 33,719 ANMs, 43.5% at the national level.(NFHS-III)

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ANNUAL REPORT 2008-09

 Accelerated Immunization Programme taken  The first cut of Integrated District Health Action
up for EAG and NE State. Plans (DHAP) has been finalized for 558
districts.
Institutional Delivery
Mainstreaming of AYUSH
 Janani Suraksha Yojana (JSY) is
operationalised in all the States, 7.04 lakh  Mainstreaming of AYUSH has been taken up
women are benefited in the year 2005-06, in the States. Total 7275 AYUSH facilities are
29.31 lakh in 2006-07, 72.01 lakh in 2007- available at District and below district level
08 and 51.55 lakh in the year 2008-2009. health institutions. AYUSH person are part of
State Health Mission/Society/RKS/ASHA
Neo Natal Care training as members.
 Integrated Management of Neonatal and Trainings
Childhood Illnesses (IMNCI) started in 219
districts this year.  Trainings in critical areas including
Anesthesia, Skilled Birth Attendance (SBA)
 With the help of Neonatology Forum over taken up for MOs/ANMs. Integrated Skill
90,401 health care personnel trained in Development Training for ANMs/ LMV/MOs,
Newborn Care in the country. Training on Emergency Obstetrics care and
 Module for Home based new born care No Scalpel Vasectomy (NSV) for MOs,
developed in consultation with Dr. Abay Professional Development Programme for
Bhang. CMOs is on full swing.

Convergence  ANM Schools being upgraded in all States.

 Over 37 lakhs in 2006-07, 49 lakhs in 2007-  New nursing schools taken up.
08 and 29 lakhs in 2008-2009 Monthly Health Mother NGOs
and Nutrition Days being organized at the
Anganwadi Centres in various States.  345 Mother NGOs appointed for 404 districts
till date are fully involved in ASHA training and
 The States have constituted 3,42,801 Village other activities.
Health and Sanitation Committees. They are
being involved in dealing with disease Health Resource Centres
outbreak.
 National Health Systems Resource Centre
 Convergence with ICDS/Drinking Water/ (NHSRC) set up at the National level.
Sanitation/NACO/PRIs ground work
completed.  Regional Resource Centre set up for NE.

 School health programmes have been  State Resource Centre being set up by
initiated in over 20 States States.

Health Action Plans Monitoring and Evaluation

 State PIPs have been received from 31 states  Independent evaluation of ASHAs/JSY by
during 2006-07, 35 in the year 2007-08, and UNFPA/UNICEF/GTZ in 8 States.
35 State PIPs received in the current year  Immunization coverage evaluated by UNICEF.
2008-09. Project Implementation Plan (PIPs)
of the States under NRHM has been  Independent monitoring by identified
appraised and funds being released for the institutions like Institute of Public Auditors of
year 2008-09. India.

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ANNUAL REPORT 2008-09
 Ground work for community monitoring 2. NRHM Finance Division stands created vide
completed. Phase I of community monitoring order dated 21.12.2006 with one Under
in 9 states namely Rajasthan, Orissa, Secretary, two Accounts Officers, one Section
Maharashtra, Madhya Pradesh, Tamilnadu, Officer, one Assistant, one data entry
Chattisgarh, Jharkhand, Karnataka and operator and one Group- D. All sanction
Assam has been completed. orders for allocation of funds under the RCH
Flexible Pool and Mission Flexible Pool are
Surveys
being prepared and issued by this Division.
 NFHS III and DLHS III completed. The reorganized FMG-NRHM which will now
have a revised strength of 16 personnel on
Financial Management
contract/deputation i.e four Finance
 Financial Management Group set up under Controllers, three Finance Analysts and nine
NRHM in the Ministry. Finance Assistants being recruited with the
assistance of the Development Partners like,
 During the FY 2005-06, out of total allocation World Bank, UNFPA, DFID etc. is also a part
of Rs. 6731.16 crore for the ministry, an of the NRHM Finance Division.
amount of Rs. 5862.57 crore was released
as part of NRHM. Objectives of FMG-NRHM
 Against Rs. 9065 crore for NRHM activities  Bring about integration in the finances of the
during 2006-07, Rs. 7361.08 crore released. National Health Programmes subsumed
under the NRHM.
 During the FY 2007-08, out of total allocation
of Rs. 11010 crore for the ministry, an amount  Improve Financial Management Systems at
of Rs. 10189.03 crore was released as part the Centre, State and District levels under
of NRHM. the NRHM.
 During the FY 2008-09, out of total allocation
 Maintain a sound system for funds flow,
of Rs. 12050 crore for the ministry, an
monitoring utilization, accounting and audit
amount of Rs. 8242.95 crore (till February,
of all programmes subsumed under NRHM.
2009) was released as part of NRHM.
Functions of FMG-NRHM
2.2 Financial Management of NRHM
 Fund release under RCH Flexible Pool and
In order to ensure that enhanced allocations to the
States/UTs and other institutions under the NRHM Mission Flexible Pool under NRHM.
are fully coordinated, managed, and utilized, a unified  Monitoring and compilation of Financial
system was devised for release, monitoring and Monitoring Reports (FMRs) on quarterly
utilization of funds. The Empowered Programme
basis.
Committee (EPC) of the NRHM decided to expand
the ambit of the existing Financial Management  Claims for refund from Development Partners
Group (FMG) to FMG-NRHM. The following financial like World Bank, DFID etc.
management arrangements and funds flow processes
under NRHM were put in place w.e.f. 1.4.2007.  Audit arrangements and submission of audit
reports to Development Partners.
Organizational Set up
 Providing Financial Management formats and
1. Director, RCH (Finance) has been Monitoring Financial performance indicators.
redesignated as Director, NRHM (Finance)
to guide the financial management activities  Capacity building of finance and accounts
of the NRHM. personnel of States/UTs.

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ANNUAL REPORT 2008-09

 Obtaining UCs for the various programmes Statutory Auditors for State & District Health Societies
under NRHM from 2008-09, in consultation with Mission Directors,
Finance & Accounts Managers of the States/UTs was
 Generating MIS reports on the basis of FMRs
held at Kolkata from 4th to 6th February, 2009 in
received.
association with the development partner DFID. In
System of Funds Release addition to this, training and capacity building of
finance & accounts personnel is also regularly taken
 Obtaining approval of National Programme up by the National Institute of Health & Family Welfare,
Coordination Committee (NPCC) and an autonomous body under this Ministry.
communicating the approved amounts to the
States/UTs An accounting system in Tally has also been
developed. Important guidelines on financial
 Releases are however, restricted to BE/RE management pertaining to NRHM are also available
envelope approved by the Ministry of Finance on the Ministry's website mohfw.nic.in
and separately communicated to States.
Other arrangements
 As per GFRs, up to 75% of the approved
BEs can be released to the States on receipt Multiple societies in the States have been merged
of provisional UCs for the previous year. into Integrated Health Societies, paving the way for
a single window release of funds from the Centre.
 Balance 25% is released after receipt of The post of Director (Finance & Accounts) sanctioned
satisfactory audited accounts with final UCs. earlier will be the overall in-charge of all financial,
Concurrence of IF is invariably obtained. accounting and audit processes of the State and
 Centrally transfer the funds electronically to District Health Societies and will be the nodal point
the State Health Societies for all programmes for interaction between the States and the Centre.
under NRHM and maintain a centralized data
2.3 Health Policy
base for all releases and utilization under all
components of NRHM viz. (a) RCH, (b) The National Health Policy-2002 (NHP-2002) gives
Additionalities under NRHM, (c) Immunization prime importance to ensure a more equitable access
and (d) National Disease Control to health services across the social and geographical
Programmes. expanse of the country. The Policy outlines the need
for improvement in the health status of the people
Training & capacity building of Finance &Accounts
as one of the major thrust areas in the social sector.
Personnel
It focuses on the need for enhanced funding and
The FMG-NRHM conducts training of finance and organizational restructuring of the public health
accounts personnel of the State/District Health initiatives at national level in order to facilitate more
Societies. The State/District level functionaries of all equitable access to the health facilities. An
high focus states have already been trained. A acceptable standard of good health amongst the
Training Workshop for State Finance and Accounts general population of the country is sought to be
Managers had been convened at LBSNAA, achieved by increasing access to the decentralized
Mussoorie in May, 2007. A Consultation Meeting for public health system by establishing new
finance & accounts personnel of the eight north- infrastructure in deficient areas ,and by upgrading
eastern States was organized with the help of the infrastructure in existing institutions. Emphasis
Regional Resource Centre (RRC) at Guwahati in has been given to increase the aggregate public
October, 2008. A National Workshop on Financial health investment through a substantially increased
Management Under NRHM to discuss and finalize the contribution by the Central Government. Priority
new Open Tender System for engagement of would be given to preventive and curative initiatives

26
ANNUAL REPORT 2008-09
at the primary health level through increased sectoral Yojana (PMSSY), for setting up six AIIMS like
share of allocation. Institutions and up gradation of 13 Medical Colleges
in the country. The AIIMS-like institution are to be set
In pursuance of the overall objectives of the Health up in each of the states of Bihar (Patna),
Policy, several health initiatives have been under Chhattisgarh(Rajpur), Madhya Pradesh(Bhopal),
implementation over the years to control/prevent Orissa (Bhubaneswar), Rajasthan (Jodhpur) and
communicable diseases and non-communicable Uttarakhand (Rishikesh).
diseases. The major programmes include National
Vector Borne Disease Control Programme, Revised In the 2nd phase of PMSSY, it is proposed to set up
TB control Programme, Leprosy Programme, two AIIMS like institutions at i) Lalganj, Rae Bareilly,
Blindness Control Programme, Mental Health UP,ii) Talganj, District Uttar Dinajpur, West Bengal. It
Programme, National Programme for the HIV/AIDS is also proposed to upgrade 5 medical college
etc. One of the major initiatives taken by the Ministry institutions-i) Govt. Medical College, Amritsar,Punjab
has been launching of National Rural Health Mission ii) Govt. Medical College Tanda, H.P. iii) Govt. Medical
(NRHM) in April, 2005. The Mission acts as an College Madurai, TN iv) Govt. Medical
overarching umbrella to the existing vertical schemes/ College,Nagpur, Maharashtra v) Jawaharlal Nehru
programmes of Health and Family Welfare including Medical College of Aligarh Muslim University,
RCH-II, Vector Borne Disease Control Programmes, Aligarh(UP).
T.B. Control Programme, Leprosy, Blindness and
Tobacco control initiative:
Iodine Deficiency. The targets set under the NHP-
2002 have been achieved in respect of elimination Recognizing the fact that consumption of tobacco
of leprosy, setting up of integrated System of Disease has led to large scale health problems in the country
Surveillance and putting in place the system of ranging from cancer, diabetes, cardiovascular
National Health Accounts. diseases, deformities to passive smoking, the Ministry
has been taking a lot of measures to prevent people
Other important health programmes initiated during
from using tobacco. A significant step in this direction
recent years are the following:-
is the recent ban on use of tobacco in public places
National Urban Health Mission (NUHM): with effect from October, 2008. It has initiated a
smoke-free workplace policy and set up a Tobacco
With a view to address primary health needs of Regulatory Authority. Besides, it is in the process of
people living in urban areas, the Ministry is launching making a pictorial warning mandatory on tobacco
NUHM. Urban Poor families, slum dwellers, migrant products. The District School Tobacco Programme
workers and extremely vulnerable population would also focuses on creating awareness against the
be identified by the Urban Local Body (ULB) and adverse impact of the use of tobacco and alcohol.
covered under the scheme and shall be issued a Various awareness programs are conducted to
photo Family Health Card. There are 427 cities educate people on the ill effect of tobacco
(including state capitals) in India having a population consumption and to affect self control on use of such
of 1.00 lakh and above out of which 100 constitute dangerous substances rather than imposing
hi-focus cities. This will complement the activities regulations.
undertaken by NRHM in rural areas. The programme
will be on Public -Private Partnership mode. Other initiatives

Strengthening Tertiary Health Care Services A number of initiatives such as establishment of the
(PMSSY) Central Food Safety and Standards Authority of India
for bringing in global quality standard for food in India,
In order to reduce the gaps in the availability of the National programme on speech and hearing,
tertiary health care across States, the Government National Emergency and Trauma Programme are
has drawn up the Pradhan Mantri Swasthya Suraksha being implemented. New initiatives such as National

27
ANNUAL REPORT 2008-09

Organ Transplant Programme, Oral Health,  To facilitate the development of a vigorous


Prevention and Control of Fluorosis, Heath Care for people's movement in support of this national
Elderly, Human Resources on Health, and National effort.
Advisory Boards for standards, National Programme
for Blood and Blood Products etc. are being proposed 2. The first meeting of the reconstituted National
to be taken up during the 11th Five Year Plan. commission on Population was held under the
chairmanship of Hon'ble Prime Minister on 23rd July
2.4 National Commission on 2005. The following decisions were taken in the
Population meeting: -
National Commission on Population was constituted  Conduct of an Annual Health Survey of all
under the Chairmanship of Hon'ble Prime Minister of districts which could be published annually
India vide Government of India Gazette Notification so that health indicators at district level are
dated 11th May 2000. The Commission started periodically published, monitored and
functioning from its Secretariat at Planning compared against benchmarks
Commission, Yojana Bhavan and was fully functional
while located at Planning Commission, Yojana  Setting up of five groups of experts for
Bhavan by exercising its financial and Administrative studying the population profile of the States
Powers, with the supportive help of PAO, Planning of Bihar, Uttar Pradesh, Rajasthan, Madhya
Commission. However, in February 2005, the Pradesh and Orissa to identify weaknesses
Commission was re-constituted as per the decision in the health delivery systems and to suggest
of Cabinet and its Secretariat was shifted from measures that would be taken to improve the
Planning Commission, Yojana Bhavan to Ministry of health and demographic status of the States.
Health & FW. The Chairman of the re-constituted
Commission remained Hon'ble Prime Minister of 3. In accordance with the above decision, the
India, Deputy Chairman of the Planning Commission following measures have been taken to implement
and the Minister of Health & FW, the two Vice the decisions:-
Chairmen and Secretary, FW, as the Member-
Secretary of the Commission. i. Ministry of Health & Family Welfare had wide
ranging discussion with Office of Registrar
The Terms of reference of the Commission are as General and Planning Commission for
follows: - conducting Annual Health Survey (AHS) and
 To review, monitor and give directions for the Office of Registrar General has been
implementation of the National Population identified as the nodal organization for
Policy with a view to meeting the goals set conducting the AHS. A Steering Committee
out in the policy. has been constituted on 6th September 2007
under the Chairmanship of Mission Director
 To promote synergy between demographic, (NRHM), Ministry of Health & Family Welfare
educational, environmental and to coordinate the content of the survey, its
developmental programmes so as to hasten methodology and comparability with the
population stabilization.
existing National level surveys. The first
 To promote inter-sectoral coordination in meeting of the Steering Committee was held
planning and implementation across on 16th October 2007 under the
government agencies of the Central and Chairmanship of Mission Director (NRHM). An
State Governments, to involve the civil society EFC Note for undertaking the Annual Health
and the private sector and to explore the Survey through the Office of RGI had been
possibilities of international cooperation in discussed in a meeting of the Expenditure
support of the goals set out in the Policy. Finance held on 4th September, 2008.

28
ANNUAL REPORT 2008-09
Process for providing HR support to Kosh (JSK) under the Societies Registration Act, 1860
undertake the Survey has been initiated. in June, 2003.

ii. Five Experts Groups have been constituted The objective of JSK is to facilitate the attainment of
on 29th September 2005 for studying the the goals of National Population Policy 2000 and
population profile of the States of Bihar, Uttar support projects, schemes, initiatives and innovative
Pradesh, Rajasthan, Madhya Pradesh and ideas designed to help population stabilization both
Orissa in order to identify weaknesses in the in the Government and Voluntary sectors, and
health delivery systems and to suggest provide a window for canalizing resources through
measures to improve the health and voluntary contributions from individuals, industry,
demographic status of these States. These trade organizations and other legal entities in
Group of Experts have already deliberated furtherance of the national cause of population
the issue pertaining to Health Delivery System stabilization.
and Demographic Status of these. The
reports of these Groups of Experts have been JSK has been reconstituted on 14-6-2005. Under
received and are being examined in this the new set up, the General Body of the JSK is
Ministry. chaired by the Minister for Health and Family Welfare,
while the Governing Board is chaired by the Secretary
The Commission has been providing policy support (H&FW). The Executive Director, selected from the
to the population stabilization efforts under overall civil society, is the Chief Executive Officer of the Kosh.
framework of implementation of NRHM by the states. Eight meeting of the Governing Board of Jansankhya
The Commission has come out with a number of Sthirata Kosh was held on 11th August 2008 under
publications in collaboration with Registrar General the Chairmanship of Secretary (H&FW) & Chairman
of India and Institute of Economic Growth, which of the Governing Board (JSK).
provides valuable inputs on future demographic
trends, challenges and suggestive measures for The major strategies initiated by JSK are given
achieving population stabilization as envisaged in below: -
NPP 2000 and NRHM goals.
GIS Mapping
2.5 State Population Commissions JSK has mapped 485 districts through a unique
State Population Commissions have been constituted amalgamation of GIS Maps and Census Data which
in 20 States/UTs. viz. Andhra Pradesh, Arunachal gives a picture of each district, its sub-division and
Pradesh, Assam, Haryana, Himachal Pradesh, J&K, the population of every village along with its basic
Kerala, Madhya Pradesh, Gujarat, Uttar Pradesh, health infrastructure. Easily accessible on the
Maharashtra, West Bengal, Meghalaya, Mizoram, internet the maps highlight inequalities in coverage
Punjab, Rajasthan, Sikkim, Tamil Nadu, Andaman & down to every village of the country at the touch of a
Nicobar Island and Lakshadweep. button. JSK has won the award under the category
of Best Government Initiative for mapping Health
2.6 Janasankhya Sthirata Kosh amenities with the help of GIS maps for entire country
except North eastern states and Himachal Pradesh
In the inaugural address of National Commission on
due to the non availability of data. The award was
Population held on 22nd July 2000, the Prime Minister
given in an event named "eINDIA 2008" held at
had announced the constitution of the National
Pragati Maidan, New Delhi on 31st July 2008.
Population Stabilization Fund (NPSF), which was set
up under National Commission on Population. Call Centre
Subsequently, the NPSF was transferred to the
Department of Family Welfare in April 2002. It was JSK has established a Call Centre to give authentic
renamed and registered as Janasankhya Sthirata information on reproductive and infant health in

29
ANNUAL REPORT 2008-09

English and Hindi, using computer based software. JSK has introduced the Prerna strategy in Madhya
The service is routed through a leading BPO provider Pradesh and Rajasthan. Couples from Dhaulpur and
Customer and trained agents give advice to Jodhpur have already received the awards at the
adolescents, newly married and about-to-be married hands of the Collector at a public function.
couples and others who seek guidance. The Call
Centre number (011-66665555) is being accessed Santushti Strategy
from different parts of the country and provides
This strategy provides an opportunity to private
information anonymously in English or Hindi. The
sector gynaecologists / vasectomy surgeons to
software has been developed by leading medical
conduct operations in Public Private Partnership
colleges and is a boon for people who seek authentic
mode and to receive payment according to
information in privacy.
compensation rates notified by the Ministry of Health
The Call Centre number is being advertised in the and Family Welfare. Santushti is a fast-track strategy
districts of EAG states to open a new window of which enables an accredited facility to get Rs.1.5
information for underserved areas. lakhs for conducting 100 surgeries with a Rs.15,000
start up advance. Rs. 500 more is also being given
Website
per case provided an accredited nursing ho me
JSK's website is accessed on an average 475 pages conducts 30 or more cases in a day. This strategy
per day with 89% Indian visits and 11% international was initiated in Madhya Pradesh and Rajasthan.
visits. Most sought after subjects are sexual health
(in Hindi) and the district health facilities through GIS Involving Private O&G Practitioner for IUCD
mapping. 380 A

Prerna Strategy JSK has involved the private sector in promoting the
intra-uterine contraceptive device called IUCD 380A
JSK has introduce a "Responsible Parenthood" which gives protection for 10 years. The improved
model called Prerna to reward couples in high focus version has not been picked up in large measure in
districts who voluntarily delay the age of marriage, the private sector although it is a boon for women
allow girls stay in school and to couples that plan who want to have both long term protection from
their family in the interest of the health of the mother
pregnancy keeping the option of having a baby
and child. JSK gives rewards for couples if they satisfy
according to preference. 4 workshops have been
the following conditions:
held with over 250 gynecologists who have been
 Girl's marriage after 19 years of age. (Reward encouraged to popularize the device within the private
of Rs.5000/-) sector.

 Giving birth to the first child after the mother Display Mindset Change Posters
was 21 years old. (Reward of Rs.7000/- if it's
a girl child & Rs 5000/- if it's a boy) In consultation with UNFPA, JSK prepared mindset
change posters which address family members to
 Keeping a 36 month gap between first and give the girl a chance to be in good health before
second child, and one parent getting she produces a child. The posters are available at
sterilized after the second child is http://www.jsk.gov.in/jsk_strategies.asp for being
born.(Reward of Rs.7000/- if it's a girl child & downloaded by any organization and they can fix their
Rs 5000/- if it's a boy) own logo and display them at places like post offices,
Coupled with: rural banks, fertilizer depots, shops or any places
where congregates .
 Registration of Marriage
This is one way of promoting mindset changes by
 Registration of birth involving civil society. These posters have already

30
ANNUAL REPORT 2008-09
been displayed by Indian Railways using their own doctors for conducting sterilization
Logo at Railway Stations in the Northern states as a procedures.
part of Corporate Social Responsibility. PSU's in the
 Laying down of checklist to be followed by
Ministry of Power and Ministry of Petroleum and
Natural Gas are also about to adopt this strategy. every doctor before carrying out sterilization
procedure.
2.7 Family Welfare Linked Health
 Laying down of uniform proforma for
Insurance Scheme. obtaining of consent of person undergoing
As a measure to encourage people to adopt sterilization.
permanent method of Family Planning, this Ministry
 Setting up of Quality Assurance Committee
has been implementing a Centrally Sponsored
for ensuring enforcement of pre and
Scheme since 1981 to compensate the acceptors of
postoperative guidelines regarding
sterilization for the loss of wages for the day on which
sterilization procedures.
he/she attended the medical facility for undergoing
sterilization.  Bringing into effect an insurance policy
uniformly in all States for acceptors of
Apart from providing for cash compensation to the
acceptor of sterilisaion some States/UTs were sterilizations etc.
apportioning some amount for creating a The above directions have all been taken into
miscellaneous purpose fund utilized for payment of consideration and consolidated in the updated
ex-gratia to the acceptor of sterilisaion or his/her manuals on standards and quality assurance in
nominee in the unlikely event of his/her death or
sterilization services available on the ministry's
incapacitation or for treatment of post operative
website (www.mohfw.nic.in). The family planning
complications attributable to the procedure of
insurance scheme is also one of the initiatives
sterilization, as under:-
launched under direction from the Hon'ble Supreme
i) Rs. 50,000/- per case of death. Court.

ii) Rs. 30,000/- per case of incapacitation. Under the existing government scheme no
compensation was payable for failure of sterilization,
iii) Rs. 20,000/- per case of cost of treatment of and no indemnity cover was provided to Doctors/
serious post operation complication. health facilities providing professional services for
Any liability in excess of the above limit was to be conducting sterilization procedures etc. With a view
borne by the State/UT/NGO/ Voluntary Organization to do away with the complicated process of payment
concerned from their own resources. of ex-gratia to the acceptors of Sterilisation for
treatment of post operative complications,
The Hon'ble Supreme Court of India in its Order dated incapacitation or death attributable to the procedure
1.3.2005 in Civil Writ Petition No. 209/2003 of sterilization, the Family Planning Insurance
(Ramakant Rai V/s Union of India) has, inter alia, Scheme was introduced w.e.f 29th November, 2005
directed the Union of India and States/UTs for for a period of one year to take care of the cases of
ensuring enforcement of Union Government's failure of Sterilisation, medical complications or death
Guidelines for conducting sterilization procedures
resulting from Sterilisation, and also provide indemnity
and norms for bringing out uniformity with regard of
cover to the doctor / health facility performing
sterilization procedures by -
Sterilisation procedure, with Oriental Insurance Co.
 Creation of panel of Doctors/health facilities and was subsequently renewed for one more year
for conducting sterilization procedures and from 29.11.2006 to 31.12.2007 with OIC. The benefits
laying down of criteria for empanelment of extended under the scheme are as follows:-

31
ANNUAL REPORT 2008-09

Policy period 29.11.2005 to 28.11.2006 (First Year)


Table -1

a) Death due to sterilization in hospital: Rs. 1, 00,000/-


b) Death due to sterilization within 30 days of discharge from hospital Rs.30,000/-
c) Failure of sterilization (including first instance of conception Rs.20,000/-
after sterilisaion).
d) Expenses for treatment of medical complications due to Rs.20, 000/-*
sterilization operation (within 60 days of operations
e) Indemnity Insurance per Doctor/facility but not more then UptoRs.2Lakh
4 cases in a year. per claim
Total liability of the insurance Company shall not exceed Rs. 9 crores in a year under each section.

Benefits after renewal of the Scheme w.e.f. 29th November, 2006 to 31.12.2007( 2nd Year)
Table -2

Section Coverage Limits

I IA Death following sterilization in hospital or within 7 days Rs. 2 lakh.


from the date of discharge from the hospital.
IB Death following sterilization within 8 - 30 days from Rs. 50,000/-.
the date of discharge from the hospital.
IC Failure of Sterilisation Rs 25,000/-.
ID Cost of treatment upto 60 days arising out of complication Actual not
from the date of discharge. exceeding
Rs 25,000/-.
II Indemnity Insurance per Doctor/facility but not more then 4
cases in a year. Upto Rs. 2 Lakh per claim
Total liability of the insurance Company shall not exceed Rs. 9 crores in a year under each section.

Renewal for third year 1.1.2008 to 31.12.2008: Renewal for fourth year 1.1.2009 to 31.12.2009: ICICI
Renewal of the Scheme/Policy for the third year has again qualified through open tender process for
i.e.1.1.2008 to 31.12.2008 has been done with ICICI continuation of the Policy under Family Planning
with the increase in the amount for sterilization failure Insurance Scheme with total premium with Service
from Rs.25,000 to Rs.30,000 and other benefits to Tax quoted as Rs. 4,92,97,950,(considering 45 Lakh
the acceptors and indemnity cover to the doctors Sterilizations) for the period 1.1.2009 to 31.12.2009.
remaining the same as in the previous year policy,
i.e., table as above. For the Policy period 1.1.2008 2.8 Compensation for Acceptors of
to 31.12.2008, a premium of Rs.3,17,41,700 was Sterilisation
paid considering 45 lakh sterilizations during the year.
With a view to encourage people to adopt permanent
As on 16.12.2008, 1115 claims including 79 claims
method of Family Planning, Government has been
of death after Sterilisation have been reported to the
implementing a Centrally Sponsored Scheme since
insurer.
1981 to compensate the acceptors of sterilization

32
ANNUAL REPORT 2008-09
for the loss of wages for the day on which he/she Jharkhand, Madhya Pradesh, Orissa, Rajasthan,
attended the medical facility for undergoing Uttar Pradesh and Uttaranchal, the compensation
sterilization. package for sterilisation had been raised from
Rs.300/- to Rs.400/- per Tubectomy, Rs.200/- to
Under the Scheme, the Central Government released Rs.400/-per Vasectomy if conducted in a public
funds to States/UTs @ Rs.300 per Tubectomy, Rs.200 health facility or approved private sector health
per Vasectomy and Rs.20 per IUD Insertion. The facility, and from Rs.20 to Rs.75 per IUD insertion, if
States/UTs had the flexibility to decide the amount of conducted in an approved private sector health
apportionment among various components, provided facility.
minimum amount of Rs.150 was paid to the acceptors
of Tubectomy/Vasectomy and Rs.60 per Tubectomy, Any liability in excess of the above limit was to be
Rs.25 per vasectomy and Rs.20 per IUD insertion borne by the State/UT/NGO/ Voluntary Organization
was used by the medical facility towards drugs and concerned from their own resources.
dressing. This was intended to ensure quality of
service in these procedures. Flexibility rested with The above compensation scheme for acceptors of
the States for determining sub components of the sterilization services was revised with effect from
remaining amount, within the total package. In the 31.10.06 and has been further improved with effect
case of EAG States viz. Bihar, Chhattisgarh, from 7.9.07. The revised rates are as follows:

A. For Public (Govt.) facilities


Table -1
Category Breakage Accep- Moti- Drugs Surgeon Anesth- Staff OT tech- Refr- Camp Total
of the tor vator and charges etist nurse nician/ esh- mana-
Compen- dress- helper ment gement
sation ing
package
High Vasectom 1100 200 50 100 - 15 15 10 10 1500
focus y (ALL)
states Tubectom 600 150 100 75 25 15 15 10 10 1000
y (ALL)

Non Vasectom 1100 200 50 100 - 15 15 10 10 1500


High y (ALL)
focus Tubectom
states y (BPL + 600 150 100 75 25 15 15 10 10 1000
SC/ST
Only)

Non High Tubectom 250 150 100 75 25 15 15 10 10 650


focus y (APL
states only)

A. For Prviate facilities


Table -2

Category Type of operation Facility Motivator Total

High focus states Vasectmy (ALL) 1300 200 1500


Tubectmy (ALL) 1350 150 1500
Non High Vasectomy (ALL)
focus states Tubectomy (BPL + SC/ST)

33
ANNUAL REPORT 2008-09

No apportioning of the above amount is admissible  Fixed day Fixed Place Family Planning
for creating a miscellaneous purpose fund for Services round the year - made possible
payment of compensation in case of deaths, on account of growing number of 24X7 PHCs
complications and failures as these are already and better functioning CHCs and other health
covered under the National Family Planning facilities under NRHM.
Insurance Scheme.
 Increasing the basket of choice by
The performance in sterilization (national figures) systematically and carefully introducing new
which was 47.35 lakh in 2000-2001 has shown slight and effective contraceptives in the
downward trend in 2006-07 with 45.14 cases. programme.

The Government has taken following steps to address Improved performance of sterilization in 2007-08: As
the concerns of the service providers and acceptors a result of the above measures and the focused
alike and the programme in general for giving a boost strategy at the Government of India level with close
to the sterilization performance: state wise monitoring as also the opportunities
afforded under NRHM in terms of plugging the
 National Family Planning Insurance
loopholes and bolstering the demand side financing
Scheme since 29.11.05: which covers both
in the new revised compensation scheme, the
the clients as well as the providers against
sterilization has shown a healthy 9.4% increase over
any mishaps like deaths, complications and
06 -07 in the country.
failures and the ensuing litigations
2.9 Health Insurance Scheme
 Orders dated 26th July 2007 of Hon'ble
Supreme Court: The orders relating to The Ministry of Finance looks after the Universal
criteria of 5 years experience for performing Health Insurance Scheme, which was launched in
sterilizations were waived off. 2003. The National Common Minimum Programme
[CMP] has made a commitment regarding Health
 The revision of Compensation package
Insurance for the poor. Accordingly National Rural
in Sept.2007 to compensate for loss of
Health Mission has also made commitment regarding
wages and also to provide compensation to
effective and viable risk pool and social health
providers of services. It also provided for
insurance to provide health security to the poor by
partnerships with the non - governmental
ensuring accessible, affordable, accountable and
sector.
good quality hospital care.
 Promoting Acceptance of No Scalpel
Under the National Rural Health Mission [NRHM], the
Vasectomy to ensure male participation.
MOHFW has set up a task force to explore new health
Holding of workshops, seminars,
financing mechanisms. The terms of reference for
advocacy meet and frequent
this task force include review of existing mechanisms
interactions with the states to orient them
to include health financing, human resource
on the GOI's strategy
implications to manage health financing and risk
 Promoting IUD 380A intensively as a pooling schemes, extent of subsidies required,
spacing method because of its longevity of ensuring equity and non-discrimination, feasibility in
10 years and advantages over other IUDs various states, suggested design of pilots and sites
to launch community based health insurance models,
 Increasing skills of IUD providers through and required modifications of existing structures to
alternative training strategy in IUD insertion introduce health financing schemes.
in 12 states to start with.

34
ANNUAL REPORT 2008-09
Based on the recommendations of the Task Force a 06/07, financial assistance to the tune of Rs 168.52
Framework for developing health insurance crores were provided from CM's Relief fund for 55361
programme [some suggestions for the States] have cases to meet hospitalization expenses for such
been developed and this Ministry has advised the people.
State/UT Governments to prepare Health Insurance
Based on this experience, Government of Andhra
models as per their local needs to be run on pilot
Pradesh introduced a health Insurance scheme in 3
basis. Government of Andhra Pradesh, Rajasthan,
districts w.e.f. 1/04/07 covering 25.27 lakhs BPL
Madhya Pradesh and Mizoram has sent proposals
families on pilot basis in Phase I for Heart, Cancer,
for funding the above pilot projects.
Neuro Surgery, Renal diseases, Burns and Poly
Andhra Pradesh: Trauma (not covered by MV Act) covering mostly 163
surgical interventions through stand alone health
Pilot project for implementation of Health Insurance
insurance company with public private partnership
Scheme from Andhra Pradesh for Anantapur,
of health providers by paying premium @ Rs 330/-
Mahboobnagar and Srikakulam Districts was
per family i.e. Rs 66 crores. Sum Insured is Rs. 1.50
received with request for providing funds to the tune
lakh with a buffer of Rs 50,000 per family.
of Rs.46.20 Crores. An amount of Rs.10 Crores was
agreed to as share of Union Government during the Reviewing the scheme, the state has introduced this
year 2007-08. Government of Andhra Pradesh scheme in Phase II by increasing the interventions
implemented the Aarogyasri Community Health to 213 by open tender process in 5 districts w.e.f. 5/
Insurance Scheme in five more districts of Chittoor, 12/07 covering 48.23 lakhs BPL families through the
East Goadavari, West Godavari, Nalgonda and same insurer which quoted the lowest rate of Rs 220/
Ranga Reddy in Second Phase from 5th December - per family.
2007. Proposal for extension of the Scheme to 15
Encouraged with the responses, now state has
more districts during the year 2008-09 in three
proposed to replicate the scheme in whole of the
phases has been received from the State
state in phased manner i.e. Phase III - 34.86 lakhs
Government.
BPL families in 5 districts from 5/04/08, Phase IV -
The State Government has sought for Rs.10 Crores 35.46 lakhs BPL families in 5 districts from 05/07/08,
in the Programme Implementation Plan under NRHM Phase V - 40.92 lakhs BPL families in remaining 5
for the Health Insurance Scheme during the year districts from 05/10/ 08. Thereby state would be
2008-09 and the same has been approved by the covering total 1.85 crores BPL families i.e. 6.55 crores
Ministry. BPL population.

Andhra Pradesh government felt a need in the state The scheme is being implemented through a trust
to provide medical assistance to BPL families for called "Aarogyasri Health Care Trust". BPL is
treatment of Critical Illness as Cancer, Kidney failure, identified by biometric ration card issued by Civil
Heart and Neuro etc requiring hospitalization. Supplies department. Now trust is issuing the health
However, government facilities do not have requisite card to all BPL families based on above data.
facilities and specialist to meet the state wide
It is presumed that BPL families will avail benefits
requirement.
under the scheme and get cashless treatment in the
Many people approached the Government for network hospital.
financial assistance to meet the medical/surgical
The Statistics of the scheme is given in next page:
expenses. During the period from 14/05/04 to 26/

35
ANNUAL REPORT 2008-09

S.No Phase - I Phase-II


1/4/07 to 31/1/08 5/12/08 to 31/1/08
1 Implementation date 01/04/07 05/12/07
2 No of Districts 3 5
3 No of Camps 1009 854
4 Patient screened 171984 206082
5 Patient referred 15417 22141
6 Pre authorization 11498 9391
7 Amount Approved Rs. 53,30,23,704 43,17,67,190
8 Total Surgery 10818 8327
9 IPD Cases 11580 9577
10 OPD Cases 11023 11201

It is mentioned that out of Rs.400 crore, Rs 250 Staff for doing additional works with the modality to
crores will be spent on women and child health and be decided by the State Government. States has
Melas being the major areas of thrust under NRHM. also been suggested to extend maternity benefits
However, the state has requested for Rs 100 crores under the scheme as well as to integrate benefits of
under NRHM for 2008-09. The State will bear the Janani Suraksha Yojana with the Scheme. The State
remaining cost on account of premium. Government has sought for Rs.39.29 Crores in the
Programme Implementation Plan under NRHM for the
Rajasthan: Health Insurance Scheme during the year 2008-09
Pilot project received from State Government of and the same has been approved by the Ministry.
Rajasthan is in respect of Sriganganagar, Udaipur, The process of expanding the pilot project to six more
Chittorgarh, Dungarpur and Banswara districts of districts namely Pratapgarh, Jaisalmer, Baran,
Rajasthan. The proposal has been considered in Dholpur, Sirohi and Bhilwara during the year 2008-
the Ministry and the approval for the same with some 09 has already been started by the State
suggestions/modifications has been conveyed to Government.
State Government on 8th December 2007. An This ministry has conveyed the approval for the
amount of Rs.23.64 Crores [75% of total premium] implementation of Health Insurance scheme in the 5
against the total premium of 37.82 Crores has been districts of Rajasthan through State Insurance and
approved to the State Government, under the NRHM Provident Fund Department of Government of
Flexipool for the year 2007-08 with the condition that Rajasthan (SIPF) from 7th Dec, 2008 and provided
number of BPL families should be as per the the subsidy of Rs. 300/- per family (considering the
guidelines of Planning Commission, Government of formula of 75% or Rs. 300/- which ever is less) per
India. The State Government will ensure that the annum under NRHM. The remaining amount was to
amount received by the Government Health facilities be born by the state.
from respective insurance agencies may be used
for up-gradation as well as towards meeting recurring The funds available under NRHM flexi-pool with the
expenditures of the Health facilities. State has been state during the year 2007-08 had to be utilized for
suggested to use 25% of such funds received for the remaining period of that year. During 2008-09,
payment of Honorarium to Doctors/Paramedics and the state has made provisions for risk pooling in their

36
ANNUAL REPORT 2008-09
PIP for 2008-09 to the tune of Rs. 39.29 Crores and premium which ever is the less for the remaining
has been approved for the 11 districts (5 earlier and period of the policy in the year 2008-09, if formal
6 new) under NRHM. approval is given. A provision for the year 2009-10
shall be required to be made in the PIP of 2009-10.
A total of 24452 claims were reported and an amount
of Rs.10,16,67,517 was paid to government hospitals Madhya Pradesh:
up to August, 2008 against the premium of Rs.
22,94,95,866 received by them in 4 installments up A proposal was received from Government of Madhya
to August, 2008 including service tax. Pradesh to introduce health insurance scheme for
families below poverty line in March 2007 to a group
SIPF has made an arrangement of risk sharing with comprising of about 20 lakh BPL families from the
ICICI, Reliance and SIPF with the ratio of 45%: 45%; total BPL population of about 43 lakhs in the rural
10% respectively from Dec, 07. The risk was area and about 13 lakhs in the urban areas on a
transferred based on the accepted share of 455: pilot basis. The Scheme was examined in this Ministry
45% to ICICI and Reliance @ Rs. 375 per beneficiary and Government of Madhya Pradesh was asked to
including service tax on 4 monthly installments @ provide list of districts for operation of the scheme
Rs.125 per installment. Two installment has been initially should not be more than 4 to 5 districts with
paid, the third installment has not been released clearly stipulating contribution of the State for
which is due from August 08. In between State Govt. payment of premium of the scheme. To begin with to
has invited the tenders for a health insurance scheme reduce the cost of premium, State was suggested to
to be implemented in whole of the state and based avoid payment of transport expenses/out of pocket
on the lowest quote received. expenses to the beneficiaries. Government of
Madhya Pradesh accordingly decided to introduce
The SIPF has been paid @ Rs. 337 from July 2008 the Health Insurance Scheme on pilot basis in the
including service tax. The scheme being implemented four districts of Ujjain, Gwalior, Indore, Jabalpur and
through SIPF will be merged with a scheme called has requested this Ministry's formal approval for the
Bhamashah Financial Improvement Scheme same. Since full details regarding the scheme as
(BHIS) being introduced from 1st Oct, 08 by the State per framework suggested by the Ministry was not
of Rajasthan in whole of the state. Bhamashah furnished by the State Government, they were
Financial Improvement Scheme (BHIS) is a scheme requested to furnish the same and include the
of financial inclusions based on banking services. proposal in Programme Implementation Plan under
Punjab National Bank and Bank of Baroda are the NRHM for the year 2008-09.
partners of the scheme.
The State Government has now proposed a Social
A tender for health insurance was invited for the entire Security and Health Insurance Scheme viz. "Dindayal
33 district and contract has been awarded to ICICI Antyodaya Upchar Yojana" with 50% support and
being L-1. Rate quote is Rs. 337 including ST for requested for a support of Rs.1500 lakhs in their
providing the health services on the lines of RSBY Programme Implementation Plan for the year 2008-
only in 25 districts including the 11 districts 09. NPCC in their meeting has approved an amount
under NRHM (5 old +6 new). It is also learnt that of Rs.1000 Lakhs for the scheme to be operated
Ministry of Labour, GOI has withdrawn their through Rogi Kalyan Samities. No further details are
scheme from the state as the implementation available.
of Bhamashah Scheme is not in accordance
with the RSBY scheme. State is also in process of Mizoram:
offering this scheme in the reaming 8 districts covered
under RSBY. Government of Mizoram has implemented "Mizoram
State Health Care Scheme" in the State from 1st April
In respect of contribution of NRHM, it was clarified 2008 for providing universal health insurance to all
that the support will be 75% or Rs 300/- of the the residents of Mizoram including APL population

37
ANNUAL REPORT 2008-09

but excluding Central, State and Public Sector discharge from the hospital, and Rs. 30,000 for failure
employees. Government of Mizoram has requested of Sterilization (limited to the actual expenditure) for
this Ministry to provide grants to the tune of Rs.5.39 medical complications. The indemnity cover to
Crores [Rs.4.90 Crores as premium @ Rs.700/- per doctors/health facilities is for a maximum amount of
family per year and Rs.0.49 Crores as administrative Rs.2 lakh per doctor/health facility per case up to a
expenses]. The total population of the State has maximum of 4 cases in a year. The cover also includes
been given as 1068953 with 202462 households out the legal costs and actual modality of defending the
of which 69745 are BPL households with a population prosecuted doctor/health facility in court which would
of 384212. The proposal from Government of be borne by the insurance scheme within limits
Mizoram has been examined in the Ministry and mentioned in the policy.
Government of Mizoram has been requested to
This scheme is applicable to all States/U.Ts.
furnish certain clarifications before their request for
Government of India has paid entire premium for the
grant is considered by the Ministry.
insurance policy to the Oriental Insurance Co Ltd.
Others States: for the period November 2005- December 2006 and
December 2006-December 2007. The Policy has
Proposal regarding taking up of pilot projects under now been renewed with ICICI Lombard for the period
the Scheme were reflected in the Programme up to 31.12.2008 States does not have to incur any
Implementation Plans of NRHM for the year 2007-08 expenditure under this scheme. The Insurance
by the States of Kerala, West Bengal, Assam, Company will make payment against the claims of
Haryana and Uttar Pradesh. These States have acceptors of sterilization directly to the acceptors
been reminded to submit their pilot projects for launch without any hassle.
of Health Insurance Scheme for BPL families. Assam,
Maharashtra, Madhya Pradesh, Rajasthan, Andhra Rashtriya Swasthya Bima Yojana Scheme
Pradesh, Jammu & Kashmir and Kerala Governments [RSBY]:
has included the Scheme in their Programme
Recently a Health Insurance Scheme [Rashtriya
Implementation Plan under NRHM for 2008-09 but
Swasthya Bima Yojana Scheme] for the Workers of
details of the scheme have been sought from
Unorganized Sector has been introduced by Ministry
respective states.
of Labour and a Technical Cell is being set up for
Family Planning [Indemnity] Insurance Scheme: providing assistance to the States for implementation
of the Scheme.
The Government of India has launched Family
Planning Insurance Scheme w.e.f. 29.11.2005 to Recently Ministry of Labour & Employment has
provide compensation for failure of sterilization, announced the "Rashtriya Swasthya Bima Yojana
medical complications arising out of sterilization (National Health Insurance Scheme)" for providing
procedure and in the most unlikely event of death. health insurance cover to Below Poverty Line workers
The insurance scheme also provides indemnity to the in the unorganized sector and their families. The
doctors/health facilities in the Government and also scheme is on similar lines as that of Health Insurance
accredited NGO and private sector providers who Scheme on pilot basis being taken up in selected
provide sterilization facilities. This provision has been districts of some states under NRHM. While giving
made because a number of doctors were facing our comments on this health insurance scheme, it
litigation on account of failure of sterilization etc. was mentioned that the pilot schemes under NRHM
would be continued to be funded. The details of the
The Indemnity Insurance Scheme provides for "Rashtriya Swasthya Bima Yojana" (copy enclosed)
compensation of Rs. Two lakh in case of death due to are as under:
sterilization in hospital or within 7 days from the date
of discharge from the hospital, Rs. 50,000 for death  The sum insured under this scheme would
due to sterilization within 8-30 days from the date of be Rs.30,000 per family per annum on a

38
ANNUAL REPORT 2008-09
floater basis, which would be available for Rashtiya Arogya Nidhi due to income of above poverty
hospitalization of most common illnesses with line, but less than Rs.50,000/- per annum. During
few exceptions. the year 2007-08, financial assistance totaling
Rs.39.23 lakh was given to 210 patients. A provision
 Contribution by Government of India: 75% of of Rs.100.00 lakh has been made during the current
the estimated annual premium of Rs.750/-, financial year i.e. 2008-09 and till October, 2008 a
subject to a maximum of Rs.565/- per family sum of Rs. 13.67 lakh has been released to 72
per annum. patients.
 Contribution by the respective State
2.11 Rashtriya Arogya Nidhi
Governments: 25% of the annual premium,
as well as any additional premium in cases Rashtriya Arogya Nidhi was set up under Ministry of
where the total premium exceeds Rs.750/-. Health & Family Welfare in 1997 to provide financial
 The beneficiary would pay Rs.30/- per annum assistance to patients, living below poverty line, who
as registration/renewal fee. are suffering from major life threatening diseases to
 Any administrative and other related cost of receive medical treatment in Government Hospitals.
Under the scheme of Rashtriya Arogya Nidhi, grants-
administering the scheme in each State shall
in-aid to also provided to State Governments for
be borne by the respective State
setting up State Illness Assistance Funds. Such funds
Governments. have been set up by the Governments of Andhra
 The scheme would be implemented in a Pradesh, Bihar, Chhattisgarh, Goa, Gujarat, Himachal
phased manner covering 20% districts of Pradesh, Jammu & Kashmir, Karnataka, Kerala,
country each year starting 2008-09 and thus Madhya Pradesh, Jharkhand, Maharashtra, Mizoram,
covering all districts in a period of five years. Rajasthan, Sikkim, Tamil Nadu, Tripura, West Bengal,
 Each BPL family would be issued Smart Card Uttrakhand, Haryana, Punjab NCT of Delhi and
for the purpose of identification as well as Pondicherry. The Grants-in-aid released to these
for keeping details about the benefits availed funds have been shown in the Annexure. Other
and expenditure. States/Union Territories have been requested to set
up the Fund, as soon as possible.
 After the approval of the project, the State
Governments shall, from time to time, intimate Applications for financial assistance up to Rs.1.5 lakh
the Union Government about the payment of are to be processed and sanctioned by the respective
the premium to the Insurers. The Union State Illness Fund. Applications for assistance
Government, on receipt of this information, beyond Rs.1.50 lakh and also of those where State
shall release its share of premium. Illness Fund has not been set up are processed in
This Ministry is supporting Ministry of Labour in this Department for release from the Rashtriya
provision of technical support as well as through Arogya Nidhi.
participation in Advisory & Approval Committee of that In order to provide immediate financial assistance,
Ministry. The Scheme has been taken-up from the to the extent of Rs.1,00,000/- per case, to critically
financial year 2008-09. ill, poor patients who are living below poverty line
2.10 Health Minister's Discretionary and undergoing treatment, the Medical
Grant Superintendents of Dr. RML Hospital, Safdarjung
Hospital, Smt.Sucheta Kriplani Hospital, All India
Financial Assistance to the poor and indigent patients Institute of Medical Sciences, New Delhi, PGIMER,
is given from the Health Minister's Discretionary Grant Chandigarh, JIPMER, Pondicherry, MINHANS,
to defray a part the expenditure on hospitalization/ Bangalore, CNCI, Kolkatta, Sanjay Gandhi Post
treatment in Govt. Hospital as these patients cannot Graduate Institute of Medical Sciences,
be considered for financial assistance under Lucknow,RIMS, Imphal, NEIGRIHMS, Shillong and CIP,

39
ANNUAL REPORT 2008-09

Ranchi have been provided with a revolving fund of Introduction of M-Visa by Ministry of Home
Rs.10-40 lakhs. The revolving fund is replenished Affairs:
after its utilization. For cases requiring financial
A new category of "Medical Visa" [M-Visa] has been
assistance above the 1,00,000/- (Rs. one lakh only)
introduced, which can be given for specific purposes
per case the applications are processed in the
to foreign tourists coming to India for medical
Department of Health & Family Welfare through a
treatment. This type of visa is granted for seeking
Technical Committee headed by Director General,
medical attendance only in reputed/recognized
DGHS before being considered for approval by a
specialized hospitals/treatment centers in the
duly constituted Managing Committee with Hon'ble
country.
Minister for Health & Family Welfare as the Chairman.
During the year 2007-08, financial assistance totaling Other Initiatives:
Rs.342.00 lakh was given directly to 212 patients
Ministry of Tourism, in close coordination with the
under Rashtriya Arogya Nidhi (Central fund.).
Ministry of Health and Family Welfare has initiated
2.12 Medical Tourism in India several measures to promote Medical Tourism.
Some of the major initiatives are as under: -
Medical tourism has gained momentum in India over
the past few years with the emergence of new high-  Indian Health Care Federation, a Non-
quality healthcare service providers. India is seeing Governmental Organization affiliated to the
a surge of patients from developed countries as well Confederation of Indian Industries, on advice
as from countries in Africa and South and West Asia. by Government, has prepared a guide on
The emergence of low-cost, high value specialist selected Indian Hospitals of the country for
medical care territories in India has been noteworthy. health tourism purposes.

