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EXECUTIVE SUMMARY:

There had been a tremendous impact in the Health sector since the implementation of NRHM in the
state. In the earlier days, Health sector had never been a priority in the state. And at the time of attainment of
statehood in 1963, Nagaland was only fortunate to inherit the legacy of a few hospital infrastructure in the then
District Headquarters. The spread of health infrastructure in the state had always been in a slow pace mostly due
to negligence and fund constraints in the State. Human resource in the health sector also had a setback with the
blanket ban on post creation since 1990. This may be due to poor socio - economic status of the State which
might have been responsible for the dismal Health Services. Thus, quality Health care has always been an
elusive dream for the people in this part of the country. The need for quality Health care has been obvious
giving the increasing number of patients from the state going out to the far and wide places in search of better
services. But with the coming of NRHM, the health sector in the State has boost up, be it be in the infrastructure
developments, capacity building or filling of manpower shortages and Health activities. The state seeing the
impact on the Health sector under the flagship of NRHM has been contributing the state share without hesitation
even with the financial crunches in the State.
For the year 2011-12, the state has taken an extensive exercise for developing the action plan right
from the grass root level. It began with the development of the village health plan involving the village health
committee (VHCs) and the communities in all the districts. The block health action plans were also done basing
on the needs from the village health action plans, ground realities and priorities. The District action plans had
been brought about with the accumulation of all the block health action plans and the district‟s specific needs.
Table: District wise Population and District Hq/Towns/Villages:
No. District Headquarter Population Towns Village
1 Kohima Kohima 219318 3 94
2 Mokokchung Mokokchung 227230 4 102
3 Tuensang Tuensang 164361 5 121
4 Phek Phek 148246 4 104
5 Mon Mon 260652 3 110
6 Wokha Wokha 161098 3 130
7 Zunheboto Zunheboto 189191 3 198
8 Dimapur Chumukedima 345237 3 216
9 Peren Peren 97068 3 106
10 Kiphire Kiphire 127448 2 103
11 Longleng Longleng 121581 2 40
Total 2061430 31 1324
Table: District wise distribution of PHIs as on 30.09.2010.
District DH CHC PHC SHC BD SC Total
1. Kohima 1 3 14 0 0 40 58
2. Mokokchung 1 3 14 0 2 51 71
3. Tuensang 1 2 11 1 0 39 54
4. Phek 1 3 24 1 0 44 70
5. Mon 1 2 15 0 0 50 68
6. Wokha 1 2 12 0 0 37 52
7. Zunheboto 1 2 13 0 0 47 63
8. Dimapur 1 2 8 0 1 47 59
9. Peren 1 1 8 0 0 16 26
10. Kiphire 1 1 4 0 0 19 25
11. Longleng 1 0 3 0 0 8 12
State Total 11 21 124 2 3 398 558
Table: Health Scenario:
Indicator Nagaland India
1. Birth rate * 17.5 22.8
2. Death rate* 4.6 7.4
3. Total Fertility rate** 3.7 2.7
4. MMR*** 240 259
5. IMR* 26 53
6. Full ANC** 31.6 50.7
7. Institutional Delivery** 12.2 40.7
8. SAB** 25.9 48.3
9. Full Immunization** 21 44
10. Contraceptive Use** 30 56.3
11. Total Unmet Need** 26.3 13.2
*Source: SRS Bulletin Oct 2009 **Source: NFHS III *** Source: India- The State of Population 2007
Year 2005-06 2006-07 2007-08 2008-09 2009-10 2010-2011
(upto Oct’10)
Patient Turnover
Out-patient Load 226957 295963 478078 523090 336959 341265
In-patient Load 18500 29158 34460 63805 54532 346683
Maternal Health
Institutional Delivery* 1182 5696 9943 12606 10765 9455
Child health **
BGG 35024 52450 49917 26799 35159 22345
DPT3 29912 60257 50441 23717 32373 19376
OPV3 30614 62653 52904 24586 33175 20067
Measles 27876 50180 51618 23157 34253 20693
Full immunization - 50180 51618 23157 34253 20693
*As per RCH/JSY Report as on Dec‟10 **As per UIP division

PROGRESS OF THE STATE SINCE LAUNCH OF NRHM:


The National Rural Health Mission (NRHM) in Nagaland was launched in Feb„06. Within the time span of
these few years, the state has shown significant improvement in health care delivery both in terms of physical
infrastructure and service delivery output. Some of the key achievements under the NRHM implementation are
as follows:
1. Better Coordination between directorate and health society:
a. The state has been deploying regular staff in the PMU.
b. The directorate is involved in policy formulations and decisions, planning, monitoring, recruitment
process, infrastructure development, procurement etc.
c. Since 2010-11 decentralised innovative funds-UF, MF and RKS fund are released and monitored
through the directorate. Community based activities such as ASHA programme, Community
Monitoring Process etc will be implemented through the Communization Cell of the directorate.
2. Decentralisation:
Prior to launching of NRHM, the enactment of the Communitisation of Public Institutions and Services
Act in 2002 ushered decentralized management of various health units by the constitution of Village Health
Committees (VHC) in SC, Health Centre Management Committee (HCMC) in PHC & CHC to promote public
participation and ownership. Under NRHM, the level of Communitisation was taken to all recognised villages
and to the District Hospital by constituting Village Health Committees and Hospital Management Society
(HMS) respectively.
Funds for maintenance fund, untied fund and RKS fund as per approved RoP under NRHM is provided to
the health units through Communitization Cell for decentralized innovative activities. The decentralization of
fund and community based programmes has strengthen the communization process in the state.
3. Civil works:
a. Since launching of NRHM in 2005-06, 135 SCs, 19 PHCs, 5 CHC, 5 Drug Warehouse, etc were
approved to strengthen the physical infrastructure public health institutions. The state could
operationalized only 38% of PHC & CHC to IPHS standard owing to lack of health professionals and
huge infrastructure gap.
b. Since last year, the state has put more trust on the infrastructure development.
c. The progress Construction activity is not as per desired pace due to climatic factors, poor road
condition and communication.
d. Service/maintenance provision for equipment is difficult incorporated in view of high cost of AMC as
the authorized dealers are not available in the state. Also most of the authorized dealers are reluctant to
come to the state.
e. Strengthening of training infrastructure for training of staff for effective utilization of the facilities to be
incorporate in the PIP 2011-12
Table: List of various civil works under NRHM
Total Units
S. No Name of Work Approved Completed Under process
1 Sub Centre 135 85 50
2 PHC 19 6 13
3 CHC 8 5 3
4 District Hospital (Upgradation) 11 11 0
5 Staff Quarters (CHC) 19 8 11
6 Staff Quarters (CHC) 30 8 22
7 Drug Warehouse 2+3 2 3
8 Nursing School Strengthening 2 2 0
9 Nursing School Dimapur 2 2 0
10 Up Gradation Of Nursing School To College 1 1 0
11 Upgradation Of Nursing School Tsg 1 0 1
Table: SC building Construction Status.
District No of NRHM State Grand
SC Completed 2010-11 Total Completed 2010-12 Total Total
Kohima 40 10 5 10 5 2 7 17
Mokokchung 51 10 5 10 5 2 7 17
Tuensang 39 6 5 6 4 1 5 11
Phek 44 14 7 14 3 0 3 17
Mon 50 11 6 11 3 1 4 15
Wokha 37 8 4 8 2 1 3 11
Zunheboto 47 5 5 5 3 1 4 9
Dimapur 47 8 3 8 3 1 4 12
Peren 16 4 4 4 3 1 4 8
Kiphire 19 3 3 3 3 1 4 7
Longleng 8 6 3 6 2 0 2 8
State Total 398 85 50 85 36 11 47 132

4. Manpower development
a. All the post of health professionals in the department is filled.
b. State has taken several measures to attract and retain manpower, however due to low remuneration,
disparity in pay structure among staff of various NDCPs, lack of difficult area incentive, lack of
quarters etc there is high attrition among contractual staffs. These issues are incorporated in the PIP
2011-12. The following personnel have been appointed on contractual basis till date.
Table: Manpower Appointment and Institutional Strengthening at State and District Programme
Management Units:
No. Manpower Grand Total
1 Medical Officer (Specialist) 7
2 Medical Officer (General) 55
3 Medical Officer (AYUSH) 21
4 Dental Surgeon 26
5 Additional Staff Nurse 162
6 Additional ANM 364
7 Additional PHN 41
8 Pharmacist 4
9 Lab Technician 48
10 CT Scan Technician 1
11 ECG Technician 0
12 X-ray Technician 1
13 Telemedicine Operator 1
14 District Programme Manager 11
15 Media Officer 11
16 Block Programme Manager 45
17 ASHA Coordinator 40
18 Accountant 11
19 Data Entry Operator 10
20 Computer Operator 11
21 Driver for Medical Mobile Units 22
Total 892
22 ASHA (Voluntary Link Worker) 1700

c. Strengthening of institutions through training and Skill-upgradation of personnel at all levels.