Meetings between Union Ministers for Health  Brochures, CDs and other publicity materials
and Tourism: to promote Medical and Health tourism have
been produced and have been widely
The first high level meeting between the Minister of circulated for publicity in target markets.
Health and Family Welfare and the Minister of State
for Tourism was held on the 5th November 2004.  Guidelines for accreditation of Ayurvedic and
Various decisions like accreditation of hospitals, spas Panchkarma Centres have been finalized and
and Ayurvedic Systems, price range within which circulated to all State Governments for
various treatments would be made available implementation.
marketing of hospitals were taken in the meeting.
 Medical and Health Tourism has been
The second meeting was held on the 15th March specifically promoted at various international
2005. Some of the major decisions taken in the platforms such as World Travel Mart, London,
meeting are as under. ITB Berlin, Arabian Travel Mart.

o Reputed institutions like CII, FICCI, IMA,  Yoga/Ayurveda/Wellness has been promoted
FOGSIE etc. would bring out websites over the last two years in the print, electronic,
containing information on good hospitals, internet and outdoor medium under the
giving advice to exercise due diligence about Ministry's "Incredible India campaign".
the cost and quality before seeking health
 Brochure, CDs on Body, Mind and Soul
care from any hospital/institution.
covering the traditional system of medicine
o Ministry of Tourism will bring out brochure, have been produced and circulated
CDs etc. to promote Medical Tourism. extensively.

40
ANNUAL REPORT 2008-09

2.13 Pre-conception and Pre-Natal Act has been renamed as "Pre-conception and Pre-
Diagnostic Techniques (Prohibi- Natal Diagnostic Techniques (Prohibition of Sex
tion of Sex Selection Act, 1994) Selection) Act, 1994" (PC & PNDT Act, 1994) to
make it more comprehensive.
Sex ratio (number of females per thousand males) is
The PC & PNDT Act, 1994 provides for:
one the most important indicator used for study of
population characteristics. Declining trend in sex  Prohibition of sex selection, before and after
ratio has been a matter of concern for all in the conception (Sec 3A of the Act)
country. Sex ratio in India has declined over the
century from 972 in 1901 to 927 in 1991. However,  Regulation of prenatal diagnostic techniques
it was 933 in 2001. (e.g. amniocentesis and ultrasonography) for
detection of genetic abnormalities, by
In contrast the child sex ratio for the age group of 0- restricting their use to registered institutions.
6 years in 2001 is 927 girls per thousand boys The Act allows the use of these techniques
against 945 recorded in 1991 Census. only at a registered place for a specified
purpose and by a qualified person, registered
The Census 2001 figures further reveal that the child
for this purpose. (Sec 4 of the Act)
sex ratio is comparatively lower in the affluent regions,
i.e., Punjab (798), Haryana (819), Chandigarh (845),  Prevention of misuse of such techniques for
Delhi (868), Gujarat (883) and Himachal Pradesh sex selection before or after conception. (Sec
(896). State/UT wise Sex ratio and Child Sex ratio as 6 of the Act)
per 1991 and 2001 Census is enclosed.
 Prohibition of advertisement of any technique
Some of the reasons commonly put forward to explain for sex selection as well as sex determination
the consistently low levels of sex ratio are son (Sec 22 of the Act)
preference, neglect of the girl child resulting in higher
 Prohibition on sale of ultrasound machines
mortality at younger age, female infanticide, female
to persons not registered under this Act (Rule
foeticide, higher maternal mortality and male bias in
3A, inserted vide GSR, 109 (e) dt 14-2-2003)
enumeration of population. Easy availability of the
sex determination tests and abortion services may  Punishment for violation of provisions of the
also be proving to be catalyst in the process, which Act (Sec 23) as under:
may be further stimulated by pre-conception sex
o Imprisonment up to 3 years and fine up
selection facilities.
to Rs. 10,000.
Sex determination techniques have been in use in
o For any subsequent offences, he/she
India since 1975 primarily for the determination of
may be imprisoned up to 5 years
genetic abnormalities. However, these techniques
and fined up to Rs. 50,000 / 100,000.
were widely misused to determine the sex of the
foetus and subsequent abortions if the foetus was o The name of the registered medical
found to be female. practitioner is reported by the
Appropriate Authority to the State Medical
In order to check female foeticide, the Pre-natal
Council concerned for taking necessary
Diagnostic Techniques (Regulation and Prevention
action including suspension of the
of Misuse) Act, 1994, was brought into operation from
registration if the charges are framed by
1st January, 1996. The Pre-natal Diagnostic
the court and till the case is disposed off.
Techniques (Regulation and Prevention of Misuse)
Act, 1994 has since been amended to make it more Other salient features of the Act are:
comprehensive. The amended Act and Rules came
into force with effect from 14.2.2003 and the PNDT  The Central Supervisory Board (CSB),

41
ANNUAL REPORT 2008-09

constituted under Section 7 of the (PC & Action taken for implementation of the Act:
PNDT Act, 1994), under the Chairmanship
 Constitution of National Inspection &
of Minister for Health and Family Welfare has
Monitoring Committee (NIMC):
been empowered for monitoring the
implementation of the Act. For taking stock of the ground realities by
field visits to the problem States. During
 State level Supervisory Boards on the lines 2006-08, the Committee has visited the State
of CSB has been introduced for monitoring of Delhi, Haryana, Maharashtra, UP,
and reviewing the implementation of the Act Rajasthan, Orissa, Karnataka, Kerala, H.P.
in States/UTs. and Punjab.
 The State/UT level Appropriate Authority have  Constitution of National Support and
been made a multi member body for better Monitoring Cell (NSMC) with funding
implementation and monitoring of the Act in from UNFPA:
the States.
For effective implementation of the Act,
 Appropriate Authorities are empowered with including formulation of modules for
the powers of Civil Court for search, seizure apprehending by the Appropriate Authorities
and sealing the machines, equipments and the persons committing female foeticide/
records of the violators of law including abetting female foeticide.
sealing of premises and commissioning of
 Frequently Asked Questions (FAQs)
witnesses.
The Ministry of Health and Family Welfare,
 It has been made mandatory for the Genetic in collaboration with the United Nations
Clinics/Centres, etc., to maintain proper Population Fund (UNFPA), have developed
records in respect of the use of ultrasound 'Frequently Asked Questions' about the PNDT
machines and other equipments capable of Act which will be useful to the lay persons,
detection of sex of foetus and also in respect medical community and to the Appropriate
of tests and procedures that may lead to pre- Authorities in understanding the provisions
conception selection of sex. of the Act for better implementation.

As per the reports received from the States and UTs  The National Level Meeting on 'Save the Girl
35661 bodies using ultrasound, image scanners etc. Child' held on 28.4.2008 at Vigyan Bhawan,
have been registered under the Act. 367 ultrasound New Delhi, was inaugurated by Dr.
machines have been sealed and seized for violation Manmohan Singh, hon'ble Prime Minister of
of the law. As on 31.3.2009, there were 464 ongoing India, in the presence of the hon'ble Union
cases in the Courts/Police for various violations of Minister of Health & F.W., hon'ble Union
the law. Though most of the cases are for non- Minister of State (I/C) for Women & Child
Development, hon'ble Minister of State for
registration of the centre/clinic and non-maintenance
Health & F.W.. The large turnout of hon'ble
of records, 99 cases relate to determination and
Health Ministers, Members of Parliament and
disclosure of the sex of the foetus in different the
senior Health officers from the Central and
States. 32 cases exist against people who have
State/UT Governments and representatives
given advertisement about facilities of pre-
of various organisations active in the area
conception/pre-natal sex selection. The concerned
of Child welfare at the daylong fruitful
State governments are regularly requested to take deliberations of the National Meet lent the
effective measures for speedy disposal of the necessary impetus to the 'Save the Girl
ongoing cases. Child' mission.

42
ANNUAL REPORT 2008-09
All the State/UT Governments have been requested media units. Workshops and seminars are
to replicate such a meeting in their respective States/ also organized through Voluntary
UTs. Organizations at State/regional/district/block
levels to create awareness against this social
 Website on PC & PNDT: evil. Cooperation has also been sought from
In addition to the Union Health & F.W. religious / spiritual leaders, as well as medical
Ministry's website, (www.mohfw.nic.in), an fraternity to curb this practice. The
independent website, 'pndt.gov.in' for PNDT Government of India has launched 'Save the
Division was launched by the hon'ble Union Girl Child Campaign' with a view to lessen
Minister of Health & F.W. on 28.4.2008. This son preference by highlighting achievements
website, in addition to containing all the of young girls. Shri Kapil Dev, former Captain
relevant information relating to PNDT Act, of the Indian national Cricket Team, has been
Rules., Regulations and activities, enables nominated as the Brand Ambassador for the
campaign.
online filing of data right down from Clinics
(including submission of From-F' online by  Gender Testing/Sex Determination Kits:
the Clinics), in the field to the District and
State level and their retrieval at the District, The Government is endeavouring to contain
State and National levels. An exercise is on the adverse impact of the Gender Testing/
to impart training to the user groups on the Sex Determination Kits being advertised on
use of the website in a phased manner the internet and their purchase online
beginning with the focused states. The through inter-ministerial consultations
Appropriate Authorities of UT of Chandigarh,
2.14 Improvement in the Quality of
NCT of Delhi, Himachal Pradesh, Gujarat,
Health Care
Rajasthan, Punjab, Haryana, Maharashtra
and U.P. have so far been imparted training. The improvement in the quality of health care over
This training programme is being conducted the years is reflected in respect of some basic
by the experts from National Informatics demographic indicators (see Table I below). The
Centre. Crude Birth rate (CBR) declined from 40.8 births per
thousand population in 1951 to 29.5 in 1991 and
 Toll Free Telephone:
further to 23.1 in 2007. Similarly there was a sharp
Along with the above said PNDT Website, a decline in Crude Death Rate (CDR) which decreased
'Toll Free Telephone' was also launched by from 25.1 deaths per thousand population in 1951
the hon'ble Union Minister of Health & F.W. to 9.8 in 1991 and further to 7.4 in 2007. Also, the
on 28.4.2008 to enable the public to seek Total Fertility Rate (Average number of children likely
general information relating to PC & PNDT to be born to a woman between 15-44 years of age)
Act & the Rules framed thereunder and to has decreased from 6.0 in 1951 to 2.8 in 2006 as
lodge complaint against any violators of the per the estimates from the Sample Registration
Act. However, this service is temporarily System (SRS) of Registrar General India (RGI),
suspended pending resolution of certain Ministry of Home Affairs.
operational details. The Maternal mortality Rate has also declined from
 Awareness Generation: 437 per one lakh (100,000) live births in 1992-93 to
254 in (2004-06) SRS, according to the Report
Various activities have been undertaken to brought out by RGI. Infant Mortality Rate, which
create awareness against the practice of pre- was 110 in 1981, has declined to 55 per 1000 live
natal determination of sex and female births in 2007. Child Mortality Rate has also
foeticide through Radio, Television, and print decreased from 57.3 in 1972 to 17.0 in 2006.

43
ANNUAL REPORT 2008-09

Table 1 : Achievement of Family Welfare Programme


Sl. No. Parameter 1951 1981 1991 Current level

1 Crude Birth Rate (Per 1000 Population) 40.8 33.9 29.5 23.1 / (2007)

2 Crude Death Rate (Per 1000 Population) 25.1 12.5 9.8 7.4 / (2007)

3 Total Fertility Rate (Per women) 6.0 4.5 3.6 2.8 / (2006)

4 Maternal Mortality Rate NA NA 437 (1992-93) 254


(Per 100,000 live births) NFHS (2004-06) SRS

5 Infant Mortality Rate (Per 1000 live births) 146 110 80 55 (2007)
(1951-61)
6 Child (0-4 years) Mortality 57.3 41.2 26.5 17.0 $(2006)
Rate per 1000 children (1972)
7 Couple protection Rate (%) $ 10.4 22.8 44.1 46.7 $ (2006)
(1971)
Source: (1) Office of Registrar General, Ministry of Home Affairs. India.
$ (2) Family Welfare Statistics-2006, Ministry of Health and Family Welfare.

Family Planning Methods. The total number of in regard to family planning achievements during
acceptors of different Family Planning methods 2007-08 and 2008-09 (up to Nov.2008) at All India
enrolled in the country during the year 2007-08 was Level.
41.47 million. Table-2 below summarizes the position

Table 2 : Family Planning Acceptors by methods


(Figures in millions)
Sl. Methods Achievement* Achievement*
No. April2007- 2008-09 2007-08
March08 (April 2008- (April 2007-
Nov-2008) Nov-2007)
1 2 3 4 5
1. Sterilisation 5.01 2.32 2.14
2. IUD Insertions 6.07 3.9 3.72
3. Condom Users(Eq.) 20.67$ 18.30 18.06$
i. Under Free Distribution 10.81 9.82 9.74
Scheme(Eq.)
ii. Under Commercial 9.85 8.48 8.31
Distribution scheme(Eq.)
4. Oral Pill Users(Eq.) 9.72 8.21$ 8.45
i. Under Free distribution 5.33 4.82 4.84
Scheme (Eq.)
ii. Under Commercial 4.39 3.38 3.62
Distribution Scheme(Eq.)
Total 41.47 32.73 32.78
Eq. : Equivalent $ : May not tally with the total due to rounding off. * : Provisional figures

44
ANNUAL REPORT 2008-09
Immunization Performance for the Year 2007-08 vis- 08 for the period April-November of the respective
à-vis 2006-07 is given in Table-3. Table-4 gives the years.
comparative performance during 2008-09 and 2007-

Table 3 :
Assessed Need of Immunisation Vis-à-vis Achievement During 2007-08
Under RCH Programme (All India)
(Figures in 000's)

Sl. Activity Assessed Achievement* % % Achvt.


No. Need for 2007-08* 2007-08 Change of prop.
2007-08 Assessed
Need

1 2 3 4 5 6 7
A. Immunisation

i Tetanus Immunisation for 30102 23959 24441 (-) 1.9 79.6


Expectant mothers

ii DPT Immunisation 25772 24192 25279 (-) 4.3 93.9


For Children

iii Polio 25772 23834 25270 (-) 5.6 92.5

iv B.C.G. 25772 25755 26676 (-) 3.4 99.9

v Measles 25772 23373 24113 (-) 3.0 90.7

vi DT Immunisation 27672 15242 18995 (-) 19.7 55.1


For Children

vii T.T. (10 Years) 27980 13653 15806 (-) 13.6 48.8

viii T.T. (16 Years) 24190 11309 13355 (-) 15.3 46.7

B. Prophylaxis against 30102 15208 19687 (-) 22.7 50.5


nutritional anaemia among
women

C. Prophylaxis against Blindness


due to Vit. `A’ deficiency (k)

i. 1st dose (below 1 year + 25772 22892 24947 (-)8.2 88.8


above 1 year)

ii. 2nd dose to 5th dose 27875 29858 51153 (-)22.0 47.3 (k)

K : Percentage achievement of need assessed is worked out by taking 2 x 1.9 times the need assessed.
* : Provisional figures.

45
ANNUAL REPORT 2008-09

Table 4 :
Assessed Need of Immunisation Vis-à-vis Achievement During 2008-09
(April, 08 to Nov, 08) Under RCH Programme (All India)
(Figures in 000's)

Sl. Activity Prop. Assessed Achievement* % % Achvt.


No. Need for 2008-09 2007-08 Change of prop.
2007-08 (Apr. (Apr. 2008 (Apr. 2007 Assessed
2008 to Nov 2008) to Nov 08) to Nov 07) Need

1 2 3 4 5 6 7
A. Immunisation
i Tetanus Immunisation for 20125 14688 14995 (-) 2.0 73.0
Expectant mothers
ii DPT Immunisation 17233 13233 15012 (-)11.8 76.8
For Children
iii Polio 17233 14162 14478 (-)2.2 80.2
iv B.C.G. 17233 15943 16375 (-)2.6 92.5
v Measles 17233 13776 1474 (-)6.6 79.9
vi DT Immunisation 1874 7045 10247 (-)31.3 37.7
For Children
vii T.T. (10 Years) 18881 6992 9066 (-)22.9 37.0
viii T.T. (16 Years) 16308 5922 7570 (-)21.8 36.3
B. Prophylaxis against 30188 13714 9278 (+) 47.8 45.4
Nutritional Anaemia
among Total Women
C. Prophylaxis against
Blindness due to
Vit. `A’ deficiency
i. 1st dose (below 1 year + 22750 12016 15667 (-) 23.3 46.5
above 1 year)
ii. 2nd dose to 5th dose27875 28219 25794 28793 (-) 10.4 24.1 K

* : Figures are provisional.


K : Percentage achievement of need assessed is worked out by taking 2 x 1.9 times the need assessed.

2.15 Health Management Information 2008. The HMIS portal captures data to be collected
System as per the revised HMIS formats on a web-based
system at the District level and also enables
The Ministry has recently launched a dedicated information to be entered for each facility. The
Health Management Information System (HMIS) portal application would facilitate timely and accurate
for all Public Health related information in October collection, capturing and dissemination of data. The

46
ANNUAL REPORT 2008-09
portal would help in converting the data locally into spread through media and other sources. The ever
useful information, management indicators, district married women's questionnaire consisted of sections
profiles, trends which could be displayed graphically on women's characteristics, maternal care,
in reports. immunization and child care, contraception and
fertility preferences, reproductive health including
The portal would be generating unique analytical
knowledge about HIV/AIDS. The unmarried women's
reports using Data Warehousing platform for fine
questionnaire contained information on her
tuning policy initiatives. Information could be made
characteristics, family life education and age at
available quickly and regularly to decision makers
marriage, reproductive health-knowledge and
and other users in the form of specific and tailored
monthly, quarterly and annual reports. awareness about contraception, HIV / AIDS, etc. The
village questionnaire contained information on
2.16 District Level Household Survey availability of health, education and other facilities in
III the village and whether the health facilities are
accessible throughout the year. For the first time,
The District Level Household Surveys (DLHS) were
population-linked facility survey has been conducted
initiated in 1997 with a view to assess the utilization
in DLHS-3. In a district, all Community Health Centres
of services provided by government health facilities
(CHCs) and District Hospital (DH) were covered.
and people's perception about the quality of services.
Further, all Sub-centres (SC) and Primary Health
The District Level household Survey (DLHS -3) is
the third in the series of the district surveys, preceded Centres (PHC) which were expected to serve the
by DLHS-1 in 1998-99 and DLHS 2 in 2002-04. DLHS population of the selected PSU were also covered.
3, like other two rounds, is designed to provide There were separate questionnaires for SC, PHC,
estimates on important indicators on maternal and CHC and DH. They broadly include questions on
child health, family planning and other reproductive infrastructure, human resources, supply of drugs &
health services. In addition, DLHS 3 provides instruments, and performance.
information on important interventions of National
The survey was conducted in two phases, starting
Rural Health Mission (NRHM).
from December, 2007 with field work of each phase
DLHS -3 interviewed ever-married women (age 15- lasting for about four months. The second phase
49) and never married women (age 15-24). started immediately after the first phase in May, 2008.
DLHS-3 adopts a multi-stage stratified sampling The preliminary results for the key findings of the 27
design and sampled households representing a States have been released in Dec 2008 in the form
district vary from 1000 to 1500. of fact sheets.

The uniform bilingual questionnaires, both in English 2.17 Population Research Centres
and in local language, were used in DLHS-3 viz.,
Household, Ever Married Women (age 15-49), The Ministry established 18 Population Research
Unmarried Women (age 15-24), Village and Health Centres (PRCs) in various institutions in the country
facility questionnaires. In the household with a view to carry our research on various topics
questionnaire, information on all members of the pertaining to population stabilization, Demographic
household and the socio-economic characteristics and other Health related programs. While 12 of these
of the household, assets possessed, number of PRCs are located in Universities, the remaining six
marriages and deaths in the household since January are located in institute of national repute. The Ministry
2004, etc. was collected. In case of female deaths, of Health & Family Welfare provide 100% financial
attempts were made to assess maternal death. The grant-in-aid to all PRCs as on a year-to-year basis
household questionnaire also collected information towards salaries of staff, books and journals, TA/DA,
on respondent's knowledge about messages related data processing / stationary/ contingency etc., and
to various government health programmes being other infrastructure requirement.

47
ANNUAL REPORT 2008-09

Studies conducted by the Population Research 14) Evaluation Study on Impact of Existing IEC
Centres in the year 2007-08: During the year 2007- Activities on Poor and Marginalised Groups
08 the studies completed by the Population on RCH Issues.
Research Centres (PRCs) on some of the important
15) Monitoring of the District Level Household
topics of research including the studies assigned by
Survey (DLHS) - 3
the Ministry are given below.
16) Supporting the Elderly in India: Some
List of studies undertaken by PRCs during 2007-08
evidence of gender disparity.
1) Changing child population and Health care
17) Women, Marriage and Mobility: Some
infrastructure in Karnataka. patterns , issues and perspectives in
2) Role of NGOs in the Presentation of HIV/ International out- migration from Indian
AIDS- a Study in Karnataka. Punjab.

3) Awareness of HIV/ AIDS in Karnataka: 18) National Family Health Survey-III Punjab; a
Preliminary Welfare indicators.
Analysis of RCH- II Data
19) National Family Health Survey-III Haryana; a
4) Determinants of Maternal and Child
Preliminary Welfare indicators.
Health(MCH) care service use : A
Regional analysis in Karnataka 20) Pre Project Survey of Border Area
Development Programme in Himachal
5) Effects of Population on Environmental
Pradesh.
degradation with special reference to India.
21) Health Care Services in Punjab: findings from
6) Economic Growth and Public Health in India. patient satisfaction survey.
7) A study of Reproductive Health problems 22) Demographic Field Surveys Recent
among men and women in urban slums with Evidence from Punjab and Haryana.
special reference to sexually transmitted
infections. 23) The Prevalence of Non-Institutional
Deliveries in Rural Punjab: Why Women
8) Maternal mortality in India : levels, Persist from Home Deliveries?
differentials and causes
24) DSHS-RCH Round II Phase II
9) Reproductive and sexual health of young
unmarried women and men in urban slums 25) Unmet need for family planning in Bihar

10) Assessment of access and quality of health 26) National Family Health Survey
services in relation to the district's RCH Status 27) Gender, Environment and Collective Action
in Gujarat. in India and Nepal
11) Emerging causes and determinants of 28) Is caring for Elder an Act of Altruism ? Some
Maternal mortality in India. Evidence based on a Household Survey in
Delhi.
12) Current and Future Health scenario vis-a vis
Development in Major States of India. 29) Unmet and Met needs for contraception in
India
13) Incidence of Reproductive tract infection and
sexually transmission diseases in India: levels 30) Women's Reproductive Morbidity and
and differentials. Treatment seeking behaviour in India

48
ANNUAL REPORT 2008-09
31) Demographic Transition in India Eastern States from the well performing
States of India and also from National
32) Challenges for the NRHM: A Study of recent Average.
trends in Demographic and Health indicators
in Selected states of India. 48) Rural and Urban divide in utilization of
Reproductive and Child Health Services in
33) Missing issues in the Imbalance of Child Sex Uttar Pradesh.
Ratio : A Study on Northwestern India
49) Fertility trends in Uttar Pradesh: An analysis
34) Immunization Coverage of Children in India based on Census Data
35) Health & Heights : Rural facilities in Himalayan 50) Routine Immunization in Uttar Pradesh
India coverage and differentials.
36) Childhood Mortality and Health in India 51) Evaluation of 24 hours Delivery Services
37) Birth Rate Trends in India: A Decomposition Scheme in Uttar Pradesh.
Analysis 52) Demographic profile of Bihar
38) World Population Growth during 1950-2000. 53) Poverty and demographic indicators in Bihar
39) Assessing the patterns and Drivers of : An evidence from RCH Results
migration / mobility of Sex workers (Females 54) Population and Health in Bihar
and Hijras) and male migrant workers in the
move and examining the links with HIV Risks. 55) Maharatna, Arup, Population, Economy and
Society in West Bengal since the 1970s
40) Family Health International Journal of Development Studies
41) General population survey of STS/ IDS in 56) Children's work activities in a Peasant
Belgaum and Bellary districts- Karnataka Household: Epitome of Neo-classical
42) A study on the role of Panchayat Raj Rationality or Else ?
Institution in Implementing RCH program in 57) Monitoring of District Level House Hold
Tamil Nadu. Survey-3( Phase-I) on Reproductive and
43) A study on co-ordination between Anganwadi Child Health in Karnataka, Goa an Madhya
Workers and Village Health Nurse in Pradesh.
delivering Adolescent Reproductive Health 58) External Evaluation of Continuing Education
Services at village level in Tamil Nadu. Programme in Mysore Districts
44) District level comparative study on household 59) Representation of Social Groups in Higher
amenities of North Eastern of India Education: An Analysis of NSSO 55th Round.
45) Maternal and Child Health care in some 60) Are Fertility differentials by Social Groups
selected districts of Assam: Evidence from converging in Andhra Pradesh
RCH-I and RCH-II
61) Quality of Health Care in Public Health
46) Evaluation of functioning of AIE Centres with Programmes: A Review.
focus on Retention of Mainstream children
in formal school in Assam. 62) Workshop on "Census of India 2001: Data
Dissemination".
47) Level of Deviation in the perform of Family
planning program of Assam and some North 63) A follow Up study of Women Undergoing

49
ANNUAL REPORT 2008-09

Ultrasound Tests in two districts of Haryana: 76) Reproductive Health of women Labourers: A
Panchkula and Ambala case study of cashew workers in Kollam
District
64) Reproductive and Child Health : Rapid
Cluster Survey in Haryana 77) Interventions of Juniors Public Health Nurses
(JPHNs) on Matters regarding Reproductive
65) Adolescent Fertility and Utilization of Health
and Child Health: A Beneficiary Perspective.
Facilities in Haryana

66) Assessment of Janani Express Scheme in 78) Reproductive Health problems of adolescents
Madhya Pradesh. and youth in selected districts of Kerala

67) Assessment of Janani Suraksha Yojana: A 79) Fertility and contraceptive use in Malappuram
pilot study in Sagar District. District of Kerala

68) Factors influencing underutilization of 80) Migration and its impact on Child Health and
immunization services in Madhya Pradesh status of women: Evidences from the State
of Kerala
69) Estimation of Demographic indicators based
on Census 2001 data for Madhya Pradesh- 81) A study on Maternal Mortality in Kerala
Part1. Study on internal Migration in Madhya
Pradesh. 82) Scenario of crimes against women in India
and Kerala.
70) Strategies for Strengthening Rural Health
Care PRIs and community involvement. 83) Awareness about AIDS in slums dwellers of
Udaipur districts
71) Population Dynamics in district Chamba in
Himachal Pradesh 84) Role of ASHA in promoting safe delivery in
Rajasthan
72) Reproductive Morbidity among women in
district Chamba. 85) Problem of services providers in Delivering
RCH services in Rural Area of Rajasthan
73) Rural Health infrastructure and its utilization
in district Chamba, Himachal Pradesh. 86) Janani Suraksha Yojana : A study of
implementation status in selected districts of
74) Evaluation of centrally sponsored scheme in
Rajasthan
Jammu and Kashmir

75) Unintended pregnancies in Jammu and 87) Study on the assessment of the functioning
Kashmir State : Levels and correlates of ANM/ MPHW(F) Training schools funded
Services in Jammu and Kashmir. by State Government / Private Organizations.

50
ANNUAL REPORT 2008-09

Chapter 3

Funding for the Programme


The Ministry of Health & Family Welfare consists of been a steady increase in the allocations made for this
four department's viz. the Department of Health & Sector from the 1st Plan. Against the tenth plan outlay
Family Welfare, Department of AYUSH, Department of Rs.36,378. 00 crores, the actual expenditure has
of Health Research and Department of AIDS Control. been of the order of Rs. 35,433.38 crores. The
The Department of Health Research was created in allocation for this sector has been substantially
September,07 & the Department of AIDS control in enhanced in the 11th Plan to Rs.1,36,147 crores. In
January,09. the table below is captured the financial outlays and
expenditure for Health & Family Welfare for the 10th
Achieving an acceptable standard of health for general
population has been the objective over the plan era in Plan (2002-07) and Health, Family Welfare and Health
the Health sector. In line with this objective, there has Research for the 11th Plan (2007-12).

Approved Outlay Expenditure


Plan Period Health F.W. Health Total Health F.W. Health Total
Research Research
10th Plan 10252.00 26126.00 X 36378.00 X
Outlay
Actual Status 10521.00 31064.00 X 41585.00 8694.15 26349.23 X 35433.38
2002-03 1550.00 4930.00 X 6480.00 1359.82 3916.63 X 5276.45
2003-04 1550.00 4930.00 X 6480.00 1325.81 4409.27 X 5735.08
2004-05 2208.00 5780.00 X 7988.00 1772.36 4864.21 X 6636.57
2005-06 2908.00 6424.00 X 9332.00 2253.72 5672.53 X 7926.25
2006-07 $ 2305.00 9000.00 X 11305.00 1982.44 7486.59 X 9469.03
11th Plan 41092.92 90558.00 4496.08 136147.00
(2007-12)
Outlay $
2007-08 $ 2985.00 10890.00 X 13875.00 2100.15 10380.25 X 12480.40
2008-09 $ 3650.00 11930.00 420.00 16000.00
2009-10 (IR) 3650.00 11930.00 420.00 16000.00
$ : Figures shown as Health and NRHM from 2006-07 IR: Interim Approved.

National Common Minimum Programme of UPA accessible, affordable, quality health services to the
Government has accorded high priority for health poorest household in the remotest rural regions, with
sector,recommending increasing the level of Public focus on primary healthcare and linkages with
expenditure on Health to the tune of 2-3% of GDP secondary and tertiary healthcare. It has been able
by 2010. In pursuance of these objectives, two major to converge standalone disease control programmes
initiatives were launched to provide good health care and revitalize local health traditions, mainstream
facilities to the population across the country. AYUSH and effectively integrate health concerns
through decentralized management at the district with
The first one is the flagship programme of National determinants of health like sanitation and hygiene,
Rural Health Mission launched in 2005 to provide nutrition, safe drinking water, gender and social

51
ANNUAL REPORT 2008-09

concerns. To cater to specialized tertiary health care which is in different stages of progress. Plan
and to improve facilities for medical education, allocation under both health and NRHM has shown
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) a significant step up since 2005-06. The scheme-
was launched for building up AIIMS like institutions in wise break up of plan and non plan expenditure
deficit States and upgrade medical colleges. In the during 2007-08 and 2008-09 for Health, NRHM and
first phase, work on 6 AIIMS like institutions and up Health Research is given at statement I and II.
gradation of 13 medical colleges is being undertaken
DEPARTMENT OF HEALTH AND FAMILY WELFARE HEALTH SECTOR
Scheme- wise Break- up of Actule Expenditure during 2007-08 and Outlays for 2008-09
(Rs.in crores)
Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
A. CENTRALLY SPONSORED 23202.50 1029.76 5.97 1035.73 2058.00 6.00 2064.00
PROGRAMMES
1 National AIDS Control Programme and 5728.00 886.73 0.00 886.73 1100.00 0.00 1100.00
National S.T.D. Control Programme
2 Cancer 2871.92 54.59 5.97 60.56 150.00 6.00 156.00
(i) National Cancer Control Programme 2400.00 46.32 5.97 52.29 120.00 6.00 126.00
(ii) Tobacco Control Programm 471.92 8.27 0.00 8.27 30.00 0.00 30.00
3 National Mental Health Programme 1000.00 14.57 0.00 14.57 70.00 0.00 70.00
4 Assistance to State for Capacity 732.95 38.50 0.00 38.50 120.00 0.00 120.00
Building (Truma Care)
5 Assistance to States for Drug 260.00 8.41 0.00 8.41 45.00 0.00 45.00
& PFA Control
New initiatives under CSS (Others) 12609.63 26.96 0.00 26.96 573.00 0.00 573.00
6 Telemedicine 183.00 16.08 0.00 16.08 15.00 0.00 15.00
7 National Programme for Prevention 1660.50 4.42 0.00 4.42 30.00 0.00 30.00
and Control of Diabetes,
Cardiovascular Disease and Stroke
8 National Programme for Health 400.00 0.00 0.00 0.00 5.00 0.00 5.00
for thr Eiderly
9 District Hospitals 1500.00 75.00 0.00 75.00
(i) Strengthening of MCH wing/ 35.00 0.00 35.00
Hospitals and other wing in
District Hospitals
(ii) Upgradation of States Govt.
Medical Colleges (NE) 1500.00 40.00 0.00 40.00
10 Human Resource for Health 4000.00 373.00 0.00 373.00
(i) Upgradation/Strengthening of 2900.00 198.00 0.00 198.00
Nursing Services
(ii) Strengthening / Creation of 1000.00 150.00 0.00 150.00
Paramedical Institutes
(iii) Strengthening / Upgradation of 100.00 25.00 0.00 25.00
Pharmacy Schools

52
ANNUAL REPORT 2008-09

Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
11 Health Insurance 4495.00 50.00 0.00 50.00
(Urban Health Mission)
12 Pilot Projects 371.13 6.46 0.00 6.46 25.00 0.00 25.00
Sport Medicines/Sport Injiry 90.00 0.00 0.00 0.00 2.00 0.00 2.00
Deafness 100.00 5.24 0.00 5.24 10.00 0.00 10.00
Leptospirosis Control 4.48 0.01 0.00 0.01 1.00 0.00 1.00
Control of Human Rabies 8.65 0.00 0.00 0.00 2.00 0.00 2.00
Medical Rehabilitation 50.00 0.99 0.00 0.99 1.00 0.00 1.00
Ogran Transplant 25.00 0.00 0.00 0.00 4.00 0.00 4.00
Oral Health 25.00 0.22 0.00 0.22 3.00 0.00 3.00
Fluorosis 68.00 0.00 0.00 0.00 2.00 0.00 2.00
B. CENTRAL SECTOR SCHEMES: 17890.42 1070.39 1479.77 2550.16 1592.00 1343.00 2935.00
1 Oversight Committee 1827.00 0.00 0.00 0.00 100.00 0.00 100.00
Strengthening of the Institutes for 531.23 38.11 32.90 71.01 50.00 40.30 90.30
Control of Communicable Diseases
2 National Institute of 60.00 6.40 10.58 16.98 7.00 14.00 21.00
Communicable Diseases
National Tuberculosis Institute, 9.48 0.80 2.96 3.76 1.95 3.66 5.61
Bangalore
Others Research Institutes 461.75 30.91 19.36 50.27 41.05 22.64 63.69
B.C.G. Vaccine Laboratory, Guindy,
Chennai 80.00 3.69 6.41 10.10 5.00 7.00 12.00
Pasteur Institute of India, Coonoor 280.00 10.00 0.00 10.00 11.15 0.00 11.15
Lala Ram Sarup Institute of T.B. and 78.75 14.63 7.00 21.63 18.24 7.00 25.24
allied diseases, Mehrauli, Delhi
Central Leprosy Training & Research 10.00 0.91 3.53 4.44 4.00 5.15 9.15
Institute Chengalpattu (Tamil Nadu)
Regional Institute of Training, 13.00 1.68 2.42 4.10 2.66 3.49 6.15
Research & Treatment under
Leprosy Control Programme
(a) R.L.T.R.I., Aska (Orissa) 3.00 0.09 0.97 1.06 1.00 1.51 2.51
(b) R.L.T.R.I., Raipur (M.P.) 2.00 0.15 1.45 1.60 0.16 1.98 2.14
(c) R.L.T.R.I., Gauripur (W.B.) 8.00 1.44 0.00 1.44 1.50 0.00 1.50
3 Strengthening of Hospitals 1162.34 114.18 516.45 630.63 150.00 429.30 579.30
& Dispensaries:
Central Government Health Scheme 565.80 33.32 432.50 465.82 50.00 339.00 389.00
Central Institute of Psychiatry, Ranchi 100.00 6.78 12.92 19.70 12.00 13.15 25.15
All India Institute of Physical Medicine 56.00 3.26 4.46 7.72 3.00 5.20 8.20
& Rehabilitation, Mumbai
Dr. R.M.L. Hospital, New Delhi 351.00 62.82 63.57 126.39 70.00 68.95 138.95

53
ANNUAL REPORT 2008-09

Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
Others 89.54 8.00 3.00 11.00 15.00 3.00 18.00

Institute for Human Behaviour & 8.00 0.00 0.00 0.00 1.00 0.00 1.00
Allied Sciences, Shahdara, Delhi
All India Institute of Speech & 81.54 8.00 3.00 11.00 14.00 3.00 17.00
Hearing, Mysore
4 Strengthening of Institutions for 2350.95 325.83 147.78 473.61 190.00 67.23 257.23
Medical Education, Training
& Research:
(a) Medical Education: 1749.67 105.72 26.23 131.95 139.10 28.40 167.50
Indira Gandhi Institute of Health & 1266.38 42.00 0.00 42.00 59.00 0.00 59.00
Medical Sciences for North East
Region at Shilong*
N.I.M.H.A.N.S., Bangalore 266.38 37.00 23.00 60.00 43.00 25.00 68.00
Kasturba Health Society, Wardha 106.91 16.48 0.00 16.48 21.21 0.00 21.21
National Medical Library, New Delhi 100.00 10.24 3.05 13.29 14.89 3.40 18.29
National Board of Examinations, 10.00 0.00 0.18 0.18 1.00 0.00 1.00
New Delhi
(b) Training: 288.65 14.59 3.51 18.10 18.85 4.99 23.84
Upgradation/ Development of
Nursing Services 280.65 14.01 0.00 14.01 18.00 0.00 18.00
Nursing Colleges 8.00 0.58 3.51 4.09 0.85 4.99 5.84
(i) R.A.K. College of Nursing, 5.00 0.44 2.73 3.17 0.70 3.27 3.97
New Delhi
(ii) Lady Reading Health School 3.00 0.14 0.78 0.92 0.15 1.72 1.87
(c) Research: 10.00 176.65 90.00 266.65 1.00 0.00 1.00
(i) Indian Council of Medical Research, 7296.08 176.65 90.00 266.65
New Delhi #
#- ICMR merged with department of Health Research from 2008-09
(ii) Membership for International 10.00 1.00 0.00 1.00
Organisation
(d) Public Health 108.81 23.20 15.99 39.19 21.30 21.53 42.83
Institute of Public Health (PHFI) 22.00 22.00 14.15 36.15 1.00 0.00 1.00
All India Institute of Hygiene & Public 86.81 1.20 1.84 3.04 20.30 21.53 41.83
Health, Calcutta (AIIH&PH) and
Serologist and Chemical Examiner,
Calcutta
i. AIIH&PH, Calcutta 85.81 1.08 0.00 1.08 20.00 18.90 38.90
ii. Serologist & Chemical Examiner, 1.00 0.12 1.84 1.96 0.30 2.63 2.93
Calcutta

54
ANNUAL REPORT 2008-09

Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
(e) Others 193.82 5.67 12.05 17.72 9.75 12.31 22.06
Indian Nursing Council 10.00 0.20 0.11 0.31 0.25 0.12 0.37
V.P. Chest Institute, Delhi 158.00 4.00 11.00 15.00 7.00 11.00 18.00
National Academy of 7.72 0.47 0.00 0.47 0.50 0.20 0.70
Medical Sciences, New Delhi
Medical Council of India, New Delhi 10.00 1.00 0.60 1.60 1.00 0.60 1.60
Medical Grants Commission 8.10 0.00 0.00 0.00 1.00 0.00 1.00
Dental Council of India ) 0.00 0.00 0.19 0.19 0.00 0.19 0.19
Pharmacy Council of India 0.00 0.00 0.15 0.15 0.00 0.20 0.20
5 System Strengthening including 1106.58 40.89 74.52 115.41 55.00 97.22 152.22
Emergency Medical Relief/
Disaster Management
(a) Health Education, Research 32.33 1.42 0.00 1.42 3.40 0.00 3.40
& Accounts
Health Education 11.65 0.14 0.00 0.14 1.00 0.00 1.00
Health Intelligence and Health Accounts 20.68 1.28 0.00 1.28 2.40 0.00 2.40
i. Intelligence 10.68 1.28 0.00 1.28 1.40 0.00 1.40
ii. Accounts 10.00 0.00 0.00 0.00 1.00 0.00 1.00
(b) Strengthening of D.G.H.S./ 25.00 2.79 41.34 44.13 3.50 51.85 55.35
Ministry:
I. Strengthening of Deptts under 15.00 1.88 21.44 23.32 2.50 26.00 28.50
the Ministry
II. Strengthening of DGHS 10.00 0.91 19.51 20.42 1.00 25.85 26.85
Other( Discretionary Grant) 0.00 0.39 0.39
(c) Emergency Medical Relief 564.82 14.59 0.00 14.59 7.30 0.00 7.30
Health Sector Disaster Preparedness
and Management 447.25 14.59 0.00 14.59 5.00 0.00 5.00
Emergency Medical Relief 117.57 0.00 0.00 0.00 2.30 0.00 2.30
(including Avian Flu)
(d) Others 484.43 22.09 33.18 55.27 40.80 45.37 86.17
Central Research Institute, Kasauli 292.92 4.55 14.28 18.83 10.00 17.97 27.97
National Institute of Biological, 62.65 11.32 0.00 11.32 10.00 0.00 10.00
NOIDA (U.P.)
Prevention of Food Adulteration 25.36 2.07 2.85 4.92 11.00 3.95 14.95
Central Drug Standard & Control 88.50 3.80 7.83 11.63 9.00 11.25 20.25
Organization (CDSCO)
Port Health Authority 15.00 0.35 8.22 8.57 0.80 12.20 13.00
i) Jawaharlal Nehru Port Sheva 8.20 0.31 0.00 0.31 0.50 12.20 12.70
ii) Setting up of offices at 8 newly 6.80 0.04 0.00 0.04 0.30 0.00 0.30
created international Airports

55
ANNUAL REPORT 2008-09

Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Plan Plan Plan
1 2 3 4 5 6 7 8 9
6 Pradhan Mantri Swasthya 3955.00 76.04 0.00 76.04 490.00 0.00 490.00
Suraksha Yojana
New Initiatives under CS 6957.32 475.34 690.67 1166.01 557.00 693.40 1250.40
7 Forward Linkages to NRHM 900.00 0.00 0.00 0.00 60.00 0.00 60.00
(New Initiatives in NE) *
8 National Centre for Disease Control 450.00 0.08 0.00 0.08 3.00 0.00 3.00
9 Advisory Board for Standards 22.00 0.00 0.00 0.00 2.00 0.00 2.00
10 Programme for Blood and 450.00 0.00 0.00 0.00 2.00 0.00 2.00
Blood Products
Medicao Store Organisation 0.00 0.00 21.60 21.60 0.00 30.00 30.00
Rashtriya Arogya Nidhi 0.00 0.00 9.90 9.90 0.00 10.00 10.00
Procurement of Meningitis Vaccine 0.00 0.00 5.49 5.49 0.00 7.50 7.50
for Inoculation of Haj Pilgrims
11 Redevelopment of Hospitals / 6035.32 475.26 653.68 1128.94 550.00 645.90 1195.90
Institutions
All India Institute of Medical Sciences 1461.00 160.00 309.98 469.98 162.00 290.00 452.00
& its Allied Departments, New Delhi
P.G.I.M.E.R., Chandigarh 625.00 70.00 133.00 203.00 50.00 133.00 183.00
J.I.P.M.E.R., Pondicherry 564.00 99.62 48.02 147.64 98.00 60.00 158.00
Lady Harding Medical College & 383.83 14.57 54.09 68.66 45.00 54.00 99.00
Smt. S.K. Hospital, New Delhi
Kalawati Saran Chilren Hospital , 74.88 8.47 13.74 22.21 15.00 13.00 28.00
New Delhi
RIMS, Imphal, Manipur 589.92 48.00 0.00 48.00 65.00 0.00 65.00
LGBRIMH, Tejpur, Assam 267.07 2.25 0.00 2.25 31.00 0.00 31.00
RIPANS, Aizwal, Mizoram 69.62 5.89 0.00 5.89 14.00 0.00 14.00
Safdarjung Hospital and College, 2000.00 66.46 94.85 161.31 70.00 95.90 165.90
New Delhi
International Co-operation 0.00 0.00 15.11 15.11 0.00 11.25 11.25
Other Schemes 0.00 0.00 2.34 2.34 0.00 4.30 4.30
TOTAL(HEALTH) 41092.92 2100.15 1485.74 3585.89 3650.00 1349.00 4999.00
III Depart of Health Research 4296.08 0.00 0.00 0.00 420.00 111.75 531.75
Indian Council of Medical 4296.08 0.00 0.00 0.00 420.00 111.75 531.75
Recearch (ICMR)
GRAND TOTAL 45389.00 2100.15 1485.74 3585.89 4070.00 1460.75 5530.75

56
ANNUAL REPORT 2008-09

DEPARTMENT OF HEALTH AND FAMILY WELFARE NRHM AND MEDICAL RESEARCH INSTITUTE
(Rs.in crores)
Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
I CENTRALLY SPONSORED SCHEMES 88451.22 10160.32 13.23 10173.55 11580.00 16.60 11596.60
A. Disease Control Programmes 6645.63 863.20 5.75 868.95 1086.57 7.28 1093.85
1 National Vector Borne Disease 3190.00 383.65 5.75 389.40 472.25 7.28 479.53
Control Programme
2 National T.B Control Programme. 1447.00 261.96 0.00 261.96 275.00 0.00 275.00
3 National Leprosy Eradication 268.70 25.00 0.00 25.00 45.00 0.00 45.00
Programme.
4 Iodine Deficience Disorder 155.40 19.46 0.00 19.46 32.00 0.00 32.00
Control Programme (IDDCP)
5 National Programme for 1550.00 163.50 0.00 163.50 250.00 0.00 250.00
Control of Blindness
6 National Drug De-Addiction 34.53 9.63 0.00 9.63 12.32 0.00 12.32
Control Programme (NDDPC)
B. Free Distribution & Social 2200.00 274.97 0.00 274.97 300.00 0.00 300.00
Marketing of Condoms for NACO
C. Family Welfare 79605.59 9022.15 7.48 9029.63 10193.43 9.32 10202.75
Infrastructure Maintenance 20459.45 2468.10 4.97 2473.07 3088.68 6.18 3094.86
(a) Direction & Administration 1955.28 215.80 4.97 220.77 348.20 6.18 354.38
(i) Maintenance of State & 1955.28 215.80 4.97 220.77 348.20 6.18 354.38
Distt.FW Bureaus
(b) Rural Family Welfare Services 16865.00 2029.13 0.00 2029.13 2477.24 0.00 2477.24
(Sub Centres)
(c) Urban Familiy Welfare Services 958.84 130.99 0.00 130.99 157.75 0.00 157.75
(d) Grants to State Training 680.33 92.18 0.00 92.18 105.49 0.00 105.49
Institutions
(a) Basic Training for ANM/LHVs 520.48 67.27 0.00 67.27 78.34 0.00 78.34
(b) Maintenance & Strengthening 93.01 14.14 0.00 14.14 16.92 0.00 16.92
of HFWTCs
(c) Basic Training for MPWs 56.09 8.72 0.00 8.72 10.23 0.00 10.23
Worker (Male)
(d) Strengthening of Basic 10.75 2.05 0.00 2.05 0.00 0.00 0.00
Training Schools
2 Free distribution of Contraceptives 330.00 36.97 0.00 36.97 65.00 0.00 65.00
3 RCH Programme (Procurement of 1500.00 300.00 0.00 300.00
Supplies & Materials)
4 Routine Immunisation 2457.16 236.49 0.00 236.49 615.00 0.00 615.00
(Supply of vaccine etc)

57
ANNUAL REPORT 2008-09

Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
5 Pulse Polio Immunisation 3994.18 1084.00 0.00 1084.00 1068.43 0.00 1068.43
(a) Procurement of Vaccines 1964.48 648.79 0.00 648.79 503.62 0.00 503.62
(b) Operating cost 2029.70 435.21 0.00 435.21 564.81 0.00 564.81
6 IEC (Inf., Edu. and Communication) 1001.50 155.83 2.51 158.34 186.31 3.14 189.45
7 Area Projects 463.51 46.23 0.00 46.23 50.01 0.00 50.01
(a) USAID assisted Projects 463.50 46.23 0.00 46.23 50.00 0.00 50.00
(b) EC assisted Projects 0.01 0.00 0.00 0.00 0.01 0.00 0.01
8 Flexible Pool for State PIPs 48119.79 4994.53 0.00 4994.53 4820.00 0.00 4820.00
(i) RCH Flexible Pool 16229.47 1842.88 0.00 1842.88 2535.00 0.00 2535.00
(ii) Mission Flexible Pool 31890.32 3151.65 0.00 3151.65 2285.00 0.00 2285.00
9 Strengthening of Maternal Health 1280.00
and Child Health Wing/Hospitals
and other wing in District Hospitals
II CENTRAL SECTOR SCHEMES 2106.78 219.93 21.34 196.27 350.00 27.65 377.65
A. DISEASE CONTROL PROGRAMME 300.45 41.07 0.00 41.07 72.00 0.00 72.00
1 Integrated Disease Survillance 300.45 41.07 0.00 41.07 72.00 0.00 72.00
Project
B. FAMILY WELFARE 1806.33 178.86 21.34 155.20 278.00 27.65 305.65
1 Social Marketing Area Project 50.00 1.70 0.00 1.70 1.50 0.00 1.50
2 Social Marketing of Contraceptives 450.00 26.71 0.00 26.71 30.02 0.00 30.02
3 F.W Training and Res. Centre, Mumbai 18.80 0.29 0.95 1.24 6.03 1.35 7.38
4 NIHFW, New Delhi 34.00 4.98 10.83 15.81 10.65 13.08 23.73
5 IIPS, Mumbai 24.00 3.39 5.33 8.72 9.00 6.25 15.25
6 RHTC, Najafgarh 23.65 0.00 4.23 4.23 4.00 6.97 10.97
7 Population Research Centres 53.50 8.60 0.00 8.60 10.00 0.00 10.00
8 CDRI, Lucknow 23.15 3.85 0.00 3.85 4.00 0.00 4.00
9 Travel of Exp. /Conf/Meetings etc. 6.00 0.93 0.00 0.93 1.00 0.00 1.00
10 International Cooperation 8.95 1.33 0.00 1.33 2.15 0.00 2.15
11 NPSF/National Commission 30.00 1.36 0.00 1.36 4.00 0.00 4.00
on Population
12 NGOs (PPP) 100.00 18.01 0.00 18.01 20.50 0.00 20.50
13 FW Linked Health Insurance Plan 40.00 3.17 0.00 3.17 6.00 0.00 6.00
14 RCH Training 51.62 2.51 0.00 2.51 6.00 0.00 6.00
15 Management Information System (MIS) 750.00 42.60 0.00 42.60 137.00 0.00 137.00
16 Other Schemes 142.66 14.43 0.00 14.43 26.15 0.00 26.15

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Sl. Name of the schemes / 11th Annual Plan 2007-08 Outlays for 2008-09
No. Institutions Plan Expenditure
Approved Plan Non- Total Plan Non- Total
Outlay Plan Plan
1 2 3 4 5 6 7 8 9
(a) Research & Study 30.00 4.15 0.00 4.15 6.00 0.00 6.00
(b) Role of Men in Planned Parenthood 16.05 0.90 0.00 0.90 2.15 0.00 2.15
(c) Training in Recanalisation 4.20 0.02 0.00 0.02 0.23 0.00 0.23
(d) Assistance to I.M.A. 1.00 0.00 0.00 0.00 0.35 0.00 0.35
(e) Testing Facilities for 4.50 0.67 0.00 0.67 0.67 0.00 0.67
IUD and Fallopian
(f) Expenditure at HQs (RCH) 30.00 2.97 0.00 2.97 3.00 0.00 3.00
(g) Regional Offices 24.00 2.54 0.00 2.54 10.25 0.00 10.25
(h) Information Technology 20.00 1.00 0.00 1.00 1.10 0.00 1.10
(i) FW Programme in Other Ministries 7.00 0.58 0.00 0.58 1.00 0.00 1.00
(j) Gandhigram Institute 5.91 1.60 0.00 1.60 1.40 0.00 1.40
Total (NRHM) 90558.00 10380.25 34.57 10414.82 11930.00 44.25 11974.25
III Depart of Health Research 200.00 45.00 0.00 45.00
ICMR & IRR 200.00 45.00 0.00 45.00
GRAND TOTAL 90758.00 10380.25 34.57 10459.82 11930.00 44.25 11974.25

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ANNUAL REPORT 2008-09

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Chapter 4

Maternal Health Programme


4.1 Introduction 100,000 live births, which in itself is very high
compared to the international scenario like Sweden
Promotion of maternal and child health has been one (3), UK (8), Greece (3) and even in neighbouring
of the most important objectives of the Family Welfare countries like Sri Lanka (58), China (45) and Thailand
Programme in India. Under the NRHM (2005-2012) (110) (Source- ‘Maternal Mortality 2005- WHO,
and the RCH Programme Phase-II (2005-10) the UNICEF, UNFPA & World Bank’). Some of the States
Government of India is actively pursuing the goals with high Maternal Mortality are: UP (517), Rajasthan
of reduction in Maternal Mortality by focusing on the (445), MP (379), Bihar (371) Assam (490)
4 major strategies of essential obstetric and new
born care for all, skilled attendance at every Causes of Maternal Mortality: Maternal Mortality
birth, emergency obstetric care for those having is a cause of great concern. The major causes of
complications and referral services. The other these deaths have been identified as hemorrhage
major interventions are provision of Safe Abortion (both ante and post partum), toxemia (Hypertension
Services and services for RTIs and STIs. This during pregnancy), anemia, obstructed labor,
policy recommends a holistic strategy for bringing puerperal sepsis (infections after delivery) and unsafe
about total intersectoral coordination at the grass abortion.
root level and involving the NGOs, Civil Societies,
Panchayati Raj Institutions and Women’s Group in
bringing down Maternal Mortality Ratio and Infant
Mortality Rate. The National Population Policy 2000
and National Health Policy 2002 have set the goal of
reducing MMR to less than 100 per 100,000 live births
by the year 2010. Accordingly, schemes and
programmes have been developed and various
interventions focused on reducing maternal deaths.
Over 77,000 women in India continue to die of
pregnancy related causes every year. The Maternal
Mortality Ratio in India is 301 per 100,000 live births
(SRS, RGI: 2001-03 Maternal Mortality Report).
However, reliable estimates of maternal mortality are
not available.

4.2 Maternal Mortality Ratio (MMR) As can be seen Hemorrhage accounts for more than
one- third of all deaths followed by puerperal sepsis
MMR is defined as the number of maternal deaths
and abortion. Besides these, anemia which has been
per 100,000 live births due to causes related to
included in "other conditions" is a major contributory
pregnancy or within 42 days of termination of
factor. Most of these deaths are preventable with
pregnancy, regardless of the site or duration of
good ante natal care, timely identification and referral
pregnancy.
of pregnant women with complications of pregnancy
MMR India: The national average of MMR is 301 per and timely provision of emergency obstetric care.

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ANNUAL REPORT 2008-09
Maternal Health Indicators: The estimates of by trained personnel etc. are used for this purpose.
maternal mortality at State/UTs levels not being very These reflect the status of the ongoing programme
robust, MMR can only be used as a rough indicator interventions as well as give a reflection on the
of the maternal health situation in any given country. situation of Maternal Health. All India figure for these
Hence, other indicators of maternal health status like indicators as per the National Family Health Survey
antenatal check up, institutional delivery and delivery (NFHS III) conducted in the period 2003-2005 are:

NFHS III (2005-06)

Any Antenatal Checkup 76.9


Three or more Antenatal check-up 50.7
Total Institutional Delivery 40.8
Safe Delivery 48.8
IFA tablets Consumed for 90 days 23.1
PNC within 2 days 37.3

4.3 Schemes For Improving Obstetric all pregnant and lactating women are provided with
Care Services one tablet (containing 100 mg of elemental iron and
0.5 mg of Folic Acid) daily for 100 days. Those who
Several specific initiatives are under implementation have severe anemia are provided with double dose
to achieve the goal of reduction in Maternal Mortality. of these tablets.
These interventions are as follows:
Provision of 24 Hrs Delivery Services at PHC: Under
Essential Obstetric Care RCH - II, all the CHCs and 50% of the PHCs are being
operationalized for providing round the clock delivery
This includes quality antenatal care including
services by placing at least 3 -5 Staff Nurses and 1
prevention and treatment of anemia, institutional /
Medical Officer in these facilities.
safe delivery services and post natal care. To provide
essential obstetric care services GoI is Post natal care for mother and newborn: Ensuring
operationalizing the PHCs for 24 X 7 services and post natal care within first 24 hours of delivery and
also training the SNs/LHVs/ANMs in Skilled subsequent home visits on day 3 and 7 are the
Attendance at Birth. important components for identification and
management of emergencies occurring during post
Quality Ante Natal care:
natal period. The ANMs, LHVs and staff nurses are
Quality ANC includes minimum of at least 3 ANCs, 2 being made aware of and also oriented for tackling
doses of T.T Immunization and consumption of IFA emergencies identified during these visits.
tablets for 100 days.
Skilled Attendance at Birth:
Prophylaxis and treatment of Nutritional Anemia:
Government of India has a commitment to provide
As per results of NFHS III (2005-06), 56.1% of ever skilled attendance at every birth both at community
married women aged 15-49 years are Anemic. The and Institution level.
problem is more severe during pregnancy, with
New Initiatives in Skilled Attendance at Birth:
57.8% of pregnant women (15-49 years) being
anemic. A programme for prophylaxis and treatment  To manage and handle some common obstetric
of anemia has been under implementation through emergencies at the time of birth, the
out the country since 1997-98. Under this programme Government of India has taken a policy decision

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ANNUAL REPORT 2008-09
to permit Staff Nurses (SNs) and ANMs to give The training shall be undertaken for only that
certain injections and also perform certain number of MBBS doctors who are required for the
interventions under specific emergency operationalization of FRUs and CHCs and shall be
situations to save the life of the mother. limited to the requirement of tackling emergency
obstetric situations only. In no way, will it be a
 Training Strategy involves a 2-3 week training replacement of the specialist anesthetists who are
of SNs and 3-6 week training of ANMs/LHVs working after pursuing degree / diploma in the
in Skilled Attendance at Birth. For this subject. Guidelines for the training programme have
Curriculum and Technical Guidelines have been disseminated to the States for taking initiatives
been developed and have already been in identifying the medical colleges in the state where
disseminated to the States. this training programme can be conducted.
Provision of Emergency Obstetric and Neonatal Training in Obstetric Management Skills:
Care at FRUs:
Government of India has also introduced training of
Provision of Emergency Obstetric and Neonatal Care MBBS doctors in Obstetric Management Skills in
at FRUs has been done by operationalizing all FRUs collaboration with Federation of Obstetric and
in the country. While operationalization, the thrust Gynecological Society of India. A 16 weeks training
should be on the critical components such as programme in obstetric management skills including
manpower, blood storage units and referral linkages Caesarian Section operation is being implemented
etc. Availability of trained manpower (Skill Based at the level of Medical Colleges and District Hospitals
Training for MBBS doctors) should be linked with in the States.
operationalization of FRUs. The initiatives being
undertaken in this regard are: Referral Services at both Community and
Institutional level:
Training of MBBS Doctors in Life Saving
Anesthetics Skills for Emergency Obstetric Establishing referral linkages between the community
Care: and First Referral Units is an essential component
for utilization of services particularly during
Provision of adequate and timely Emergency Emergencies. Since emergencies during the process
Obstetric Care (EmOC) has been recognized globally of birth can not be predicted, it is essential to place
as the most important intervention for saving lives of effective referral linkages which can be accessed by
pregnant women who may develop complications all pregnant women in case of emergency.
during pregnancy or childbirth. The operationalization
of First Referral Units, at sub- district i.e. CHC level Other Major Interventions are:
for providing EmOC to pregnant women is a critical Safe Abortion Services/ Medical termination of
strategy of RCH-II, which needs focused attention. It Pregnancy (MTP):
has not been possible to operationalize these FRUs
till now due to various factors most pertinent being Abortion is a significant medical and social problem
shortage of specialist manpower, i.e. gynecologist in India. An ICMR study (1989) documented that the
and Anesthetist, particularly at district and sub district rates of safe (legal) and unsafe (Illegal) abortions
level. were 6.1 and 13.5 per 1000 pregnancies,
respectively. It is evident that perhaps two-thirds of
In view of this, for effective and better management all abortions take place outside the authorized health
of Emergency Obstetric needs at the grass root level, services by unauthorized, often unskilled providers.
GOI has taken a policy decision and is implementing
18 weeks programme for training of MBBS doctors The Medical Termination of Pregnancy Act was
in anesthetic skills for Emergency Obstetric care at passed by the Indian Parliament in 1971 and came
FRU. into force from April 1. 1972. The aim of this Act was
to reduce maternal mortality and morbidity due to

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ANNUAL REPORT 2008-09
unsafe abortions. The MTP Act, 1971 lays down the  Encourage private and NGO sectors to
conditions under which a pregnancy can be terminated establish quality MTP services.
and the place where such terminations can be
performed. A recent amendment to the Act (2003) Guidelines for Manual Vacuum Aspiration (MVA) upto
includes decentralization of power for approval of 8 weeks of pregnancy for Medical Officers for
places, as MTP centers, from the states to the district performing safe abortions at primary health care
level with the aim of enlarging the network of safe facilities have been disseminated to the states for
MTP service providers. The amendment also provides implementation.
for specific punitive measures for performing MTPs The ministry also proposes to develop
by unqualified persons and in places not approved comprehensive safe abortion guidelines including
by the government. medical abortion and providing services for medical
Whether spontaneous or induced, abortion has been abortion through the peripheral health care
a matter of concern over many decades now, infrastructure.
particularly because of sepsis and other complications Provision of RTI/STI services at all FRUs, CHCs
associated with it. Eight percent of maternal deaths and at 24 X 7 PHCs is also being made under
are attributed to complicated abortions. This is a RCH II
preventable tragedy. This is also an indication of the
unmet need for safe abortions. The National Population Reproductive Tract Infections/Sexually Transmitted
Policy 2000 underlines the provision of safe abortions Infections (RTIs/STIs) Reproductive tract and
as one of the important operational strategies. Provision sexually transmitted infections (RTI/ STIs) were not
of MTP services at 24 X 7 PHCs, CHCs and FRUs are recognized as a public health problem until recently.
being strengthened by training of medical manpower Research conducted in India to document the
in techniques of MTP by the States. magnitude of reproductive morbidity, has made the
incidence of these infections more visible and
 Strategies: brought them into the reproductive health agenda.
Several studies conducted in India during the past
 Community level:
decade suggest high prevalence of reproductive
 Spread awareness regarding safe MTP morbidity among women. As per DLHS-II (2003-
in the community and the availability of 2004), about one-third of women reported some
services thereof. symptoms of RTI/ STI, but only 32% sought treatment.
The spread of HIV infection and the role that RTI/STI
 Enhance access to confidential plays in the transmission of HIV have also brought
counseling for safe MTP; train ANMs, urgency to the problem. The identification and
AWWs and link workers/ASHAs to provide management of reproductive tract infections is an
such counseling. important objective of the RCH Programme.

 Promote post-abortion care through  Strategies under RCH II:


ANMs, link workers/ASHAs and AWWs
while maintaining confidentiality.  The prevention, early detection and
effective management of common lower
 Facility level: reproductive tract infections have been
included as a component of essential care
 Provide quality MVA (Manual Vacuum through the existing primary health care
Aspiration) facilities at all CHCs and at infrastructure.
least 50% of PHCs that are being
strengthened for 24-hour deliveries.  Convergence with the National AIDS
Control Programme (NACP) is envisaged
 Provide comprehensive and high quality in provision of these services, in terms of
MTP services at all FRUs.
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ANNUAL REPORT 2008-09
utilization of services for case provide ante natal/ post partum care for pregnant
management, laboratory services, women, promote institutional delivery and health
counseling services, drugs, equipments, education apart from other various services.
blood safety etc.
4.4 Janani Suraksha Yojana (JSY)
 Under RCH - II there is a commitment for
implementing the RTI/STI services at sub- The Jannani Suraksha Yojana (JSY) is a 100%
district level i.e. in at least 50% of the centrally sponsored scheme and it integrates cash
PHCs and all FRUs, including drugs, assistance with delivery and post delivery care. The
training, disposable equipment, and scheme was launched with focus on demand
provision for laboratory technicians. promotion for institutional deliveries in states and
regions where these are low. It targeted lowering of
 National Guidelines for Management of
MMR by ensuring that deliveries were conducted by
RTIs/ STIs have been developed in
Skilled Birth Attendants at every birth. The Yojana
coordination with National Institute for
has identified ASHA, the accredited social health
Research in Reproductive Health,
activist as an effective link between the Government
Mumbai (under ICMR) and have been
and the poor pregnant women in l0 low performing
disseminated to States.
states, namely the 8 EAG states and Assam and J&K
Setting up of Blood Storage Centers (BSC) at and the remaining NE States. In other eligible states
FRUs: and UTs, wherever, AWW and TBAs or ASHA like
activist has been engaged for this purpose, she can
Timely treatment of complications associated with
be associated with this Yojana for providing the
pregnancy is sometimes hampered due to non-
services.
availability of Blood Transfusion services at FRUs.
The Drugs and Cosmetics Act has been amended to The JSY scheme has shown phenomenal growth in
facilitate establishment of Blood Storage Centers at the last three years. Starting with a modest number
such FRUs. of 7.39 Lakhs beneficiaries in 2006-07, the total
Village Health and Nutrition Day number reached 73.29 Lakhs in the year 2007-08 -
a Ten Fold growth. The expenditure also rose from
Organizing of Village Health & Nutrition Day (VHNDs) Rs. 38 Crores in the year 2006-07 to 755 Crores in
at Anganwadi center at least once every month to the year 2007-08.

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ANNUAL REPORT 2008-09

The rapid increase in the institutional deliveries, Following activities have already been started under
coupled with improvement in infrastructure, this project.
manpower and training has resulted in improvement
in the figures of Institutional deliveries in all major Patient Safety Committees have been constituted in
states except Jharkhand in the DLHS III data as three centrally administrated tertiary care hospitals
compared with DLHS II. The growth in the institutional in Delhi namely Dr. Ram Manohar Lohia Hospital,
delivery figures is substantial in the five major states Safdarjung Hospital and Lady Harding Medical
of U.P. Rajasthan, M.P., Orissa and Bihar College & associated Hospitals. The committee is
headed by Medical Superintendent / Additional
4.5 Patient Safety Project Medical Superintendent. The members of committee
include Heads or their representatives of
After signing of India Pledge on patient Safety by Departments; Incharges of Infection Control, Blood
DGHS in July 2006, the Directorate General of Health Transfusion, Waste Disposal, Injection Safety, Death
Services, Ministry of Health and Family Welfare Govt. Review Committee, representative of Nursing Staff;
of India has taken up patient safety issues on priority Medical Social Worker; representative of a Non Govt.
basis in the form of a new initiative "patient safety Organization (engaged in patient safety activities);
project". The aims of this project are: One Journalist and One patient or his or her relative.
 A successful, healthy outcome of patient care These hospitals conduct meetings of their patient
 Safe, error-free care safety committees every month to review the patient
safety issues, adverse events reported, actions
 The most expert and advanced medical care taken and maintain records of all the meetings of
available for patients their patient safety committees. The functioning of
these patient safety committees is reviewed
 Comfort and peace of mind for patients and
periodically centrally in Directorate General of Health
providers.
Services. A module on patient safety is being

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ANNUAL REPORT 2008-09
developed to upscale the skills of hospital staff in punitive system. It is followed by Root Cause Analysis
the area of patient safety. to find out why adverse event occurred and taking
appropriate steps to avoid it in future.
Following Performas have been introduced in the
3 hospitals as mentioned above as part of patient Auto disabled syringes have been introduced for
safety project. giving injections in Centrally Administered Institutions
with effect from 1-4-09, to promote safe injection
i. Modified version of WHO Surgical Safety practices.Various other safety measures have been
check list for use in Operation Theatre, introduced like trainings in infection control and Bio-
to suit Indian requirements. medical waste management for different levels of
ii. Check list for safety of surgical patients Health workers, implementation of WHO guidelines
in the ward to be used by senior resident on Hand Hygiene in Health Care, both using soap
doctors of Surgery & Anesthesia and Staff and water and alcohol based formulation, devising
nurses. safety norms for patients in vital areas of hospital,
conducting regular death review meetings, training
iii. Patient safety evaluation Performa for of senior resident doctors in giving D.C. shock,
obtaining feedback from patient or his obtaining feedback from Grievance Cell,
attendant at the time of discharge. The data Implementation of Patient Safety Measures in Out
so obtained is analyzed for improvement of Patient Departments in the form of Single Window
services from patient safety point of view. Approach, May I help you counter and proper signage
system etc. Adequate emphasis is given to the
iv. Adverse Event Reporting Performa:
suggestions of patients and their attendants and
Error reporting is encouraged through non- action taken to put them into practice.

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ANNUAL REPORT 2008-09

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ANNUAL REPORT 2008-09

Chapter 5

Child Health Programme


5.1 Introduction technological advances in the world of medicine by
incorporating them in the programme as and when
In 1951, India was the first country in the world to the planners felt that these advances fulfilled the felt
launch a family planning programme. Since then needs of the community. Hence over the years
approaches aimed at reducing population growth methods like the lippes loop (incorporated into the
have taken a variety of forms. The passive, clinic- programme during the third Five Year Plan) and the
based approach of the 1950s gave way to a more National Health Policy 1983 envisioned
proactive, extension approach in the early 1960s. significant reduction in IMR, NMR & CMR by
The late 1960s saw the emergence of a "time-bound", 2000. All the child health programmes are
"target-oriented" approach with a massive effort to directed towards achieving these goals.
promote the use of IUDs and condoms. This was
followed by an even more forceful "camp approach" India is a signatory to the Millenium Development
to promote male sterilization in the 1970s. The Goals(MDGs).The fourth Millenium Development
excesses of these campaigns lead to a backlash from Goal is reduction of child mortality and the target for
which it took years for the programme to recover. this is to reduce by two thirds, between 1990-2015
The 1980s saw the rebuilding of the programme with the mortality rate of children under five. This is
an emphasis on female sterilization, and maternal reflected in the Tenth Five Year Plan (2002-07),
and child health. In the 1990s the International which states that Infant Mortality Rate is to be
Conference on Population and Development, Cairo reduced to 45/1000 by 2007 and 28/1000 live births
and the International Conference on Women by 2012.
prompted a paradigm shift, with the advocacy of a
client-centred, need based, quality-oriented
5.2 Infant Mortality Rate
reproductive health approach. . The National Status
Population Policy of 2000 and the National Health
Policy 2002 took cognisance of this and accordingly Infant mortality, currently at 58 per 1000 live
broadened the perspective of the National Family births(2005), has declined substantially(by 35%) over
Welfare programme and renamed it the the past 15 years. Manipur has the lowest IMR (13 /
Reproductive and Child Health programme and set 1000 live births) and Madhya Pradesh is the highest
2010 as the target date to achieve replacement-level at 76 per 1000 live births. Infant mortality rates have
fertility. declined in both urban(40/1000 live births) and rural
areas(64/1000 live births). Higher rates of ante-natal,
Method-specific targets were removed, and the delivery and post natal care are usually associated
programme focused on the unmet needs of clients. with lower infant mortality. Such an inverse
RCH II continues with this approach Technologically relationship is observed with higher education status
the programme has attempted to keep pace with the of mothers and a higher standard of living index.

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ANNUAL REPORT 2008-09
manpower resource intensive. As per the  As per the results of the National Family
results of NFHS III, although Kerala has an Health Survey III, anaemia levels are at an
institutional delivery rate of 97 per cent , only alarming level of 79 % among children and
85% of the mothers and newborns receive on comparison with the results of the second
postnatal and newborn care respectively. round, it is even more painful to note that all
India levels of anaemia have actually
 Andaman & Nicobar Islands have
increased from 74% to 79%. However, this
experienced an increase in infant mortality
has been countered by incorporating a policy
from 19 to 27 per thousand live births for
the years 2004 and 2005 respectively. This change whereby all children from six months
could be due to the long term deleterious of age up to adolescence are now part of the
effects of the Tsunami RCH II programme and to improve
compliance, iron preparations in the form of
 As per the National Family Health Survey syrup will be provided for children six months
results of the second and third rounds, there to five years of age.
are mixed results for immunization.
Immunization of children has a very little role  Also, it is with these factors in mind that
in reduction of infant mortality but has a holistic interventions like Integrated
significant role to play in reduction of child Management of Neonatal and Childhood
mortality. Sikkim (47 to 70), West Bengal(44 Illnesses(IMNCI) have been initiated and
to 64), Chattisgarh(22 to 49), Bihar( 12 to policy decisions like introduction of Zinc as
33) and Jharkhand (9 to 33) are the states an adjunct to ORS in the management of
which show marked improvements in diarrhea and Vitamin A reintroduced for all
immunization. It is unfortunate that well children from 9 months of age to five years
performing states like Tamil Nadu(89 to 81), of age (as is the norm all over the world)
Himachal Pradesh(83 to 74), Maharashtra(78 and not up to only three years as was being
to 59), Punjab(72 to 60), Mizoram(60 to done earlier. Mass awareness about the
46),Gujarat (59 to 45) and Andhra
female childs rights and the Pre-natal
Pradesh(53 to 45) are the states which show
Diagnostic Techniques (Regulation and
declines in immunization thus losing gained
Prevention of Misuse) Act, 1994, is being
ground. Laying stress on immunization is one
implemented to correct the male female
of the priorities of the second phase of RCH
ratio.
II.
5.3 Integrated Management of
Neonatal and Child Hood Illness
Integrated Management of Childhood and Neonatal
Illness (IMNCI) strategy encompasses a range of
interventions to prevent and manage five major
childhood illnesses i.e. Acute Respiratory Infections,
Diarrhoea, Measles, Malaria and Malnutrition and the
major causes of neonatal mortality - prematurity, and
sepsis. In addition, IMNCI teaches about nutrition
including breastfeeding promotion, complementary
feeding and micronutrients. It focuses on preventive,
promotive and curative aspects, i.e it gives a holistic
outlook to the programme.

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ANNUAL REPORT 2008-09

The major components of this strategy are: feedback, a facility based newborn care programme
is being set up.
 Strengthening the skills of the health care
workers Level II sick newborn units have been proposed by
the states in their RCH II PIPs and are being set up
 Strengthening the health care infrastructure throughout the country in a phased manner, initially
 Involvement of the community at district hospitals. Facilities have been established
at Purulia, Birbhum, Cooch behar, Uttar Dinajpur and
The first two components are the facility based IMNCI Bankura, Udaipur, Jaipyr, Bhilwada, Tonk, Guna,
and the third is the community based IMNCI. Vaishali, Lalitpur, Guwahati, Nadia, Burdwan, Malda,
North 24 Parganas (Barasat) and Darjeeling
5.3.1 Goals
(Siliguri).
Current NRHM MDG
5.6 Vitamin - A
status 2012 2015
Objective
IMR (Infant 58 30 27
Mortality Rate) (SRS 2005) With the objective of decreasing the prevalence of
Vitamin A deficiency to levels below 0.5%, the strategy
NMR 37 < 20* < 19*
being implemented is:
(Neonatal (SRS 2004)
Mortality Rate) Strategy

*Estimated Infancy

5.4 Home Based New Born Care  Health and nutrition education is being taken
up to encourage colostrums feeding,
The Government of India has recently approved the exclusive breastfeeding for the first six
implementation of Home Based Newborn months and the introduction of
Care(HBNC) based on the Gadchirolli model , where complementary feeding thereafter.
appreciable decline in Infant Mortality Rates has been
documented on the basis of work done by SEARCH,  1,00,000 IU dose of Vitamin A is being given
a NGO. ASHAs will be trained in identified aspects at nine months
of newborn care during the second year of their Childhood
training. The modules have been finalized and state
sensitization workshops have been held. In the five  Health education efforts to ensure adequate
high focus states to be covered under the Indo intake of Vitamin A rich food throughout
Norway Initiative , the HBNC shall be implemented childhood
by SEARCH with support from ICMR. Permission has  Early detection and prompt treatment of
been accorded in 2 districts in each of these five infections
states(- MP, UP, Orissa, Rajasthan and Bihar) for
ASHAs to use injectable antibiotics for neonatal sepsis  Vitamin A dose of 1,00,000 IU at 9 months
and childhood pneumonia. and 2,00,000 I.U thereafter at six monthly
intervals up to five years of age.
5.5 Facility Based New Born Care
Sick children
The facility based newborn care programme
 All children with xerophthalmia to be treated
implanted by the Government in 140 districts with
at health facilities
technical assistance from the National Neonatology
Forum(NNF) has been evaluated and based on this  All children suffering from measles to be

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ANNUAL REPORT 2008-09
given one dose of Vitamin A if they have not  Is the single most cost effective intervention
received it in the previous one month for reduction of infant mortality.

 All cases of severe malnutrition to be given  Delays return to fertility in the mother and
one additional dose of Vitamin A. hence acts as a natural contraceptive
(Lactational Amennarrhoea Method, LAM)
Achievements:
(i) Strategy A breastfeeding partnership of he
Latest available status of Vitamin A
government with all major professional bodies
Vitamin A coverage Achievement % achievement and various NGOs has been formed. The
Infant Milk Substitute (IMS) Act is being
1st dose 24,976,653 107.5
implemented
2nd- 5th dose 45,645,858 58.9
a. Baby Friendly Hospital Initiative
Source: Family Welfare Statistics in India 2006
b. Lactation Clinics
5.7 Anaemia Among Children
c. Peer Counselling
To manage the widespread prevalence of anaemia
in the country, the policy has recently been revised. 5.9.2 Iron and folic acid supplementation
Infant from the age of 6 months onwards up to the
age of five years shall receive iron supplements in (i) Objectives
liquid formulation in doses of 20mg elemental iron  Screening of children for anaemia wherever
and 100mcg folic acid per day for 100 days in a year. required and appropriate treatment of those
Children 6-10 years of age shall receive iron in the found anaemic
dosage of 30 mg elemental iron and 250mcg folic
acid for 100 days in a year and adolescents 11-18 (ii) Strategy
years shall receive supplements at the same dosage
 Iron supplementation for at least hundred
and duration as adults.
days in a year for all age groups, infants
5.8 Promotion of Infant and Young above six months of age up to adolescence
Child Nutrition (IYCN) and beyond, for all diagnosed as anaemic,
with iron
A Breastfeeding Partnership involving all the key
partners has been formed under the auspices of the  Children from six months of age to five years
Hon'ble MOS . Revival of the Breastfeeding Hospital to be supplemented with liquid iron.
initiative(BFHI) has been approved and
 Improve dietary intake to meet RDA for all
implementation shall be initiated.
macro and micronutrients;
5.9 Child Nutrition in the RCH  Dietary diversification-inclusion of iron folate
Programme rich foods as well as food items that promote
iron absorption;
5.9.1 Breastfeeding
 Food fortification, including introduction of
(i) Objectives
iron and iodine-fortified salt and other iron-
Breastfeeding: "Exclusive breastfeeding of the first fortified items(e.g. atta in specific areas);
six months of life" to be propagated as it would the
following benefits:  Health and nutrition education to improve
over all dietary intakes and promote
 It is the ideal method of infant feeding, consumption of iron and folate-rich foodstuffs

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(iii) Infants: (vi) Implementation

 Exclusive breast feeding for six months, and Through the health institutions under the government
introduction of green leafy vegetables along sector
with cereal/pulse/oilseed mix in the seventh
month for the prevention of anaemia; 5.10 Routine Immunization
Programme
 Screening for anaemia in pre-term , low birth
weight infants and those with growth faltering Immunization programme is one of the key
and repeated episodes of infection; and interventions for protection of children from life
threatening conditions, which are preventable.
 Appropriate treatment for anaemic infants. Immunization Programme in India was introduced in
1978 as Expanded Programme of Immunization. This
(iv) Preschool Children
gained momentum in 1985 as Universal Immunization
 advocacy with regard to dietary diversification Programme (UIP) and implemented in phased
for the prevention of anaemia; manner to cover all districts in the country by 1989-
90. UIP become a part of Child Survival and Safe
 all growth retarded children and those with Motherhood Programme in 1992. Since, 1997,
repeated infections have to have HB immunization activities have been an important
estimation carried out and component of National Reproductive and Child Health
Programme. Immunization is one of the key areas
 those found to be anaemic are provided with
under National Rural Health Mission (NRHM)
appropriate treatment. launched in 2005.
In hookworm endemic areas, it is necessary to Under the Immunization Programme Government of
improve: India is providing vaccination to prevent six vaccine
 sanitation and educate people not to walk preventable diseases i.e. Tuberculosis, Diphtheria,
barefoot; Pertussis, Tetanus, Polio, and Measles. The
vaccination schedule is as under:
 treat children with a history of passing worms
with broad spectrum antihelminthics;  BCG (Bacillus Calmetter-Guèrin)- Birth

 screen all anaemic children for hookworm  DPT ( Diphtheria, Pertussis and Tetanus
infestation and treat them Toxoid )- 6,10,14 weeks and at 16-24 months
of age
The co-operation of the PRIs and womens' self help
 OPV (Polio)- 6,10,14 weeks & 16-24 months
groups, where ever existent, may be sought to
of age and birth dose for institutional delivery
promote and monitor intake of IFA tablets in their
community.  Measles - 9-12 months of age
(v) Coverage  DT (Diphtheria and Tetanus Toxoid) - 5 years
of age
 As per a survey carried out in 2002 by the
National Nutrition Monitoring Bureau, under  TT (Tetanus Toxoid ) - 10 years and 16 years
the ICMR, 67% of the preschool children were of age
anaemic.
 TT - for pregnant woman two doses or one
 2,84,729 kits are distributed throughout the dose if previously vaccinated within 3 years
country each year under the RCH
programme, each kit containing 13,000 The Immunization coverage of vaccines under
tablets of paediatric IFA tablets. Routine Immunization as per NFHS-II and NFHS-III

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data is enclosed. To improve the coverage in low  Provision for deploying additional manpower
performing NE States, Speical Immunization weeks to carryout Immunization activities in urban
are being observed in the NE States along with EAG slums and underserved areas where services
States from the year 2005-06 every year. are deficient.

To further strengthen the Routine Immunization, with  Mobility support to State Immunization Officer,
the aim to improve the coverage, Government of India District Immunization Officer and other Officer
has taken the following initiatives as part of NRHM: as per State Plan for monitoring and
supportive supervision.
 Introduction of AD syringes for all
immunization replacing the existing glass  Review meeting at the State level with the
syringe and needles. districts on 6 monthly intervals.

 Downsizing the BCG vial from 20 dose to 10  Training of ANM, Cold Chain Handlers, Mid
dose. Level Managers, Refrigerator Mechanics etc.

 Plans for alternate vaccine delivery from PHC  Support for mobilization of children to
to Sub centre and outreach sessions. immunization session sites by Accredited
Social Health Activist (ASHA), Women Self
 Outsourcing immunization activities in urban Help Groups etc.
slums and under served areas.
 One Computer Assistant to State Head
 Strengthening supervision and monitoring. Quarter and each District.

 Mobility support to District Immunization officer  Printing of Immunization Cards and other
for supportive supervision and monitoring. tools like tickler bag, tally sheet, monitoring
chart, Cold Chain temperature monitoring
 Review meeting at the State level with the chart, vaccine inventory charts etc.
districts on 6 monthly basis.
 Implementation of Routine Immunization
 Mobilization of children to immunization Monitoring System (RIMS) software.
session sites by Accredited Social Health
Activist. (ASHA), Link workers, Women Self  Support for other specific issues.
Help Groups etc.
 In addition the central support of the following
All the States/UTs are asked to prepare their own will continue under Immunization as supplies
State Programme Implementation Plan (PIP) for to States -
Immunization as part 'C' of NRHM PIP from the year  Strengthening of cold chain system in the
2005-06 to address their specific needs. State
5.10.1 Status of Routine Immunization  Cold Chain Maintenance
To strengthen Routine Immunization Government of  Supply of vaccines
India under NRHM has launched newer initiatives as
part of the State Programme Implementation Plan  Supply of vaccine van at the rate of one per
(PIP), some initiatives are: district

 To ensure injection safety, Auto Disable (AD) 5.11 Introduction of Hepatitis - B


Syringe introduced throughout country. Vaccine
 Support for alternate vaccine delivery from A pilot project for the introduction of Hepatitis-B
PHC to Sub-Centres and Outreach Sessions. vaccine in the National Immunization Programme was

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ANNUAL REPORT 2008-09

approved by the Government and launched by pilot undertaking in Delhi in 1994, Nation-wide PPI
Hon'ble Prime Minister on 10th June 2002. Under rounds was undertaking in 1995 covering children
the pilot project 33 districts and 15 metropolitan cities in the age group of 0-3 years from 1996-97 the age
implemented Hepatitis B vaccination. The current cohort for vaccination was started to cover 0-5 years
schedule includes birth dose along with earlier 3 children. Till 1998-99 two rounds used to be
doses. organized in the month of December and January
each year. From 1999-2000 house to house
Vaccine and syringes are being made available by
vaccination of missed children was also introduced
Global Alliance for Vaccine and Immunization (GAVI)
to vaccinate children missed during the fixed booth
for the expansion programme. Expenditure for IEC,
based vaccination of children. This resulted in
training and monitoring budget is being incurred
increasing coverage of 2-3 crore additional children.
through the domestic funds.
5.12.2 The annual strategy for polio eradication is
5.11.1 The progress of Hepatitis-B project
decided on the basis of the recommendations of the
After the success of pilot project, the Hepatitis B India Expert and International Experts from World
programme has been expanded to 10 states viz. Health Organization (WHO), United Nation's Children
Andhra Pradesh, Himachal Pradesh, Jammu & Fund (UNICEF), and Centre for Disease Control
Kashmir, Karnataka, Kerala, Madhya Pradesh, (CDC) Atlanta. The IEAG reviews the Polio
Maharashtra, Punjab, Tamil Nadu and West Bengal epidemiological situation two times a day and
in phased manner. As on 2008, the overall coverage recommend the suitable strategies for the country.
of infants in 11 districts and 6 cities, which have been The National Polio Surveillance Project( NPSP) of
continuing Hep-B vaccination since the pilot project, WHO provides technical support for high quality
is 56.7%. The overall coverage of infants in the 10 Acute Flaccid Paralysis(AFP) surveillance and assists
states is 39.0 %. the government in micro planning, training and
monitoring of polio immunization campaign.
5.11.2 Introduction of Japanese Encephalitis
(JE) Vaccine 5.12.3 Since the initiative to eradicate polio from
India started in 1995, significant success has been
JE Vaccination was started 2006 in 11 districts and 4 achieved in reducing number of polio cases in the
states using SA-14-14-2, with 88% of the targeted country and total cases decline gradually to only 66
10.5 million children in the 12 month to 15 years age cases in 2005. Out of 35 States & UTs, 33 States &
immunized. In 2007, 27 districts in 10 states were UTs were free from indigenous transmission of polio
covered with 75% of the targeted 22.0 million children virus since last three years. It is taking more times in
in the 12 month to 15 years age immunized. In 2008, UP and Bihar to achieve zero transmission due to
24 more endemic districts have been added. factors like high population density and poor
sanitation.
The JE vaccine is being integrated into routine
immunization in the districts where campaign had 5.12.4 In order to achieve the goal of zero
already been conducted to immunize the transmission at the earliest, the strategy in UP and
unimmunized cohort of children by vaccinating with Bihar has been modified to have increased number
single dose at 16-18 months of polio immunization campaign with Monovalent
vaccine type I (mOPV 1) as per the recommendation
5.12 Pulse Polio Immunization
of India Expert Advisory Group on polio to target the
In pursuance to the World Health Assembly Polio virus type 1 and polio virus type 3 sequentially.
resolution No. 1988/41.28 pulse Polio Immunization
5.12.5. As a result of this strategy, there has been a
(PPI) Programme was started in India from 1995 to
significant decline in the number of cases caused by
eradicate Polio from India. Following the successful

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ANNUAL REPORT 2008-09
the most virulent strain of polio virus type 1 (P1).  One SNID would be held in November 2008
Only 62 type 1 polio cases (till 31st October 2008)
 During each NID 172 million children less
have been reported this year as against 83 Type 1
than 5 years are given polio drops and during
last year and 648 cases during 2006. The reported
each SNID around 70 million children are
cases of P1 in endemic region of Western Uttar
vaccinated. The SNIDs are usually cover the
Pradesh are an importation from Bihar.
endemic states of UP and Bihar and other
5.12.6. P1 circulation in Bihar is restricted to a small areas at risk of poliovirus such as Delhi and
proportion of Blocks that have operational difficulties surrounding areas and Mumbai and
that got worse during the recent floods. Only 2 cases neighboring areas
of P1 type has been reported till 31st October 2008.
 In each NID nearly 2.3 million vaccinators
Efforts are being made to overcome these
under the direction of 1,55,000 Supervisors
operational barriers and it is feasible to stop type 1
visit 209 million houses. To reach people on
circulation in Bihar during the low season of 2008.
the move, mobile and transit vaccination
5.12.7. Out of 437 Poliovirus Type 3 reported so far, teams immunize the children at Railway
Bihar has reported 224 and UP 203 and rest cases stations, inside running trains, at bus stands,
have been reported from Delhi, Maharashtra, market areas brick kilns, construction sites
Haryana, Orissa, Andhra Pradesh, Madhya Pradesh, etc.
Rajasthan & West Bengal. This is consistent with the
 In addition to planned NIDs/SNIDs, mop-up
immunization strategy recommended by the IEAG
rounds have been conducted in response
focusing on curtailing transmission of Polio type 1
to polio cases dected in the country
virus and keeping Type 3 virus in check because P1
circulates more widely has been responsible for 5.12.9. In order to achieve the goal at the earliest
International spread and has the propensity to cause the implementation strategy has been further
large outbreaks. strengthened like:

 Vaccinating children at fixed booth and house


to house visit , efforts in vaccinating children
in transit at railway stations, insides long
distance trains, major bus stops, market
places , religious congregations, major road
crossing etc. through out the country have
been intensified. Through these efforts 5
million children in transit have been
effectively administered polio drops during
each immunization rounds.

 Migratory population (children) from UP and


Bihar in Haryana, Punjab, Gujarat and West
Bengal are being immunized during the
SNIDS in UP and Bihar.
5.12.8. Activities Undertaken
 ASHA have been involved as team member
 So far in 2008, two country wide National for mobilization and vaccination of children'
Immunization Days (NIDS)in January and
 The missed children during SNIDs are being
February and five Sub National Immunization
mobilized by ASHA//AWW and vaccinated
Days( SNIDs) in March, April, June, July and
during the monthly Health days.
September have been conducted.

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ANNUAL REPORT 2008-09

 Strategy to involve the leaders and opinion of India during 1997-98 launched the RCH
makers of the underserved committee is being Programme for implementation during the 9th plan
adopted in Western U.P. districts to involved period by integrating Child Survival and Safe
the community better in the programme Motherhood (CSSM) Programme with other
reproductive and child health (RCH) services. In
5.13 Cold Chain System Vaccine addition, a new component for management of
Storage At PHC/CHC Level Reproductive Tract Infection (RTI) and Sexually
Transmitted Infection (STI) has also been
The National Cold Chain Assessment has been
incorporated. The RCH Programme is partly funded
conducted in the country with support of UNICEF and
by World Bank, UNICEF, UNFPA and European
WHO to assess the gaps and take necessary actions
Commission etc. Reproductive and Child Health
to strengthen the cold chain. The cold chain system
Program is in 5th year of its operation and is currently
consists of a series of transportation & storage
operational in entire country. The program follows a
facilities for vaccines from the manufacturers to the
differential strategy with inputs under the program
beneficiaries at a recommended temperature. More
linked to the needs of the area coupled with the
than 72000 units consisting of the following
capacity for implementation. The program was
equipments have been supplied to the States for
reviewed extensively not only in context of
storing the vaccines:
achievements during mid-term stage, but also in
1. Walk-in-Coolers and Walk-in-Freezers context of National Population Policy.
Rooms: These are supplied at State/
Efforts were made to strengthen the routine
Regional Level to maintain a vaccine stock
immunization as well as PPI by launching a project
required for 3 months in its catchment area.
for Immunization Strengthening with the World Bank
There are at present 161 walk in coolers and
assistance. The ongoing activities were accelerated
36 walk in freezers installed at various
and new schemes on Financial Envelop, Dais'
locations of the States in the country.
Training, RCH Camps and RCH out reach services
2. Ice Lined Refrigerators (Large) and Deep were started to address felt gaps. The implementation
Freezers (Large) at the District Level: of EC assisted Sector Investment Programme has
6300 numbers ILRs (L) and Deep Freezers geared up, especially State/District level activities and
(L) have been supplied. At the district stores urban RCH component.
Deep Freezers can be used for storing Polio
Under the Reproductive and Child Health Programme
vaccine at below (-)15 Centigrade.
(RCH) being implemented in all States of the country
3. A Twin set of ILR/Deep Freezer: These various interventions for reduction of infant mortality
have been supplied in pairs to all PHCs, rate are being implemented. These include
where a stock of one month's requirement of immunization against fixed vaccine communicable
vaccines is maintained. 65700 such units diseases, control of death during diarrhea, control
have been supplied to different health of deaths due to acute respiratory infections;
institutions. prophylaxis against vitamin A deficiency and iron
deficiency anemia. Essential new born care and
5.14 Reproductive & Child Health- II promotion of exclusive breastfeeding and
(RCH II) appropriate complementary feeding practices.
In order to effectively improve the health status of Unequal access of pregnant women in rural areas
women and children and fulfill the unmet need for and those in the lower socio economic bracket is
Family Welfare services in the country, especially recognized as an important issue. Provision has been
the poor and under served by reducing infant child kept under the National Rural Health Mission to
and maternal mortality and morbidity, Government strengthen the services at village and sub-center level

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ANNUAL REPORT 2008-09
and also for provision of transport facilities to representatives from Ministry of Health and Family
pregnant women needing emergency treatment. Welfare Government of India. The Adaptation Group
developed Indian version of IMCI guidelines and
Integrated Management of Neonatal and Childhood
renamed it as Integrated Management of Neonatal
Illnesses(IMNCI) package will be implemented in a
and Childhood Illness (IMNCI).
phased manner throughout the country in the second
phase of the RCH programme. It offers a The major components of this strategy are:
comprehensive package for the management of the
 Strengthening the skills of the health care
most common causes of childhood illnesses i.e
workers
sepsis, measles, malaria, diarrhoea, pneumonia and
malnutrition. It is supported by appropriate  Strengthening the health care infrastructure
strengthening of the health care system and
promotion of positive health care practices of the  Involvement of the community
community.
The major highlights of Indian adaptation are:
Integrated Management of Childhood Illness (IMCI)
 Incorporation of neonatal care as it now
strategy, which has already been implemented in constitutes two thirds of infant mortality
more than 100 countries all over the globe,
encompasses a range of interventions to prevent  Inclusion of 0-7 days
and manage five major childhood illnesses i.e. Acute
 Incorporating National guidelines on Malaria,
Respiratory Infections, Diarrhoea, Measles, Malaria
Anemia, Vitamin A supplementation and
and Malnutrition. It focuses on preventive, promotive
Immunization schedule
and curative aspects, i.e it gives a holistic outlook to
the programme.  Training schedule reduced from 11 to 8 days
Govt. of India recognized the need to strengthen child  Training begins with sick young infant upto 2
health activities in the country. In order to strengthen months
Child Health activities and introduce IMCI in the
country, a Core Group was constituted which included  Proportion of training time devoted to sick
representatives from Indian Academy of Pediatrics young infant and sick child is almost equal
(IAP), National Neonatology Forum of India (NNF), The Government has initiated implementation
National Anti Malaria Program (NAMP), Department of the IMNCI strategy in four districts each in nine
of Women and Child Development (DWCD), Child- selected states of Orissa, Rajasthan, Madhya
in-Need Institute (CINI), WHO, UNICEF, eminent Pradesh, Haryana, Delhi, Gujarat, Uttaranchal, Tamil
Pediatricians and Neonatologists, and the Nadu and Rajasthan.