 State & District Planning Teams have completed the 3rd Capacity Building on District Health
Planning & Management conducted in collaboration with RRC NE at Guwahati and Kohima
respectively.
 To reduce the gap of specialist doctors, GDMOs are sent for multiskilling training on
Anesthesiology (LSAS) and Emergency Obstetrics Care (EmOC). So far a total 5 LSAS and 2
EmOC MOs respectively has been trained till date. However, 3 trained MOs have left to pursue
PG studies.
The state is undertaking training of doctors on LSAS and EmOC and GNMs on OT
Techniques selected from identified CHCs w.e.f Jan 2011 by partnering with CMC Vellore
through the CIHSR, Dimapur. On completion of the training, a readymade team will be in position
to operationalise the health facility.
 RCH training programmes are being carried out in the 3 DH (Kohima, Mokokchung and Dimapur)
identified as zonal training centre.
 To improve quality of maternal health care, training on Skilled Birth Attendant (SBA), Blood
Safety, Reproductive Tract Infection/Sexually Transmitted Diseases (RTI/STD) management was
conducted for Medical Officers and Nurses. The state is will also to operationalise BEmOC
training for doctors with the assistance from the CIHSR Dimapur.
 To improve quality of care for child health, IMCI & Immunization trainings were conducted for
MOs and Nurses.
 To improve quality care of reproductive health and facility planning training on IUCD, Lap ST,
Mini Lap & MTP was conducted for Medical Officers and Nurses.
 Training on Adolescent Reproductive Sexual Health (ARSH) is being conducted for Medical
Officers and Paramedics.
 Activities such as ARSH talks covering 55 Schools, One-Day Seminar in one college and 3 Radio
Talks have been achieved during the last 2 Quarters.
 Induction & orientation training were conducted for all the ASHA coordinators, BPMs and DPMs
to strengthen the programme management units.
 Orientation training on DHIS for On-line Health Management Information System was conducted
for DPM, Data Entry Operators and Computer Assistants.
 Training on IEC/BCC was conducted for Media Officers.
5. Procurement & Supply of Medicines:
The NRHM is supplementing the medicine supply under state procurement and RCH to all the health units
as stated under.
No. Unit Total no. of Units 2008-09 Rs. In Lakhs 2009-10 Rs. In Lakhs
1 SC 397 34.62 143.99
2 PHC 123 38.34 36.80
3 CHC 21 87.12 86.24
4 DH 11 103.59 110.00
TOTAL 263.61 377.03

6. Procurement & Supply of Equipments and Instruments:


The following amount was incurred for Procurement & Supply of Equipments and Instruments for various
health units as per approved RoP over the years.
No. Unit Total no. of Units 2008-09 Rs. In Lakhs 2009-10 Rs. In Lakhs
1 SC 397 50.00 0.00
2 PHC 123 69.39 138.55
3 CHC 21 216.78 31.95
4 DH 11 53.66 0.00
TOTAL 389.83 170.50

7. Procurement & Supply of Ambulance:


No. Unit No. of Health Units No. of Ambulances provided 2008-09 2009-10
Rs. In Lakhs
1 SC 397 - - -
2 PHC 123 28 - 182.00
3 CHC 21 20 147.00 0
4 DH 11 9 70.00 0
TOTAL 57 217.00 182.00