TAMIL NADU MATERNAL AND NEONATAL HEALTH PROJECT


Tamil Nadu, a South Indian state, has a MMR of 115/ 100,000 live births compared to the
national figures. The IMR in this state is just 37/1000 live births vis-à-vis a nationally reported
figure of 58/1000. The main interventions responsible for this rapid progress were the growth
of safe deliveries and provision of Emergency obstetric care.

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Comprehensive Emergency Obstetric & Newborn Care (CemONC) was made available at a
minimum of 2-3 centers in each district with particular emphasis on accessibility.

The centers were selected so that the EOC & NB services were available within 1 hour travel
time. 24-hour caesarean section facilities were made available at the CemONC centers with even
general surgeons doing caesarean sections. Separate Obstetric and neonatal casualties were created
apart from general casualty, with one doctor posted at each casualty. Quality assurance was ensured
by providing Accreditation to CemONC centres. Social audit of all maternal deaths was performed by
the district collector. Accreditation was also introduced for private hospitals for tubectomy operations.

5.15 Major Milestones in Child Health childhood tuberculosis, poliomyelitis, measles and
neonatal tetanus was introduced in the country in a
Till 1977 the major health activity was family planning phased manner in 1985, which covered the whole of
which was changed into Family welfare programme India by 1990. Significant progress was made under
with Maternal and Child Health becoming integral part the Programme in the initial period when more than
of family planning programme with the vision that 90% coverage for all the six antigens was achieved.
reduction in birth rate has a direct relationship with
reduction in infant and child mortality. The UIP was taken up in 1986 as National Technology
Mission and became operational in all districts in the
The diarrhoeal disease control programme was country during 1989-90. UIP become a part of the
started in the country in 1978. The main objective of Child Survival and Safe Motherhood (CSSM)
the programme was to prevent death due to Programme in 1992 and Reproductive and Child
dehydration caused by diarrheal diseases among Health (RCH) Programme in 1997. Under the
children under 5 years of age due to dehydration. Immunization Programme, infants are immunized
Health education aimed at rapid recognition and against tuberculosis, diphtheria, pertussis,
appropriate management of diarrhea has been a poliomyelitis, measles and tetanus. Universal
major component of the CSSM. Under the RCH immunisation against 6 vaccine preventable
programme ORS is supplied in the kits to all sub- diseases (VPD) by 2000 was one of the goals set in
centres in the country every year. the National Health Policy (1983).

Universal Immunization Programme against six The ARI Control Programme was started in India in
preventable diseases, namely, diphtheria, pertusis, 1990.It sought to introduce scientific protocols for

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ANNUAL REPORT 2008-09
case management of pneumonia with co-trimoxazole. maternal morbidity and mortality. The programmes
Initially 14 pilot districts were selected and later on seek to sustain high coverage levels achieved under
new districts were included. A review of the health the Universal Immunisation Programme (UIP) in good
facility done in 1992 revealed that although 87% of performance areas and strengthen the immunisation
personnel were trained and the drug supply was services of poor performing areas. The programme
regular yet there were problems in correct case also provides for augmenting various activities under
classification and treatment. Since 1992 the the Oral Rehydration Therapy (ORT) Programme,
Programme was implemented as part of CSSM and universalising prophylaxis schemes for control of
later with RCH. Cotrimoxazole tablets are supplied anemia in pregnant women & control of blindness in
as part of drug kit for use by different category of children and initiating a programme for control of
workers for managing cases of Pneumonia. Under acute respiratory infection (ARI) in children. Under
RCH-II activities are proposed to be implemented in the safe motherhood component, training of
an integrated way with other child health traditional birth attendants (TBA), provision of
interventions. asceptic delivery kits and strengthening of first
The Child Survival and Safe Motherhood Programme referral units to deal with high risk and obstetric
jointly funded by World Bank and UNICEF were emergencies were taken up. The approved outlay
started in 1992-93 for implementation up to 1997- for the CSSM Programme was Rs. 1125.58 crores
98. The Child Survival and Safe Motherhood for the entire IDA credit facility of SDR period. The
Programme were implemented in a phased manner Programme yielded notable success in improving the
covering all the districts of the country by the year health status of pregnant women, infants and children
1996-97. The objectives of the programmes were to & also making a dent in IMR, MMR and incidence of
improve the health status of infants, child and vaccine preventable diseases.

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Chapter 6

National Programmes under NRHM

6.1 Introduction Indoor Residual Spraying in selected high risk


areas, use of Insecticide treated bed nets,
Several National Health Programmes such as the use of Larvivorous fish, anti larval measures
National Vector Borne Diseases Control, Leprosy in urban areas including bio-larvicides, minor
Eradication, TB Control, Blindness Control and Iodine environmental engineering.
Deficiency Disorder Control have now come under
the umbrella of National Rural Health Mission. (iii) Supportive Interventions including
Behaviour Change, Communication, Public
6.2 National Vector Borne Disease Private Partnership & Inter-sectoral
Control Programme (NVBDCP) convergence, Human Resource Development
through capacity building, Operational
The National Vector Borne Disease Control
research including studies on drug resistance
Programme is a comprehensive programme for
and insecticide susceptibility, Monitoring and
prevention and control of vector borne diseases
evaluation through periodic reviews/field
namely Malaria, Filaria, Kala-azar, Japanese
visits and Management Information System.
Encephalitis (JE), Dengue and Chikungunya which
is covered under the overall umbrella of NRHM. The 6.3 Malaria
States are the implementing agency for prevention
& control whereas the Directorate of NVBDCP, Delhi Malaria is acute parasitic illness caused by
provides technical assistance, policies and assistance Plasmodium falciparum or Plasmodium vivax in India.
to the States in the form of cash & commodity, as per Nine major species of anopheline mosquitoes
approved pattern. Malaria, Filaria, Japanese transmit malaria in India. The main clinical
Encephalitis, Dengue and Chikungunya are presentation is fever with chills, however nausea and
transmitted by mosquitoes whereas Kala-azar is headache can also occur. The diagnosis is confirmed
transmitted by Sandflies. The transmission of vector by microscopic examination of a blood smear and
borne diseases in any area is dependent on RD Kits for Pf cases. Majority of the patients recover
frequency of man-vector contact, which is further from the acute episode within 7 to10 days. Malaria
influenced by various factors including vector density, continues to pose a serious public health threat in
biting time, etc. different parts of the country, particularly due to
Plasmodium falciparum, as it is sometimes prone to
The general strategy for prevention and control of
complications, if not treated early.
vector borne diseases under NVBDCP is described
below: The major vector mosquito for rural malaria viz.
Anopheles culcifacies, is distributed all over the
(i) Disease Management including early case
Country and breeds in clean ground water
detection and complete treatment,
strengthening of referral services, epidemic collections. Other important Anopheline species
preparedness and rapid response. breed in running channels, streams with clean water.
Some of the vector species also breed in forest
(ii) Integrated Vector Management (for areas, mangroves, lagoons, etc, even in those with
Transmission Risk Reduction) including organic pollutants.

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In urban areas, malaria is mainly transmitted by


Anopheles stephensi which breed in man-made water
containers in domestic and peri-domestic situations
such as tanks, wells, cisterns, which are more or less
of permanent nature and hence can maintain density
for malaria transmission throughout the year.
Increasing human activities, such as urbanization,
industrialization and construction projects with
consequent migration, defiant water and solid waste
management, use of automobiles and consumer
goods and their indiscriminate disposal (tyres,
containers, junk materials, cups, etc.) create * Data for 2009 upto Januauy
mosquitogenic conditions and thus contribute to the
Assistance to States: Government of India provides
spread of vector borne diseases.
100% central assistance for programme
The national Health Policy (2002) has set the goal implementation to the northeastern states Including
of reduction in mortality on account of malaria by Sikkim. The northeastern region is prone to malaria
50% by 2010. Reduction of malaria morbidity and transmission mainly due to topography and climatic
mortality is also important to meet the overall conditions that largely facilitate perennial malaria
objectives of reducing poverty and is included in the transmission, prevalence of highly efficient malaria
millennium Development Goals (Goal 6 and target vectors, pre-dominance of Pf as well as prevalence
8).Epidemiological Situation: Pre-independence of chloroquine resistant pf malaria. The Govt. of
estimates of Malaria were about 75 million cases and India is also supplying commodities like drugs,
0.8 million deaths annually. The problem was virtually insecticides/ larvicide's as per approved norm to all
states/ Uts according to the technical requirements
eliminated in the mid sixties but resurgence led to an
of the states/UTs
annual incidence of 6.47 million cases in 1976.
Modified plan of operation was launched in 1977 and In 100 districts in 8 states namely Andhra Pradesh,
annual malaria incidence started declining. The Maharastra, Orissa and Rajasthan, 1045 PHCs
cases were contained between 2 to 3 million cases predominally inhabited by tribal were also provided
annually till 2001 afterwards the cases have started 100 percent support including operational expanses
declining. During 2008, the malaria incidence was under the Enhanced Malaria Control Project (EMCP)
around 1.52 million cases, 0.76 million Pf cases and with World bank assistance from 1997 to 2005.World
935 deaths. About 80% of malaria cases and deaths Bank new Project on "Malaria Control and Kala-azar
are reported from Northeastern (NE) States, Elimination " for a period of 5 years w.e.f. 2008-09
Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, (commencing from 1st September, 2008 ) has been
Andhra Pradesh, Maharashtra, Gujarat and approved by World Bank.
Rajasthan, West Bengal and Karnataka. However,
The additional support under project supported by
other States are also vulnerable and have local and
Global Fund for AIDs, Tuberculosis and Malaria
focal outbreaks. Resistance in Plasmodium (GFATM) is provided for implementation of intensified
falciparum to Chloroquine is being detected from more Malaria Control Project (IMCP) in NE states (except
areas and Artesunate Combination Therapy has Sikkim), selected high risk areas of Orrisa, Jharkhand
been introduced in such areas as first line treatment. and West Bengal with the objectives to increase access
For strengthening surveillance, Rapid Diagnostic Test to rapid diagnosis and treatment in remote and
(RDT) for diagnosis of malaria due to P.falciparum inaccessible areas through community participation,
has also been introduced in high endemic areas. malaria transmission risk reduction by use of
The state-wise data is at Table 1. insecticide treated bed nets (ITNs) and enhance

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ANNUAL REPORT 2008-09
awareness about malaria control and promote Indoor Residual Spraying (IRS): under integrated
community, NGO and private sector participation. vector control initiative, IRS is implemented selectively
only in high risk pockets as per district-wise Macro
For strengthening early case detection and prompt
Action Plans. The Directorate has issued Guidelines
treatment more than 301499 ASHAs have been
on IRS to the State for technical guidance. Guidelines
involved in high malaria endemic areas along with
on uniform evaluation of insecticides have also been
Fever Treatment Depots (FTDs) and Malaria clinics.
developed in collaboration with National Institute of
Out of these, 164480 ASHAs have been especially
Malaria Research (NIMR), Delhi. Over the years,
trained for use of RDT. This is in addition to the
there is a reduction in integrated population in view
treatment facilities available at the health facilities
of paradigm shift alternative to vector control
and hospitals. Anti malaria drugs and funds for
measures. During 2008, about 61 million population
training are provided to them by Government of India.
was projected for spray and 87.62% of targeted
Under the programme, nearly 100 million fever cases
population was protected with IRS.
are examined annually.
Urban Malaria Scheme:
As per the National Drug Policy, Cholorquine is used
for treatment of all P.vivax cases and Pf cases in Urban Malaria scheme is being implemented in 131
areas at low risk of Pf and considered sensitive to towns of the country and as per reports from these
Cholorquine. Artesunate Combination Therapy(ACT) towns about 7.8% of the total cases of malaria are
with Sulfadoxine Pyrimethamine is being used for the reported from these urban areas since 2004.
treatment all Pf cases in 117 districts i.e. 67 districts Maximum numbers of malaria cases are reported
of NE states and 50 high Pf districts from state of from Vijayawada, Vishakapatnam, Amhedabad,
Andhra Pradesh, Chattisgarh, Jharkhand, Madhya Gandhi Nagar, Vadodara, Bellary, Greater Mumbai
Pradesh and Orissa. In addition 256 PHCs from Ratlam, Rourkela Sambalpur, Kolkata. The
states other than above have also been using ACT epidemiological profile of malaria in urban towns of
combination on the basis of chloroquine resistance the country is as follows:
status in surrounding cluster of Blocks.

Year Population BSE/ Total P.f P.F % SPR SFR Deaths


BSE cases

2004 96391252 6083111 151390 19697 13.62 2.49 0.32 62


2005 102098354 5585427 89543 11648 13.01 1.60 0.21 71
2006 105359301 6101219 85270 13893 16.29 1.40 0.23 100
2007 112046000 5659362 108573 18232 16.87 1.92 0.32 103
2008 112647089 4377791 72639 9750 13.42 1.66 0.22 1
2009 113326094 1158481 5681 944 16.62 0.42 0.08 0

The Urban Malaria Scheme (UMS) under NVBDCP states for promulgation and implementation to reduce
is presently protecting 113.3 million population from mosquito breeding in domestic and peri-domestic
malaria as well as from other mosquito borne diseases situations. The Bye-laws have been enacted and
in 131 towns in 19 states and Union Territories. Model implemented in Delhi, Mumbai, Chandigarh,
Civic Bye-laws in urban areas have been prepared Ahmedabad, Bhavnagar, Surat, Rajkot, Bhopal,
by the Directorate of NVBDCP and circulated to all Tripura and Goa.

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ANNUAL REPORT 2008-09

Directorate of National Vector Borne Disease Control


Programme regularly cross chicks anti-larval
operations in Municipal Corporation of Delhi (MCD),
New Delhi Municipal Council (NDMC) Railways,
Cantonment areas as well as Zoological Park and
Presidents Estate in NCT Delhi and near by
townships /localities of National Capital Region
namely Ghaziabad and Noida in Uttar Pradesh,
Faridabad, Gurgaon and Sonepat in Haryana and
provides feedback about the larval density and
remedial measures to be undertaken by them. The
*upto March'09
monthly entomological indices of Municipal
Corporation of Delhi (MCD) and New Delhi Municipal
Central Cross Checking Organization (CCCO): Council (NDMC) for Aedes aegypti survey are as
The Central Cross Checking Organization of the below:

HI,CI & BI in NCT Delhi- 2008 HI,CI & BI in NCT Delhi- 2009

Month HI CI BI HI CI BI
January 0.00 0.00 0.00 0.00 0.00 0.00
February 0.04 0.03 0.04 0.02 0.03 0.03
March 0.11 0.13 0.14 0.09 0.07 0.09
April 0.54 0.48 0.56
May 1.20 1.10 1.30
June 4.80 5.00 5.80
July 4.40 5.20 7.70
August 4.50 5.20 7.80
September 4.10 4.40 5.80
October 2.30 2.30 2.10
November 0.40 0.40 0.50
December 0.10 0.10 0.10

HI= HOUSE INDEX, CI= CONTAINER INDEX, BI= BRETEAU INDEX

6.4 Elimination of Lymphatic Filariasis drainage, sanitation. The disease is endemic in about
250 districts in 20 states and UTs.
Filariasis:
The population at risk is over 590 million is at risk of
Filariasis is transmitted by mosquito species i.e. Culex lymphatic filariasis. This disease causes personal
quinquefasciatus and Mansonia annulifera / trauma to the affected persons and is associated
M.uniformis. The vector mosquitoes breed in polluted with social stigma, even though it is not fatal.
water in drains, cesspits etc., in areas with inadequate

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A N N U A L RE P O R T 2008-09

The Line listing of lymphoedema and Hydrocele cases


were initiated since 2004 by door to door survey in
these filaria endemic districts. The enlisted cases
are regularly being updated by state health
authorities and more cases are being recorded. This
increase is mainly due to incomplete surveys during
initial years and reluctance on part of community to
reveal their manifestations of lymphoedema and
Hydrocele. The updated figure till 2007 revealed that
7.7 lakhs lymphoedema and 3.8 lakhs Hydrocele
cases have been enlisted. The initiation have also
been taken to demonstrate the simple washing of
foot to maintain hygiene for prevention of secondary
bacterial & fungal infection in chronic lymphoedema
cases so that the patients get relief from frequent
acute attacks. The states have also been requested
to update the list and intensify the hydrocele
operations in their respective states.

The microfilaria survey in all the implementation units


(districts) is being done through night blood survey Kala-azar Control Programme was launched in 1990-
before MDA. The survey is done in 4 sentinel and 4 91. The annual incidence of disease came down from
random sites as per the guidelines. The analysis of 77,099 cases in 1992 to 44533 cases in 2007 and
overall reports reveals that during 2007 (based deaths from 1419 to 203 in 2007 respectively. During
on the data of 2006), 180 districts have reported the year 2008, 33234 cases and 146 deaths were
microfilaria rate less than 1%. The data of pre MDA reported whereas in 2009 till March, 2254 cases and
survey during 2008 is being analyzed. There is definite 5 deaths have been reported - Table- 3.
evidence of microfilaria reduction in the MDA districts.
However, the repeated survey for 3-4 consecutive To realize the goal of elimination of Kala-azar, the
years will reflect the trend of mf reduction. Govt. of India is providing 100% support to endemic
states sincr 2003-04.
6.5 Kala-Azar
Initiatives undertaken for Kala-azar elimination:
Kala-azar is caused by a protozoan parasite
Leishmania donovani and spread by sandfly, which z Active Case Search: The frequency of case
breeds in shady, damp and warm places, in cracks searches has been increased, from a single
and crevices in the soft soil, in masonry and rubble annual case search to quarterly case
heaps, etc. Proper sanitation and hygiene are critical searches. The active case searches are
to prevent sand fly breeding. The National Health carried out during a fortnight designated as
Policy (2002) of Government of India has set the the 'Kala-azar Fortnight', during which the
goal for elimination of Kala-azar from the country by peripheral health workers and volunteers are
2010. In pursuance to achieve the elimination goal, engaged to make door-to-door searches and
case detection and treatment compliance has been refer cases conforming to case definition of
strengthened and Rapid Diagnostic Test kit and oral kala-azar and PKDL to the treatment centres
drug miltefosine have been introduced. World Bank for definitive diagnosis and treatment.
is providing assistance in 46 districts in 3 states
z Institutional Surveillance (passive case
namely Bihar, Jharkhand and West Bengal.
detection): Majority of the kala-azar cases are
Kala-azar, is endemic in 52 districts (31 in Bihar,4in reported from PHC's/district hospitals. Many
Jharkhand, 11 in West Bengal and 6 in UP). The private practitioner, NGO, FBO's have been

88
A N N U A L RE P O R T 2008-09
advised to report cases to the district health
authorities.
z Treatment: To ensure complete treatment
compliance, a Patient Coding Scheme has
been put in place in all the treatment cetnres.
z Vector Control: Two rounds of DDT spray are
undertaken in affected villages of the
endemic district, at a dosage of 1g/m2.
z A health education programme with personal
contacts as well as through mass media has
been initiated to create awareness of the
disease amongst the public, emphasizing the
need for early case detection, acceptance
of a full course of treatment and other control
measures.
maintained in the nature by animal reservoirs of JE
z Intensive training programme for all levels of
virus like pigs and water birds. Man is the dead end
health staff has been undertaken including
host, i.e. JE is not transmitted from one infected
one Inter-country training & one Inter-country
person to other. Outbreaks are common in those
training on standard operation.
areas where there is close interaction between
z Introduction of rapid diagnosis and oral drug animals/birds and human beings. The vectors of JE
miltefosine in 10 pilot district of 3 endemic breed in large water bodies such as paddy fields.The
states. population at risk is about 300 million.
z The kala-azar activist/ Accredited Social
Epidemiological Situation: JE has been reported from
Health Activist (ASHA) under the National
different parts of the country.The disease is endemic
Rural Health Mission (NRHM) will be provided
in 14 states of which Assam, Bihar, Haryana, and
incentives to involve them in the various
Uttar Pradesh have been reporting outbreaks. During
activities for control of kala-azar.
2006, 2871 cases and 663 deaths due to AES/JE
6.6 Japanese Encephalitis were reported. During the year 2007, the reported
AES figures indicated 4110 cases and 995 deaths.
Japanese Encephalitis is a zoonotic disease which In the year 2008, 3838 cases and 684 deaths were
is transmitted by vector mosquito, mainly belonging reported. State-wise JE cases and deaths are given
to Culex vishnui group. The transmission cycle is in Table - 4.

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A N N U A L RE P O R T 2008-09

There is no specific cure for this disease, symptomatic states are advised fogging with malathion (Technical)
and early case management is very important to as an outbreak control measure in the affected areas.
minimize risk of death and complications. A killed mouse
brain JE inactivated vaccine is manufactured at the 6.7 Denguefever / Dengue
Central Research Institute (CRI), Kausauli and Haemorrhagic Fever
procured directly by the states. However, the
production of this vaccine is inadequate and does not Dengue Fever is an outbreak prone viral disease, also
meet the state demand. There are operational transmitted by Aedes aegypti mosquitoes. Aedes
problems in the delivery of three doses of this vaccine aegypti mosquitoes prefer to breed in man made
and booster dose after every three years. Considering containers, viz., cement tanks, overhead tanks,
these problems, during the year 2006, Govt. of India
launched JE vaccination programme as an integral
component of Universal Immunization Programme
(UIP) with single dose live attenuated JE (SA- 14-14-
2) in 11 endemic districts of 4 States namely Uttar
Pradesh, Assam, West Bengal and Karnataka for
children between 1 and 15 years of age and 88.39%
coverage was achieved. During 2007, JE vaccination
with SA-14-14-2 vaccine has been expanded to 28
districts in 10 states (Assam, Karnataka, Uttar
Pradesh, West Bengal, Haryana, Bihar, Andhra
Pradesh, Tamil Nadu, Maharashtra and Kerala) During
2008 JE vaccination has seen carried out in 22 districts.
In Uttar Pradesh all the 34 identified JE endemic
districts have been covered under JE vaccination.

In addition, implementation of public health measures


such as, Health Education through different media like underground tanks, tyres, desert coolers, pitchers,
radio, TV including cable network miking, inter- discarded containers, junk materials, etc, in which water
personal communication, etc for disseminating stagnates for more than a week. This is day biting
appropriate messages in the community is crucial. The mosquito and prefers to rest in hard to find dark areas
emphasis is given on keeping pigs away from human inside the houses. The risk of dengue has shown an
dwellings or in pigsties particularly during dusk to dawn increase in recent years due to rapid urbanization, life
which is the biting time of vector mosquitoes. style changes and deficient water management including
Sensitization of the community regarding avoidance improper water storage practices in urban, peri-urban
of man-mosquito contact by using bet nets and fully and rural areas, leading to proliferation of mosquito
covering the body are also advocated. Since early breeding sites. The disease tends to follow seasonal
reporting of cases is crucial to avoid any complication pattern i.e., the cases peaks after monsoon and it is not
and mortality, community is given full information about uniformly distributed. Dengue is a self limiting acute
the signs and symptoms as well as availability of health mosquito transmitted disease characterized by fever,
services at health centres/hospitals. Besides, the headache, muscle, joint pains, rash, nausea and

90
A N N U A L RE P O R T 2008-09
vomiting. Some infections results in Dengue The States have been communicated to undertake
Haemorrhagic Fever (DHF) and in its severe form widespread campaigns for community awareness and
Dengue Shock Syndrome (DSS) can threaten the mobilization through different media like mass media,
patient's life primarily through increased vascular miking, inter-personal communication, etc. The
permeability and shock. The case fatality rate which was emphasis is on elimination of mosquito breeding
3.3 % in 1996 had come down to 0.63 in 2008 because sources like avoidance of water collection in and
of better management of Dengue cases in the country. around houses, removal of all discarded and
disposed/junk materials, keeping all water containers/
Epidemiological Situation: Dengue is endemic in storage facilities tightly covered and cleaning the
23 states/UTs. After 1996, outbreak with a total water coolers at least once a week before re-filling.
number of 16517 cases (suspected) and 545 deaths Since early reporting of cases is crucial to avoid any
again upsurge of cases were recorded in 2003 with complication and mortality, the community is given
12754 cases and 215 deaths. Subsequently, in the full information about the signs and symptoms as
year 2005 again, 11985 cases along with 157 deaths well as availability of health services at health centres/
had been reported respectively. In 2008 total 12561 hospitals. Alerting the Hospitals for making adequate
cases and 80 deaths have been reported. During arrangements for management of Dengue/Dengue
2009, till March 665 cases and 3 deaths have been Haemorrhagic Fever cases have also been advised.
reported (Table-5).
The Directorate of National Vector Borne Disease
Control has provided detailed guidelines for the
prevention and control of dengue to the affected
states. Intensive health education activities through
print, electronic and inter-personnel media, outdoor
publicity as well as and inter-sectoral collaboration
with civil society organization (NGOs/CBOs/Self-Help
Groups), PRIs and Municipal bodies have been
emphasized. Regular supervision and monitoring is
conducted by the Programme. The Government of
India in consultation with
States has identified 137
sentinel surveillance
hospitals with laboratory
There is no specific anti-viral drug for dengue and support for augmentation of
mortality can only be minimized by early diagnosis diagnostic facilities in the
and prompt symptomatic management of the cases. endemic states. Further, for
A strategic action plan has been developed for advanced diagnosis and
prevention and control of Dengue and issued to the backup support, 13 Apex
endemic States for implementation. Guidelines for institutions (Table-7) have
clinical management of dengue fever/ dengue been identified and linked
haemorrhagic fever and dengue shock syndrome with sentinel surveillance
has been developed and sent to the states for wider hospitals.
circulation. Advisories have been sent to the endemic
6.8 Chikungunya
areas for effective vector control through inter-
sectoral collaboration and active community Chikungunya is a debilitating
involvement, regular monitoring of fever, Dengue non-fatal viral illness caused
cases as well as entomological parameters to forecast by Chikungunya virus has
likely outbreaks and take timely remedial measures. re-emerged in the country

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A N N U A L RE P O R T 2008-09

after a quiescence of three decades. In India a major containers which are common around human
epidemic of Chikungunya fever was reported during dwellings. These containers such as discarded tyres,
the last millennium viz.; 1963 (Kolkata), 1965 flower pots, old water drums, family water trough,
(Pondicherry and Chennai in Tamil Nadu, water storage vessels and plastic food containers
Rajahmundry, Vishakapatnam and Kakinada in collect rain water become the source of breeding of
Andhra Pradesh; Sagar in Madhya Pradesh; and Aedes mosquitoes. Ae.aegypti played the major role
Nagpur in Maharashtra) and 1973, (Barsi in in transmitting the disease in all the states except
Maharashtra). This disease is also transmitted by Kerala, where Ae. albopictus played the major role.
Aedes mosquito. Both Ae. aegypti and Ae.albopictus Ae. albopictus breeding was detected in latex
can transmit the disease. Humans are considered to collecting cups of rubber plantations, shoot-off leaves
be the major source or reservoir of Chikungunya of areca palm, fruit shells, leaf axils, tree holes etc.
virus. Therefore, the mosquitoes usually transmit the There is neither any vaccine nor drugs are available
disease by biting infected persons and then biting to cure the Chikungunya infection. Supportive
others. The infected person cannot spread the
infection directly to other person (i.e. it is not
contagious disease). Symptoms of Chikungunya
fever are most often clinically indistinguishable from
those observed in dengue fever. However, unlike
dengue, hemorrhagic manifestations are rare and
shock is not observed in Chikungunya virus infection.
Chikungunya outbreaks typically result in large
number of cases but deaths are rarely encountered.

During 2006, total 1.39 million clinically suspected


Chikungunya cases reported in the country. Out of
15961 samples tested 2001 (12.5%) were found
positive for Chikungunya serologically. Out of 35
States/UTs 16 were affected: Andhra Pradesh,
Karnataka, Maharashtra, Tamil Nadu, Madhya
Pradesh, Gujarat, Kerala, Andaman & Nicobar
Islands, GNCT of Delhi, Rajasthan, Pondicherry, Goa,
Orissa, West Bengl, Lakshadweep and Uttar
Pradesh. There are no reported deaths directly
related to Chikungunya. In 2007, total 14 states were
affected and reported 59535 suspected
Chikungunya fever cases with nil death. Out of 7850
samples tested 1826 (23.26%) were confirmed
positive for Chikungunya virus. Subsequently in
2008, 95091 suspected Chikungunya fever cases
and nil deaths have been reported. Though 13
states had reported Chikungunya fever cases,
maximum cases were reported from Karnataka
(48.91%) followed by Kerala (25.96%) and West
Bengal (18.82%) (Table-6).

As already mentioned, Aedes mosquitoes bite during


the day and breed in a wide variety of man-made

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A N N U A L RE P O R T 2008-09
enhancing diagnostic facilities for Chikungunya/ the
137 Sentinel Surveillance hospitals involved in
dengue in the affected states also carries
Chikungunya tests. Both Dengue and Chikungunya
Diagnostic kits to these institutes are provided
through National Institute of Virology, Pune and cost
is re-imbursed by GOI. Further, rapid response by
the concerned health authorities has been envisaged
on report of any suspected case from the Sentinel
Surveillance Hospitals to prevent further spread of
the disease.

The overall strategies for prevention and control are


same as in Dengue such as symptomatic
management of cases, reduction of breeding
sources, personal protection and intensive IEC and
therapy that helps ease symptoms, such as
capacity building. Initiatives undertaken by Govt. of
administration of non-steroidal anti-inflammatory
India for prevention and control of Dengue/
drugs, and getting plenty of rest are found tom be Chikungunya
beneficial.
z Continuous monitoring of Chikungunya and
Government of India is continuously monitoring the Dengue situation in states.
situation & sending guidelines and advisories for
prevention and control of Chikungunya fever to the z Circulation of guidelines and advisories for
states. Support in the form of logistics and funds are prevention and control of diseases to
provided to the states. The central teams are deputed affected states.
to the affected states for technical guidance of the
z Launch of Intensive IEC and Behaviour
state health authorities. Since same vector is
Change Communication activities through
involved in the transmission of Dengue and
print, electronic media, interpersonal
Chikungunya strategies for transmission risk
communication, outdoor publicity as well as
reduction by vector control are also same. A
inter sectoral collaboration with civil society
comprehensive Long Term Action Plan for prevention
organizations (NGOs/CBOs/ Self Help
& control of Chikungunya and Dengue/Dengue
Groups), PRIs.
Haemorrhagic Fever has been prepared and
disseminated for guidance to the states. As most z Provision of larvicides and adulticides to
transmission occurs at home, therefore community affected states.
participation and co-operation is of paramount
importance for successful implementation of z Identification and strengthening of Apex
programme strategies for prevention and control of Referral Laboratories and sentinel
Chikungunya. Therefore, considerable efforts have surveillance hospitals for diagnosis and
regular surveillance.
been made through advocacy and social mobilization
for community education/awareness. For effective z NIV, Pune has been entrusted for supply of
community participation, people are informed about test kits to the identified institutions and to
Chikungunya and the fact that major epidemics can upscale its test kit production capacity.
be prevented by taking effective preventive
measures by community itself. Contingency grant provided to the Apex Referral
Laboratories and sentinel surveillance hospitals to
For carrying out proactive surveillance and meet the operational cost.

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A N N U A L RE P O R T 2008-09

Table - I
State-wise Malaria Cases & Deaths

STATEs/UTs 2006 2007 2008 2009 (Upto March)


Malaria Pf Malaria Pf Malaria Pf Malaria Pf
cases cases cases cases cases cases cases cases
Andhra 34081 20317 27803 16996 26165 15815 1450 970
Arunachal 39182 12854 32072 8535 28072 7074 0 0
Assam 126178 82624 94853 65515 83869 58224 1773 1243
Bihar 2744 428 1451 615 496 63 0 0
Chhattisgarh 190590 147766 147525 102926 123495 94803 24155 20583
Goa 5010 1196 9755 3047 9822 2727 580 155
Gujarat 89835 17932 71121 18407 50884 11668 1272 447
Haryana 47142 506 30895 330 35683 1397 63 5
Himachal Pd 114 8 104 3 144 2 2 0
J& K 164 8 240 17 200 17 4 2
Jharkhand 193888 48388 184878 45926 212496 74178 11616 5453
Karnataka 62842 16459 49355 11295 47162 9957 2036 433
Kerala 2131 314 1927 293 1804 217 0 0
Madhya Pd. 96160 29053 90829 36694 105265 42274 1502 631
Maharashtra 54420 17506 67850 22691 67321 22238 3963 1648
Manipur 2709 1301 1194 400 708 356 23 13
Meghalaya 29924 25907 36337 30731 38210 35037 1989 1907
Mizoram 10668 7126 6081 4189 7306 6172 130 101
Nagaland 3361 506 4976 820 5674 817 134 37
Orissa 380216 331773 371879 323150 359619 314130 0 0
Punjab 1888 37 2017 41 2494 38 11 0
Rajasthan 99529 9481 55043 3447 57482 3954 0 0
Sikkim 93 31 48 7 38 10 1 1
Tamil Nadu 28219 1276 22389 1363 27373 992 1469 18
Tripura 23375 19058 18474 15928 25451 22806 502 451
Uttaranchal 1108 6 953 2 1059 47 10 0
Uttar Pradesh 91566 1875 82538 2106 93383 2310 1025 17
West Bengal 159646 43448 87754 21974 104757 24058 0 0
A.N.Islands 2993 1299 3973 2230 4688 3176 408 286
Chandigarh 449 7 340 3 347 6 1 0
D & N Haveli 3786 1813 3780 1269 3037 995 55 32
Daman & Diu 140 19 99 15 110 19 3 0
Delhi 928 36 182 2 253 0 0 0
Lakshadweep 0 0 0 0 0 0 0 0
Pondicherry 50 2 68 5 72 5 0 0
Total 1785129 840360 1508783 740972 1524939 755582 54177 34433

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A N N U A L RE P O R T 2008-09
Table - 2
State wise Population Coverage (%) under MDA for ELF

Sl. State/UT 2004 2005 2006 2007 2008


No.
1 Andhra Pradesh 84.78 81.05 89.66 89.13 91.96

2 Assam 25.42 42.94 69.95 80.01 81.34

3 Bihar 84.39 77.82 79.77 81.28 ND

4 Chhattisgarh 84.17 82.80 ND 93.88 91.30

5 Goa 97.92 95.33 97.17 97.83 97.46

6 Gujarat 45.47 98.23 98.02 112.61 93.25

7 Jharkhand 46.13 73.72 73.60 80.03 84.64

8 Karnataka 85.22 89.31 90.20 89.67 90.53

9 Kerala 86.10 90.15 ND 92.19 93.67

10 Madhya Pradesh 73.74 79.29 88.01 88.48 90.14

11 Maharashtra 78.68 90.23 87.80 88.39 89.71

12 Orissa 90.11 90.60 87.40 88.47 84.53

13 Tamil Nadu 95.18 ND ND 89.51 ND

14 Uttar Pradesh 66.40 71.03 75.97 79.87 81.67

15 West Bengal 39.58 51.24 ND 76.63 77.79

16 A&N Islands 85.85 88.31 93.17 98.73 94.10

17 D & N Haveli 91.13 98.26 94.93 94.16 96.67

18 Daman & Diu 94.96 73.23 87.17 93.27 91.85

19 Lakshadweep 64.53 84.60 83.16 86.83 85.98

20 Pondicherry 94.76 96.63 ND 96.30 97.01

ND = Not Done

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A N N U A L RE P O R T 2008-09

Table - 3
State-wise Kala-azar Cases & Deaths
Sl. No. State/UT 2007 2008 2009 (upto Mar)
C D C D C D
1 Bihar 37819 172 28125 137 2080 5
2 W . Bengal 1817 9 1256 3 0 0
3 UP 69 1 26 0 0 0
4 Jharkhand 4803 20 3690 5 169 0
5 Delhi* 19 0 34 0 1 0
6 Assam 0 0 98 0 2 0
7 Uttarakhand 2 0 0 0 0 0
8 Sikkim 0 0 4 1 2 0
9 Gujarat* 4 1 0 0 0 0
10 M.P 0 0 1 0 0 0
INDIA 44533 203 33234 146 2254 5
C:Cases D: Deaths *Imported
Table - 4
State-Wise Cases and Deaths Due to Suspected AES/JE
Sl. Affected 2006 2007 2008 2009
No. State/UT (upto Mar)
C D C D C D C D
1 Andhra Pradesh 11 0 22 0 6 0 10 0
2 Assam 392 119 424 133 319 99 0 0
3 Bihar 21 3 336 164 203 45 0 0
4 Chandigarh 0 0 0 0 0 0 0 0
5 Delhi 0 0 0 0 0 0 0 0
6 Goa 0 0 70 0 39 0 14 3
7 Haryana 12 6 85 46 13 3 0 0
8 Karnataka 80 3 15 3 3 0 10 0
9 Kerala 3 3 2 0 2 0 0 0
10 Maharashtra 14 0 2 0 23 0 0 0
11 Manipur 0 0 65 0 4 0 4 0
12 Punjab 0 0 0 0 0 0 0 0
13 Tamil Nadu 18 1 42 1 144 0 0 0
14 Uttar Pradesh 2320 528 3024 645 3012 537 133 29
15 West Bengal 0 0 16 2 58 0 0 0
16 Nagaland 7 1 0 0 0 0
17 Uttarakhand 0 0 0 0 12 0 0 0
Grand Total 2871 663 4110 995 3838 684 171 32

C : Cases D : Deaths

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A N N U A L RE P O R T 2008-09
Table - 5
State-Wise Dengue Cases and Deaths
Sl. State/UT 2005 2006 2007 2008 *2009 (upto
No. Mar)
C D C D C D C D C D
1 Andhara Pd. 99 2 197 17 587 2 313 2 20 0

2 Bihar 0 0 4 0 0 0 1 0 0 0

3 Chandigarh 2 0 182 0 99 0 167 0 0 0

4 Delhi 1023 9 3366 65 548 1 1312 2 1 0

5 Goa 1 0 1 0 36 0 43 0 0 0

6 Gujarat 454 11 545 5 570 2 1065 2 59 0

7 Haryana 183 1 838 4 365 11 1137 9 1 0

8 Karnataka 587 17 109 7 230 0 339 3 22 0

9 Kerala 1028 8 981 4 603 11 733 3 449 2

10 Maharashtra 349 56 736 25 614 21 743 22 64 0

11 Sikkim 0 0 0 0 0 0 0 0 0 0

12 Punjab 251 2 1166 6 28 0 4349 21 0 1

13 Rajasthan 370 5 1805 26 540 10 682 4 5 2

14 Tamil Nadu 1142 8 477 2 707 2 530 3 16 0

15 Uttar Pradesh 121 4 639 14 132 2 51 2 0 0

16 West Bengal 6375 34 1230 8 95 4 1038 7 27 0

17 Pondicherry 0 0 0 0 274 0 35 0 1 0

18 D&N Haveli 0 0 0 0 0 0 0 0 0 0

19 Madhya Pd. 0 0 16 0 51 2 3 0 0 0

20 Orissa 0 0 1 0 4 0 0 0 0 0

21 J & K 0 0 24 1 0 0 0 0 0 0

22 Manipur 0 0 0 0 51 1 0 0 0 0

23 Uttrakhand 0 0 0 0 0 0 20 0 0 0

TO TAL 11985 157 12317 184 5534 69 12561 80 665 3

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Table - 6
State-wise Status of Chikungunya Situation
Sl. State/UT 2008 *2009 (upto
No.
Total fever No. of No. of No. Total fever No. of No. of No.
cases/ samples confirmed of cases/ samples confirmed of
Suspected sent to cases deaths Suspected sent to cases deaths
Chikungunya NIV/ Chikungunya NIV/
fever cases NICD fever cases NICD

1. Andhra Pradesh 5 2 1 0 549 45 22 0

2. Karnataka 46510 2957 1008 0 594 201 94 0

3. Maharashtra 750 323 224 0 102 21 10 0

4. Tamil Nadu 46 0 0 0 16 16 16 0

5. Madhya Pradesh 0 0 0 0 0 0 0 0

6. Gujarat 246 122 31 0 0 0 0 0

7. Kerala 24685 1356 492 0 29 24 17 0

8. A&N Islands 0 0 0 0 0 0 0 0

9. GNCT of Delhi 14 14 14 0 0 0 0 0

10. Rajasthan 3 3 3 0 0 0 0 0

11. Pondicherry 0 0 0 0 0 0 0 0

12. Goa 52 14 21 0 35 35 20 0

13. Orissa 4676 238 11 0 0 0 0 0

14. West Bengal 17898 2789 593 0 35 35 11 0

15. Lakshadweep 0 0 0 0 0 0 0 0

16. Uttar Pradesh 11 11 7 0 0 0 0 0

17. Haryana 35 0 20 0 0 0 0 0

TOTA L 94931 7829 2425 0 1360 377 190 0

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A N N U A L RE P O R T 2008-09
Table - 7
APEX Referral Laboratories
(i) All India Institute of Medical Sciences, New Delhi,
(ii) National Institute of Communicable Diseases, Delhi
(iii) National Institute of Virology, Pune,
(iv) National Institute of Mental Health and Neuro-Sceinces, Bangalore,
(v) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
(vi) Postgraduate Institute of Medical Sciences Chandigarh,
(vii) ICMR Virus Unit (NICED), Kolkata,
(viii) Kings Institute of Preventive Medicines, Chennai,
(ix) Institute of Preventive Medicine, Hyderabad,
(x) B.J. Medical College, Ahmedabad,
(xi) Kerala State Institute of Virology and infectious diseases, Alleppey,
(xii) Defence Research Development and Establishment, Gwalior.
(xiii) Regional Medical Research Centre (ICMR), Dibrugarh, Assam

6.9 National Leprosy Eradication Background


Programe (NLEP) Leprosy is a chronic infectious disease with long
Introduction incubation period and affects all age groups. Leprosy
is classified mainly as Pauci Bacillary (PB) and Multi
Since the inception of National Leprosy Eradication Bacillary (MB). Since the leprosy bacilli affect the
Programme (NLEP) in the year 1983 spectacular peripheral nerves, patients lose sensation by and
success have been made in reducing the burden of large in their hands, feet and eyes if not properly
Leprosy. The country achieved the goal of leprosy cared for. Injuries to these insensitive parts may lead
elimination as a public health problem. i.e. prevalence to disfigurement, the main consequence of this
rate (PR) of less than 1 case / 10,000 population at disease which leads to stigma and discrimination
National level by December 2005, as set by National against persons affected with leprosy. Early detection
Health Policy 2002. Although prevalence has come and prompt treatment of leprosy with prescribed Multi
down at national and state level, new cases are being Drug Therapy (MDT) not only cures leprosy, but also
continuously detected and these cases will have to be interrupts transmission.
provided quality leprosy services through GHC system.
Govt. of India launched the National Leprosy Control
NLEP is being continued with Govt. of India funds Programme in 1955 based on dapsone
from January 2005 with technical support from WHO monotherapy. Multi Drug Therapy came into wide use
and International Federation of Anti Leprosy from 1982 following recommendation of WHO study
Association (ILEP) organizations. group and National Leprosy Eradication Programme
was launched in 1983 with the objective to arrest the
Achievements of National Leprosy Eradication
disease in all the known cases of leprosy. In 1991,
Programme in India
the World Health Assembly resolved to eliminate

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A N N U A L RE P O R T 2008-09

Out of 1.34 lakhs new leprosy cases detected during cases. Substantial declining trend can be seen in
the year, 48% were MB cases, 10.1% child cases, the Leprosy Prevalence and Annual New Case
35.2% female cases and 2.8% were visible deformity Detection Rate (ANCDR) in the diagram below-

Major Initiatives taken- z Under the programme, more focus was given
to districts and blocks with prevalence rate
z More emphasis is being given on providing of more than 2/10,000 population. During
Disability Prevention and Medical 2007-08, special activities in the form of Block
Rehabilitation (DPMR) services. In addition & Urban Leprosy Awareness Campaigns
to 36 NGOs in the country, 27 govt. institution aiming at spreading awareness & providing
have been strengthen for providing treatment to newly detected leprosy cases
reconstructive surgery services to disabled were carried out successfully in endemic 275
persons affected with leprosy for correction blocks and 53 urban areas. 5137 new cases
of their disability. were detected and put under treatment.
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A N N U A L RE P O R T 2008-09

z More focus has now been given to new case iv) Support of NRHM for improving delivery of
detection rather than prevalence which only leprosy services by involvement of ASHA,
give the number of cases on record at a point Village Health & Sanitation Committees and
in time. The New Case Detection Rate is the Rogi Kalyan Samities.
main indicator for programme monitoring now
being calculated on quarterly basis by the v) Community Based Rehabilitation of leprosy
affected persons.
state as per the guidelines.
vi) Renewed focus on reduction of stigma &
z Treatment Completion Rate (TCR) has been
discrimination against leprosy affected
taken as an important indicator to be
persons and their family members.
calculated on regular basis every year all
over the country as an inbuilt component of To streamline the activities and to guide the states/
the programme. The guidelines for calculation U Ts in proper implementation of the "New Paradigms
of TCR by Cohort Analysis had been issued in NLEP", following guidelines were issued-
to states and the rates for the reporting year
2006-07 and 2007-08 have been received z Guidelines for use of Treatment completion
as base line information. rate as an Indicator under the National
leprosy Eradication Programme.
z IEC campaigns with the theme 'Towards
Leprosy Free India' was started from 30th z Guidelines on Quarterly assessment of New
January 2008 with focus on further reduction Case Detection Rate (NCDR) under National
in leprosy burden in the community, early Leprosy Eradication Programme.
reporting of cases & treatment completion, z NLEP- Monitoring and Evaluation tools for
provision of quality leprosy services and implementation of New Paradigms during 11th
reduction of stigma & discrimination. Plan period.
New Paradigms- z NLEP quality service indicators- Significance
After elimination of leprosy, the programme has & actions required.
expanded the scope of providing leprosy services to z Guidelines on "other cases" under NLEP.
the patients, their families and community at large.
To sustain leprosy services for many years to come, z Disability, MB & Child proportion-
there has been a shift from campaign like elimination Epidemiological significance & interpretations.
approach, towards the long term process of
z Guidelines on Community Based
sustaining integrated high quality leprosy services.
Rehabilitation.
New paradigms under the programme take into
z Guidelines on reduction of Stigma and
consideration the following-
Discrimination.
)
i More focus on new case detection and
z Guidelines strategy for Behavioral Change
treatment completion. Communication.
i) Improvement of quality of leprosy services z Guidelines for facilitating Reconstructive
which are accessible to all and follow the Surgery in Leprosy.
principle of equity & social justice.
Urban Leprosy Control Programme-
iii) Strengthening referral services with more
focus on long term care of the leprosy affected To address the complex problem like larger
persons. population size, migration, poor health infrastructure

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A N N U A L RE P O R T 2008-09
and increasing prevalence in urban areas, the Urban WHO Support-
Leprosy Programme was initiated in 2005.
WHO support the programme in the form of providing
Urban Leprosy Control Programme has been financial assistance to the state leprosy societies and
implemented since 2005 under which assistance is technical support through State/Zonal NLEP
being provided by Govt. of India to 422 urban areas Coordinators in the high endemic states. Financial
having population size of more than 1 lakh. For the support to NLEP is also extended by WHO for
purpose of providing graded assistance, the urban conducting periodic review meetings at national level.
areas are grouped in four categories i.e. Township I, WHO continues to provide requirement of anti-leprosy
Medium Cities I, Medium Cities II, Mega Cities. (MDT) drugs to the country free of cost with
assistance from NOVA RTIS.
Involvement of NGOs-
IEC-
Non Governmental Organizations (NGOs) have been
involved for the cause of leprosy elimination for many z Four video spots of IEC of Leprosy were
decades and their contributions have made a positive produced with the help of TLM Media Centre,
impact in reducing the prevalence of leprosy. Noida.
Presently 38 NGOs are getting grant-in-aid from
Govt. of India under Survey, Education and Treatment z Leprosy free India campaign was launched
(SET) scheme. Few NGOs have been given on 30th January, 2008. Advertisement on
recognition for conducting reconstructive surgeries 'Leprosy Free India' was published in country
(RCS) where facilities for these services are wide newspapers.
available.
z Mass Media campaign was done on four
The NGOs serve in remote, inaccessible, uncovered, channels viz. D.D, Aaj Tak, Zee News and
urban slums, industrial / labour population and other ETV.
marginalized population groups. The various activities
undertaken by the NGOs are, IEC, Prevention of z Independent evaluation of IEC activities of
Impairments and Deformities, Case Detection and the programme were conducted by Centre
M D T Delivery. From financial year 2006 onwards, for Media Studies, New Delhi
Grant-in-aid is being disbursed to NGO through State
Disability Prevention & Medical Rehabilitation
Leprosy Society. Under SET scheme, Rs. 2.22
(DPMR)-
crores were released to NGOs during 2008-09.
The main activities carried out during the year 2008-
ILEP Agencies
09 are as under -
International Federation of Anti-leprosy Association
1. Implementation of DPMR activities as per
(ILEP) is actively involved as partner in NLEP. In
guidelines and reporting its outcome -
India, ILEP is constituted by 10 Agencies viz. The
Outcome of DPMR activities e.g. treatment
Leprosy Mission, Damien Foundation of India Trust,
of 'Leprosy Reaction', ulcers, Physiotherapy,
Netherland Leprosy Relief, German Leprosy Relief
Reconstructive Surgery and providing MCR
Association, Lepra India, ALES, AIFO, Fontilles -
India, AERF - India and American Leprosy Mission. shoes /protective aids is being reported
A MOU was signed with ILEP partners in October through 'Monthly Progress Report' from the
2008 for providing technical support to the programme states to Central Leprosy Division. 2960
till March 2012. ILEP is providing support in the form persons were operated and benefited by
of planning, monitoring & supervision of the RCS services, 39325 MCR foot wears were
programme, capacity building of GHC staff, providing given to needy cases having anesthesia sole,
re-constructive surgery services and socio economic 28058 were provided with self care kits to
rehabilitation of persons affected with leprosy. prevent & treat recurrent ulcers and 11805

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cases of Leprosy reaction were treated by and supervision of the programme activities at
Prednisolone. Central, State, District & Peripheral level.

2. The number of institutes providing ¾ Simplified Information System (SIS) was


Reconstructive Surgery services has been introduced in 2002 so that GHC service
increased to 63. In addition to 20 Govt. personnel can easily adapt to the system of
Hospitals recognized for re-constructive recording and reporting under the
surgery in the 11th Plan (PIP) another 7 Govt. programme. This system has drastically
Hospitals / Medical Colleges have been improved recording, reporting and its
recognized in 2008-09. Similarly, 4 more NGO transmission. The programme is monitored
Hospitals have been recognized in 2008-09 at District, State and Central level through
bringing the total number NGO hospitals to scrutiny of regular monthly reports.
36.
¾ Leprosy Elimination Monitoring (LEM)
3. Integrating DPMR services - There are exercise were undertaken with WHO support
provision of services to Persons with through the NIH&FW, New Delhi, to assess
Disability' (PWD) by various departments the programme achievement in identified
under different ministries. Convergence of indicators during the year 2002, 2003 and
NLEP services into NRHM facilitated this 2004. Immediate actions were initiated on the
integration. deficiencies observed.

4. Training of GHC staff - Many states have ¾ An independent evaluation of the programme
carried out trainings of GHC staff to improve was carried out during 2007-08 through the
the quality of DPMR services delivered by Indian Institute of Health Management
PHC system. Training of surgeons and Research, Jaipur.
surgical team of medical college hospitals in ¾ Evaluation of IEC activities under the
leprosy surgery has enhanced the services programme was carried out through Centre
of 'Reconstructive Surgery' for persons with For Media Studies (CMS), an independent
disability due to leprosy. agency.
5. Monitoring DPMR activities - Analysis of ¾ The programme is reviewed at District and
reports, feedback to states and review PHC level in monthly meetings. Quarterly
meetings remain main activities to monitor the review meetings were held at State level for
DPMR program. Field visits and review the District Leprosy Officers and other
meetings at state level has further partners, which are also attended by officers
strengthened the monitoring of DPMR for the Central Leprosy Division.
program.
¾ For the North Eastern and also Northern
6. Ministry of Health and Family Welfare is states, Regional level meetings were
coordinating with other ministries / organized in the year 2008-09, which were
departments and state governments for also attended by all the partners'
identifying and striking down the organizations.
discriminatory provision existing in various
Acts, Laws, Rules, Govt. Orders etc. against Future Strategy-
leprosy affected persons. Although the prevalence has come down at national
Monitoring and Evaluation of NLEP- level, yet large numbers of new leprosy cases are being
detected every year. These new cases will continue to
NLEP has an inbuilt information system for monitoring occur and will have to be provided quality leprosy

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A N N U A L RE P O R T 2008-09
z In 1st quarter 2009, 372,837 TB patients a. The programme is in the process of
have been registered for treatment. establishing a network of about 27
accredited Culture and Drug
z 91% of the diagnosed smear positive cases
Susceptibility testing Intermediate
living in the district are being put under
Reference Laboratories (IRL) across the
DOTS.
country in a phased manner for
z ~ 125,000 patients being put on DOTS every diagnosis and follows up of MDR TB
month. patients. The IRLs at Gujarat,
Maharashtra, Andhra Pradesh, Delhi,
7. Involvement of other sectors: Over 2345 Kerala, Tamil Nadu, Rajasthan have
NGOs, 19202 Private practitioners, and 150 been accredited recently.Another 7 IRLs
corporate houses have been involved in the (Haryana, West Bengal, Uttarakhand,
provision of RNTCP services. Presently, 267 Chattisgarh, Jharkhand Uttar Pradesh-
medical colleges (including private colleges) lucknow and Orissa) are under the
have been involved in RNTCP and are accreditation process and are expected
estimated to contribute nearly 10-15% of to be accredited in 2009. The reaining
case detection in the districts that have IRLs will be accredited in 2010.
medical colleges. Health facilities in
government sectors outside Health Ministry b. To supplement and support the IRL
have been involved viz. ESI, Railways, Ports network the programme is also involving
and the ministries of Mines, Steel, coal, etc. Mycobacteriology laboratories of
Collaboration for increased participation of Government Medical Colleges as well
all sectors in RNTCP is being strengthened laboratories in the NGO and Private
through constant interaction with all stake Sector. Till date, two such labs (CMC-
holders, including professional bodies like the Vellore and BPRC-Hyderabad) have
Indian Medical Association, Indian been accredited and about 12 such labs
Association of Pediatricians.and Faith Based have applied for accreditation.
Organisations such as Catholic Bishops c. DOTS Plus services for management of
Conference of India. MDR TB have been rolled out in the
states of Gujarat, Maharashtra, Andhra
8. TB-HIV collaboration: The collaborative
Pradesh, Haryana, Delhi, Kerala, West
activities which were being undertaken in 14
Bengal, Tamil Nadu and Rajasthan. Ti l
states earlier have been scaled up to involve
date a total of around 400 MDR-TB
all the states in 2007. NACP & RNTCP have
patients are on treatment in these states.
developed "National framework of joint TB/
HIV Collaborative activities" in 2007 (later d. Remaining states will be covered under
revised in 2008) which redefines the scopes DOTS Plus in 2009-10.
of TB/HIV collaborative activities being
implemented in the country. In 2008, more 10. Advocacy, Communication and Social
than 195,055 TB suspects were referred from Mobilization (ACSM): A training module for
ICTCs to RNTCP and of them more than improved Inter-Personal Communication
25,000 were diagnosed as having TB and (IPC) skills has been developed and
initiated on DOTS. More than 136,622 TB incorporated in the existing modules. IEC
patients were tested for HIV and of them about strategy at different levels has been planned.
11,800 were diagnosed as HIV positive and Web based resource centre for IEC materials
were offered access to HIV care. has been made available on the programme
website. In addition to this,
9. DOTS Plus services for the management of
MDR-TB o A media agency has been hired to

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A N N U A L RE P O R T 2008-09

support the IEC activities at the national Uttarakhand from the Round 6) and USAID ( for entire
level 21 million population of Haryana)

o Most of the states have appointed The second phase of the RNTCP is consolidating,
communication facilitators to support the maintaining and further improving the achievements
IEC activities at the district level of the first phase. Phase II of the RNTCP is a step
towards achieving the TB-related Millennium
o Quarterly reporting on IEC activities is in Development Goal (MDG) targets. DOTS remain the
place and is monitored at the state and core strategy. In addition to the ongoing activities,
central level the following new activities have been envisaged in
the second phase.
11. Impact of the programme:
¾ the scaling up of the State-level intermediate
a. TB mortality in the country has reduced
referral laboratories (IRL) capacity for nation-
from over 42/lakh population in 1990 to
wide implementation of external quality
28/lakh population in 2007 as per the
assessment (EQA) of sputum smear
WHO global report 2009. microscopy services and provision of culture
b. The prevalence of TB in the country has and drug sensitivity testing.
reduced from 586/lakh population in ¾ Implementation of DOTS-Plus for multi-drug
1990 to 283/lakh population by the year resistant TB cases will occur in a phased
2007 as per the WHO global TB report, manner
2009
Major Initiatives
c. Repeat population surveys conducted by
TRC indicate an annual decline in Public Private Mix in RNTCP
prevalence of disease by 12%. The RNTCP employs the Public Private Mix (PPM)
d. Programme is currently undertaking which is the strategy to diagnose and treat TB
repeat A RTI survey (2007-09), disease patients reporting to all sectors of health care under
RNTCP through a mix of different types of health
prevalence surveys (2007-09) to
care providers.
additionally monitor the progress towards
MDGs. NGO/PPs: Currently, for enhancing the involvement
of NGOs and PPS under RNTCP, the guidelines have
RNTCP Phase II
been revised with enhanced financial outlays. The
The RNTCP Phase II of the World Bank project has programme has entered into a Memorandum of
been approved by the Government for the period understanding with large NGOs/Professional
Oct 2006 to Sep 2011 for a total outlay of Rs 1,156 Associations like RK Mission, World Vision, Christian
Crore (USD 256.9 million) which includes credit from Medical Association of India, Catholic Health
World Bank of Rs 765 Crore (USD 170 million) and Association of India, Indian Medical Association etc.
commodity assistance of anti-TB drugs from DFID In addition, many local NGOs support programme
activities to improve access of RNTCP in difficult and
through WHO for Rs 287 Crores (USD 63.7 million)
uncovered areas.
with balance of RS 191 Crore (USD 42.5 million) will
be given by GoI. In addition, 385.5 crores is available Medical colleges/TB Hospitals and others: Medical
through GFATM (for 110 million population in Bihar colleges are being provided with manpower and
and Uttar Pradesh under Round 2, and 110 million logistic support to facilitate their participation in the
population in the states of Andhra Pradesh and programme. Theinvolvement of medical colleges is
Orissa under Round 4; and 60 million population in monitored by the Task Force mechanism at the State/
the states of Chhatisgarh, Jharkhand and Zonal and National levels.

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Other sectors -All the 16 centrally owned ESI central government has urged all providers of health
hospitals, Zonal Railway Hospitals, Coal, Steel and care to adopt RNTCP to ensure adherence to the
mines health facilities, Port trust hospitals, CGHS internationally recognized standard of care for TB.
hospitals and 150 corporate hospitals are involved
in RNTCP services. The 14 pilot districts under the intensified PPM
surveillance started in 2003 continue to be as sentinel
Urban DOT Projects-The four Urban DOT projects sites.
funded through GFATM (round 2) at Mumbai,
Hyderabad, Varanasi and Indore have completed two TB/HIV coordination: Globally, the HIV epidemic is
years of project with increase in case detection at all worsening the TB situation, by increasing the number
the sites as a result of improved quality and reach of of tuberculosis cases and accelerating the spread
RNTCP to special groups like slum dwellers and of the disease. HIV increases a person's
migrants, through more "patient friendly" treatment susceptibility to TB infection and Tuberculosis
observation, involvement of private and NGO sectors increases morbidity and mortality in HIV infected
and IEC. persons. HIV is the most potent risk factor for
progression of TB infection to disease. Since 2001,
Urban TB for slum dwellers - Recognizing the problem Government has been implementing a joint action
and impact of TB on urban slum population RNTCP plan in co-ordination with National AIDS Control
intends to provide greater levels of access to its Programme (NACP), to counter the growing
services to the urban slum population. In addition, a incidence of the HIV-TB Co-infection, initially in the
special PPM scheme for Urban Slum dwellers has six high HIV prevalence States of Maharashtra, Tamil
been introduced under the recently revised PPM Nadu, Andhra Pradesh, Karnataka, Manipur and
schemes. Nagaland. Services for HIV infected TB patients are
provided through linkages between the Integrated
Other initiatives- Counseling and Testing Centre (ICTC) supported by
The IMA has formed a National Working Group for the HIV/AIDS Programme and Designated
R N T C P and has selected National and State Microscopy Centres (DMCs) supported by RNTCP,
coordinators. National, state and local workshops are joint IEC activities and infection control measures.
being organized by the IMA to sensitise the opinion In 2007, the national action plan for TB/HIV has been
leaders. The PPM project assisted by GFATM (round revised. RNTCP & NACP have formulated a National
6) has been launched from April '07 which is to be framework for joint TB/HIV Collaborative activities
implemented in the states of UP,A P, Maharashtra, which replaces the action plan. The document
Punjab, Haryana, and Chandigarh. elaborates the various activities that need to be
There has also been a Professional coalition against undertaken at the National, State & district level and
TB by IMA with IAP(Indian Academy of provides the guidelines for the same. Under the
Pediatrics),NCCP (National College of Chest National framework there is enhanced focus on the
Physicians),ICS (Indian Chest Society),FPAI provision of HIV care including A RT, for all known
(Federation of Family Physicians Association of India) HIV infected TB patients in order to reduce mortality
as its members. in this group of TB patients. With the formulation of
National framework, the TB/HIV collaborative activities
The RNTCP has adopted the recently published are being extended to the entire country. The
"International Standards for TB Care" (ISTC) framework looks to establish mechanisms for
document to improve the standards of TB coordination between the two programmes at all level.
management across all sectors of health care in Technical working groups with the key staff of both
India, and to recruit and involve additional health the programmes as members have been established
care providers in RNTCP activities. As the RNTCP at the National and State level, which are meeting on
conforms to all standards laid down in the ISTC, the a monthly basis.

109
A N N U A L RE P O R T 2008-09

A RT- DOTS linkages are being established at all the appropriate activities. Communication
A RT centres of the AIDS control programme to ensure strategies for TB control takes care of
optimal access to TB diagnostic and treatment opportunities for interactive communication,
services to the HIV positives at advanced stage of such as engaging cured patients to convince
disease. Medical officers posted at the A RT Centres and support others, group meetings to
have been trained in RNTCP so as to prioritize joint discuss all aspects of TB control, including
training modules on TB/HIV have been formulated the social aspects.
for various categories of staff of RNTCP and NACP
2. It focuses on decentralized planning, choice
and the training activities are being scaled up. TO Ts
of communication channels and monitoring
have been conducted for State and District level
to ensure contextual relevance and wide
trainers and the training of field staff is on-going and
reach of information. The states and districts
is at various stages in the different States. IEC
have to take active part in this process while
materials regarding TB are being made available at
Centre continues to provide leadership,
NACP facilities. Selective IEC material on HIV is
develop core messages, mass media and
displayed at RNTCP facilities.
advocacy events.
MDR-TB: Another challenge to TB control in India is
3. IEC takes care to address social issues
the MDR-TB. The data available to date shows that
related to TB such as stigma and gender,
levels of MDR-TB remain relatively low, at around
and special communication initiatives to
3%, amongst new patients and 12-17% in re-
address the needs of the special groups and
treatment cases. However, these relatively low
'hard to reach populations'
percentage figures translate into large absolute
number of MDR-TB cases, which increase the RNTCP emphasizes on decentralized planning and
magnitude and severity of TB epidemic and pose a implementation of health communication initiatives.
major threat to TB control. Guidelines for States and districts develop need based annual action
management of MDR TB cases (DOTS Plus) have plans and implement activities using local popular
been formulated and published. The Programme media. To support the districts in planning and
Division has an ambitious plan to scale up services implementing, Communication Facilitators have been
for management of MDR-TB patients in the country engaged who identify opportunities and network
and is in the process of securing funding for the same. through which communication activities are
undertaken to spread information about TB and
Information, Education and communication (IEC) or availability of free diagnosis and DOTS treatment.
Advocacy, Communication and Social Mobilization Other important role of Communication Facilitators
(ACSM) continue to be an important component of is to integrate communication about TB within the
the programme. In line with the Stop TB strategy, context of other health programmes and NRHM.
replacement of the terminology with 'Advocacy,
Communication, and Social Mobilization' (ACSM) is RNTCP encourages states to: i) systematic planning
being promoted, as the term ACSM has advantage and implementation of communication activities based
over IEC as it clearly defines the components and on the needs, knowledge of target groups, using the
initiatives. local appropriate media; ii) to undertake IEC activity
for maintaining desired level of awareness,
The IEC strategy in RNTCP envisages that: motivation, support and services in patient friendly
environment; and iii) monitor IEC activities regularly
1. IEC is a long term commitment where in IEC
like other components of the programme.
is a process and not product oriented.
Implementing IEC activities is based on RNTCP is also working to increase in state and district
analysis of the needs, and developing level capacity to plan and execute IEC activities. For
strategy to plan need based, locally this purpose, each state has undertaken an IEC audit

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A N N U A L RE P O R T 2008-09
totake stock of its current capacity.This was done Reference Laboratories and National Reference
with a standardized format and procedure. Laboratories has been operationalised. Similarly,
an independent agency had been contracted to test
The objective is to assess the existing capacity in quality of RNTCP drugs at various points.
states and districts for planning and implementing
IEC activities. In many case IEC planning and Research activities: The RNTCP encourages
implementation is individual driven depending upon Operational Research (OR) and has provision for
the leadership role taken by the programme manager funding such studies. Funds have also been made
or the designated person. There is need to available to States for inviting proposals and funding
institutionalize these processes and IEC capacity research activities in their respective States. The
audit is a step in this direction to document that exists OR priority research areas as well as formats for the
at this point of time. proposals are available on the RNTCP website. The
aim of the research is to improve DOT services to
W eb-based Resource Centre for IEC: A web-based make them more patient- friendly, ensure that
resource Centre for IEC is being used by the States treatment is directly observed and increase detection
and Districts for reproduction of material. The of smear positive cases. A number of studies have
resource Centre is available on the Programme's web been done in this field. Some of these have been
site:. and are being initiated/sponsored and funded by the
Quality Control of diagnosis and drugs: A protocol Central TB Division, some have been undertaken
for External Quality Assurance (EQA) of sputum by the States and national/central institutes, and
microscopy of slides by different level of staff at the others have been carried out by the teaching and
Microscopy Centres (MCs), Districts, Intermediate training institutes.

Physical Performance
Comparative statement of achievements under RNTCP during the last 8 years
Indicators 2001 2002 2003 2004 2005 2006 2007 2008 2009 (till
31st March,
2009)
Population 450 530 775 947 1080 1114 1 1131 2 1148 1164
coverage,
(millions)
Total number 471658 622873 906472 1187353 1293083 1397498 1475587 1517333 372619
of cases put
on DOTS
New smear 185178 245051 358496 465331 506193 553660 592635 616016 152311
positive
patients put
on treatment
Cure rate 84% 84% 86% 86% 84% 84% 84% 84% 84%
(expected
85%

No. of NGOs 230 410 650 1011 1600 2263 2400 2524 2341
involved
(approx)

1 Entire country covered under RNTCP in March 2006


2 Projected population in 2007

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Financial Performance
Year Outlay as budgeted Actual expenditure
(Rs. in Crores) (Rs. in Crores)

2006-07 202.17 220.97

2007-08 267.00 262.12

2008-09 275.00 279.90

2009-10 297.25 96.39 (till 29.6.2009)

6.11 National Programme for Control b) To develop Comprehensive Eye Care facilities
of Blindness (NPCB) in every district;

c) To develop human resources for providing


Background
Eye Care Services;
National Programme for Control of Blindness (NPCB)
d) To improve quality of service delivery;
was launched in the year 1976 as a 100% centrally
sponsored scheme with the goal of reducing the e) To secure participation of Voluntary
prevalence of blindness to 0.3% by 2020. Rapid Organizations/Private Practitioners in eye
Survey on Avoidable Blindness conducted under Care;
NPCB during 2006-07 showed reduction in the
prevalence rate of blindness from 1.1% (2001-02) f
) To enhance community awareness on eye
to 1% (2006-07). care.

Due to formation of National Rural Health Mission, Year Wise details of targets and achievements
the structure of the Programme (both the in respect of major performance indicators of
administrative requirements and the Programme NPCB
inputs) have been implanted vis-à-vis the available
i
) Cataract Operations:
resources under NRHM. State Blindness Control
Societies and District Blindness Control Societies
formed for implementation of the Programme in Year Target Cataract % surgery
states under NPCB have been merged with State operations with IOL
Health Societies and District Health Societies performed
respectively formed under NRHM.
2002-03 4000000 3857133 77
The Pattern of Assistance for National Programme
for Control of Blindness during the 11th Five Year 2003-04 4000000 4200138 83
Plan has been approved by the Cabinet Committee
2004-05 4200000 4513667 88
on Economic Affairs. The Pattern of Assistance for
the 11th Five Year Plan will be effective, w.e.f., 16th 2005-06 4513000 4905619 90
October, 2008.
2006-07 4500000 5040089 93
The main objectives of the programme are:
2007-08 5000000 5404406 94
a) To reduce the backlog of blindness through
identification and treatment of blind; 2008-09 6000000 5822000 94

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ii) School Eye Screening Programme: Pattern of Assistance during 11th Plan

Year Target No. of free spectacles The following are the main features of Pattern of
provided to school age Assistance during 11th Plan:
group children
z Keeping in view austerity measures and to
2002-03 50,000 98,697 avoid duplicity of work, State Ophthalmic Cell
has been merged with State Blindness Control
2003-04 60,000 1,84,305
Society. Due to formation of National Rural
2004-05 60,000 2,83,070 Health Mission (NRHM), State Blindness
Control Society (SBCS) under NPCB has
2005-06 70,000 3,85,403 been further merged with State Health
2006-07 70,000 4,566,34 Society under NRHM. District Blindness
Control Society (DBCS) under NPCB has also
2007-08 30,000 5,12,020 been merged with District Health Society
under NRHM.
2008-09 30,000 9,73,000
z Increase in assistance for commodity to
iii) Collection of Donated Eye various facilities to increase their capacity for
treatment of all types of eye ailments;
Year Target Collection of
donated eyes z Facility for Intra-ocular Lens (IOL)
implantation expanded up to Taluka level;
2002-03 25,000 19833
z Marginal increase in grant-in-aid to Eye
2003-04 30,000 23741
Banks, Eye Donation Centres and NGOs due
2004-05 35,000 23553 to escalation of costs and to improve quality
of services;
2005-06 40,000 28007
z In addition to cataract, assistance would also
2006-07 45,000 30007 be provided for other eye diseases like
2007-08 40,000 38546 glaucoma, diabetic retinopathy, management
of laser techniques, corneal transplantation,
2008-09 50,000 41,780 vitreoretinal surgery, treatment of childhood
blindness etc.
iv) Training of Eye Surgeons:
z Assistance for construction of dedicated Eye
Year Target No. of eye W ards and Eye Operation Theatres in North
surgeons trained East States and few other states as per need;
2002-03 25,000 19833 z Assistance for appointment of Ophthalmic
2003-04 30,000 23741 manpower - Ophthalmic Surgeons,
Ophthalmic Assistants and Eye Donation
2004-05 35,000 23553 Counsellors - on contractual basis;
2005-06 40,000 28007 z Assistance for involvement of Private
Practitioners in sub-district, block and village
2006-07 45,000 30007
levels;
2007-08 40,000 38546
z l Assistance for maintenance of
2008-09 50,000 41,780 Ophthalmic equipments supplied under the

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programme; Development of Mobile logy, Medical Colleges, District/Sub-District


Ophthalmic Units with Tele-ophthalmology Hospitals, PHC/Vision Centres.
Network and some fixed tele-models to cover
difficult hilly terrains and difficult areas; 6.12 National Iodine Deficiency
Disorders Control Programme
z Critical posts of 228 Eye Surgeons and 510
Ophthalmic Assistants sanctioned during the Iodine is an essential micronutrient required daily at
9th Plan and continued during 10th Plan, 100-150 micrograms for normal human growth and
would be integrated within the State Plan in development. Deficiency of Iodine can cause
a phased manner; physical and mental retardation, cretinism, abortions,
stillbirth, deaf mutism, squint & various types of goiter.
z Strengthening of Management Information Results of sample surveys conducted in 325 districts
System; covering all the States/Union Territories have
z Intensification of IEC activities. revealed that 263 districts are endemic where the
prevalence of Iodine Deficiency Disorders is more
New Initiatives during 11th Five Year Plan than 10%. It is estimated that more than 71 million
persons are suffering from goiter and other Iodine
1. Construction of dedicated Eye Wards & Eye
Deficiency Disorders.
O Ts in District Hospitals in North-Eastern
States, Bihar, Jharkhand, J&K, Himachal Objectives:
Pradesh, Uttarakhand and few other States
where dedicated Operation Theaters are not z Surveys to assess the magnitude of the
available as per demand. Iodine Deficiency Disorders.

2. Appointment of Ophthalmic manpower z Supply of iodated salt in place of common


(Ophthalmic Surgeons, Ophthalmic salt.
Assistants and Eye Donation counselors on z Resurveys to assess iodine deficiency
contractual basis. disorders and the impact of iodated salt after
3. Grant-in-aid to NGOs for management every 5 years.
of other Eye diseases other than Cataract
z Laboratory monitoring of iodated salt and
like Diabetic Retinopathy, Glaucoma
urinary iodine excretion.
Management, Laser Techniques, Corneal
Transplantation, Vitreoretinal Surgery, z Health Education and Publicity.
Treatment of childhood blindness etc. of Rs.
750 per case for Cataract/IOL Implantation Achievements:
Surgery and Rs.1000 per case of other major z Consequent upon liberalization of Iodated salt
Eye Diseases as described above. production, Salt Commissioner has issued
4. Development of Mobile Ophthalmic Units in licenses to 824 salt manufacturers out of
NE States, Hilly States & difficult Terrains for which 532 units have commenced production.
diagnosis and medical management of eye These units have an annual production
diseases. capacity of 124 lakh metric tones of Iodated
salt.
5. Involvement of Private Practitioners in Sub
District, Blocks and Village Level. z A production of Iodated salt of 49.61 lakh MT
was recorded during the period from April 07
6. Maintenance of Ophthalmic Equipments to March 2008 against 50.00 lakh MT target
supplied to Regional Institutes of Ophthalmo- for the year 2007-08.

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z The Ministry of Health & Family Welfare have Activities through the Directorate of Field
issued notification banning the sale of Non Publicity
Iodized salt for direct human consumption in
The Directorate of Field Publicity carried out special
the entire country w.e.f.17th May,2006 for
programmes through their 207 regional units in 29
effective implementation of NIDDCP at the
States for extensive IEC campaigns in the country
state level.
regarding consumption of Iodated salt in prevention
z For effective implementation of NIDDCP 31 and control of IDDs. The activities include Film
States/UTs have established IDD Control shows, Group discussion and other special
Cells at the State Health Directorate. programmes

z In order to monitor the quality of Iodated salt Activities through Doordarshan


and Urinary Iodine excretion 18 States/UTs
IDD Spots containing messages on consequences
have already set up IDD monitoring
of Iodine Deficiency Disorders and benefits of
laboratories while the remaining States are
consuming Iodated salt were telecast (i) through the
in the process of establishing the same.
National Network of Doordarshan on an average 4-
z For ensuring the quality of Iodized salt at 5 times daily and telecast of the IDD messages thrice
consumption level, a total No. of 25857 salt in a week under the Health Magazine Kalyani
samples were analyzed out of which 22613 Programme from the 8 regional Kendaras of
(87.55%) salt samples were found confirming Doordarsahn in regional languages.
to the standards during the year 2006-07.
Activities through All India Radio
z IDD survey was conducted in the Cuttack
district of Orissa State during the month of IDD spots containing messages on consequences
January 2008. The State Government of of Iodine Deficiency Disorders and benefits of
Punjab has conducted 3 District surveys in consuming Iodated salt were broadcast by the All
their state during the year 2007-08. India Radio through its 40 regional channels, 123
primary channels and 22 FM channels from April
z Global IDD prevention day was observed 2007.
throughout the country on 21st October,
2007. Massages on benefits of consumption Activities through the Directorate of
of iodated salt in prevention and control of Advertisement and Visual Publicity
IDD were published in National and Regional Messages for consumption of Iodated salt to
News papers on the eve of Global IDD Day . overcome the problem of Iodine Deficiency Disorders
A Two Days National workshop on NIDDCP were published in the leading 543National as well as
was organized on the occasion at vigyan regional Newspapers on the occasion of Global IDD
bahvan, New Delhi.
Day on 21.10.2007.
Information Education &Communication
Activities through the State Health Directorate
Activities
State Governments have also provided grants for
Activities through Song and Drama
undertaking IEC activities at the local level in their
Song and Drama Division carried out extensive IEC regional languages to make the impact of IEC
campaign activities, through their field units in 16 activities more effective including celebration of
States till 31st March, 2008. Global IDD prevention day in their all districts.

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Chapter 7

Information, Education
and Communication
7.1 Introduction IEC initiatives undertaken during the year under
NRHM:
Public policy and communication strategies influence
both individual and collective change. The interface z To position focussed visibility through multi
between these two components provides the media tools
framework to position behaviour change. In other
z Branding of the key IEC intervention under
words, the balance between communication and
NRHM
policy facilitates health seeking behaviour. Over the
years the thrust of the Department has been to place z To create enabling environment for Health
IEC as an intervention tool to generate demand for providers through on intra communication
the range of services under the umbrella framework process
of National Rural Health Mission (NRHM).
z Communication tools to inter-link demand
The Communication Strategy aims to facilitate generation with access and availability of
awareness, disseminate information regarding services
availability of and access to quality health care within
z Strong emphasis on integrated IEC for
our Public Health System. The key objective of the
focused content delivery
strategy is to encourage a health seeking behaviour
that is doable in the context in which people live. z Combination of mass media, social mobilization
The strategy views recipients of health services as and inter-personal communication methods
not merely users of services but key participants in
z Close monitoring of actual media utilization
generating demand for services.
and behavioral outcomes along with financial
During the year, the communication strategy has allocations
focused on sustaining behaviour change on key
z Designing innovative strategies
health issues through multi media tools. This implies
that it was not enough to just give information and z National Immunization Day(NID) held in Jan.-
raise awareness about a particular health issue, Feb. 2009.
awareness and information dissemination should be
used as tools to provide tools to the community to The following tools were used during the year:
press for changes to improve access to health service z Interpersonal Communication
provisions.
z Community Channels
Under the framework for implementation in the
National Rural Health Mission, norms have also been z Mass Media
outlined for supporting IEC activities. The framework
z Folk and Traditional Media
incorporates a variety of activities involving
communities and also the media. z Outdoor Media

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z Advocacy z Communicable and non communicable


diseases Platform for integration
z Events, Image management, PR and Publicity
A Budget allocation of Rs. 186.31 Crores was
z Intra communication provided for IEC for the year 2008-09 for IEC.
The target audiences included: Major achievements during 2008-09 were as under:
z Direct Healthcare Providers(ANM, ASHA, - Reinforcing the brand identity for NRHM.
AW W )
- Innovations at State level for NRHM advocacy
z Healthcare Managers / Administrative
functionaries - Intra Communication strategies for
implementation at State level
z Health Communicators
- New content for multi-media tools
z Grass-root functionaries
- Integrated IEC management through Kalyani
z Other Govt. Departments, e.g. Panchayati Programme News Magazine format through
Raj, WCD, Water & Sanitation Prasar Bharati being telecast from EAG
States and Assam.
z NGOs, Civil society stake holders and Media
- Special publications on achievements of
During the year, the following issues were being NRHM capturing developments in States
highlighted through multi-media tools:
- Sponsorship of Access Cards at Tirumala
z Janani Suraksha Yojana Tirupati Devasthanams for disseminating
Health Messages under NRHM.
z ASHA
- Reinforced presence in Cable and Satellite
z Age at Marriage TV channels and Private FM Radio.
z Routine Immunization - Special theme based issues for NRHM
Newsletter.
z PNDT and Girl Child
The IEC strategy of the Department has undergone
z Contraceptive choice and spacing
a strategic shift. The communication challenge today
z Breast Feeding is not only demand generation, creating awareness,
but at the same time initiating a comprehensive
z Use of Iodized Salt understanding of behavior change communication
in the socio-cultural framework of our Public Health
z Care of New born
System. A number of initiatives were taken to
z Institutional delivery professionalize IEC activities and emphasis was laid
on intensive media planning and inter-personal
z Maternal Care, Positioning of ASHA, Village techniques for effective rollout of programmes and
and Health Nutrition Day, JSY, IMNCI and also messages.
awareness campaign on age at marriage,
P N D T, spacing and contraception. 7.2 Activities through Media Units of
I & B Ministry
z Adolescent health
The Media Units of the Ministry of Information and
z RCH and HIV/AIDS Broadcasting provide communication support to the

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FW Programmes as per the requirements and messages. NRHM spots were shown in cinema
guidelines of the IEC Division of MOHFW.The focus theatres throughout the country.
is on mother and child health issues, population
growth, status of women, small family norms, the Song and Drama Division
Community Needs Assessment Approach and also To educate the people about Family Welfare issues,
other issues related to health programmes such as Song & Drama Division organized live entertainment
Ophthalmology, Cancer, Tobacco etc. programmes like puppet shows, dance, dramas, folk
Doordarshan shows, during India International Trade Fair 2008.

Doordarshan telecasted video spots at prime time All India Radio


on a range of NRHM issues including Polio At present the major Programme on All India Radio
Eradication. Spots were telecast on regional channels are also follows.
as well. Doordarshan also telecasted various
programmes including panel discussions, interviews - The spots of 30 second duration are also
and covered important functions related to NRHM being broadcast 12-14 times on popular
activities in the States. A half an hour Magazine programme and a film on woman programme
Programme entitled 'Kalyani' I & II is being telecast on rural programme and also before and after
from regional kendras of Doordarshan of 9 States. Regional news being broadcast from primary
Spots in regional languages of N.E. Region were channels in 18 States.
dubbed for telecast in N.E.States as a special
campaign. Video Spots were not only being telecast - Ministry has also hired slots in the National
from Prasar Bharti but also from the satellite channels News for the broadcast of NRHM spots of 30
in Hindi and regional languages. A tele-serial ''Atmaja' second duration before National News at 7.59
of 13 episodes was telecast on Doordarshan. Kyonki a.m., between the National News and at 8.10
Jeena Isi ka Naam Hai - A teleserial on the theme of a.m. before the National News at 8.44 p.m.
NRHM produced by UNICEF and M/O Health and and between the National News in the
Family Welfare and was telecast on DD-I at prime evening.
time.
- NRHM spots were also being broadcast at
Special campaign on Safe Motherhood and Breast prime time on private FM channels like Radio
Feeding and Save the Girl Child were launched. Mirchi, Radio City, Red FM, Go FM and other
Panel discussions and programmes were also channels through DAV P.
telecast under the Kalyani Programme. The video
7.3 Press Information Bureau
Spots on Emergency Contraceptive Pill, NSV and
CuT-380-A were telecast through discussions also It provided media coverage on important occasions,
incorporated in Kalyani-II Programme. events, activities, policies and programmes of the
Department. PIB arranged coverage of Family
D AVP
Welfare Melas, World Population Day functions,
D AV P produced a number of video spots under the Pulse Polio Programme and other important events.
NRHM programme. These spots were dubbed in
regional languages and were telecast on Prasar
7.4 Activities in the States/Union
Bharti/Satellite channels.
Territories

Cinema Theatres Activities were given multi-dimensional and integrated


thrust to increase the outreach and impact of
Cinema Theatre is a new initiative. The medium of Reproductive and Child Health and Family Welfare
cinema theatre was used to disseminate health messages with the objective of bridging the gap

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A N N U A L RE P O R T 2008-09

between awareness and acceptance. Annual plans Unani, etc. of CGHS Wing and NCT Delhi to patrons
for 2008-2009 with an outlay of Rs. 186.31crores . Non Scalpel Vasectomy (NSV) counseling and 249
were formulated through closer interactions with NSV operation were performed in the pavilion; AIDS/
States, keeping in view the differential approach. HIV counseling and free HIV test was performed. One
person was found positive. Live Yoga performance
7.5 Training of IEC Personnel was organized by the Morarji Desai Rashtriya Yoga
Sansthan, New Delhi for adopting healthy life style
The IEC Division organised a series of capacity
to live healthy. Educative live cultural shows were
building programmes for IEC personnel at Central,
organized in foreground near entrance of pavilion
States and district level through NIHFW, New Delhi
by the Song and Drama Division. In addition to above
and other State Training Centres. The awareness
UNICEF, HLL, VHAI, JSK, Heart Care Foundation, etc.
generation training coordinated by the National
also participated in our exhibition.
Institute of Health & Family Welfare for health
functionaries of the State & district level include a The jury of the India Trade Promotion Organization,
module on inter-personal communication. ITPO adjudged our pavilion for excellence and the
Union Minister of State for Commerce and Power,
7.6 World Population Day
Mr. Jairam Ramesh awarded to this Ministry Gold
Like every year, the World Population Day was Medal and certificate of excellence on 27.11.08.
observed on 11th July, 2008. The function was
organized at Patna.
7.8 Adolescent Health Programme
Adolescent health is a critical component of RCH
7.7 Exhibition in IITF, 2008
programme. The strategy for addressing Adolescent
The main theme of the Family Welfare Exhibition was Sexual and Reproduction Health in the RCH-II
"Swastha Bharat Samardha Bharat" covering issues programme was approved. A two-pronged strategy
of National Rural Health Mission(NRHM). Progress was adopted for mainstreaming adolescent health
and services under following schemes: Janani in the public health management system. In the first
Surakshya Yojana(JSY); Safe Motherhood; component, the Deptt. would incorporate adolescent
Accredited Social Health Activists (ASHA); issues in all RCH training programmes and all content
Observation of Village Health Day in Anganwadi related to RCH in order to facilitate behavior change.
Centre and supplementary nutrition; Universal This would entail interventions for addressing unmet
Immunization Programme and immunization Care of need for contraception and pregnancy care,
infant; Reproductive and Child Health (RCH); prevention of STIs including HIV/AIDS. In the second
Comprehensive Primary Health Care; PNDT; stage of the strategy, the overall conceptual
Adolescent Health and Right Age of Marriage; framework would be implemented in selected districts
Promotion of Healthy Life Style; Anti-tobacco identified across the country.The objective being to
campaign and related health hazard like Cancer,T.B., introduce adolescent health in the public health
etc. along with vector borne diseases controlled system in a phased manner so as to cover 75 Districts
programme, were incorporated and displayed in the country.
through pictures, TV spots and laser show.
It may be mentioned that adolescent development is
Free health checkups i) Blood test, ii) Height test, iii) a broad issue of which Ministry of Youth Affairs and
Weight test, iv) Eye test, vi) Family planning Sports is the Nodal Ministry.
counseling and services for male, vii) Family planning
counseling and services for female with various family
7.9 Print Software/Print Publicity
welfare methods, viii) treatment for communicable Press Advertisements:
and non communicable diseases were arranged by
the systems of Allopathic, Ayurvedic, Homeopathic, The IEC Campaign through Press Advertisements

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enabled the division to highlight key initiatives in both b) India Guaranteeing Quality Primary
national and regional media. A number of campaigns Healthcare for All;
were launched through the national and regional
press. Especially designed full page colour c) Bulletin on Rural Health Statistics in India;
advertisement on the occasion of World Health Day d) 3 Books on Indian Public Health Standards
and half page advertisement on Safe Motherhood for Sub-Centres, PHCs & CHCs;
Day 2008 were released in the newspapers all over
the country to generate mass awareness on health e) 5 Books on Indian Public Health Standards
issues. Colourful advertisements on National Rural for Sub-Div./Sub-District and District
Health Mission were released to the newspapers on Hospitals; and
the occasion of Independence Day, Gandhi Jayanti
f
) Guidelines for VHSC, Untied Funds for SCs,
and Republic Day2009. Special campaign in the form
PHCs & Rogi Kalyan Samities etc.
of full page colour advertisement highlighting
initiatives and achievements of various programmes The IEC Division also published a number of posters
under National Rural Health Mission were also on Health issues in English, Hindi and regional
released in the newspapers on 25.2.09, 26.2.09, languages to generate awareness among the
27.2.09 and 01.3.09. people.

The most intensive print media campaign was for 7.10 NRHM Newsletter
the Pulse Polio Programme which was done
The NRHM Newsletter is now established as an
systematically through a series of press
important publication for promotion of the
advertisements in numerous newspapers on all India
programmes under National Rural Health Mission.
basis, on and before all the rounds of the PPI
The NRHM Newsletter is being published in Hindi,
Programme. This included thematic advertisements English, Assamese, Urdu, Oriya and Tamil for health
designed by IEC Division in the PPI programme functionaries and NGOs working at the Sub-Centre,
before the Pulse Polio rounds. PHC, CHC and District level. The Newsletter publishes
The IEC Division also released advertisement based view points of all development partners, viz. NGOs,
donor agencies etc.
on focused theme such as save the girl child, PNDT
related issues, Maternal Child Health Care, World During the year, a special issue of Newsletter on
Population Day, IITF etc. The Division as part of an "Save the Girl Child Campaign" was brought out. The
integrated IEC campaign covered a range of issues focus of this special issue was adverse sex ratio and
on NRHM related themes which provided a platform implementation of PC&PNDT Act in States/UTs and
for information dissemination and awareness building save the girl child.
an advocacy through the print media.
Another special issue was on "Janani Suraksha
Print Software: Yojana" and Public-Private Partnerships in
Healthcare. The issue highlighted demand driven
In order to showcase NRHM as a flagship programme, intervention for promotion of safe delivery, reduction
emphasis was laid on publishing a series of of maternal and neo-natal mortality.This issue also
documents. Each document reflected critical areas focused on Public-Private partnership for better
of NRHM and related programmes. These healthcare service in rural areas.
documents were distributed at major advocacy
meetings and programmes to all stake-holders. The There has been tremendous response to the
prominent documents published during the year Newsletter, especially from the grass-root health
were: workers from different regions. A number of health
related issues, in the form of reader's response have
a) NRHM: Making a difference everywhere; been discussed through these Newsletter editions.

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7.11 Annual Wall Calendar 7.13 Mass Mailing Unit (Press)


This year special efforts were made to design the The Mass Mailing Unit (Direct Mail Communication)
Calendar on integrated themes with poster value. whose main objective is to build up an effective mailing
The Calendar, designed in-house, has come out with list of the opinion leaders from different parts of the
innovative designs highlighting initiative taken on country with a view to utilize their services to bring
various health & family welfare issues. Special efforts awareness and attitudinal changes among common
were made through visual publicity like this year's people. To educate, inform and motivate these
Calendar for spreading message on health issues persons regularly, it has been proposed to bring
as an integrated theme of the Ministry.The Calendar about a large number of periodicals and publications
was circulated to all the health set ups in the country. regularly through direct mailing up to grass root level.

7.12 Handbook Diary At, Present , Mass Mailing Unit, Deptt. of Health &
Family Welfare is disseminating the Ministry's regular
Handbook diary with detailed information about the Journals NRHM News letters in Engl8ish, Hindi, Oriya,
improvements in different programmes under the Assamese, Urdu and Tamil quarterly and Wall
National Rural Health Mission was brought out in a Calenders annually.Apart from this regular dispatch,
handy and useful form. Slogans on different health the Mass Mailing Unit has Mailed various type of
issues on every page highlight the campaign. publicity materials, like posters leaflets, pamphlets
Important Health Days have been included in this on Health and Family Welfare Programmes provided
Handbook Diary.This would be very useful book for by various sections of the Ministry to the Health
health functionaries. Functioneries all over the country.

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Chapter 8

Partnership With Non-


Government Organisations

8.1 Introduction cutting edge of programme implementation. NGOs


will be involved in ASHA's training, activities relating
The National Rural Mission (NRHM) seeks to build to National Disease Control Programmes, PNDT act
greater ownership of the program among the and service delivery in addition to health education
community through involvement of Non-Government and awareness programmes.
Organizations. Promotion of Public-Private
Partnership for achieving public health goals is one 8.3 New Guidelines
of the strategies initiated by the department in this
According to the revised guidelines of NGO Scheme,
regard. This partnership will reinforce the strategy
the States have been given an important role in
of involvement of NGOs already spelt out in the
selection/approval of the NGOs and overseeing
National Population Policy 2000.
implementation of the projects undertaken by them.
The Government of India is committed to voluntary An inbuilt mechanism of monitoring the working of
and informed choice in family planning, reproductive the NGOs and various activities undertaken under
and Child health care services. Towards this end, the project, in addition to the mid-term appraisal, etc,
the Government, the corporate sector, voluntary and by the designated evaluating agencies/
non-voluntary sector are expected to work together organizations, has been built into the guidelines:
in partnership. The professional bodies like Indian
The key features are:-
Medical Association, Federation of Obstetricians &
Gynaecologists are also involved in the partnership z Decentralization of the schemes to the State
to achieve the desired goal. and District level.

8.2 Partnership with Non- z Integration with NRHM.


Government Organizations z Training of A S H A
The Government of India envisages collaboration with z Activities relating to various National Disease
NGOs through enhanced participation by the State Control Programmes
Governments also. Under RCH-II, the ownership of
the programme has been decentralized to the State z Awareness relating activities concerning
Governments. The planning process now starts from P N D T Act.
the district level. The scheme has been included in
z Shift from exclusive IEC and awareness
the State PIP for NRHM under RCH-II.
generation to Service Delivery.
NGOs in particular, have been assigned
z Delivery of RCH services by NGOs in
supplementary or complementary role to that of the
unserved and under served areas.
Government health care delivery, thus aiding them
in reaching the masses meaningfully. They have a z Clearly defined eligibility criteria for
comparative advantage of flexibility in procedures, Registration, Experience, Assets and
rapport building with communities and are at the Jurisdiction.

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z Rationalization of the jurisdiction Institutional Framework for Programme


area serviced by the NGO to provide in Management:
depth service and optimize resources.
The programme management under the revised
Mainstreaming gender issues in all
scheme is decentralized to the State and district
intervention areas.
Authorities. The State Govt. forms State RCH Society,
z Enhanced male participation and involvement which has the responsibility for the overall
in delivery of all RCH services. m a n a g e ment of the scheme. The State NGO
committee will be responsible for MGNO selection,
z Emphasis on measurable, qualitative and recommendation of projects for MNGO selection,
quantitative performance indicators. recommendation of projects for Government of India
approval, fund disbursement, capacity building,
z Selection, approval, funding and monitoring monitoring and evaluation. The District RCH society
of MNGO/SNGO projects by State and District is responsible for all the operational aspects of the
RCH committees. programme management at the district level. The
district NGO committee holds the responsibility for
z Increased interface of NGOs with local
recommendation of MNGO composite proposals to
government bodies.
State RCH Society, facilitating the signing of MOU
8.4 Service NGO (SNGO) Scheme with the MGNO and passes it on for fund release to
state RCH society, undertakes review meetings and
The Service NGOs (SNGOs) are, those NGOs, which periodic monitoring in the field for assessing FNGO/
are expected to provide clinical service and other MNGO performance.
specialized aspects such as Dai training, MTP, male
involvement, covering 100,000 population and Role of Government of India is related to provision
contributing to achieving the RCH objectives. of policy guidelines, final approval of proposals, and
technical support for capacity building of NGOs and
NGOs with an establishment institutional and fund release to State governments.
infrastructure for service delivery are encouraged
to compliment the public health care delivery system 8.5 State NGO Coordinators
in achieving the goals of RCH-II programme. These
(SNGOCS):
SNGOs will cover an area co-terminus to that of a The SNGOCs are responsible for monitoring the
CHC/block PHC with approximately 1,00,000 implementation, facilitating timely submission of NGO
population or around 100 villages. Service NGOs are reports to the state government, providing
expected to provide a range of clinical and non- government feed back to NGOs, communicating
clinical services, directly to the community, as an government policies and programmes, and facilitating
integrated package of RCH-II services. Some of the NGO dialogue with district health system.
services expected to be provided by SNGOs include
At present there are 13 SNGOCs in position and
safe deliveries, neo-natal care, treatment of
other states are in active process of positioning
diarrhoea and ARI, abortion and IUD services, RTI/
them soon.
STI etc.
8.6 Institutional Framework for NGO
Currently, 338 MNGOs are working in 450 districts.
Capacity Building
MNGO selection process has been completed in the
states/UTs of Gujarat, Chattisgarh, Uttarakhand, The Regional Resource Centres (RRCs) and the
Himachal Pradesh, Maharashtra, Sikkim, Goa, West Best Practice Centres (BPC), are the two institutional
Bengal and Orissa. The numbers of MNGOs are likely mechanisms available to support this programme.
to increase steadily to cover the entire country.

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The RRC pool has expanded to 11 and process has managerial and technical competencies of the
begun to select 14 more RRCs, to make the MNGOs, support and oversee FNGO training,
programme more effective. NGOs with expertise and document and disseminate best practices, collect and
experience in RCH and having national level stature, disseminate RCH policies, laws, and programme from
are identified as RRCs. the respective states, where they work, and
maintenance of database on technical and human
The RRCs are playing role to be a catalyst, advocacy resources related to RCH.
and net working with state governments, strengthen

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Chapter 9

Family Planning

9.1 Introduction The Quality Assurance Committees set up at the


State and District level monitor the sterilisation
The National Family Planning Programme launched services and conduct medical audits and at the
in 1952 was primarily aimed at population central level these activities are monitored through
stabilization and the strategy was to regulate birth reports and field visits.
by providing fertility control methods both for limiting
and spacing. The programme is presently being Actions and Achievements
repositioned not only to achieve population
z Quality Assurance manuals revised and
stabilization but also to reduce maternal mortality and
printed in 2006- 07 ( last edition in 1996)
infant and child mortality. The birth rate has been
brought down to 24.8 and TFR to 2.8 due to the z Manual on Standards for Female and Male
successful intervention of this programme. However Sterilisation revised and printed in 2006-07
there still remains a huge unmet need for family (last edited 1999)
planning methods with concomitant interstate
z Six Regional Dissemination Workshops on
variations. The main reasons for the high unmet need
Quality Assurance on the revised Standards
and unwanted fertility are the non availability of and QA manuals held countrywide covering
quality services, lack of skilled providers and gender all the states with the objective of
biased programme with poor male participation. strengthening the quality in Sterilisation
ICPD in 1994 identified and emphasized the services.
relevance of bringing about population stabilization z The reference manual on IUCD for Medical
by integrating the various health determinants in a Officers has been revised, printed and
wholesome manner thereby ensuring population distributed countrywide (2007-08).
development. Another reproductive need to be
addressed is the fertility promotion for the infertile z The reference manual on IUCD for Nursing
couples who constitute nearly 10 to 15% of the total Personnel has been revised and is in print
population in India. (2007-08).
z A manual on Standard Operating Procedures
The Family Planning Division has formulated many
(SOP) to ensure the quality in camps has
interventions for increasing contraceptive choices
been developed for the first time and is in
and meeting the unmet need in contraception thereby
print.
reducing the TFR.:
z The manual on Emergency Contraceptive Pill
9.2 Quality Assurance in Family has been revised and is awaiting printing.
Planning
9.3 Repositioning of IUD as a Long
Quality assurance in family planning services is a and Short Term Spacing Method
major decisive factor in the acceptance of the service.
in the Family Planning Programme
The guidelines to be followed on Quality care and
Standards in FP services in the implementation of The acceptance of spacing methods in the country
the national program are provided by the division. is still very low in spite of the large unmet need and

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one of the main reasons is lack of skilled manpower. problems, requirements for training,
To address this problem an alternative methodology acceptability by clients, provider biases,
of training in IUD services using pelvic models has logistical issues as well as possible
been developed and the pilot phase of this managerial and programmatic problems
intervention had been launched in 12 states. envisaged in synergizing with the use of the
existing IUD 380 A.
Based on the positive feed back received from the
various pilot states, the strategy was expanded to z The multiload 375 will be officially launched
cover the rest of the 23 states. once the results of the trial are favourable

The programme is being administered directly by the 9.4 Male Participation in Planned
Government of India and the trainings are being Parenthood Including No Scalpel
monitored diligently from the central level with the Vasectomy (NSV)
help of technical consultants.
With the aim to bring men to the forefront in
Actions and Achievements population and reproductive health programmes
special budgetary provisions have been made in the
z Three National level training of master tenth plan under the Male Participation.
trainers have been conducted at NIHFW Delhi
in collaboration with JPHEIGO and USAID for The No Scalpel Vasectomy (NSV), a modified male
all the 12 pilot states of the first phase. sterilization technique, was introduced in 1997 in the
NFWP as a simple and safe technique with very little
z Four National level trainings of master chance of complications compared to female
trainers have been completed for the rest of sterilization.
the 35 second phase states with the one for
North Eastern states held at Guwahati and The camp approach adopted by states like MP,A P,
the other three held at NIHFW, Delhi. Punjab and UP has shown that a well conceived and
intensive advocacy, combined with assured service
z 11 of the 12 first phase states and five of provision, results in significantly increased
the second phase states have completed the acceptance. Based on the experiences of these
state level master trainers' training. states, a strategy on advocacy and community
mobilization for increasing NSV acceptance through
z 10 of the states have gone ahead with their
camps has been introduced in the Family Planning
district level training.
Programme in 2005. The guidelines have been sent
z More than 3000 medical and paramedical to all states/UT Government.
personnel have been trained so far in the
The camp approach is gradually becoming popular
states in a short span of 6 to 8 months
in many districts.The camp approach has since been
The Government of India has approved the revised with the fund allocation for holding such
introduction of a new improved IUD, namely Multiload camps being rationalized with the idea of better
375 as an added choice to the existing IUD 380 A in conduct of the camps in sterilization services. The
a bid to increase the contraceptive choice as well as detailed order is on the website of the Ministry at
contraceptive prevalence in spacing methods. w w w.mohfw.nic.in under guidelines for family
planning.
Actions and Achievements
Programmatic shortcomings for promotion of
z As approved in the minutes, a protocol is NSV:
being developed by ICMR for a six months
z Lack of trained providers (manpower)
fast track pilot in some states, medical
colleges and NGOs to study the operational z Lack of assured service delivery points

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z Less thrust at the state level wereapprised on their performance and
accordingly felicited.
z Poor dissemination of the method
z The performance in NSV has almost doubled
z Lack of counseling services in 2007-08
Actions and Achievements z In six states the performance of NSV to total
Manpower Development: Development of sterilization has been more than 10%
manpower for service provision is not uniform in all z In six other states the performance of NSV to
the states. The well performing states have stepped total sterilization has been between 5 - 10%
up their training of service providers in NSV which is
not seen in the other states. To address this concern, 9.5 Introduction of Newer
a three pronged strategy has been developed Contraceptives
namely:
Introduction of newer contraceptive in the program
Surgical faculty training: As NSV is overlooked increases the basket of choice for eligible couples.
during under graduate training in Medical Colleges,
a new strategy of hands on training of Surgical Actions and Achievements
Faculty of the Medical Colleges in NSV has been z Funds have been released to ICMR for Post
started this year so as to involve them in training of marketing surveillance study in Centchroman,
undergraduates and post graduates, which will in turn a non steroidal oral contraceptive developed
help in increasing the pool of trained service indigenously by CDRI, Lucknow, before
providers. About 200 members of the surgical introducing it in the National Program.
faculties of medical colleges have been trained in
52 courses held at 6 designated training centres in z Study on Cyclofam (one month injectable )
the country during 2007-08. The trainings are going and Net En (two monthly injectable ) have
on in 2008-09, and the data would be compiled at been completed and presented before the
the end of the financial year. Secretary (Health & Family Welfare)

District Trainers Training: It been taken up at z A 3 year pre introductory study on Net-EN
Maulana Azad Medical College, Delhi to have a and Cyclofem has been approved by the
qualitative, uniform training of District Trainers Research Advisory Committee to be
certified to train Medical Officers in NSV in a conducted by ICMR at its HRRCs and Medical
decentralized and faster manner since Jan'06 and Coleges. Prior to introduction in the National
also to attain the goal of having one district trainer Programme.
per district for all the 632 districts in the country. 12
9.6 Ensuring Availability of Family
District trainers' courses have been held till date
and 6 states - Punjab, Rajasthan, HP, Uttarkhand,
Planning Services at All Levels of
Haryana, Chattisgarh have become self sufficient with Health Care Delivery System
a minimum of one District trainer per district. NSV Under NRHM efforts are being made to strengthen
providers training at the district level through funds CHC, PHCs, Subcentres with infrastructure and
released from RCH II flexipool is being conducted up human resource to IPHS standards. This will also
by the various states ensure the provision of various types of terminal and
z A National NSV workshop was conducted to spacing methods of fertility regulation at Govt.
take stock of the NSV scenario in the country institutions. In addition to the government
where 23 states participated and the states functionaries A S H A , the accredited social health
activist, is seen as a major catalyst for bringing about

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behavioral change in the community in all matters z The servicing of the claims have improved
related to RCH services including contraception substantially over last year

9.7 Revised Compensation Scheme z A new clause has been added to pay the
for Acceptors of Sterilization family of the bereaved a compensation of
Services Rs.50,000 immediately from the Rogi Kalyan
Samity funds, to be recouped from the
Government of India has been providing insurance company once the mandatory
compensation to the acceptors of sterilization for their paper works are completed
loss of wages and giving infra structural support to
the state for providing quality services in z The detailed scheme is available on the
contraception. ministry's website at www.mohfw.nic.in

Actions and Achievements 9.9 Assisted Reproductive Technolo-


gies (ART) for Infertility
z This scheme has been revised in Sept. '07,
taking into consideration the rise in the cost As per WHO data the incidence of infertility in various
of living especially for the BPL/SC/ST families countries including India is around 10-15%. There
as well as the need to promote vasectomy has been an increased demand for assisted
more than tubectomy to address the existing reproduction from these infertile couples. This has
gender inequity. lead to mushrooming of infertility clinics in India and
in many of these centres the quality of services is in
z Funds in the scheme have also been
question. The National Guidelines on A RT has been
earmarked for the compensation to the pool
developed by ICMR and National Academy of Medical
of service providers who perform this extra
Sciences for Government of India for regulating and
work in difficult terrain and difficult conditions
in the national interest. The detailed scheme supervising the functioning of A RT clinics and this
is available on the ministry's website. would help the A RT clinics in providing safe and
ethical services.
z The same has contributed handsomely to
almost 10% improvement in sterilization Actions and Achievements
performance in the country in 2007-08
z Draftbillon A RT prepared and sent to ICMR
9.8 National Family Planning for finalisation.
Insurance Scheme 9.10. Improved Performance in Family
Government of India launched the National Family Planning in 2007-08
Planning Insurance Scheme on Nov 11th 2005 for
From the absolute figures available it is observed
compensation to the acceptors of sterilization or his/
that sterilization had a marginal increase from 2000-
her nominee in the unlikely event of his/ her death,
failure or complications following a sterilization 01 till 2003-04. Thereafter subsequently there was
operation. The scheme also provides for Indemnity a drop in sterilization by 4.1% in 2005-06 over
insurance cover to the Medical officers and the 2004-05 and a further drop of 3.8% in 06-07 over
facilities for up to four cases of litigation per year he/ 05-06.
she or the facility may face as a consequence of
The following factors are thought to have contributed
performing sterilization operations.
in the gradual fall in the achievements in Family
Actions and Achievements planning in the past decade

z The Insurance scheme has been renewed ™ Supreme Court directives on ensuring quality
with the ICICI Lombard Insurance company. in Sterilisation services

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z The mandatory 5 year post degree relating to 5 years experience criteria were
experience clause reduced the pool of waived off.
service providers.
z The revision of Compensation package
z Previously many states were allowing in Sept.2007 to compensate for loss of
MBBS doctors to perform laparoscopic wages.
sterilizations which promptly stopped
z Promoting Acceptance of No Scalpel
z ISM doctors were also performing mini- Vasectomy to ensure male participation.
lap sterilizations who too were withdrawn.
z Promoting IUD 380A intensively as a
z Medical Officers were reluctant to spacing method because of its longevity of
perform sterilizations in view of increased 10 years and advantages over other IUDs
awareness on quality among the public
z Increasing skills of IUD providers through
and consequent rising litigations.
alternative training strategy in IUD insertion
™ Surgeons' apathy in all the states in the country.

™ Lack of skilled providers z Fixed Day Static Services round the year.

™ Withdrawal of payments to the motivators z Setting up performance levels (ELA -


from the community estimated level of achievement) for States in
Terminal and Spacing methods based on local
™ The dependence on the camp approach: unmet need
™ Shift away from the focus on Family Planning z Increasing the basket of choice by
post ICPD in Cairo 1994. systematically and carefully introducing new
9.11 Corrective Actions Taken by and effective contraceptives in the
programme
Government of India for
Addressing these Areas of z Holding of workshops, seminars,
Concern advocacy meet and frequent
interactions with the states to orient them
The following steps were taken by the Government on the GOI's strategy
of India to address the concerns of the providers
and acceptors alike and the programme in general As a result of the above measures and the focused
- strategy at the Government of India level with close
state wise monitoring as also the opportunities
z National Family Planning Insurance afforded under NRHM in terms of plugging the
Scheme since 29.11.05: which covers both loopholes and bolstering the demand side financing
the clients as well as the providers against in the new revised compensation scheme, the deficit
any mishaps like deaths, complications and has not only been wiped out but has also shown a
failures and the ensuing litigations healthy 10.99% increase over 06 -07. Performance
this year (07-08) has been 50,12,766 as against in
z Orders dated 26th July 2007 of
45,48,811 in 06-07.
Hon'ble Supreme Court: The orders

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STATEWISE DESCENDING ORDER OF % OF STERILISATION IN 07-08


2006-07 2007-08 %06-07 % 07-08
INDIA (TO TAL) 45,48,811 50,12,766 -3.8 10.99
SN STATES.
1 Bihar 119977 3,00,918 24.5 150.0
2 West Bengal 136757 2,66,155 -29.9 94.6
3 Orissa 93739 1,20,983 12.9 29.1
4 Madhya Pradesh 366842 4,51,896 0 23.2
5 Arunachal Prad. 1427 2,311 0.7 18.8
6 Sikkim 1471 1,735 -3.1 17.9
7 Gujarat 267549 3,10,064 -4.6 15.9
8 Nagaland 972 1,125 -18.7 15.7
9 Chhatisgarh 133094 1,53,836 6.9 15.6
10 Himachal Pradesh 26445 30,480 -6.8 15.3
11 Rajasthan 288089 3,30,488 -9.2 14.7
12 Jammu & Kashmir 17985 21,800 -16.2 13.1
13 Utttar Pradesh 429441 4,71,891 -4.7 9.9
14 Andhra Pradesh 767593 7,22,111 -5.9 9.0
15 Assam 17,282 18669 -28.6 8.0
16 Uttarakhand 32767 34,799 -6.3 6.2
17 Maharashtra 595728 5,54,284 -9.7 6.0
18 Jharkhand 101297 1,06,383 19.7 5.0
19 Andaman & Nicob 988 1,009 -11.2 2.1
20 Punjab 93758 94,673 -12.9 1.0
21 Lakhsadweep 40 40 75.5 0.0
22 Tamil Nadu 356936 3,52,856 -9.2 -1.0
23 Kerala 127701 1,26,096 -4 -1.3
24 Pondicherry 10483 10,303 2.6 -1.7
25 Dadra & N. Haveli 978 937 5.2 -4.2
26 Goa 5325 5,066 -0.5 -4.9
27 Haryana 85751 80,895 -7.7 -5.7
28 Karnataka 375303 3,52,185 -0.3 -6.2
29 Daman & Diu 500 454 6.6 -9.2
30 Delhi 28746 26,108 -15.9 -9.6
31 Chandigarh 2385 2,152 8.3 -9.8
32 Mizoram 2342 1,833 1 -21.7
33 Meghalaya 2533 1,858 11.9 -26.6
34 Tripura 3303 2,397 -17 -27.4
35 Manipur 185 220 -89 -45.8

The matter is all the more reassuring because the bulk of the improvement has been observed in the eight
EAG states where the increase has been more than 25% approximately.The performance this year has
been 1971194 as against 1565246 in 06-07

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DESCENDING ORDER OF STERILISATION IN 2007-08 IN EAG STATES


2006-07 2007-08 % INCREASE IN 07-08
INDIA (TO TAL) 45,48,811 50,12,766 10.99
EAG- (TO TAL) 1565246 1971194 25.9
SN STATES.
1 Utttar Pradesh 429441 4,71,891 9.9
2 Madhya Pradesh 366842 4,51,896 23.2
3 Rajasthan 288089 3,30,488 14.7
4 Bihar 119977 3,00,918 150.0
5 Chhatisgarh 133094 1,53,836 15.6
6 Orissa 93739 1,20,983 29.1
7 Jharkhand 101297 1,06,383 5.0
8 Uttarakhand 32767 34,799 6.2

9.12 Performance in NSV (Male z The performance of NSV has been better in
Sterilization): the eight EAG where the percentage of
vasectomy to total sterilization has also
Another heartening feature has been the improved to an all time high of 5.6 % in 2007-
performance in male sterilization which has exceeded 08 from 2.9 % in 2006-07
all expectations;
z If the two High Focus States of Himachal
z Percentage of male sterilization out of the total Pradesh and Jammu and Kashmir together
sterilization in the country had been quite low with the two major states of Gujarat and West
at 2.5% of total sterilization during 2006-07. Bengal are also pooled in, then the
contribution is a creditable 7 % in 2007-08
z However the performance in NSV has as against 3.2 % in 2006-07.
substantially improved from 1,14,735 in
2006-07 to 2,26,118 in 2007-08 (an increase z The states which have performed creditably
of over 92%) which is the highest in the in NSV this year has been Gujarat,
country since the last 30 years. Jharkhand, Madhya Pradesh, Himachal
Pradesh, Haryana, Punjab, Delhi, Andhra
z The percentage of vasectomy to total Pradesh, West Bengal, Maharashtra and
sterilization has also improved to a 30 year
Jammu and Kashmir.
high to 4.5 % in 2007-08 from 2.5% in 2006-
07
VA S E C TO M Y

2006-07 2007-08 % in total ster. % in total ster.


(06-07) (07-08)
INDIA 114065 2,19,776 2.5 4.5
EAG states 37383 87,463 2.9 5.6

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The data also reflects that in 18 out of the 29 states However the decline of 8% in the last year has been
in the country, there has been a perceptible shiftin stalled and the graph has shown a 2 % rise this year
focus on male sterilization. Many reasons have been (07-08).
put forth for this. However the main reason identified
With the new alternative training strategy in IUD
is the emphasis given by the state government to
services being piloted in all the states and concrete
the programme. The brightest examples are the
plans in place for rolling out in the remaining states
states of Gujarat, Jharkhand and West Bengal.
in the country by August this year, the much needed
9.13 Factors Responsible for the boost in spacing methods would be injected in the
Upsurge in Sterilization Services programme at the central level and the states are
expected to follow suit. With the implementation of
z Frequent monitoring of the programme this strategy it is hoped the IUD uptake would rise in
through telephones and email the near future.
z Emphasizing the GOI’s state specific 9.14 Future Strategies to Maintain the
strategy of servicing the local unmet need Momentum
at all the forum of interactions with the states
Moreover the ministry has also set in motion new
like state JRMs, RCH review, NRHM review
approaches to sustain the momentum gained in the
and NPCC sub group and final meetings.
sphere of population stabilization this year, some of
z Frequent state tours to attend CMOs’ which are as follows:
meetings to make presentations on the
z Organizing six regional dissemination
family planning strategy of the GOI in the
workshops countrywide shortly in 2007-08
focus states and undertake field visits to
to orient the states on the comprehensive
clarify doubts about various aspects of the
family planning strategy of the Government
programme.
of India.
z The revised compensation scheme, z Statewide dissemination of advocacy
considering that 80% of the operations have material developed by the ministry in
been conducted since September 2007 when collaboration with experts in the field,
the new scheme was operationalised. comprising audio, video and print materials
which have of late has been conspicuous by
z Prompt payment to the acceptors at most
t
is absence in the whole country.
places for their loss of wages to undergo the
surgery. This has empowered them to avail z Rolling out the comprehensive training
of the services, plan for development of trained manpower
in family planning services which has been
z Graded payment to the service
an area of concern for quite some time now.
providers has been one of the force
multipliers. The providers are no more a z Ensuring the fixed day static services
disgruntled lot as their concerns are being round the year for delivery of family planning
addressed. services through increasing the service
centres as well as the pool of trained
z Systematic manpower development plan from manpower
the central level especially in NSV.
z Increasing the basket of choices in
Unfortunately the uptake in IUD services has not contraceptives offering more options to the
picked up as much as the sterilization services. clients.

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z Repositioning the Family Planning development, it is hoped that the performance in
Programme not just for achieving population 08-09 improves further over 07-08 and especially
stabilization but also substantially reducing NSV will regain its preeminent position in sterilization
the maternal mortality and infant and child services in the near future with the men shouldering
mortality and morbidity. the responsibility of family planning and rectifying
the gender inequity prevalent in the society hitherto,
As regards sterilization services the all round
and family planning becomes a way of life with the
improvement seen in the programme both in terms
people of the country.
of service delivery as well as manpower

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Chapter 10

Training Programme

10.1 Introduction care through her drug kits. She will assist in
formulation of village health plan by the village health
Availability of qualitative services to the community and sanitation committee. There will be one A S H A
depends largely upon the efficacy with which health per 1000 population. In tribal, hilly, desert areas,
functionaries discharge their responsibilities, which, their norm could be relaxed to one A S H A per
in turn would depend mainly upon their education habitation, depending on workload etc.ASHA must
and training. Department of Family Welfare had be primarily a woman resident of the village - married
recognized the crucial role of training of health / widow/ divorced, literate with formal education up
personnel in providing effective and efficient health to class VIIIth and preferably in the age group of 25
care to the rural community from the very beginning to 45 years. This may be relaxed only if suitable
of the Five Year Plans. The pre-service and in- person with this qualification is not available.
service training for different categories of health
personnel are imparted through the following Training and Selection of A S H A
schemes/activities: It was envisaged that selection and training process
10.2 ASHA Under NRHM of A S H A will be given due attention by the concerned
State to ensure that at least 50% trained ASHAs are
The Government of India in April 2005 has launched in place by 2007 and 100% by 2008. ASHAs are to
the NRHM to improve access of people, especially be selected by the community, from among the
the poor women and children to quality primary health residents within the community. She is to work in close
care services. Accredited Social Health Activist coordination with AWW and ANM and these will be
(ASHA) is a major strategic intervention under the integrating in their roles with use of common resource
mission. Initially the scheme was for the 10 high focus facilities like AWW centres etc. Capacity building of
States namely, Uttar Pradesh, Uttaranchal, Bihar, ASHA is critical in enhancing her effectiveness and
Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, this has been seen as a continuous process. The
Rajasthan, Assam and Jammu & Kashmir. Later on it induction training of A S H A would be completed in 23
has been extended to NE states and tribal areas of days spread in five rounds over a period of 12 months
other states. to be followed by periodic re-training for about two
days once every alternate month. For the training
ASHA is envisaged as a trained women community of ASHA, four training modules based on thematic
health volunteer who will reinforce community action approach have been developed. These have already
for universal immunization, safe delivery, new born been disseminated to the states. The States have
care, prevention of water borne and communicable translated the training modules in the local language
disease, improved nutrition and promotion of for use in the training of ASHAs. Progress made in
household toilets. She will inform, interact, mobilize selection and training of ASHAs (as on 27.2.09)
and facilitate improved access to preventive and given in following on next page:-
promotive health care and also provide basic curative

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Sector Total
10 High 8 NE High Total in 18 In other Non
focus focus High Focus High Focus
States States States States

No. of ASHAs proposed for the 455595 50838 506433 322942 829375
Mission Period

No. of ASHAs selected during 05-06 119642 10673 130315 - 130315


No. of ASHAs selected during 06-07 221736 29639 251375 49261 300636
No. of ASHAs selected during 07-08 58799 5031 63830 107787 171617
No. of ASHAs selected during 08-09 11984 3969 15953 71239 87192
Total Selected 412161 49312 461473 228287 689760
% Selected out of Proposed 90.47 97.00 91.12 70.69 83.17
Total Trained 386263 46461 432724 170084 602808
% Trained out of selected 93.72 94.22 93.77 74.50 87.39
%Trained out of Proposed 84.78 91.39 85.46 52.67 72.68

Funds for this activity are being release by NRHM was felt in all the States, the expansion of A S H A
Division from NRHM flexi pool against requirement scheme to the rest of the states was approved in the
and activities proposed by states in NRHM meeting of 9th Empowered Programme Committee
Programme Implementation Plan. (EPC) held on 3rd January, 2008. Later on it was
approved in the meeting of 4th Mission Steering
10.3 Support Mechanism For ASHA Group (MSG) held on 04.08.08.
Being a volunteer from community it is felt that A S H A
In view of the above it is suggested that the Link
cannot work in isolation or in absence of support in
Worker/and other name given to CHW in the state
her work in the villages. She has to reach out to the
may be appropriately synergized with the term ASHA.
women from lower income quintiles so as to address
Also the state may like to select ASHAs for hitherto
equity dimension in coverage with services and
uncovered areas as per norms and necessity.
improvement in health outcomes. She will definitely
need some kind of institutional support in initial ASHA Mentoring Group
phase. Absence of such support in her work will not
be conducive for effective functioning and sustaining The Government of India has set up an A S H A
her interest in the scheme. Mentoring Group comprising of leading NGOs and
well known experts on community health. Similar
The following set of guidelines have been issued to mentoring groups at the State/District/Block levels
enable the States to develop and put in place a could be set up by the States to provide guidance
proper support mechanism for ASHA. The States have and advise on matter relating to selection, training
been requested to take appropriate steps to locally and support for ASHA. At the District level, MNGOs
adopt these guidelines and make the A S H A scheme and at Block level, FNGOs could be involved in the
a complete success. mentoring of ASHA. The State Govt. may utilize the
Expansion of A S H A Scheme to the rest of States. services of Regional Resource Centre (RRC) and
include them in the Mentoring Group at the State
Since requirement of a Community Health Worker level.

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A N N U A L RE P O R T 2008-09
Selection of A S H A Familiarizing A S H A with the village

As A S H A will be in the village on a permanent basis, After the selection of ASHA, the next step would be
she should be selected carefully through the process to familiarize her with the health status of the villagers
laid down in the first set of A S H A guidelines. It is and facilitate her adoption to the village conditions.
possible that the selected A S H A drops out of the Although, A S H A hails from the same village, she may
programme. It is, therefore, necessary to keep a not be having knowledge and information on the
record of such cases at Subcentre/ PHC level. In the health status of the village population. For this
above circumstance, a new A S H A could be selected purpose, she should be advised to visit every
from the panel of three names previously prepared household and make a sample survey of the
on the recommendation of the Gram Sabha. residents of village to understand their health status.
This way she will come to know the villagers, the
Training of A S H A
common diseases which are prevalent amongst the
The guidelines already issued on A S H A envisage a villagers, the number of pregnant women, the number
total period of 23 days training in five episodes. of newborn, educational and socio economic status
However,itisclarifiedthat ASHA training is a continuous of different categories of people, the health status
one and that she will develop the necessary skills & of weaker sections especially scheduled castes/
expertise through continuous on the job training. After scheduled tribes etc. She can be provided a simple
a period of 6 months of her functioning in the village it format for conducting the surveys. In this the AW W
is proposed that she be sensitized on HIV / AIDS issues and the Village Health & Sanitation Committee should
including STI, RTI, prevention and referrals and also support her.
trained on new born care.
The Gram Panchayat will be involved in supporting
Training for the 5th Module ASHAs in her work. All ASHAs will be involved in this
Village Health and Sanitation Committee of the
To further strengthen the activist role of the ASHA,
Panchayat either as members or as special invitees
the 5th Module for Training of ASHAs has been
(depending on the practice adopted by the State).
developed by Chetna, an NGO. It has already been
ASHAs may coordinate with Gram Panchayats in
placed before the A S H A Mentoring Group at the
national level. Given the contents of the 5th module, developing the village health plan. The untied funds
a lot of the emphasis is on the self actualization of placed with the Sub-Centre or the Panchayat may
the A S H A as the community activist. The NRHM be used for this purpose. At the village level, it is
Framework for Implementation has already provided recognized that A S H A cannot function without
for setting up of grants in aid committee at the State support. The SHGs, Woman's Health Committees',
level to process proposals of NGOs. A network of Village Health and Sanitation Committees' of the
NGOs is also available through the NGO Division of Gram Panchayat will be major sources of support to
the Ministry of Health and Family Welfare with RRCs ASHA. The Panchayat members will ensure secure
MNGOs, FNGOs etc. at various levels. The and congenial environment for enabling ASHAs to
organization which has prepared the module has also function effectively to achieve the desired goal.
accepted the responsibility for training of master
Maintenance of Village Health Register
trainers who can then rollout the 5th module in the
field. The National Health System Resource Centre A village health register is maintained by the AW W,
(NHSCR) which is now the Secretariat for the A S H A which is not always complete. A S H A can help AW W
Mentoring Group at the national level is also willing, to complete and update this register by maintaining
to facilitate the rollout of the 5th module with the active a daily diary. The diaries, registers, health cards,
involvement of the NGOs in the States under the over immunization cards may be provided to her from the
all direction and supervision of State/UT untied funds made available to the Sub-Centres.
Governments.

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A N N U A L RE P O R T 2008-09

Organization of the Village Health and Nutrition to receive her incentives. States may ensure that
Day payments to ASHAs are made promptly through a
simplified procedure. During these meetings, the
All State Governments are presently organizing support received from the Village Health and
monthly Health and Nutrition day in every village Sanitation Committee and their involvement in all
(Anganwadi centers) with the help of AWW/ANM. activities also should be carefully assessed. The
A S H A along with AWW should mobilize women, ASHA kits also could be replenished at that time.
children and vulnerable population for the monthly Replenishment of kit should be prompt, automatic
health day activities like immunization, careful and through a simplified procedure.
assessment of nutritional status of pregnant/lactating
women, newborn & children, ANC/PNC and other Monthly meetings of A S H A s
health check-ups of women and children, taking
weight of babies and pregnant women etc. and all A meeting of A S H A could be organized on the day
range of other health activities. The ANM and the monthly meetings are organized at the PHC level to
AWW will guide the A S H A during the monthly health avoid unnecessary travel expenditure and wastage
days. The organization of the monthly Health and of time. The idea is that apart from the meeting with
Nutrition Days ought to be jointly monitored by the officials they should be given opportunity to share
CDPO, LHVs, and the Block Supervisor of the ICDS sometime of their own experience, problems, etc.
periodically. They will also get an opportunity to independently
assess the health system and can bring about much
Co-ordination with SHG Groups needed changes.

ASHA would be required to interact with SHG Groups, In addition to monthly meetings at PHC, periodic
if available in the villages, along with AW W, so that a retraining of ASHAs may be held for two days once
work force of women will be available in all the villages. in every alternate month where interactive sessions
They could jointly organize check up of pregnant will be held to help then to refresh and upgrade their
women, their transportation for safe institutional knowledge and skills, as provided for in the original
delivery to a pre-identified functional health facility. guidelines for ASHA.
They could also think of organizing health insurance
at the local level for which the Medical Officer and Block level management
others could provide necessary technical assistance. At the block level, the BMO will be in overall charge
Meeting with A N M of A S H A related activities. However, an officer will be
designated as Block level organizer for the A S H A to
ANM should have a monthly meeting with the ASHAs be assisted by Block Facilitators (one for every 10
stationed (5-6 ASHAs) in the villages of her work area ASHAs). Block Facilitators could be appointed as
at the Anganwadi Centre during the monthly Health provided for under the first set of guidelines on A S H A
and Nutrition Day to assess the quality of their work already issued to the States. The Block Facilitator
and provide them guidance. must necessarily be women. However, male members
if any, who may have already been appointed earlier
Monthly meetings at PHC level as Block Facilitator may continue. The Block
The Medical Officer In-charge of the PHC will hold a Facilitators would provide feedback on the
monthly meeting which would be attended by A N M functioning of ASHAs to the BMO & Block level
and ASHAs, LHVs and Block Facilitator. During this organizers. They shall also visit the ASHAS in villages.
period, the health status of the villages will be Management Support for A S H A
carefully reviewed. Payment of incentive to ASHAs
under various schemes could be organized on that Officials in the ICDS should be fully involved in ASHAs
day so that A S H A need not visit the PHC many times activities and their support should be provided for at

140
A N N U A L RE P O R T 2008-09
every level i.e. PHCs, CHCs, District Society etc. The be to provide support to A S H A from village to the
management support which would be provided under district level without any blockage on the way.
RCH/NRHM at the Block, District & State level should
be fully utilized in creating a network for support to Funding Norms
ASHA including timely disbursement of incentives, at Under the present funding norms Rs. 10000/- per
various levels.This support system should have full ASHA are available out of which Rs. 6415/- are
information on the number of ASHAs, quality of their earmarked for selection process, training of ASHA,
out put, outcomes of the Village Health and Nutrition training of trainers, drug kit. Remaining part of Rs.
Day, periodic health surveys of the villages to assess 3585/- can be used by State Govt. for A S H A support
her impact on community etc. system which includes funding support for A S H A
Community monitoring resource center, programme management unit at
district health society, at block level and at PHC level.
Periodic surveys are envisaged under NRHM in every
village to assess the improvement brought about by Compensation to A S H A
ASHA and other interventions. The funding for the ASHA is an honorary volunteer and would not receive
survey will be provided out of the untied funds any salary or honorarium. Her work would be so
provided to the Sub-Centre. The first survey would tailored that it does not interfere with her normal
provide the base line for monitoring the impact of livelihood.
health activities in the village.
However A S H A could be compensated for her time
Role of District Health Missions: in the following situations:
The District Health Mission in its meetings will specially .
i For the duration of her training both in terms
assess the progress of selection of ASHAs, their of TA and DA. (So that her loss of livelihood
training and orientation, usefulness to the villages for those days is partly compensated)
etc. They should also have a Cell in the DPU to collect
all information related to A S H A and the community, i. For participating in the monthly/bi-monthly
which should be available on the computer network. training, as the case may be. (For situations
This information should be accessible by the State (i) and (ii), payment will be made at the venue
Health Missions as well as the Mission at the national of the training when ASHAs come for regular
level. training sessions and meetings).

Linkages with Health Facility iii. Wherever compensation has been provided
for under different national programmes for
The success of NRHM to great extent depends on undertaking specific health or other social
performance of A S H A and her linkage with functional sector programmes with measurable outputs,
health system. The health system has to give due such tasks should be assigned to ASHAs on
recognition to A S H A and take prompt action on the priority (i.e. before it is offered to other village
referrals made by her; otherwise the system cannot volunteers) wherever they are in position.
be sustained. Every A S H A must be familiar with the (For situation iii. Disbursement of
identified functional health facility in the respective compensation to ASHAs will be made as per
area where she can refer or escort the patients for the specific payment mechanism built into
specific services. The persons manning these health individual programmes).
facilities should be sensitized to effectively respond
to the instant needs of the local people. Funds Other than the above specific programmes, a number
available under IEC programme may be used for of key health related activities and service outcomes
education and publicity in respect of above services. are aimed within a village (For example all eligible
The role of the State & District level Missions would children immunized, all newborns weighed, all

141
A N N U A L RE P O R T 2008-09

pregnant women attended an antenatal clinic etc). region specific health channels. While Submitting
The Untied Fund of Rs.10,000/- at the Sub-Center their PIPs, the States will have to provide complete
level (to be jointly operated by the ANM and the details of activities for which performance based
Sarpanch) could be used as monetary compensation payments will be admissible to the ASHAs. The
to A S H A for achieving these key processes. The payment arrangements from programme funds must
exact package of processes that form the package be taken into account before determining the activities
would be determined at the state level depending for which the Gram Panchayat shall provide payments
on the supply - side constraints and what is feasible to entire that there is no duplication or delay.
to achieve within the specified time period) for
situation iv.The payment to ASHAs will be made at States to decide in the context of their needs to
Panchayats). ensure that the Accredited Social Health Activists
remains a community worker accountable to local
It has been felt that a wider range of public health community institutions like the village Health and
functions be brought under the performance based Sanitation Committee. This is being emphasized to
payment arrangementsfor ASHAs. An illustrative list retain the character of the A S H A worker as a member
of such public health functions is as follows: of the community rather that the last rung in the
health bureaucracy.
.
I Organizing Village health & Nutrition Day.

I. Making a series of five family visits in the first 10.4 NHSRC Support for Strengthening
month of life of which one visits is in the first Community Process Under NRHM
two hours-for home based newborn care and
1. Drafting out 'Terms of Reference' for
early detection of sickness in the neonate.
effectively functional 'ASHA Resource Center'
III. Maintaining and updating a village health or 'Community Process Resource Center' for
register that could be used in village health setting up of support structures at the State,
planning and promotion of complete districts and block levels of programme
registration of births and deaths. facilitation - Draft TOR and work plan is ready
for States of Uttarakhand, Orissa, Madhya
As regards the delayed performance based Pradesh, Rajasthan and Jharkhand. This is
payments, the current arrangement is to provide this finalized for Orissa which is presently under
payment under the approved programmes of implementation. In case of other states the
government. While efforts have been made to
work plan is approved incrementally.
ensure timeliness of such payments, the States may
consider, if feasible(if account could be maintained 2. Capacity building of State 'ASHA Resource
and expenditure reported periodically), creating a Centres' in setting up 'Support Structures'
permanent advance of Rs.5000/- at the level of the and Training of District level and Block level
sub centre head in the joint account of ANM and support team on 'Community Processes'-
Sarpanch to facilitate performance based payments
for activities which are not covered under existing z Processes initiated for the 'Community
approved programmes. The Gram Panchayat shall processes Resource Center' in Orissa
make the decision for payment based on the priorities (Recruitment and Training of District
and the approved norms for the specific region. The Coordinators completed)
provision for a permanent advance at the Sub centrer
z Processes of recruitment of District
level has been provided in the Framework for
coordinators initiated in Jharkhand
Implementation of NRHM State Governments, may
like to operationalize this to facilitate both the z Madhya Pradesh, Rajasthan the process
timeliness of payments as also the wider range of of District Coordinators deployment is yet
performance based arrangement that will meet to begin

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A N N U A L RE P O R T 2008-09
z Deployment of Block level facilitators Dialogue initiated with state of UP for
covering 50% of districts in Madhya organizing master trainers training on Module
Pradesh is completed - orientation plan V in four different zones in the state.
is in place
7. Conducting Assessments of 'State specific
z Orientation on PIP review and input to innovations for initiating mid-course
revision of 'Annual work Plan' relating to corrections' and suggesting states for scaling
'Community Processes' is initiated up of best practice problem solving strategies
on 'Sustaining Community Processes under
z Assisted State of UP for the recruitment NRHM' - An ongoing supportive supervision
of District A S H A Coordinators - for exercise is carried out bi-monthly by reviewing
implementation support to A S H A Scheme State Facilitator's performance, status of
ASHA implementation support, revised work
3. Establishing and operationalising guidelines
plan for the subsequent period specific to
on 'periodic review and supportive
concerned state. This is mostly facilitated
supervision' for effective monitoring of
jointly with the Training Division, MOHFW,
Community Processes - A S H A & VHSCs and GOI. This is communicated to NRHM, Mission
involvement of PRIs and NGOs - Facilitators Director through NHSRC State Facilitators'
Manual for ' Community Processes' is made in these States along with Training Division
available in all these states where NHSRC & ED, NHSRC on a regular basis.
State Facilitators are in Place.
10.5 Centrally Sponsored Scheme of
4. Handholding of district support mechanism, "Basic Training of ANM/LHV"
reporting & documentation on state specific
strategies, facilitation of support system at ANMs/LHVs play a vital role in MCH and Family
the state level in coordinating Department of Welfare Service in the rural areas. It is therefore,
Health, Mission Directorate and NHSRC for essential that the proper training to be given to them
technical assistance - Ongoing activity. so that quality services be provided to the rural
population.
5. Secretariat for the 'ASHA Mentoring Group'
in organization and coordination of State For this purpose 318 ANM/Multipurpose Health
level AMG for optimizing NGO involvement in Worker (Female) schools with an admission capacity
of approximately 13,000 & 42 promotional training
Community Processes-Facilitation of three
schools for LHV/ Health Assistant (Female) with an
National AMG consultations including one
admission capacity of 2600.
Regional AMG Consultation for the NE states
along with state level AMG consultation for These training institutions are imparting pre-service
states of Rajasthan, Orissa, Jharkhand and training to prepare required number of ANMs and
Madhya Pradesh in initiated. LHVs to man the Sub centres, Primary Health
Centres, Community Health Centres, Rural Family
6. Mobilizing NGO involvement through
W elfare Centres and Health posts in the country.The
Government-NGO cooperation in organization duration of training programme of ANM is one and
of TOT for Module V in respective state level half years and minimum admission requirement for
and rolling out of A S H A training at block level this course is 10th pass. Senior ANM with five years
involving Mother NGOs/Field NGOs/RRCs of experience is given six months promotional training
and NHSRC - initiated in the states of to become LHV/ Health Assistant (Female). Health
Uttarakhand, Assam for the master trainers Assistant(Female) provides supportive supervision
training on Module V.This will follow similar and technical guidance to the ANMs in sub-centres.
exercise for the states of Jharkhand, Orissa Curricula of these training courses are provided by
and Madhya Pradesh in the same order. the Indian Nursing Council.

143
A N N U A L RE P O R T 2008-09

The staffing pattern of the school for, which financial Item Norm (in Rupees)
assistance is provided by the Department of Family
Welfare, varies according to the annual admission Rent (for basic schools) Rs. 10,000 / month
capacity of the school. The financial pattern of
Rent for hostel Rs. 250 / month per
assistance has been revised w.e.f. 7.2.2001. Other
(for basic schools) candidate
approved costs besides salary to staff are stipend
to trainees, contingency and rent. Stipend Rs. 300 / month /
candidate
Item Norm (in Rupees)
Educational Aids and Rs. 15,000
1. Salary & allowances As per State
Training Material per annum
of staff Government
2. Stipend for trainees 500/- per month/ Transportation Rs. 30,000
trainee (for hiring bus) per annum

3. Contingency 10,000/- per annum Contingency Rs. 50,000


school per annum
4. Rent* 60,000/- per annum
Funds under the scheme are released by Family
school
W elfare Budget Section on the basis of audited A/C
* Rent payable in respect of such schools, which are functioning in submitted by States and unspent balance with states.
rented buildings.
Under the scheme during 2008-09 under BE
Funds under the scheme are released by Family Rs.1023.00 lakhs were available.
W elfare Budget Section on the basis of audited A/C
submitted by States and unspent balance with states. 10.7 Maintenance of Health and
Under the scheme during 2008-09 under BE Family Welfare Training Centre
Rs.7834.00 lakhs were available. 47 Health and Family Welfare Training centres were
10.6 Centrally Sponsored Scheme of established in the country in order to improve the
"Basic Training for Multi Purpose quality and efficiency of the Family Planning
Programmes and to bring the changes in the attitude
Health Worker (Male)"
of the personnel engaged in the delivery of health
The Basic Training of Multi Purpose Health Worker services through in service training programmes.
(Male) scheme was approved during 6th Five-Year These training centres are supported under
Plan and taken up since 1984, as a 100% Centrally Centrally Sponsored Scheme of "Maintenance of
Sponsored Scheme. This training is provided Health and Family Welfare Training Centre".
through Health & Family Welfare Training Centres
These training centres are now conducting various
and also through basic training schools of
Multipurpose Health Workers (Male). The training is in-service training programmes of Department of
of one-year duration and on successful completion Family Welfare. Apart from in-service education
of the training, the Male Health Worker is posted at some of the selected centres are also responsible
the sub-centre along with an ANM/Health Worker for conducting the basic training of Male Health
(Female). W orker's course of one year.

The financial pattern of assistance for this scheme Apart from the salary of the staff of the training
has been revised since 7.2.2001. Under the scheme centres, other assistance under the scheme includes
the salary of the staff, rent for school and hostel, contingency for purchase of educational material,
stipend for trainees, educational aids and training rent for training centres and payment to guest faculty.
material, transportation and contingency are The financial pattern of assistance for this scheme
supported. The financial norms are as follows:
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A N N U A L RE P O R T 2008-09
has been revised since 7.2.2001. The details of the Funds under the scheme are released by Family
financial norms are as follows: W elfare Budget Section on the basis of audited A/C
submitted by States and unspent balance with states.
Item Norm (in Rupees) Under the scheme during 2008-09 under BE
Rs.1692.00 lakhs were available.
Contingency Rs. 15,000
per annum 10.8 Revised Norms of TA/DA for
Rent* Rs. 40,000
Trainers Particularly for Anaes-
per annum thesia and Emoc Trainings

Payment to Rs. 50,000 Mission Steering Group in its meeting on 28.1.09


Guest Faculty per annum approved the revised norms of TA/DA for trainers
invited to conduct examination and undertake
monitoring visits particularly for Anaesthesia and
*Rent payable in respect of such centres that are functioning from
EmOC trainings. It has also approved the revised
rented buildings.
norms of DA for the participants.

Approved rates for TA/DA for Experts for Certification and Monitoring of Anaesthesia
and EmOC trainings:
(in Rs.)

Accommodation (If Examination Honorarium Travel per day


Government accommodation Fee per day per day during
is not available) monitoring
State Capital District Level

Guest faculty/ 3000 2000 NIL 1000 As per the


Outstation approved rates
Experts of Central
(Monitoring) Government
Experts 3000 2000 1500 NIL Same
Examiners
Trainees 500 300 NIL NIL NIL

Approved DA for Group A, B, C and D : 10.9 Report of Training Activities


Under NRHM / RCH - II
S. Budget Head Proposed DA
No. rates (Rs per National Institute of Health and Family Welfare
day) (NIHFW), has been identified as Nodal Institute with
support of 18 Collaborating training Institutes (CTls)
1 D A to group A, B and 700 for training under NRHM/RCH - II. NIHFW has pursued
equivalent participants responsibilities of organizing National level Training
Courses and coordination of the NRHM including
2 DA to group C, D and 400 RCH training activities with the help of Collaborating
equivalent participants Training Institutions (CTls) in various parts of the
country. Under this programme Rs.600 lakhs were

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A N N U A L RE P O R T 2008-09
available under BE 2008-09. The activities being ANM for IUCD insertion is continuing in all
undertaken in this regard are given below: the states. The objective is to ensure that
there is adequate number of trained
Training Courses / Workshops and other related manpower to provide good quality of services
activities at National Level (at NIHFW)
for prevention and management of unwanted
a.) PMU pregnancy. During the quarter, 5226 persons
have been trained in various specialized
z A workshop for Officials of SPMSU & clinical skill training programme. .
DPMSU of High Focus States was at
NIHFW Delhi from 5th - 7th January 2009. b.) S B A Training:
39 participants from the states of Assam,
Arunachal Pradesh, Himachal Pradesh & The objective of SBA training is to upgrade
Jharkhand attended the course. skills of ANM/LHV/Staff Nurses, posted in
district hospital/ CHC/PHC to improve quality
Training of Trainers (TOT) Conducted at State of intra-partum and New Born care in institution
Level and achieve better maternal and infant
salvage. During the quarter (Jan.-March 09),
a.) SBA :- During the quarter (Jan.-March 09),
7502- persons were trained in SBA and a total
174persons were trained as Trainers (TOT).
of 17316 persons were trained upto 31.03.09.
Training at District Level
Achievement in various types of Training:-
a.) Specialized Clinical Skill Training
Details regarding the total number of persons trained
Specialized Skill Training of MOs in Minilap during the quarter and since beginning of the
sterilization and MTP as well as a team of programme under each of the above training
Gynecologist/Surgeons, Staff Nurse and OT activities reported upto 31/03/09 are given in the
Technician for Laparosocpic sterilization and consolidated table below:-

Type of Training Progress from Cumulative Progress


01-01-09 to 31-03-09 upto - 31-03-09
(since inception)
Integrated Service Delivery under NRHM
National Level - 280
State Level 135 393
PMU National Level - 70
Workshop (at NIHFW) 39 105
State Level 427 202
SBA National Level - 121
State Level 174 4035
District Level 7502 17316
Contraceptive National Level - 133
State Level 572 2632
IUD - 380 Training National Level - 164
District Level 5420 5686
IMNCI 26446 80955
RTI/STI 1123 1123
Anesthesia 479 479
EmOC 1791 1791
Blood Storage (MO/LT) 577 577
Specialized Clinical Skill Training 5226 56166
Note: State wise cumulative progress report is enclosed as per annexure

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A N N U A L RE P O R T 2008-09
Meetings / Workshop: 10.10 Professional Development
Course (PDC):-
z Sub-group meeting were held at MOHFW in
order to review the PIP from. The PIPs all z The Professional Development Course for
State & UTs for 2009-10 were revised and M anagement, Public Health & Health Sector
the following issues highlighted on (i) 09-02- Reforms for District Level Medical Officer
09 Rajasthan, Andhra Pradesh, (ii) 10-02- funded by MOHFW was stared with the
2009 Chhattisgarh & Gujarat, (iii) Jharkhand objective of training middle level medical
& West Bengal, (iv) 12-02-09 Madhya officer with 12-16 years of services, to be
Pradesh & Kerala (v) 13-02-09 Uttar Pradesh able to function effectively for service
& Maharashtra, (vi) 16-02-09 Tamil Nadu & delivery.This integrated training incorporates
Bihar, (vii) 17-02-09 Karnataka & Orissa, (viii) management, public health ongoing reforms
18-02-09 Himachal Pradesh & Uttarakhand
in the country including the NHRM in a ten
and 19-02-09 J&K, Punjab & Goa. Nodal
weeks programme.
Officer, (NRHM/RCH-II) & Consultant &
Faculty NIHFW attended the meeting. z This Course is now a component of IPHS
norms for Medical Officer at District Level in
z NPPC meeting were conducted at Nirman
NRHM. Supervision and mentoring has been
Bhawan. Faculty & Consultants NIHFW
done regularly by faculty from NIHFW. The
attended the NPCC meeting in the following
dates (i) 24-02-09 Rajasthan, Andhra course was started by NIHFW (Nodal Institute)
Pradesh, Chhattisgarh, (ii) 25-02-09 in 2001 and has been rolled out with 15 CTI
Jharkhand, West Bengal, Madhya Pradesh, participants in conduction of the course.
Kerala, (iii) 26-02-09 Uttar Pradesh,
z During the year 2008-09 (till 31st March,
Maharashtra, Tamil Nadu, Bihar (iv) 27-02-
2009), a total of115 and a cumulative total
09 Karnataka, Orissa, Haryana, Himachal
of 1129 officers have been trained from
Pradesh, (v) 03-03-09 Uttarakhadn, J&K,
various states.
Punjab, Goa. Nodal Officer, (NRHM/RCH-II) &
Consultant & Faculty NIHFW attended the
meeting.

Participants trained during the quarter from Jan. - March 2009


S. Name of the Institute Date No. of Trained Remarks
No. Participants

1. 10th Course at NIHFW 28/07/08 to 04/10/08 17


2. 5th Course SIHFW Ahmedabad 18/08/28 to 24/10/08 20
3. 4th IIHMR, Jaipur 10/11/08 to 17/01/09 16
4. 5th Course SGPGIMS, Lucknow 10/11/08 to 18/01/09 25
5. 5th Coruse SIHFW,Ahmedabad 18/08/08 to 24/10/0/ 20
6. 7th Course PHI, Nagpur 16/08/08 to 19/10/08 17
Total 115

Note: State wise cumulative progress report is enclosed as per annexure

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Chapter 11

Research

11.1 Research Activities Under RCH 11.3 Central Drug Research Institute
Programme (CDRI, Lucknow)
The need for research and development in the areas The mission of the institute is to strengthen and
related to the RCH is extensive. The research advance the field of drug research in India. It has
activities in the country in the field of contraceptives the following charter of activities:
research have been modest due to meager financial
z Development of new drugs and diagnostics.
support for Research and Development activities and
also because research expertise beyond ICMR was z Cellular and molecular studies to understand
not utilized. With a view to increase research efforts disease processes and reproductive
the National Committee on Research in Human physiology.
Reproduction (NCRHS) constituted a committee in
September 1997 and identified national priorities. z Development of contraceptive agents and
Presently the committee is called as "Research devices.
Advisory Committee (RAC) for RCH and
z Systematic evaluation of medicine properties
Contraceptive study" which is chaired by the
of natural products.
Secretary (H&FW) and meets regularly to scrutinize
and fund the various proposals received from NGOs z Development of technology for drugs,
and other Government institutions. intermediates and biological.
Guidelines for the submission of projects and the z Dissemination of information in the field of
areas identified for research has been put up on drug research, development and production.
the website of this ministry. Presently many
research projects are in different stages of z Consultancy and development of technical
implementation. ma npower.

11.2 Indian Council of Medical Among the notable achievements of this institution
in the contraceptives field is the development of
Research (ICMR)
Centchroman, an oral non steroidal contraceptive
The Indian Council of Medical Research (ICMR), and CONSAP a contraceptive cream. Both the
the apex body for the planning, organization, products are now available in the market.
implementation and coordination of medical Government of India provides grant in aid to this
research in the country promotes biomedical institution for its research activities.
research through a network of its 21 permanent
Institutes and 6 Regional Medical Research Centres
11.4 Testing Facility at IIT, Kharagpur
distributed throughout the country and also through In order to ensure that quality equipments are utilized
grants-in-aid given to projects in non-ICMR in the program, a national centre for testing of IUD
Institutes. The budget allocation for ICMR for 2008- and tubal ring was set up at the Bio-medical
2009 was : Plan Rs. 286.00 Crores and Non-Plan Engineering wing at IIT, New Delhi in 1986-87 with
Rs.110.00 Crores. financial assistance from UNFPA. Since April, 1992

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the Centre is being funded by Government of India. professionals throughout the country. It is one of
IIT is imparting training to personnel of different testing the largest voluntary organizations working in the field
laboratories in good testing procedures and also of public health, medical education and for
gives training on good manufacturing procedures to propagation of Family Welfare Programme through
the industries manufacturing contraceptives and NSV t
is local branches in the States/UTs.
instruments. It is also engaged in the process of
conducting research in development of new The Government of India has entrusted the following
contraceptives and contraceptive technologies. The activities to IMA :
centre is now functioning from the School of Medical z Holding of seminars/trainings/workshops on
and Biological Sciences at IIT, Kharagpur. contraceptive updates to propagate the
message of small family norm and adoption
11.5 Indian Medical Association
of spacing and permanent methods;
The Indian Medical Association (IMA) with its
z Establishment of Family Welfare Cell at IMA
headquarters in Delhi has been functioning for over
headquarters for dissemination of information
65 years through a network of 1200 branches with a
on family welfare and the existing policy.
total membership of over 1,30,000 medical

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Chapter 12

Other National Health Programmes

Several National Health Programmes are now under District Cancer Control Programme: A grant-in-
the umbrella of NRHM. Details of other National aid of Rs.90.00 lakhs spread over a period of 5 years
Health Programmes are in this chapter. is provided for the District Cancer Control Program.

12.1 National Cancer Control Decentralized NGO Scheme: A grant of Rs.8000/-


Progarmme per camp is provided to the NGOs for IEC activities
through nodal agency of the State Govt.
Cancer is an important public health problem with 8
to 9 lakh cases occurring every year. At any point of Guidelines for the various schemes are available on
time, it is estimated that there are nearly 25 lakh the official website of the Ministry of Health & Family
cases in the country. Every year about 4 lakh deaths Welfare at www.mohfw.nic.in.
occur due to cancer. 40% of the cancers in the The EFC for the 11th five year plan in respect of
country are related to tobacco use. Hence Tobacco- National Cancer Control Programme is at final stages
related cancers are very common among males which also includes a component of "Public Private
namely cancers of the lungs and oral cavity. Among Partnership". It has also been propose to enhance
women, cancer of uterine cervix and breast are the quantum of assistance under various schemes.
common.National Cancer Control Programme was
launched in 1975-76 with the objectives of primary Regional Cancer Centres : As of now, there are
prevention, early detection, treatment and 27 Regional Cancer Centres (RCC) in different parts
rehabilitation. In view of the magnitude of the problem of the country mainly responsible for carrying out
and the requirement to bridge the geographical gaps research activities and for providing comprehensive
in the availability of cancer treatment facilities across cancer care services.
the country, the programme was revised in 1984-85
and subsequently in December 2004. Oncology wing: Support has been given to both
Government Medical Colleges and Government
National Cancer Control Programme (NCCP) has the Hospitals for development of Oncology wing. At
following schemes: - present there are 210 institutions having more than
350 teletherapy facilities across the country.
Recognition of New Regional Cancer Centers
(RCCs): A one-time grant of Rs.5.00 crores is being IEC Activities: Health education is an important tool
provided for New RCCs. for prevention and early detection of cancers, which
is given importance in every scheme under the
Strengthening of existing Regional Cancer National Cancer Control Programme. The programme
Centers: A one-time grant of Rs.3.00 crores is supports activities of health magazine 'Kalyani' and
provided to the existing Regional Cancer Centers. telecast by Prasar Bharti targeting especially those
Development of Oncology Wing: Government living in the most populous States.
Hospitals & Government Medical Colleges are It is an interactive programme which provides an
provided with a grant of Rs.3.00 crores for the interface to the people with experts on various health
development of Oncology Wing. and social issues. Kalyani is telecasted through

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ANNUAL REPORT 2008-09

9 capital Doordarshan stations and 12 sub regional Early detection, treatment, follow-up and
stations. IEC materials in the form of audio-video management of cancer cases are the main services
spots, posters, leaflets, flipcharts etc. have been to be provided by this project.
developed and advertisements have been inserted
in the leading dailies for creating awareness among National Cancer Awareness Day: The birth
the general masses. anniversary of Nobel Laureate Madam Curie, 7th
November is being observed as National Cancer
Onconet- India: All 27 RCCs will be linked with each Awareness Day since 2001, to create more
other and also each RCC would in turn be linked to awareness about cancer. The slogan for this year
4 peripheral centres thus facilitating telemedicine was "Detect Early, Save Life'. Like all the years the
services and continued medical education. same was observed by the Regional Cancer Centres
Telemedicine Services including tele-consultations, by conducting activities related to creating awareness
tele-referral, tele-pathology etc. will be provided. about cancers.

On 7th November, 2008 Regional Cancer Centres Establishment of Health Minister's Cancer Patient
at Kancheepuram, Bikaner, Shimla and Kolkata Fund - Approval of Competent Authority has been
conducted camps for early detection of cancer cases, obtained for establishment of Health Minister's
workshops for health care workers, rally etc which Cancer Patient Fund with a total outlay of Rs. 100.00
are shown above. crore from the National Cancer Control Programme.

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Budget Allocation: The tentative budget for the i) To encourage mental health knowledge and
11th Five Year Plan for NCCP is Rs. 2400.00 crores skills in general health care and social
and the budget allocation for 2008-09 is Rs. 120.00 development.
crore.
iii) To promote community participation in mental
12.2 National Mental Health health service development and to stimulate
Programme self-help in the community.

It is estimated that about 1-2% of the population suffer As reflected in the National Health Policy 2002, the
from major mental disorders and about 5% of the objectives of the NMHP and global trend of
population from minor depressive disorders. It is also community care of mentally ill, community based
estimated that 25% of people who attend primary mental health care at district level was initiated as
health care clinics suffer from various types of District Mental Health Programme (DMHP) in 1996
psychological problems. Around 20% of all patients and it was extended to 27 Districts across 22 states/
seen by primary health care professionals have one U Ts in the IXth plan.
or more mental disorders. One in four families is likely
to have at least one member with a behavioural or NMHP during Xth Plan
mental disorder. These families not only provide An evaluation of the NMHP was undertaken in 2003
physical and emotional support, but also bear the and the programme was restrategised to incorporate
negative impact of stigma and discrimination. Together expansion of DMHP to 100 districts all over the
these disorders accounted for 12% of the global
country, modernisation of state run Mental Hospitals,
burden of disease (GBD) and an analysis of trends
upgradation of Psychiatry wings in the Govt. Medical
indicates this will increase to 15% by 2020. Most of
Colleges/General Hospitals, IEC activities, Research
them (>90%) remain un-treated. Poor awareness
& Training in Mental Health for improving service
about symptoms of mental illness, myths & stigma
delivery.
related to it, lack of knowledge on the treatment
availability & potential benefits of seeking treatment The Xth Five Year Plan had an outlay of Rs.139
are important causes for the high treatment gap. crores. Expenditure during 10th Plan was Rs.106.46
crores. During the 10th Five Year Plan, DMHP was
However, most of mental illness do not require
extended to 109 Districts, Upgradation of Psychiatric
hospitalization and are manageable by OPD
Wings of 71 Medical Colleges/General Hospitals and
treatment and follow up care. The new thinking on
modernisation of 23 Mental Hospitals was funded.
mental health at the national and international level
is to make the services of mental health, community Status of NMHP
based rather than hospital based. Such community-
based services are cost-effective, accessible, help As on date 123 District have been covered under
to ensure respect for human rights, limit stigma and D M H P, Psychiatric Wings of 75 Medical Colleges/
lead to early treatment and recovery. General Hospital and 26 Mental Hospitals have been
funded.
To address the huge burden of mental disorders,
National Mental Health Programme (NMHP) was Areas of Concern/Programme Weakness
started in 1982 with the following objectives:
The following areas of concern/weakness have been
)
i To ensure availability and accessibility of identified in implementation of the programme.
minimum mental health care for all in the near
)
i Poor availability of skilled manpower in
foreseeable future, particularly to the most
psychiatry and allied specialties impedes
vulnerable sections of the population. recruitment of staff for DMHP.

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i) Lack of A wareness regarding Mental 3000 Psychiatrists, 500 Clinical Psychologists, 400
Illnesses. PSWs & 900 Psychiatric nurses are available in the
country. The training infrastructure in the country
iii) Stigma attached to Mental Illness
produces approximately 280 Psychiatrists, 50 Clinical
iv) Lack of Coordination between state Psychologists, 25 PSWs & 185 Psychiatric nurses
Departments e.g. DMHP being implemented per year. Due to shortage of manpower in mental
through the Medical Education Department health, the implementation of DMHP suffered
and District health system coming under the adversely in previous plan periods. To address the
Health Department. acute shortage of qualified mental health
professionals in the country two schemes for
v) Lack of community involvement. manpower development are proposed:
vi) Non-availability of standardized training Centres of Excellence in Mental Health: It is
manuals/ modules. proposed to establish Centres of Excellence in the
field of Mental Health by upgrading and
vii) Many aspects of mental illness e.g. Suicide
strengthening identified existing mental health
prevention, Workplace stress management,
hospitals/institutes for addressing the acute
School and College counselling were not
manpower gap & provision of state of the art mental
covered.
health care facilities in the long run. These institutes
Strategy for XIth Plan will focus on production of quality Man Power in
Mental health with primary aim to fulfill manpower
To address the above stated areas of concern, needs of the NMHP. It is proposed to establish at
strategies for implementation of NMHP during XIth least 11 Centres of Excellence under the Scheme
Plan have been redefined. These are enumerated during the plan period. This would result in increase
below: in at least 44 PG seats in Psychiatry, 176 M.Phil.
District Mental Health Programme: seats in Clinical Psychology & PSW each and 220
DPN seats in Psychiatric Nursing each year.
Following the globally accepted trends in Mental
Health As envisaged in National Health Policy 2002 Scheme for Manpower Development in Mental
and following globally accepted trend of community Health: To provide an impetus for development of
care of mentally ill, it has been planned to extend Manpower in Mental Health it is proposed that other
DMHP to more under served Districts in the country training centers (Government Medical Colleges/
in a phased manner during the XIth plan period. In Government General Hospitals/ State run Mental
line with felt needs of the community new components Health Institutes) be supported for starting PG
of School Mental Health Services, College courses or increasing the intake capacity for PG
Counselling services, Work place Stress training in Mental Health. It is proposed to support
management and Suicide Prevention services are setting up/strengthening 30 units of Psychiatry, 30
being planned under the DMHP. DMHP would be departments of Clinical Psychology, 30 departments
extended to more districts following the outcome of of PSW and 30 departments of Psychiatric Nursing.
an independent evaluation of the existing DMHPs It is expected to generate about 60 Psychiatrists, 240
which is likely to be complete by the end of November Clinical Psychologists, 240 PSWs and 600 Psychiatric
2008. Nurses per year.

Manpower Development Research & Training- There is gap in research in


the field of mental health in the country. Funds will
As against an estimated requirement of 11500 be provided to institutes/ organizations for carrying
Psychiatrists, 17250 Clinical Psychologists, 23000 basic, applied and operational research in mental
PSWs & 3000 Psychiatric nurses only approximately health field.

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In order to address shortage of manpower on medium modernized. A grant of upto Rs. 3 crore per mental
& short-term basis training strategies are required hospital would be provided to mental hospitals for
to be developed. Short term training courses through modernisation of facilities and equipments. Similarly,
tele-networking, e-mode would be supported for psychiatry department of government medical
Psychiatry and allied specialties in identified centers colleges which have not been funded earlier need
during the plan period. This would be in addition to to be supported during the plan period. Some of the
training under DMHP and on the job training. deserving areas where there is no well established
Information, Education & Communication: It has been Govt. Medical colleges, Government General
observed that there is very low awareness among hospitals/District hospitals could be funded for
communities regarding mental illness and its establishment of a psychiatry wing. The grant to be
treatment. There is a lot of stigma attached to Mental provided would be upto Rs. 50 lacs/ college for
Illness leading to poor utilisation of available mental Upgradation of facilities and equipments. Preference
health resources. would be given to colleges/ hospitals planning to
start/increase seats of PG (MD/DPM/DNB) courses
Innovative IEC strategies involving Mass media at in Psychiatry.
Central/Regional level to reduce stigma attached to
mental illness and to increase awareness regarding 5.8. The NMHP be mainstreamed by integrating it
mental health, available treatment and mental health with NRHM and NUHM.
care facilities is considered essential. Increased
awareness regarding provisions under Mental Health 6.0 The allocation for National Mental Health
Act 1987 is also required for its ground level Programme for XIth Plan is Rs.1000 crore.
implementation.
12.3 Guinea Worm Eradication
A media plan for mass media IEC activity is planned Programme (GWEP)
to begin from October 2008.
In 1983-84, National Institute of Communicable
NGO /PPP Diseases (NICD) was made the nodal agency by the
Ministry of Health & Family Welfare, Govt. of India,
The burden of mental disorders is very high and
for planning, co-ordination, guidance and evaluation
government efforts need to be supplemented by
of Guinea Worm Eradication Programme (GWEP).
NGOs/voluntary organizations working in this field.
Many of these organizations need financial support The last guinea worm case was reported in July 1996
to scale up their activities. Services for homeless in Jodhpur district of Rajasthan. World Health
mentally ill, Out of school adolescents, slum dwellers, Organization certified India as guinea worm disease
other vulnerable groups etc. is planned to be free country in February 2000. However, WHO
implemented through dedicated & credible NGO recommended routine surveillance and IEC to be
partners. Innovative schemes on pilot basis with continued till global eradication of the disease, which
involvement of NGOs/PPP basis are also planned to are being undertaken in all formerly guinea worm
test the success and subsequent up scaling of the disease endemic states.
projects.
12.4 Yaws Eradication Programme
Monitoring, Implementation & Evaluation (YEP)
It is planned to have a dedicated teams at State & Yaws Eradication Programme (YEP) was launched
Center level for monitoring and implementation of as a centrally sponsored scheme in 1996-97 to cover
the programme. all the 51 yaws endemic districts in ten states of
Spill Over of XTH Plan Schemes Andhra Pradesh, Orissa, Maharashtra, Madhya
Pradesh, Chhattisgarh, Tamil Nadu, Uttar Pradesh,
Some State run Mental Hospitals still remain to be Jharkhand, Assam and Gujarat during the 9th Plan

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period. The programme aims to reach the un- State Surveillance Officers, District
reached tribal areas of the country. Surveillance Officers, Rapid Response Team,
other medical and paramedical staff on
National Institute of Communicable Diseases has
principles of disease surveillance
been identified as nodal agency for the planning,
monitoring and evaluation of the Programme. The - Use of Information Technology for collection,
Programme is implemented by the State Health collation, compilation, analysis and
Directorates through the existing health care system. dissemination of data
The number of reported cases has come down from
3751 to NIL during the period from 1996 to 2004 and - Strengthening of public health laboratories
subsequently no case has been reported from any
For Project implementation, Surveillance Units have
of the states till September 2008.
been set up at Central, State and District level.
Funds in the form of "Grant-in-aid" are being
provided to the States. The components wise details are as under:

12.5 Integrated Disease Surveillance Data Management:


Project (IDSP) Under IDSP data is collected on a weekly (Monday-
Integrated Disease Surveillance Project (IDSP) was Sunday) basis. The information is collected on three
launched by Hon'ble Union Minister of Health & Family specified reporting formats, namely "S" (suspected
Welfare in November 2004. It is intended to detect cases), "P" (presumptive cases) and "L" (Laboratory
early warning signals of impending outbreaks and confirmed cases) filled by Health Workers, Clinician
help to initiate an effective response in a timely and Clinical Laboratory staff. The weekly data gives
manner. Total Budget for the project from 2004-09 the time trends.
is Rs 408.36 crores
Whenever there is a rising trend of illnesses in any
Objectives area, it is investigated by the Medical Officers/Rapid
Response Teams (RRT) to diagnose and control the
! To establish a decentralized state based
surveillance system for communicable outbreak. Data analysis and action are being
diseases to detect the early warning signals, undertaken by respective units. Emphasis is being
so that timely and effective public health laid on reporting of surveillance data from major
actions can be initiated in response to health hospitals both in public and private sector and also
challenges in the country at the district, state Infectious Disease hospitals. IDSP receives weekly
and national level. disease surveillance data from 606 districts and for
the year January 2008 to March 2009, 55% of phase
! To improve the efficiency of the existing
I, II & III states have reported.
surveillance activities of disease control
programs and facilitate sharing of relevant Outbreak Surveillance and Response:
information with the health administration,
community and other stakeholders so as to Central Surveillance Unit, IDSP receives disease
detect disease trends over time and evaluate outbreak reports from the states/UTs as and when
control strategies. reported as on weekly basis. Even NIL weekly
reporting is mandated and the report is shared with
Components: all stakeholder & Prime Minister's Office (PMO),
- Integrating and decentralization of Hon'ble Health & Family Welfare Minister, Hon'ble
surveillance activities Minister of State (HFW), Secretary (H&FW), DGHS
(H&FW), Addl. Secretary & Mission Director (NRHM),
- Human Resource Development - Training of Addl. Secretary (GB) and Joint Secretary (RSS).

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A N N U A L RE P O R T 2008-09
On an average 10 to 12 outbreaks are reported to monitor and evaluate the timeliness and
CSU weekly.A total of 587 outbreaks were detected quality of spray such as IRS, insecticide
and responded to by the states/UTs through IDSP treated nets and distribution of larvivorous
from January 2008 to March 2009. fishes.

Media Scanning and Verification Cell: ! Under take entomological surveillance. Map
and monitor entomological density and
Media scanning is one of the important systems of bionomics and sensitivity to insecticides.
surveillance in detecting the Early Warning Signals.
With this background, media scanning and Information & Communication Network:
verification cell was established on 24 July 2008 at
ICT plays an integral and most powerful role in
NICD, Delhi. On an average 8-12 media alerts on
implementing IDSP across the country. One of the
occurrence of unusual health events are being
important components of the project is data
detected and verified per week and from January
management, analysis and rapid communication in
2008 to March 2009 416 media alerts were detected
case of impending outbreaks. To strengthen the
and verified.
transmission of data IDSP has established linkages
Entomology Unit: with State Head Quarters, District Head Quarters and
all Government Medical Colleges on a Satellite
Vector borne epidemic prone diseases (VBD) like Broadband Hybrid Network. The details are as under:
Malaria, JE, Dengue/ Chikungunya, Kala-azar, and
Plague are the major public health concern. Every Data Centre Equipments
year outbreak / epidemics occur in different parts of
National Informatics Centre (NIC) has established
the country wherein high morbidity and mortality are
broadband connectivity at 760 out of 796 sites of
reported. These outbreaks of VBD are reported more
which 352 sites have been established from January
frequently from newer and newer areas and disease
2008 to March 2009. The objective of Data Centre
like plague and chikungunya in the areas where they
is speedy data transmission and online entry of data
were quiescent for long time. In addition to above
to central servers.
disease like KFD, Tick typhus and other tick mite
borne diseases though are of localized importance Training Centre Equipments
but gradually spread from their area of influence and
are reported in the areas where they were not Training centre equipments has been installed at 275
reported earlier. Keeping these in view, an out of 396 sites of which 155 sites have been installed
Entomology unit in the CSU, IDSP has been from January 2008 to March 2009. State to district
established in December 2008, with the following communication is possible by NICs E-Learning Portal
objectives: (http://e-learning.nic.in/lms), which has facility in
managing life virtual classrooms for training (State/
! Regular dissemination of data on Area specific discussion on disease surveillance
entomological surveillance and other vector activities), e-learning, interactive electronic
aspects from district to state with the liaison discussion (Chat rooms, Boards, Mailing Lists) and
of state SPO(NVBDCP) and Entomologists reviewing & monitoring project related activities.
working in different zones of the country with
the help of newly recruited Entomologist Video Conferencing
under NRHM. Indian Space Research Organization (ISRO) has
! To provide technical support to state/ district installed 330 out of 400 EDUSAT/V-SAT sites of which
RRT in vector related issues 90 sites have been installed from January 2008 to
March 2009. In States, Medical Colleges, Video
! Under take field visits as per the schedule to conferencing (VC) has been used for discussion with

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SSOs/SRRT/ DSOs/ DRRT on outbreak investigation, Training of State/District Surveillance Teams has been
verification and documentation with expert panels, completed for 9 States of Phase-I & 14 States of phase
project review and monitoring, training of data II and 6 states in Phase-III.
managers and data entry operators on data reporting
and analysis. The main focus of training for state level participants
is on basics of disease surveillance, concepts of
Call Centre epidemiology and data management, whereas, the
district trainings only focus on correct procedures of
A 24X7 call centre has been established to receive
data collection, compilation and reporting. A need
disease alerts from anywhere in the country on a toll
based special two weeks Disease Surveillance and
free number 1075 for verification and initiating
Field Epidemiology Training Programme (FETP)
appropriate actions of public health measure. Multiple
language calling and answering capabilities has led have been initiated for the District Surveillance
to receive toll free calls from across the country.The officers. 188 District Surveillance Officers have
call centre also has a response mechanism for already been trained in this special 2 weeks FETP.
informing respective health officials at concerned National Health System Resource Centre (NHSRC),
districts for early detection and prevention. Total a technical support body to NRHM has been given
number of calls received till March 2009 is 34,459 the responsibility of recruiting epidemiologists at state
out of which 77 were health alert calls and 7 were and district headquarters, microbiologists at identified
outbreaks. laboratories and entomologists at state HQs. There
IDSP Portal were 766 vacancies (646 epidemiologist, 85
microbiologist, 35 entomologist), 1033 candidates had
The IDSP portal is a one stop portal which has appeared for the interview and 599 (491
facilities for data entry, view reports, outbreak epidemiologists, 85 microbiologists, 23
reporting data, analysis, training modules and entomologists) professionals have been selected and
resources related to disease surveillance. states are in the process of issuing offer letters to
the selected candidates.
Training
Strengthening of Laboratories
The Training in IDSP is three-tiered:
50 district laboratories are being focused for
- Master Trainers State & District Surveillance
strengthening in the country for laboratory diagnosis
Officers and RRT members are trained at
of epidemic prone diseases. Comprehensive
identified 9 national level institutes.
guidelines for the procurement of equipments for the
- The Medical Officers and District Lab priority district labs have been sent to 33 states.
Technicians are trained by Master Trainers Reminders to the remaining 2 states namely, Bihar
at state level. and Lakshadweep, who have not yet identified the
priority labs, are sent along with the survey forms.
- Health Workers & Lab Technician/Assistants
at peripheral institutions are trained by District A network of reference labs linking the remaining
officers/Medical Officers at district level. districts is being developed on an output based basis

Category Phase I Phase II Phase III Total

Medical Officers 14,051 9,609 560 24,220


Health Workers 71,740 64,136 1,680 1,37,556
Laboratory Technicians 4,500 3,652 163 8,315

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utilizing the functional laboratories in Medical IDSP has started a pilot project for strengthening
Colleges\ existing public health laboratories. A community based disease surveillance in 3 states
meeting was held in Karnataka in to develop state (Maharashtra, Orissa and Karnataka).
specific plan for laboratory strengthening on 18th Dashamantapur (Koraput-Orissa), Similiguda
and 19th March 2009. Action plan based on Aide (Koraput-Orissa), Akkalkuwa (Nandurbar-
Memoir of Laboratory component is framed up. SOP's Maharashtra) and Taloda (Nandurbar-Maharashtra)
& course curriculum for various levels are being made. have started community based surveillance activities.
A technical committee for giving technical inputs for
Infectious Disease Hospital Surveillance
lab component as per Aide Memoir is being
Network:
constituted.
7 Infectious Disease Hospitals, one each in four
NCD Risk Factors Survey
metros and Bangalore, Ahmedabad and Hyderabad
NCD Risk factor survey is done under this project in have been given funds for strengthening reporting
a phasic manner. NCD risk factor survey Phase I from ID Hospitals.
was done by ICMR. The risk factors to be studied
Prevention and Control of Avian Influenza:
are Height, Weight, Waist Circumference, Physical
Inactivity, Diet, Socio Demographic Profile, Fasting IDSP is supporting activities related to Avian Influenza
Plasma Glucose, Cholesterol, and consumption of under IDSP with total outlay of Rs. 20.85 crores for
Alcohol and Smoking. The survey was taken up in 7 three years (2006-09) for Human Component. A
states i.e. Andhra Pradesh, Tamil Nadu, Kerala, networking model has been developed with 10
Maharashtra, Madhya Pradesh, Uttrakhand and laboratories and additionally ICMR with its four branch
Mizoram in 2007-2008 and is completed. Draft report laboratories. MoU is being modified with respect to
of this survey is ready for all the states and the final regional laboratory.The procurement of equipments
report will be submitted by April 15th 2009. for these labs is in progress.

Advertisement for Phase-II survey was published in Project Monitoring:


the major newspapers. Evaluation of the Expression
The IDSP progress is being reviewed by the Senior
of Interest is under process.
Officers of the Ministry of Health and Family Welfare,
Urban Surveillance: Government of India. The project is biannually
reviewed by World Bank Team comprising of
Urban Surveillance is proposed for 4 metropolitans members from CDC, WHO and UNAIDS. The last
of Delhi, Mumbai, Chennai and Kolkata. In the cities review meeting by World Bank was held from 12th
of Mumbai, Kolkata & Chennai Urban Surveillance January to 29th January 2009. The states are ranked
plans have been developed. Kolkata has already for healthy competition. Teams from Centre for
begun activities. Mumbai and Chennai have signed Disease Control and Prevention, (CDC) Atlanta also
MOU and funds are released visit India regularly to support IDSP.

Community Based Surveillance: Finance

It is planned to strengthen community based Budget estimate for 2008-09 was fixed for Rs 72.00
surveillance through active involvement of crores. Due to slow implementation of project
community institutions and volunteers, utilizing the activities by states funds could not be released as
large number of community groups/institutions expected. Besides this less expenditure made on
present in districts such as the Panchayati Raj contingencies and AI lab network. Therefore revise
Institutions, Village Health and Sanitation Committees, estimates was scaled down to Rs 30.00 crores. Again
Mahila Mandals, Self Help Groups (SHG), Youth due to less work on AI lab network our expenditure
Clubs, Schools (Primary and Secondary), NGOs, achieved to the tune of Rs 21.90 crores during the
Traditional/Private Health Care providers. financial year 2008-09.

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Keeping in view our past achievements we have put other tobacco product companies.
forward our budget estimates for the financial year (implemented w.e.f. 1st May 2004)
2009-10 at Rs 48.50 crores. Out of this EAP is Rs
37.15 crores and DBS is Rs11.35 crores. We have e) Ban of sale of tobacco products within 100
earmarked Budget Estimates for Northeast at Rs 3.00 yards of educational institutions.
crores out of total budget of Rs 48.50 crores. (implemented w.e.f. 1st December 2004)

12.6 Tobacco Control Legislation f


) No person shall trade in any tobacco products
including imported products unless the
A comprehensive tobacco control legislation titled specified warnings are indicated. (Rules
"The Cigarettes and Other Tobacco Products have been notified and would come into
(Prohibition of Advertisement and Regulation of effect on 31st May, 2009)
Trade and Commerce, Production, Supply and
Distribution) Act, 2003 was notified in the official There are various strategies envisaged for reduction
gazette on 19th May, 2003. The Act is applicable to of demand and reduction of supply of tobacco. Most
whole of India and covers all types of tobacco of the provisions of FCTC are contained under
products. The important provisions of the Act are as Tobacco Control Act, 2003 except those relating to
providing alternative livelihood to tobacco farmer and
follows:
workers engaged in tobacco industry / manufacturing
a) To prohibit direct and indirect advertisement and environmental issues. Also FCTC provides
of and provide for regulation of the trade and guideline for implementation of its various articles
commerce in, production, supply and e.g. testing of tobacco products for their contents
distribution of all tobacco products. and emission, protection from secondhand smoke,
ban on tobacco advertising, promotion and
(implemented w.e.f. 1st May 2004)
sponsorship etc.
b) No person shall engage in smoking in a
In order to have effective tobacco control measures
public place; (Rules have been notified
and implementation of various provisions of the Act
and has come into effect on 2nd
and at the same time creating awareness about ill
October, 2008) effects of tobacco. The pilot phase of National
c) No person shall sale tobacco products to any Tobacco Control Programme was launched in 2007-
08 in 18 districts of 9 States and upscaled to cover
person below the age of 18 years.
24 districts of 12 States during the year 2008-09.
(implemented w.e.f. 1st May 2004)
The proposed programme broadly envisages-
d) There shall be a total ban on sponsoring of
any sport /cultural events by cigarette and ! Mass media anti-tobacco campaign

India ratified WHO Framework Convention on tobacco on 5th February 2004.

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! Establishing tobacco testing labs foods, fortification of foods, proposals, project
evaluation, review of research project etc.
! Capacity building at the State and District
Level by setting up State Tobacco Control The cell has been making efforts in creating
Cells and District tobacco control cell. This awareness regarding prevention of micronutrient
component would be integrated with NRHM deficiency disorders, diet related chronic disorders
activities. and promotion of Healthy life style through
dissemination of various types of material. So far,
! Pertaining with Ministry of Rural Development posters and pamphlets on the above mentioned
and social welfare for providing alternative issues, video spots on IDD were developed. Video
livelihood to tobacco farmer/ workers. Ministry films on National iodine Deficiency Disorders Control
of Health and Family Welfare has also Programme, Diet related non communicable chronic
released Grant-in-aid to Central Tobacco Diseases and Promotion of Healthy Life Style in Hindi
Research Institute (CTRI), Rajahmundry, were also developed along with Radio Programme
Andhra Pradesh for pilot studies on on under nutrition, including Micronutrient deficiency
alternative cropping to tobacco. in different Regional languages. Updation of the
publication entitled "Guidelines for Standardized
First Global Adult Tobacco Survey (ATS) in India is Hospital Diets" has been under process.
also being conducted with the technical assistance
from WHO and CDC Atlanta. The main aim of ATS is The Cell organizes meetings and workshops (National
to establish the State wise prevalence of tobacco & Regional levels workshops ) on core issues related
use, ascertain levels of awareness/ knowledge about to nutrition i.e. micronutrient, hospital diets, fluorosis,
the ill-effect of the tobacco products. This survey will diet related chronic disorders & promotion of healthy
also provide baseline data for capacity of the States life style, fast/junk food etc. Technical Committee
in tobacco control initiative. meeting was convened to examine issues related to
Soya bean.
During 2008-09, Ministry of Health and Family
Welfare conducted one National and five regional An expert group meeting was organised to finalize
advocacy workshop to sensitize the stakeholder for the content of " Comprehensive Therapy Guidlilnes
implementation of the Tobacco Control Programme. in Clinical Practices - A handbook for Physicians,
Dieticians and Nurses held at Vigyan Bhavan on 29th
Setting up of a National Tobacco Regulatory Authority -30th September 2008.
(NTRA) for effective monitoring and enforcement of
In order to address the problem of fluorosis in the
law and the programme is also under consideration.
country a new initiative i.e. "National Programme for
Budget allocation for the Tobacco Free Initiative for Prevention & Control of Fluorosis (NPPCF)" has been
the year 2008-09 is 39.00 Cr. (including 6.00 Cr.for approved for implementation in 100 districts with
NE region and 9.00 Cr. received from IEC Division), financial allocation of Rs. 68 crores during the 11th
out of which an amount of Rs 35.17 Cr. has been Five year Plan. 1st phase of the programme is to be
incurred for under the said Programme. implemented from current year. A preparatory
meeting for the new Health Initiative entitled," National
12.7 Nutrition Programme for Prevention & Control of Flulorosis
was convened on 19th January, 2009.
The Nutrition Cell in the Directorate General of Health
Services provides technical advise in all matters The Nutrition Cell also keeps State Nutrition Division
related to policy making, Programme implementation, located in 17 States/UTs. updated on development
monitoring & evaluation, training content for different in the field of nutrition, micronutrient deficiencies, diet
levels of Medical ;and Para ;Medical workers. It takes related chronic non-communicable disease, junk/fast
up technical scrutiny of standards and labels for foods etc.

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12.8 Strengthening of Emergency 50 Kilometers and a designated trauma centre is


Facilities of State Hospitals available at every 100 Kilometers. The project,
Located on National Highways therefore, comprises of well equipped life support
Ambulance at every 50 Kilometers of the National
With a view to provide immediate treatments to the Highways with well-equipped & staffed trauma centre
victims of road accident, the Ministry of Health & at every 100-200 Kilometers of the National Highways.
Family Welfare has been implementing a Project for
up gradation and strengthening of emergency During the 11th Plan period, in the year 2007-08,
trauma care facilities in State Government Hospitals financial assistance have been sanctioned to 26 State
located on National Highways under the Scheme - Govt. Hospitals/Medical Colleges of 6 States and
"Assistance for Capacity Building", under which during the year 2008-09, 55 State Govt. Hospitals/
financial assistance was provided upto a maximum Medical Colleges of the 10 States have been
of Rs. 150 lakhs per hospital or actual requirement sanctioned financial assistance under this scheme
of the hospital, whichever was less, during the Xth which includes 6 hospitalsof Assam State in the North-
Plan. East Region.

However, during the XIth Five Year Plan, a revised 12.9 National Programme for
new scheme at a total outlay of Rs. 732.75 crores Prevention and Control of
has been approved for developing a network of Diabetes, Cardiovascular Disease
Trauma Centres along the Golden Quadrilateral, and Strokes
North-South and East-West corridors of the National
Highways, This project would be a major stepping Considering the fact that Non-Communicable
stone in moving towards the desired objective of Diseases (NCDs) are surpassing the burden of
bringing down preventable deaths in road accidents communicable Disease in India and the existing
to around 10% subsequently National Highways Health system mainly focused on communicable
(other than GQ & NE corridor) with substantial number diseases, need for National Programme for
of accidents and Prevention and Control of Diabetes, Cardiovascular
Diseases and Stroke (NPDCS) was envisaged.
! Connecting two capital cities During the 11th Five Year Plan, and outlay of Rs.
1660.50 crores has been provided for the
! Connecting major cities other than capital
Programme. The Programme is being implemented
cities
in phased manner with a piloting being done in the
! Connecting ports to major cities first phase. Subsequently, the Programme is
proposed to be implemented across the country.
! Connecting industrial townships with capital
cities A pilot scheme has been launched in January, 2008
and encompasses 10 States with one District each
Could also be covered by the proposed network/ namely, Kamrup, Assam; Jalandhar, Punjab, Bhilwara,
system of trauma care, keeping in view the fact that Rajasthan, jabalpur, Madhya Pradesh, Shimoga,
instead of random selection of hospitals as had been Karnataka, Kancheepuram, Tamil Nadu,
done in the past, the scheme should focus on Thiruvananthapuram, Kerala.
development of a network of trauma care facilities
along the selected corridors of National Highways The Pilot Programme aims at prevention and control
and also to bring down the morbidity and mortality of (NCDs) using health promotion and health
on account of accidental trauma in India. education advocacy, early detection of persons with
high level of risk of developing diseases through
The trauma care network has been so designed that opportunistic screening capacity building of health
no trauma victim has to be transported for more than system at all levels to tackle NCDs and improvement

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of quality of care and developing trained manpower results in major health disorders like dental fluorosis,
at various health care set-up in Districts/States. skeletal fluorosis and non-skeletal fluorosis besides
inducing ageing. These harmful effects being
12.10 National Programme for permanent and irreversible in nature are detrimental
Prevention and Control of to the health of an individual and the community which
Deafness in turn has an impact on growth development
Hearing impairment / deafness is the second most economy and human resource development of the
common cause of disease morbidity in the country. country.
There has been no national level intervention on one A new initiative has been conceived during the 11th
of the most common preventable cause of disability. Five Year Plan with a goal to prevent & control
MOHFW has therefore launched the new National Fluorosis in the country. The objectives under the
Programme on Prevention and Control of Deafness programme are to collect assess and use the baseline
(NPPCD). This programme has been approved by survey data of fluorosis of Department of Drinking
the competent authority and approximately 80 districts water Supply for starting the project; Comprehensive
are being covered in 2008-09. The key components management of fluorosis in the selected areas;
include early detection and screening; medical and Capacity building for prevention, diagnosis and
surgical treatment; rehabilitation of children with management of fluorosis cases.
hearing aids; awareness campaigns. The strategies under the porogramme are training
As part of the strategy two personnel will be deployed to health personnel for prevention health promotion
in each district - One Audiometric Assistant and one early diagnosis and prompt intervention; Capacity
Instructor/lecturer. The shortage of Audiometric building of district and medical college hospital for
Assistant is being met by introduction of new DHLS reconstructive surgery and rehabilitation;
Program from AIISH, Mysore. This programme Establishment of diagnostic facilities in the district
introduced in 2007 has already trained more than hospitals; Health education for prevention and
75 Audiometric Assistants. The Programme is being control of Fluorosis cases.The activities of the
upscaled from 5 centres to 11 centres this year, each programme are to be implemented in phased manner
of which are linked to interactive Audio-visual (Fluorosis affected) in 100 districts of the country.
connectivity, making it possible for the e-education The National Programme for Prevention & Control
from AIISH, Mysore. of Fluorosis" (NPPCF) has been already initiated in
12.11 National Programme for 6 districts namely Nellore (Andhra Pradesh),
Prevention and Control of Jamnagar (Gujarat), Ujjain (Madhya Pradesh),
Fluorosis Nayagarh (Orissa), Nagaur (Rajasthan) &
Dharmapuri (TamilNadu) in the current financial year
Fluorosis, a public health problem is caused by 2008-09. The Programme is planned for expansion
excess intake of fluorosis through drinking water/food to 14 more districts of the country during the year
products/industrial pollutants over a long period. It 2009-10.

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Chapter 13

Medical Relief and Supplies

13.1 Introduction members. Over the years, the scheme has been
extended to cover central government pensioners,
In the event of natural disaster, the Centre rushes their dependant family members and certain other
emergency medical relief and medical teams to categories like members of parliament and ex-
render immediate relief to the affected peope and members of parliament, freedom fighters etc.
advise State Governments concerned on the public Employees of some select autonomous bodies as
health measures to be taken to contain any outbreak also PIB accredited journalists have also been
of diseases. The Ministry also assists in extended CGHS facilities on cost-to-cost basis in
investigations for serological and chemical Delhi.
examination service.
Membership Profile
13.2 Central Government Health
Scheme As on 31st March 2004, CGHS had 10 lakh members
with a coverage over 45 lakh beneficiaries. However,
Central Government Health Scheme (CGHS) is a in the year 2006, the membership stood at 9.12 lakhs
scheme for providing health care to serving Central with 33 lakh beneficiaries. The break-up of the
Government employees and their dependant family current membership profile is given in the table below:

Membership profile (31.3.2007)

Category Card Beneficiaries A verage % distribution


Holders number of of card
Dependants holders

Serving 642244 2774976 4.05 72.5%

Pensioners 241502 598316 2.50 25.4%

Freedom Fighters 12123 26324

MPs 566 2306

Ex-MPs 1134 3251

Journalists 325 876

Others 1030 2512

General Public 1411 2804

Total 900335 3411365

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Coverage

CGHS was started initially in Delhi. Today it covers 25 cities as indicated below:

Ahmedabad Allahabad Bangalore Bhubaneshwar Bhopal Chennai Chandigarh

Delhi Dehradun Guwahati Hyderabad Jaipur Jabalpur Kanpur

Kolkata Lucknow Meerut Mumbai Nagpur Patna Pune

Ranchi Shillong Jammu Thiruvananthapuram

There is no CGHS coverage in the States of Himachal emergency services in allopathic system, free supply
Pradesh, Tripura, Manipur, Mizoram, Nagaland, of necessary drugs, laboratory and radiological
Sikkim, Goa and Puducherry. investigations, domiciliary visits to the seriously ill
patients, specialists consultation both at the
CGHS Infrastructure dispensary and hospital level, family welfare services,
The beneficiaries are being provided health service treatment in specialised hospitals, both Government
through a huge network of: and CGHS empanelled private hospitals etc. are
being provided to the beneficiaries through
a. Dispensaries (247 Allopathic, 82 Ayush), dispensaries, polyclinics and Government / CGHS
empanelled private hospitals / diagnostic centers.
b. Yoga Centres (4), There are special facilities for the convenience of
c. Polyclinics (19), pensioners and senior citizens. CGHS Pensioner
beneficiaries can obtain a CGHS pensioner card with
d. Laboratories (65)+ 1(Hind lab) life-time validity, by paying an amount equivalent to
ten years' subscription. Those pensioners living in
e. Dental Units (17)
areas not covered by the CGHS they have the option
.
f Gynae - maternity Hospital (1) to get their CGHS pensioner card from the nearest
CGHS covered city. Credit facilities are also available
In addition, beneficiaries enjoy medical facilities in to the pensioners for treatment taken in private
around 400 private empanelled hospitals and around hospitals /diagnostic centres empanelled under
170 diagnostic centres, all over the country. CGHS by obtaining a permission / referral letter from
CGHS. In such cases, the hospitals are directed to
The CGHS was finding it difficult to fill up the vacancies
send the bill for the treatment to the CGHS and not
of medical officers as the majority of the doctors
to charge from the pensioners. Pensioner
recommended by the Union Public Service
beneficiaries are being allowed to get medicines for
Commission did not assume charge in the CGHS for
chronic ailments up to three months at a stretch.
various reasons. To overcome the problem of unfilled
vacancies, it has been decided to appoint, on Two Geriatric Clinics has been established and
contract basis, doctors who had retired from functioning at CGHS Timarpur & Janakpuri in Delhi.
Government service. As a result of this decision, 79
Computerisation of CGHS
retired doctors have been appointed on contract
basis in the CGHS. CGHS has embarked on an ambitious project for
computerisation of the entire operation of the CGHS.
Facilities provided under CGHS:
The process of computerisation has been completed
Facilities of outpatient care in all systems and in Delhi (including Faridabad, Gurgaon, NOIDA and

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Ghaziabad). Computerisation of CGHS Delhi has As the number of applications received from CGHS
helped in lot of information becoming available which beneficiaries was between 50 - 60% of the total
was not so readily available earlier. The position number of beneficiaries in Delhi, it has been decided
regarding age-wise patient details, details of to hold special camps in different buildings housing
commonly prescribed drugs, number of patients Ministries / Departments of Government so that
attended to by each Medical Officer, etc. beneficiaries are enthused to apply for the plastic
Computerisation of other CGHS cities will be done in card. The first camp was held in Nirman Bhawan
a phased manner. during 13 - 20 June, 2009, when 1600 cards were
Once computerisation of all CGHS cities is completed printed.
and networked, a beneficiary can go to any wellness The benefit of having a plastic card is that the
centre for treatment and will not be bound by beneficiary, while on tour to any CGHS city can go to
geographical restriction about the wellness centre
the wellness centre in that city and obtain treatment
where he / she can go for treatment.
in case of need.
Issue of plastic cards
Subscription to CGHS:
Alongwith computerisation of the functioning of the
Serving Government servants residing in areas
CGHS, it has been decided to issue plastic card to
covered by the CGHS are compulsorily covered by
each beneficiary with a distinct beneficiary
the CGHS. In order to avail the CGHS facility, they
identification number. Each card will have bar code.
have to contribute on a monthly basis at the rates
Each dispensary will be provided with a bar code
being brought into force from 1st June, 2009, which
scanner. In Delhi so far 5.10 lakh cards have been
is as below:
printed and distributed.

S. Grade pay drawn by the officer Contribution


No. (Rupees per month)

1 Upto Rs. 1,650/- per month 50/-

2 Rs. 1,800/-; Rs. 1,900/-; Rs.2,000/-; Rs.2,400/-; and 125/-


Rs.2,800/- per month
3 Rs. 4,200/- per month 225/-
4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and Rs. 6,600/- per month 325/-

5 Rs. 7,600/- and above per month 500/-

Central Government pensioners can avail CGHS (i) Husband / wife


facilities by depositing the applicable subscription
(ii) Parents and stepmother
rates. Pensioners have the option of either
subscribing on an annual basis or pay a lump sum (iii) Female employee has a choice to include her
equivalent to 10 years' contribution and avail CGHS parents or her parents-in-law and option
facilities for the life time of the beneficiary and his / exercised can be changed once during the
her dependent family members. service period

Definition of Family (iv) Children (including legally adopted children)


subject to the condition that:
Family for purposes of availing CGHS facilities has
been defined as under: (a) Son - till he starts earning or attains the

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age of 25 years, whichever is earlier. A diagnostic centres and those private hospitals and
son, if married, even if he is dependent diagnostic centres which accepted the rates were
on his parents and is below 25 years' of empanelled under CGHS.
age will not be part of the family for CGHS
purposes. Private hospitals and diagnostic centres which were
empanelled under CGHS were required to sign a MOA
Son, even if he is more than 25 years' of with the CGHS. Any violation of the provisions of the
age, but is suffering from permanent MOA meant that fines would be levied on these private
disability and is fully dependent on his hospitals and diagnostic centres and bank guarantee
parents will be entitled to CGHS facility could also be utilised.

(b) Daughter - Till she starts earning or gets Action has been initiated to revise the rates for the
married, whichever is earlier, irrespective procedures / tests. For this purpose speciality-wise
of age-limit. Widowed dependent committees were formed under the chairmanship of,
daughters; divorced / separated Additional Directorate General of Health Services to
daughters if dependent on her parents recommend removal of obsolete procedures, etc.,
will be entitled to CGHS facility and to recommend inclusion of newer procedures,
irrespective of age-limit. etc. which are presently not on the list. The number
of procedures now to be brought under package rate
(v) Sisters including unmarried / divorced /
regime will go up substantially and is likely to be
abandoned or separated from husband /
around 2,000 from the present 1,400.
widowed sisters, if dependent on the
Government servant will be entitled to CGHS Procedure for referral to empanelled hospitals
facilities irrespective of age-limit. & diagnostic centres
(vi) Minor brothers The CGHS beneficiary first visits the dispensary (now
Dependency Criteria renamed as Wellness Centre) for treatment of an
ailment. The CMO in the wellness centre will refer to
Members of the family (other than one spouse) whose the patient to a specialist in a Government hospital
income from all sources is less than Rs.3,500/- plus for suggesting the procedure / tests, etc., to be
an amount equivalent to the DA announced by the undergone by the patient. If the CGHS beneficiary
Government from time to time will be treated as is a pensioner, then the wellness centre will issue a
dependent on the Government servant and hence referral letter to the private hospital and diagnostic
are entitled to avail CGHS facilities. centre where the beneficiary wants to be treated.
The private hospitals and diagnostic centres will
Empanelment of private hospitals and
provide credit facility to the beneficiary and raise their
diagnostic centres
bill on the CGHS.
As CGHS does not adequate facilities to offer medical
If, however, the CGHS card holder is a serving Central
treatment to its beneficiaries in Government
Government servant, then he / she will have to obtain
hospitals, it empanels private hospitals and
permission from his / her Ministry / Department.
diagnostic centres in all CGHS covered cities. For
this purpose tenders were floated in 2004 calling for Change in procedure for payment of hospital /
private hospitals and diagnostic centres interested diagnostic centres' bills:
in being empanelled under CGHS to offer their rates
for various procedures / tests, etc. Based on the Private hospitals and diagnostic centres have
rates quoted by the private hospitals and diagnostic to provide credit facility to pensioner CGHS
centres, the lowest rate in respect of each procedure beneficiaries referred to it by the CGHS. Due to
/ test was offered to the private hospitals and paucity of funds, settlement of the bills of private

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hospitals and diagnostic centres got delayed with Regional Cancer Centres deemed to be empanelled
the result that many private hospitals and diagnostic under CGHS:-
centres refused to extend credit facility without
1. Kamla Nehru Memorial Hospital, Allahabad,
receiving payment towards the bills already
Uttar Pradesh;
submitted. To overcome the problem, it has been
decided to engage Third Party Administrators (TPA) 2. Chittaranjan National Cancer Institute,
for processing of bills and release of payments Kolkata, West Bengal;
electronically through a bank. After the bank makes
3. Kidwai Memorial Institute of Oncology,
the payment through electronic medium, will lodge
Bangalore, Karnataka;
its claim on the CGHS for recoupment of the
payments made. CGHS will, then, release payments 4. Regional Cancer Institute (WIA), Adyar,
to the bank. CGHS will pay service charge / interest Chennai, Tamil Nadu;
to TPA and banks. This procedure will be introduced
5. Regional Cancer Centre,
in Delhi in the first phase and later on extended to
Thiruvananthapuram;
other CGHS cities in a phased manner.
6. Gujarat Cancer Research Institute,
CGHS will then carry out medical audit of the bills
Ahmedabad, Gujarat;
passed for payment by the TPA
7. MNJ Institute of Oncology, Hyderabad, Andhra
Supply of medicines to beneficiaries Pradesh;
Medicines for CGHS are procured by HSCC / Medical 8. Dr. B.B. Cancer Institute, Guwahati, Assam;
Stores Depot on the basis of the indents made by
different wellness centres, and supplied to the 9. Indian Rotary Cancer Institute (AIIMS) , New
wellness centres. The medicines prescribed by the Delhi;
treating doctor, if available in the store of the wellness 10. R S T Hospital & Research Centre, Nagpur,
centre, are supplied to the beneficiary. If, however, Maharashtra;
the prescribed medicine is not available by the brand
name but in another brand name or there is another 11. Tata Memorial Hospital, Mumbai,
medicine with the same active ingredients, then the Maharashtra; and
same is supplied to the beneficiary. 12. Indira Gandhi Institute of Medical Sciences,
Patna, Bihar.
Treatment for Cancer
Regional Cancer Centres deemed to be empanelled
As there is no private hospital empanelled under
under CS(MA) Rules, 1944
CGHS for treatment of cancer patients (both old and
new), ad-hoc arrangements for treatment of cancer 1. Acharya Harihar Regional Cancer Centre for
patients in view of the hardships faced by CGHS Cancer Research & Treatment, Cuttack,
beneficiaries undergoing treatment for cancer, Orissa;
patients can be referred to the any hospital offering
2. Pondicherry Regional Cancer Society,
treatment to CGHS beneficiaries suffering from
JIPMER, Pondicherry;
cancer.
3. Regional Cancer Control Society, Shimla,
In addition, orders have been issued treating the Himachal Pradesh;
following Regional Cancer Centres to be treated as
to have been deemed as empanelled under CGHS / 4. Cancer Hospital and Research Centre,
CS (MA) Rules Gwalior, Madhya Pradesh;

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5. Pt. JNM Medical College, Raipur, branded and generic drugs, which are distributed to
Chhatisgarh; the beneficiaries on the basis of prescriptions of
specialists. If any drug is not available in stock, then
6. Acharya Tulsi Regional Centre Trust and
the wellness centre places an indent on the locally
Research Institute (RCC), Bikaner, Rajasthan;
and authorised chemist for the wellness centre for the
supply of the drugs.
7. Regional Cancer Centre, Pt. B. D. Sharma
Post Graduate Institute of Medical Sciences, As it is not possible for the wellness centres keep in
Rohtak, Haryana. stock all the drugs that are prescribed by the
specialists and if drugs with the same active
Other facilities ingredients are also not available, then the wellness
CGHS beneficiaries in Kolkata can avail treatment / centre is authorised to place an indent on the locally
facilities in the Afternoon Pay Clinics run by the authorised chemist for the supply of the drug
Government of West Bengal, with provision for prescribed by the specialist.
reimbursement of the consultation fee. The OPD
Local authorised chemist for each wellness centre is
consultation fee charged by the Pay Clinics will be
appointed on the basis of tenders floated by the
reimbursed at the rate of Rs. 100/- (Rupees one
hundred only) for the first visit and Rs. 60/- (Rupees CGHS for such appointment. The selection of the
Sixty only) for subsequent visits. The reimbursement chemist is done on the basis of the highest rebate
of the expenditure will be made by the concerned offered by the chemist on the printed MRP. Before
Department / Ministry in case of serving employees the chemist is appointed his premises is inspected
and by CGHS in case of pensioner beneficiaries. to ensure that he has the capacity to handle the
volume of indents that will be placed by the wellness
It has been decided that all the laboratories on the centre on the chemist.
panel of CGHS have to get certificate issued by the
National Accreditation Board for Testing and Grievance redressal mechanism
Calibration Laboratories under the Quality Council
of India. Local Advisory Committees

Beneficiaries under CGHS possessing a valid Instructions have already been issued to all CGHS
CGHS card can avail treatment / investigation cities that meetings of Local Advisory Committees
facilities at Nizam's Institute of Medical Sciences, be held on Second Saturday of every month in each
Hyderabad, for which prior referral / permission / dispensary. The meetings are held under the
approval will not be necessary from the concerned chairmanship of CMO in charges of the dispensaries
D e partment / CGHS Dispensary. Similarly, in which Area Welfare Officers, representatives of
beneficiaries under Central Services (Medical pensioners' associations, are members to discuss
Attendance) Rules, 1944 can also avail treatment local problems faced by the dispensaries and to
/ investigation facilities at Nizam's Institute of resolve the issue.
Medical Sciences, Hyderabad without prior referral
/ permission / approval. Beneficiaries who are All wellness centres have been directed to keep a
living outside Hyderabad and wish to undertake Complaints / Suggestions Box and also to maintain a
treatment at the Institute without being referred by Complaints / Suggestions register. The Complaints
the competent authority will not be entitled to claim Box will be opened at the time of the meeting of the
TA / DA for the journey to be performed by them LAC.
for the purpose of treatment.
Holding of claims adalats in Delhi
Local indenting of medicines
Complaints were received in the CGHS and in the
Each wellness centre holds certain quantity of Ministry that old cases of reimbursement of medical

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expenses incurred by pensioners were pending for in Delhi, requesting aggrieved pensioners to apply
settlement for long time. It was decided that claims to the Zonal Additional Directors by furnishing the
adalats be held in each Zonal office of CGHS, Delhi, details of their long pending claims.
under the chairmanship the Additional Directors of
These Adalats settled cases which could be done
the respective zones. For the holding of the adalats,
within the existing regulations and instructions.
advertisements were released in leading newspapers

Expenditure: The details of actual expenditure since 2004 - 05 are as under :-


(Rs. In Crores)

S. No. Year PORB Head Other heads Total Expenditure

1. 2004-05 249.20 532.44 581.64

2. 2005-06 272.62 323.69 596.31

3. 2006-07 349.47 397.86 747.39

4. 2007-08 438.45 470.69 909.14

5. 2008-09 498.00 547.91 1045.91

Construction of CGHS Buildings: W orld War in 1942 as a base hospital for the allied
forces. It was taken over by the Government of India,
In Delhi, three CGHS dispensaries are under various
Ministry of Health in 1954. Until the inception of All
stages of construction, at Shalimar Bagh; Dilshad
India Institute of Medical Science in 1956, Safdarjung
Garden; and Kamla Nehru Nagar, Ghaziabad. Two
Hospital was the only tertiary care hospital in South
duplex flats for administrative office & dispensary
Delhi. Based on the needs and developments in
have been purchased for CGHS Dehradun.
medical care the hospital has been regularly
Status in respect of North East : upgrading its facilities from diagnostic and therapeutic
angles in all the specialties. The hospital when started
The CGHS is in operation in two cities in the North in 1942 had only 204 beds, which has now increased
Eastern States Viz. Guwahati and Shillong since 1996 to 1531 beds. The hospital provides medical care to
and June 2002 respectively. One Ayurvedic and one millions of citizens not only of Delhi but also the
Homeopathy dispensary in Guwahati has since neighboring states.
started functioning. There are 12,239 card holders
with 46,507 beneficiaries in Guwahati and 1595 card Staff Position (Sanctioned)
holders with 5,395 beneficiaries in Shillong as on
.
i Medical Officers and Specialists 381
31-3-08. For providing specialised treatment to the
beneficiaries of CGHS, two private hospitals and two i. No. of Resident Doctors 941
diagnostic centers at Guwahati and three private
iii. No. of Nurses 1292
hospitals at Shillong has been approved for
empanelment under CGHS. iv. No. of Para Medical staff 758

13.3 Safdarjang Hospital & VMMC v. No. of Ministerial staff 347

Introduction of the Hospital vi. No. of Group 'D' staff 1451


TOTAL 5170
Safdarjung Hospital was founded during the Second

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A N N U A L RE P O R T 2008-09

The hospital runs many specialties, super-specialties with I.P. University.The hospital is also conducting
and special clinics like Neurology, Urology, CTVS, short-term courses for Medical and paramedical
Nephrology, Respiratory Medicine, Burns & Plastics, personnel sponsored by various Central and State
Pediatric Surgery, Gastroenterology, Cardiology, organizations to update their knowledge and
Arthroscopy and Sports Injury clinic, Diabetic Clinic, skills.The hospital has been selected by the
Thyroid Clinic. Further, it has two Whole Body CT Directorate General to give training to para medical
Scanner,MRI, Colour Doppler, Digital X-ray, Cardiac staff working in the Government of India, placed at
Cath. Lab. A Homoeopathic OPD and Ayurvedic OPD various peripheral center. Besides the above, the
are also running within this hospital premises. hospital is an WHO approved center for training and
observer-ship in various discipline. OBC reservation
Training and Teaching
has been given in Post Graduate Course.
Teaching of post-graduate degree and / or diploma
Web Site
to the students of Delhi/IP University in the
Departments of Medicine, Surgery, Orthopedics, VMMC & Safdarjang Hospital had launched its web
Obstetrics and Gynaecology, Paediatrics, site (www.vmmc-sjh.nic.in) which was inaugurated on
Anaesthesia, Radiology, Radiotherapy, Ophthalmo- 17.09.2002 by the then Union Health Minister, Shri
logy, ENT, Dermatology and Rehabilitation is Shatrughan Sinha. The website has been recently
undertaken. Every year 2 students are enrolled in
redesigned and upgraded. The new website was
the department of Burns & Plastic Suregery and 1
launched July 2008. The new website is more user
student in the Department of CTVS for M.Ch.
friendly and is regularly upgraded by specially trained
courses. Every year 46 MD, MS and 37 Diploma
staff of the hospital.
students are enrolled. Training of DNB students
through National Board of Examination in the OPD Services
departments of Medicine, Surgery, Orthopaedics,
Obstetrics and Gynaecology, Paediatrics, The hospital has an ever increasing attendance of
Anaesthesia, Radiology, Radiotherapy, Ophalmo- 21,17,201 in the year 2006 -2007 i.e. @ 7056 per
logy, ENT, Dermatology and Rehabilitation, Urology, working day of patients in the OPD. To cater to this
CTVS, Paed.-Surgery, Neuro-Surgery is undertaken load and for convenience of the patients a new OPD
and DNB training is going to start from session Block was commissioned in August, 1992. All
January 2009 in the department of Cardiology and departments run their OPD in the new OPD block.
Resp. Medicine. There are several disciplines for which the OPD
services are provided daily. The OPD complex has
The college has started a PhD course in Physiology a spacious registration hall with 18 registration
from this academic year. The regular courses are
windows. The OPD registration services have been
also being run for Nurses Training, Medical Lab.
computerized and the new system is functional since
Technology (MLT) apprenticeship; Diploma in Lab
mid February 2005. The first floor of the OPD
Technology; Pre-hospital trauma Technician course
complex caters to the department of G. Medicine and
and courses in pharmacy. Medical Record Technician
allied super-specialties; the second floor caters to
(MRT) and Medical Record Officer training,
the Department of General Surgery and allied super-
Physiotherapy training, O.T.Assistants training and
specialties; the third floor is occupied by Pediatrics
Short term laboratory training programs for all MLT
and Homeopathy; the fourth floor houses the ENT &
are being conducted regularly.
Eye OPD's and the fifth floor is occupied by the
School of Nursing has been upgraded to College of Department of Skin & STD. The out - patient
Nursing which has admitted 1st Batch of 100 students attendance for the last 5 years are as under (Jan to
this year for a 3 year Degree Course and is affiliated Dec):

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A N N U A L RE P O R T 2008-09
the disciplines of Medicine, Surgery, Paediatrics,
Orthopaedics and Neuro-Surgery are available round
the clock in the causality to provide emergency care.

The administrative requirements of the causality are


taken care of by a chief medical officer and a
specialist (nodal officer) who are also posted in the
causality from various departments by rotation.
There is a 24 hour laboratory facility besides round
the clock ECG, Ultrasound, X-ray & CT Scan services.
Year O P D Attendance The departments of Obs & Gynaecology and the
burns have separate, independent causalities.
2003. 18,13,443
Plans are afoot to create a four bedded ICU, with
2004. 18,71,631
monitor and ventilators in Ward A totake care of the
2005. 19,36,245 Critically Ill Patients. Similarly, an eight bedded ICU
2006. 21,17,201 is to be developed in Ward B for care of critically ill
2007. 21,19,980 surgical patients. These services are to be made
available besides the regular ICU services available
2008. 1396407 (till Aug 08)
in the hospital.

In-patient Services Several new super speciality departments


(Endocrinology, Medical Oncology, Nephrology,
The hospital has total bed strength of 1531 including Nuclear Medicine and Haematology) have been
bassinets. There are in addition observation beds started in the hospital this year headed by a specialist
for medical (Ward A) and surgical (Ward B) patients in the respective fields. The hospital also provides
in the first and second floor of the main causality the services for cardiac catheterisation, lithotripsy,
building. There are 10 beds in the causality for sleep studies, endoscopies, arthroscopies, video
observation. As a policy the hospital does not refuse E E G, spiral CT,MRI, colour Doppler, mammography
admission if indicated to any patient in the causality. and BAC T ALERT microbiology rapid diagnostic
As a major shift in policy decision, the casualty is now system. The hospital has added a new cobalt
run by post graduate doctors. Senior Residents from radiotherapy unit for the department of Radiotherapy.

Total No. of In-Patients admitted and operations conducted in this hospital for
the last 5 years is as under (Jan to Dec) :-

YEARS ADMISSIONS O P E R ATIONS


Major Minor Total

2002 97,813 20,498 50,827 71,325


2003 1,06,906 21,669 52,041 73,710
2004 1,12,829 23,039 56,652 79,691
2005 1,14,704 21,811 54,266 76,077
2006 1,15,441 21,385 57,827 79,212
2007 1,18,923 19,638 61,847 81,485
2008 78426 14746 47,064 61,810
(till Aug 08)

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A N N U A L RE P O R T 2008-09

The department of Obst. & Gynae. has 308 beds. The total number of deliveries conducted
during the year 2007 was 24,287 & for 2008 (till Aug 08) was 15,883.

Total No. of Daily 2003 2004 2005 2006 2007 2008


(till Aug 08)

Lab. examination 8970 29, 84,853 31, 33,868 32, 74,071 3392554 3431028 2190153

X-Ray examination 579 1, 94,583 2, 03,132 2,11,418 214802 225793 152603

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A N N U A L RE P O R T 2008-09

Hospital Waste Disposable Services these are published in National and international
medical journals. A few journals are also published
The hospital waste disposable has been streamlined from Safdarjang Hospital. The research activities
with the installation of microwave and shredder to are often in coordination with ICMR, DST& WHO.
insure proper disposal of biological waste.
Construction Activities
Indian System of Medicine
Continuing with the improvement in infrastructural
The hospital has also extended its support to the areas, CPWD carried out renovations in the vascular
Indian Council of Ayurvedic Research Centre in surgery OT, renovation-cum- installations of eye OT
opening its free Ayurvedic OPD within the hospital in the 4th floor of D wing from the previous building
premises for general patients. The Homeopathic vacated on instance of DMRC, completion of
OPD is also running within the hospital premise, which renovation in North & South wings of Nursing Hostel
is also open for general patients. which has been converted to boys & Girls hostel for
Research Activities VMMC students with complete renovation of dinning
hall ad surrounding areas in hostel area of VMMC.
Besides the regular clinical work various research Further conversion of 4th floor A wing of OPD into
activities are undertaken on a regular basis in the modern operation theatre for CTVS including modular
different departments of the hospital. A number of O Ts complete with OT pendent and medical gas line

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A N N U A L RE P O R T 2008-09

was started. This will be one of the most modern OPD and MS office shifted after renovations in 5th
operation theatres in the city. Electrical department floor D wing. Usual maintenance by CPWD (Civil/
replaced obsolete window type AC with more electrical/horticulture) was efficiently maintained.
efficient split A/c in many places. Energy efficient
electrical fittings & luminaries were replaced in Ambulance Service
phased manner in many buildings. The Safdarjung Hospital has 16 ambulances which are
administrative wing of hospital was shifted to New available for emeregency services round the clock.

Budget Allocation

(Rs. In crores)

SAFDARJANG HOSPITA L & VMMC

Funds Budget Allocated


(2004-2005) (2005-2006) (2006-2007) (2007-2008) (2008-2009)
Plan 55.00 55.54 48.00 70.00 70.00
Non - Plan 67.80 72.25 74.40 79.90 95.70
TOTAL 122.80 127.79 122.40 149.90 165.70

(Rs. In crores)

VMMC (Revenue)

Budget allocated Expenditure incurred


2004-05 5.00 4.66
2005-06 BE 28.76 FE 32.25 32.24
2006-07 (plan) 4.00 FE 4.20 4.03
2007-08 (Plan) 1.00 FE 2.50 2.49
2007-08 (Non-Plan) 0.01 -
2008-09 Nil Nil

PLAN (SJH)
(Rs. In crores)

Year Allocation Achievement in terms of


(Year wise) utilization of funds
2004-2005 55.00 43.01
2005-2006 BE 55.54 FE 49.80 49.68 Cr
2006-07 48.00 47.66
2007-08 30.00 FE 37.22 37.08
2008-09 30.00 17.45 (upto 30th Sep 08)

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A N N U A L RE P O R T 2008-09
NON - PLAN (SJH)
(Rs. In crores)

Year Allocation Achievement in terms of


(Year wise) utilization of funds
2004-2005 67.80 71.55
2005-2006 BE 72.25 FE 74.35 74.31
2006-07 (non plan) 74.40 FE 81.41 81.33
2007-08 79.89 F.E 95.79 95.65
2008-09 95.70 51.70 (upto 30th Sep 08)

VMMC (4210) Construction

BE Expenditure incurred

2006-07 26.00 25.32


2007-08 20.00 FE 15.00 15.00
2008-09 20.00 5.83 (upto 30th Sep 08)

4210 (SJH)

BE Expenditure incurred

2007-08 19.00 16.06


2008-09 20.00 8.74 (upto 30th Sep 08)

Achievements/New Technologies /Facilities ! As a major shift in policy decision, the


Planned / Introduced in the Hospital casualty is now run by post graduate doctors.
Senior Residents from the disciplines of
! A second 40 Slice Spiral C.T. Machine has Medicine, Surgery, Paediatrics, Orthopaedics
started functioning and Neuro-Surgery are available round the
! School of Nursing has been upgrade to clock in the causality to provide emergency
College of Nursing with three years Degree care.
Course. Ist batch of 100 students have been
! Plans are afoot to create a four bedded ICU,
admitted.
with monitor and ventilators in Ward A totake
! OBC reservation has been given in Post care of the critically ill patients. Similarly, an
Graduate Course. eight bedded ICU is to be developed in Ward
B for care of critically ill surgical patients.
! DNB training in Cardiology, Urology, Neuro-
These services are to be made available
Surgery and Resp. Medicine is going to start
besides the regular ICU services available in
from session January 2009.
the hospital.
! 10 new posts of Sister Tutor have been
! Several new super speciality departments
sanctioned.

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A N N U A L RE P O R T 2008-09

(Endocrinology, Medical Oncology, Nursing Home was established during the year 1933-
Nephrology, Nuclear Medicine and 35 out of donations from His Excellency Marchioner
Haematology) have been started in the of WILLINGDON. Later,its administrative control was
hospital this year headed by a specialist in transferred to the New Delhi Municipal
the respective fields. Committee(NDMC). In the year 1954, this hospital
was taken over by the Central Government. In the
! Upgradation of one of the Ambulances with recent past, the Old Building portion of the hospital
Advance Life Support System is under has been declared as a Heritage Building.
process.
Starting with 54 beds in 1954, the hospital expanded
! All Cardiac Surgeries are done free, patients to meet the ever-increasing demand on its services
have to pay only the cost of implants. and now is a 1074 bedded hospital, spread over an
! Angiography and Dialysis has been made area of 34 acres of land. The hospital caters to the
nearly free to all poor patients. needs of C.G.H.S. beneficiaries and Hon'ble MPs,
Ex-MPs, Ministers, Judges and other V.V.I.P.
! Number of seats increased in PG/Diploma dignitaries besides other general patients. The
Courses. mandate of the hospital is to provide utmost patient
care and the hospital authorities are making all out
! 250 rooms hostel in under construction and efforts to fulfill the mandate for which it has been
will be completed in this financial year. set-up. The hospital is providing comprehensive
! Animal House of Pharmacology Sanction has patient care including specialized treatment to
been given and in progress or under C.G.H.S. beneficiaries and General Public. Nursing
construction. Home facilities are available for entitled CGHS
beneficiaries. The Nursing Home is having 75 beds
! Lay out of Internet lane is under process. for the CGHS and other beneficiaries

! OT IInd floor is renovated. The hospital is one of the most prestigious


Government Hospitals not only because of its central
! EOT is under renovation. location, near the Parliament House and in close
! 170 rooms in the hostel have been renovated proximity to North and South Block where most of
and are occupied by girl students. the V.V.I.Ps stay but also because of availability of
expertise and super specialties. The Government of
! Semester system has been started in Medical India has chosen this Hospital for NABH accreditation,
College. an international hallmark for health care service
provider, through the Quality Council of India (QCI).
! Post Doctoral Course in (M.Ch. Cardiac The accreditation application is being made to QCI
Surgery) has been started. shortly for undertaking inspection to get the
13.4 Dr. Ram Manohar Lohia Hospital accreditation and to become the first Central
Government Hospital.
Backgrounder
The hospital annually provides health care services
The Hospital, originally known as Willingdon Hospital to approximately 14 lacs outdoor patients and admits
and Nursing Home, renamed as DR. RAM MANOHAR around 50000 patients indoor. About 1.5 lacs
LOHIA HOSPITAL, was established by the British patients are attended in the Emergency and Casualty
Government in the year 1933. The hospital has thus Department annually. The hospital has round-the-
surpassed over 75 years of its existence and also clock emergency services and does not refuse any
emerged as a Centre of Excellence in the Health patient requiring emergency treatment irrespective
Care under the Government Sector Hospitals. Its of the fact that beds are available or not. All the

178
A N N U A L RE P O R T 2008-09
services in the hospital are free of cost except Nursing Departmental Special Clinics
Home treatment and some nominal charges for
" Diabetic Clinic
specialized tests.
" Asthma Clinic
The Services A vailable
! Pre Anesthetic Clinic
The hospital provides services in the following
! ART Clinic
Specialties and Super Specialties covering almost
all the major disciplines: ! ARC Clinic

Clinical Services Paediatrics & Neonatology Speciality Clinics

" Accident & Emergency Services " Neonatology & Well Baby Clinic
" Anesthesia Services " Follow - up clinic
" Dermatology " Neurology Clinic
" Eye " Nephrology Clinic

" ENT " Rheumatology Clinic

" Family Welfare " Asthma Clinic

" General Medicine " Thalassemia clinic

" General Surgery " Nutrition Clinic

" Gynecology & Obstetrics Gynecology & Obstetrics

" Orthopedics " Antenatal Clinic


" Pediatrics " Infertility Clinic
" Psychiatry Psychiatry
" Physiotherapy " Child Guidance Clinic
! Dental " Drug De-addiction Clinic
Super Speciality Departments / Units " Marriage counseling
" Neuro-Surgery " Psycho-Sexual Clinic
" Burns & Plastic Surgery ! Geriatric Psychiatry Clinic

" Cardiology ! Yoga Centre for cardiac and other patients

" Cardio Thoracic & Vascular Surgery Skin


" Gastroenterology " Leprosy Clinic
" Neurology " Leukoderma
" Pediatrics Surgery Eye
" Urology
I.O.L
" Nephrology
" Glaucoma
" Endocrinology " Retina

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A N N U A L RE P O R T 2008-09

Dental completely renovated recently with new equipments


and infrastructure. The hospital has a well laid down
" Dental Fracture disaster action plan & disaster beds, which are made
Unani OPD (Daily) operational in case of mass casualties and disasters.

Diagnostic Services A Disaster Management Unit is also functioning in


the Casualty Department to attend the serious
" Hematology
patients with the desired care. The hospital handled
" Pathology meticulously victims including the serious patients
" Microbiology during the serial blasts in Delhi in 2005 & 2008.
They were treated and managed very well which
" Histopathology & Cytology
brought appreciation from the Media and the people
" Biochemistry alike.
" Radiology including CT Scan, digital X-
The Hospital has comprehensive trauma care facility
ray,Color Doppler, Ultrasound & MRI
with 74 beds at the Trauma Care Centre started in
" Blood Bank March,2008 in readiness to shoulder the added
responsibility of providing comprehensive & timely
Support Services
emergency medical care to victims of trauma in the
State of the art Library event of any accidents occurring in Delhi especially
in Lutyen's Delhi.
" C.S.S.D
" Laundry
Sanitation & Beautification of Hospital
Campus
" Pharmacy
The hospital has given high importance to the
" Bank
sanitation and beautification of entire campus to
" Post Office create a nature friendly ambience. Under a Special
" ISD, STD, PCO Booth Drive, remodeling of Plants, landscaping of Central
Park Lawns, relaying of grass, creation of Artificial
! Mortuary including Hearse Van
W ater Falls & Fountains and a beautiful Herbal
! Hospital Waste Management Facilities Garden in the Nursing Home Block to give a
! Departmental Canteen refreshing look to the visitors and the patients alike.
Special Sanitation Drives are undertaken at regular
! Ambulance Services
intervals to ensure proper cleanliness and hygienic
Emergency & Trauma Care Services atmosphere in the hospital.

This hospital has well- established Emergency Recent Achievements of the Hospital
services including round- the-clock services in
The following are the latest additions of the patient
Medicine, Surgery, Orthopedic and Paediatrics while
care facilities in the hospital;
other specialties are also available on call basis. All
services like laboratory, X-Ray, CT-Scan, Ultra-sound, Resident Doctors' Hostel:The construction work
Blood Bank and Ambulances are available round the of the extension of Resident Doctor's Hostel for
clock. A well established Coronary Care Unit (CCU) additional rooms has been completed. With the
and an Intensive Care Unit (ICU) exist in the hospital addition of these rooms (total 143 rooms), the
for serious Cardiac and Non-Cardiac patients. The availability of resident doctors on duty in the campus
Coronary Care Unit of the hospital has been has significantly improved.

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A N N U A L RE P O R T 2008-09
Hyper baric Oxygen Chamber Therapy: Dr. RML of outdoor patients and to reduce their waiting time
Hospital is the only Government Hospital in India in the hospital. There are separate Registration
where facility of Hyper baric Oxygen Therapy exists. Counters opened for Senior Citizens, physically
This therapy involves giving hundred percent oxygen handicapped persons and the staff. The
to body tissues at high pressure to treat the patients computerization of Accounts & Administration work
of Head Injury, non-healing Ulcers, Post Plastic has also been started for easy retrieval of information/
Surgery with excellent results. There are two Hyper record. Only recently, NIC has undertaken the
baric Chambers installed in the Department of comprehensive E-Hospital Project with approved cost
Anesthesia. of 3.50 crores to cover all the activities under its
umbrella. OPD registration & Repeat visits, IPD
Anti Retroviral Therapy Centre: Anti Retroviral
registration & ward allotment, Casualty registration,
Therapy (ART) Centre has been started in the
transfer and discharges under E-Hospital software
hospital under National AIDS Control Organisation
had been implemented. E-Hospital implementation
(NACO) and assisted by WHO. This is helping the
covering all aspects of patient care, Labs, Human
AIDS patients to get the treatment effectively and
Resources of the Hospital, Inventory control System
also free medicines. Till now, this clinic has enrolled
for the Hospital and IT induction in PGIMER are
4637 patients and all the eligible 1464 clinically
expected to be completed by end of July, 09. In
eligible patients are under treatment. A Voluntary
addition to the above, and implementation of Library
Counseling & Testing Centre (VCTC) for the
Management Software called e-Granthalaya and
screening of patients for HIV has also been setup.
introduction of e-Procurement System for the Hospital
Department of Physical Medicine and Rehabilitation: are being planned. Moreover, a proposal for
A new Department of Physical Medicine and digitization of entire medical record is also under
Rehabilitation has also been started in 2008. consideration.

College of Nursing: The Hospital's School of Renovation of existing departments: The


Nursing set up in 1963 with 25 students capacity per renovation of the Department of Bio-Chemistry,
year has been upgraded into College of Nursing Neuro-Surgery, Burns and Plastics, Anaesthesia,
with intake capacity of 50 students, at an estimated Emergency Block, Library, Nephrology, Physiotherapy,
project cost of Rs.4.08 Crores from the year 2008- Family Welfare, Radiology, Psychiatry,Accounts, etc
2009 in the Nurses Hostel of this hospital. The has been done to provide better infrastructure and
Construction work of the new campus of college has working condition for the patients and working staff.
almost been completed by HSCC to shift it to new
campus in July, 2009. Departmental Canteen has also been revamped
significantly to provide cost effective food items to
Dharamshala: A Dharamshala for attendants of the staff as well as the visitors coming to the hospital.
patients has been planned to be constructed on one Moreover, the Kiosks of Mother Dairy, Saras & Amul
acre of land allotted to hospital near the Birla Mandir have also been opened in the campus to facilitate
to help the attendants/relatives of the outpatients the availability of healthier and good quality food items
coming from different parts of the country. The in the campus at reasonable rates.
designs /clearances have been approved &
estimates are under approval. Improvements in the Services: The hospital has
focused attention towards the patient care and
Computerization: The computerization of improved services. Many new and sophisticated types
centralized OPD Registration was started from 2005 of equipment have been procured in the hospital to
to facilitate the outdoor patients to get their update the hospital services.
registration done from any of the 16 Counters in the
OPD Block. Four more counters are being added at These equipments include Julabo Shaking Water
different locations to facilitate the timely registration Bath, Video Gastroscope, Pressure Dye Intector,

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A N N U A L RE P O R T 2008-09

Patient Monitoring System, Blood Gas Analyser, of Delhi, Public Grievance Redressal Machinery has
Autoclave Electric Drill, X Ray Tube, CT Scanner, also been set up to inform the patients about the
Laproscope set, hemodylasis Machine, Lecial facilities available and also redressal of their
Operating Microscope, Echo Cardiography Machine, grievances, if any. There are 19 Complaint &
Color Doppler, Central Monitoring Station, 4 ICU Grievance Boxes placed at various strategic
Ventilators, Bronchoscope, Fully Auto Blood Cell locations which are opened periodically and put up
Counter, Heart Lung Machines, 1000 MA Digital before a High Powered Committee headed by a
Radiography System, 16 Spiral/Slice CT Scanners, Consultant & HOD & reviewed by a Designated Addl
Cardiac Cath Lab., Chemistry Analyzer, Patient MS and also by the Medical Superintendent. The
Monitoring System, ICU Ventilators, OT Tables, OT complainants are given an opportunity to speak in
Lights. The approximate cost of these equipments is person to the CMO in charge and a written reply of
Rs. 15.30 Crore. the outcome of the complaint is also sent to the
complainant.
The proposal for construction of additional floors etc
in Laundry/ OPD Blocks is under consideration. The Post Graduate Institute of Medical Education &
centralized CCTV based Surveillance System & Research (PGIMER), DR. RML Hospital, New
Public Address Systems has been planned in the Delhi
hospital during the year 2009-2010.

Upgradation of Library & Information System: In the


age of knowledge and information, the hospital has
given the focused attention for providing the latest
information in the field of Medical Sciences and
Research made at international levels. The prestigious
medical journals(more than 1500) and books worth
Rs. 1 Crore have been purchased to facilitate the
faculty, students and staff to keep them abreast of
latest developments. A proposal for the digital library
is also being started in the Hospital Library.

Focus on Environment: The hospital has given


due importance to the improved environment and
eco-friendly solutions. The rain-water harvesting PG Courses in Medical Education have been
systems in the major buildings of the hospital have continuing in Dr. RML Hospital for decades together.
been undertaken. A Tree Plantation Drive launched The students were sent by Delhi University for
in January 2008 involved the senior faculty and the pursuing their PG Courses. With the growth of Dr.
staff alike to plant more than 120 saplings for RML Hospital whereby the number of disciplines
improving greenery in the campus. A Bio-Medical increased and Super-Specialities were added, a
W aste Management system has been set up in the need was felt to have a full-fledged Post Graduate
hospital. The Hospital has a sound Hospital Waste Institute of Medical Education & Research (PGIMER).
Disposal System. Two incinerators, one plastic EFC was submitted to the Government and it was
shredding machine and one Micro Wave Unit exist recommended to construct a separate building with
for this purpose. A chemical de-contamination plant budget allocation of over Rs. 60 crores. Hospital
has also been completed and commissioned recently. Services Consultancy Corporation (India) Limited
(HSCC) was entrusted the task of construction of
Citizen Charter & Public Grievance Redressal
PGIMER on a piece of approx. 4 acres of land
The Hospital has adopted a Citizen Charter since adjoining the Hospital. The building constructed by
1998 and as per the directives of Hon'ble High Court HSCC(I) Ltd. comprises of Administrative Block,

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A N N U A L RE P O R T 2008-09
Academic Block, Library Block, Examination Hall, After construction of the PGIMER building, which has
State-of-art Auditorium having seating capacity of 400 a separate Library Block having two Floors, the
plus, Guest House, Cafetaria and other Conference/ Library of Dr. RML Hospital has since been shifted in
Seminar Halls, etc. The ambience of the Campus is that Block. There are 5 computers available in the
conducive to the academic activities. Various Library for the use of faculty and students. 2 Internet
Departments are holding their Seminars/Conferences Connections have also been provided for e-mail
and other academic activities in the Conference & facility.
Meeting Rooms of PGIMER.

PG & Super- Speciality Seats:

EFC recommended 49 PG Degree/Diploma seats and


20 seats in Super-Speciality courses for PGIMER. The
Institute is presently affiliated to Guru Gobind Singh
Indraprastha (GGSIP) University, Delhi. In the year
2008, the Government sanctioned a total of 26 PG
Degree/Diploma seats and 2 seats in Super-Speciality
courses. The Institute started functioning from the
academic year 2008-09 and all the seats sanctioned
by the Government were filled up. Seats earmarked
for reserved category including OBC candidates were
also filled up. Subsequently 9 additional PG Degree/ It has collection of 26,000 medical books and 12,000
Diploma seats have been sanctioned during this year
bound journals. Annual intake of periodicals on
and they have been included for being filled up in the
various subjects is about 205 (both Indian and
current session 2009-10. A High Powered Committee
International).
constituted by DGHS also visited the Hospital in the
recent past to examine the available infrastructure, The Library timings are :
bed strength and the existing faculty for making
recommendations regarding the enhancement of Monday to Friday - 10.00 a.m. to 6.00 p.m.
number of seats in PGIMER. The decision of the Saturday - 10.00 a.m. to 2.00 p.m.
Government in this regard is awaited.
Closed on OPD Holidays
Faculty:
Electronic Retrieval Medical (ERMED) Resources
PGIMER is utilising the available faculty in Dr. RML facility is available. ERMED currently provides access
Hospital for teaching of PG/Post Doctoral Students. to a collection of 1500+ journals (Electronic + Print),
During the year 2005, GGSIP University granted from NML and other publishers. Aidop vodep
Equated Teaching Designation to 107 Faculty Cassettes amd CDs amd Xerox facility are also
members in Dr. RML Hospital. With the existing faculty available in the Library.There is a separate reading
becoming eligible for enhancement/grant of equated room where users can take their books and reading
teaching designation, another proposal has been material. Older editions of books and journals are
sent to the University for considering 61 more faculty issued to Members of the Library. Separate
members for this purpose. We have yet to receive Departmental Libraries have also been provided to
the decision of the University in this regard. each Department in PGIMER.

Library: Financial Allocations: -

Dr. RML Hospital Library was established in 1957. The financial allocations made to the hospital during
Year after year it made a steady and good progress. the last five financial years are given in next page:

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A N N U A L RE P O R T 2008-09

(Figures in Lakhs)

Final Estimate Expenditure

2005 - 2006

Plan 3191.00 3186.11


Non Plan 5730.50 5729.82

2006 - 2007

Plan 5673.50 5672.95


Non Plan 5801.05 5794.82

2007 - 2008

Plan 7081.12 7078.33


Non Plan 6381.00 6360.73

2008 - 2009

Plan 8379.51 8315.75


Non Plan 9315.00 9313.47

2009-2010

Plan 8500.00 8500


Non Plan 9723.00

13.5 Institute of Serology, Kolkata Antigen and Antisera to all Government and Non-
Government organization throughout the country.
This pioneer Institute of the country was established
in the year 1912. Initially, this Institute was established The Institute has indegeneously developed and
for Forensic Serology but since 1970 it started standardized the technology for the production of
diversifying into different fields of Serology, Immunochemically pure different classes of Human
Immunology, VDRL Antigen production, Antisera Immunoglobullins viz IgA, IgG & IgM and to raise
production , STD Training, research and Polio Virus their heavy chain specific (Mono specific &
isolation from stool sample of AFP cases. respectively) antisera. The quality of these reagents
has been Certified and approved by WHO Reference
The annual report of this Institute is a compilation of Laboratory at U.K.
all the achievements and activities of this Institute.
The Institute organizes several seminars, training The WHO, National Polio Laboratory has been
workshops etc. to continuously update the functioning since March 1997 and we are catering
knowledge and skill of Medical and Non-medical to the whole Eastern & North Eastern Region of the
Officers and all categories of paramedical staff on Country in addition to the Jharkhand State. This
the latest progress and developments taking place Institute has also started working on Measles
in various fields of Science & Technology. Eradication Programme of WHO.

The Institute is the sole manufacturer and supplier STD has become very important in our National
to meet the entire demand of widely required VDRL scenario specially because of the rapid spread of

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A N N U A L RE P O R T 2008-09
HIV/AIDS infection in the country . STD and AIDS is ! To involve our department with National &
a global problem that the country is facing today. State run health projects where our
Regional STD Reference Laboratory for Eastern laboratory's role is very useful.
Zone under NACO was established in this Institute.
! Isolation of Polio Virus from stool samples of
We are the regional STD Co-ordinator for Eastern &
North Eastern Region for laboratory diagnosis of suspected Polio cases from whole Eastern
Sexually Transmitted Diseases and to extend our Region as part of surveillance of Pulse Polio
laboratory support to other Government and Non- Immunization.
Government organizations. Furthermore, this ! To provide Laboratory support to STD and
laboratory conducts inter-laboratory Evaluation of other projects.
VDRL test with other laboratories of Kolkata. The
laboratory is also working in STD intervention Our Plan
programme and work in collaboration with STD clinics
! To develop Polymerase Chain Reaction
of different medical colleges of Kolkata amongst high
(PCR) technique in the Institute, for the
risk population. We also impart STD training for
diagnosis of various diseases.
laboratory Technicians, conduct research activities
in this field. ! To start Serological tests for diagnosis of
dengue.
Chief Objectives & Newer Activities
The Institute has the following infrastructure for
! Production & supply of various diagnostic
performing specialized jobs. These are:-
reagents like VDRL Antigen, specific Antisera
etc. to the Government and Non-Government Forensic Serology Section
Institution all over the country.
)
i M.L.-I
! To undertake blood group serology , and to
offer expert opinion about different types of i) M.L.-II
Medico-legal exhibits or biological materials
Antigen Production Unit for production of VDRL
send to this Laboratory and to resolve
Antigen.
paternity dispute or maternity questioned.
Antisera Production Unit.
! To establish this department as fore runner
in the country in the field of Serology, Immunology & Immunochemistry Division.
Immunology,Virology and Quality Assurance
with products of various Antisera, VDRL ! Immunochemistry division is engaged in the
Antigen, Anti-H Lectin, Anti-A1 Lectin and Fractionation, Characterization and
Coomb's reagent. Standardization of different classes of
Immunochemically pure human
! Preparation, standardization and immunoglobulin fractions and to raise their
characterization of Heavy Chain specific monospecific antisera (Heavy Chain).
antisera against human IgG, IgA and IgM
respectively and IgG specific antisera against ! To raise the IgG specific antisera against
different animals. different Animal species.

! Training of Laboratory Technicians in various Quality Assurance & Control and Inter-
fields of serology and Sexually Transmitted laboratory Evalustion Laboratory.
Diseases and imparting training in Forensic STD Serology: -
Serology to different scientists and Police
personale. ! VDRL Laboratory

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A N N U A L RE P O R T 2008-09

! Regional STD Reference Center.

Regional STD Training & Research Center under


NACO

! Clinical Room

! Microscopy Room

! Regional STD Reference Laboratory

National Polio Laboratory under WHO

At the behest of National Immunization Mission,


Department of Family Welfare this Institute has also
taken up the assignment of Isolation of Polio Virus
IRCS is a recognised force in the disaster
from stool samples of suspected AFP cases from
management sector in the South Asia region. During
March 1997.
the floods of 2008 it released relief items to the tune
Measles Eradication Programme of WHO: of Rs. 7.5 crores to the affected States. It also
deployed Water & Sanitation Units in the flood-
Our Institute has started working on this affected states of Assam & Bihar for providing clean
programme of WHO drinking water. 5000 to 10,000 litres of clean drinking
water can be made available within one hour with
W ashing & Sterilization Section.

Animal House.

Hindi Section

Training Division

! Conference Room.

! Library.

! Audiovisual & Health Education.

! Student Laboratory, Seminar Room,


Demonstration Room.

13.6 Indian Red Cross Society


The Indian Red Cross Society (IRCS) is the largest the help of a single unit, which would suffice to the
autonomous humanitarian organization of India. It is needs of 10,000 beneficiaries per day. It also
a huge family of 12 million volunteers and members succeeded in establishing video-conferencing
and staff exceeding 3500. It reaches out to the system in Red Cross State Branches 11 most disaster
community through 700 branches spread through prone States and six IRCS regional warehouses.
out the country. With a variety of activities in health, During the reporting period, the focus in the field of
disaster and organizational development, it is also health continued on: (i) HIV; (ii) voluntary non-
working towards achieving the Global Agenda and remunerated blood donation; (iii) emergency health
Millennium Development goals. and (iv) community- based health. HIV interventions

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A N N U A L RE P O R T 2008-09
programmes and Mine Risk Education training
programme at State/District level. Under Restoring
Family Links 107 Red Cross Messages were
delivered to the addressees. In the reporting year
there were 24 active tracing cases out of which 12
cases were successfully closed and for the rest FNS
department is doing continuous follow-up with the
branches and other National Societies.

Post Graduate Diploma Course in Disaster


Preparedness and Rehabilitation started in 2006-
07 with 27 students enrolled, 35 students in the 2nd
batch and 40 students are undergoing the course in
the current batch.

included prevention, care and support, as well as The Society has launched Anjar Integrated
anti-stigma and anti-discrimination initiatives. It has Earthquake Recovery Project and Tamil Nadu
scaled up services in line with the commitment made Integrated Community Recovery Programme.
under the Global Alliance on HIV. Efforts have been
During the reporting period the Society is in the
intensified to establish IRCS blood banks in state
process of developing a new strategic plan for 2009-
Capitals and modernization of the existing blood bank
12, wherein priorities and focus are on strengthening
at the National Headquarters. During the reporting
activities in areas such as disaster management,
period the blood bank at the National Headquarters
health care, organizational development and
organized 291 blood donation camps and collected
humanitarian values.
26169 units of blood out of which replacement
donation was 4374, voluntary accounted to 19565 13.7 St. John Ambulance for the Year
and in-house 2228. Public health in emergencies 2006-07
trainings and workshops were conducted to address
the preparation and response mechanisms and to St. John Ambulance functions as a network spread
strengthen the capacity of the IRCS and targeted all over the country with approximately 680 State/
communities. Brochures and pamphlets were revised UT/Railway Centres formed in different states,
and pri