8. Mobile Medical Unit (MMU) and Ambulance:


2007-08: In order to provide better health service to the un-reached areas, 11 MMU has been provided to all
the districts with medical staff comprising of doctor, nurse and lab technician along with basic laboratory
equipments including ultrasound machine & ECG.
9. Health Management Information System (HMIS):
In order to circumvent the inherent problems associated with difficult terrain, the state has made an
elaborate plan to exploit the IT technology for HMIS and other reporting system of various national health
programmes. Thus, in collaboration with NHSRC, New Delhi a pilot project for mobile-data transmission has
been launched in six Sub-Centres under Jalukie block of Peren district in 2009-10 and during the current FY,
process is underway to provide the facility to all health units in the state.
Also since this year, HMIS is being uploaded facility wise to the GoI web portal. The reports are being
analyzed monthly and feedback sent to the districts to undertake necessary remedial measures. With the
triangulation of health information, the quality in the management of health issues at the state and the district
level has improved tangibly.
10. Financial Management System:
The Mission has appointed qualified personnel in accounts at the State and District Health Management
Units. In order to maintain proper records, computerized financial management and monitoring system is being
introduced. The districts have started reporting the FMR monthly and are being uploaded into the web portal.
Internal audit, concurrent audit and annual external audit is a regular feature apart from monthly financial
management reports.
Table: Allocation of Fund under NRHM:
Year GOI 15% state Amount Amount Amount
Allocation Share received received spent
from GOI from State
2005-06 372.00 NA 372.00 NA 372.00
2006-07 2103.00 NA 1587.00 NA 1587.00
2007-08 4753.00 553.00 4753.00 600.00 4753.00
2008-09 5511.04 826.66 5541.04 900.00 6441.00
2009-10 8552.15 1175.00 4425.00 921.77 4260.54
2010-11 (till Oct ‟10) 9810.00 1262.00 2341.00

Chart: State Plan Outlay:

State Plan Outlay


6000 4917
4547
4000 3313
2281.89
2000
45.19% 37.24% 8.14%
0
2007-08 2008-09 2009-10 2010-11

Table: State Non-Plan Expenditure (Rs. in lakhs):


Year Allocation Medicine Salary
2005-06 7350.62 16.63 6288.55
2006-07 8058.85 20.00 6897.72
2007-08 9822.76 20.00 8606.43
2008-09 10624.06 20.00 9403.42
2009-10 12573.37 120.00 11026.36
2010-11 17247.22 20.00 15699.79

11. ASHA (Accredited Social health Activist)


With the completion of the training of ASHAs on module 5, visible changes could be observed among the
ASHAs. The ASHAs are now more confident and their level of sincerity has improved reasonably. Equipped
with effective communication and counseling skills, the ASHAs are now able to more easily motivate the
community in seeking health services.
The need for skill up-gradation for ASHAs to be able to function, not only as a link worker but also as a
service provider is felt as an urgent requirement. It is hoped that with the completion of the training of ASHAs
on modules 6 and 7, they will be able to provide the basic services for ANC and new born home based care.
Some achievements under ASHA programme are as follows:
• All the 1700 ASHA so far sanctioned are in position.
• Development of ASHA diary completed and distributed to all ASHAs.
• Regular featuring of ASHA in State‟s NRHM quarterly Newsletter.
• Regular monthly thematic meeting initiated in most of the blocks by ASHA Coordinators.
• Radio sets provided to all the ASHAs.
• Translation of ASHA Reading Materials into 3 major local dialects viz. Ao, Tenydie and Phom
completed.
• ASHA Drug Kit despatched to Districts to be distributed during the Block level trainings.
• Hand Weighing machines and thermometers procured for ASHAs.
• Training of ASHA Coordinators completed. (21 st – 23rd Oct. 2009).
• Training of ASHA on 5th Module completed.
• State Trainer for modules 6 and 7 trained at SEARCH, Gadchiroli, Maharashtra.
• Training of District/ Block Trainers on 6th and 7th Modules completed.
ASHA Resource Centre/ Support Structure
• Nodal Officer appointed w.e.f. June 2009.
• ASHA section set up within NRHM office at State level.
• AMG constituted with representatives from Govt., Civil and Academia sectors.
• ASHA Coordinators appointed in 48 blocks to give handholding support to ASHAs.
• Supportive supervision done at regular intervals.

Some activities for the way forward


• Translation of ASHA Reading Materials into the rest of the major local dialects.
• Skill up-gradation trainings e.g. Dhai/ SBA.
• Exposure trips for ASHAs and ASHA Coordinators– in coordination with NHSRC/ RRC.

12. IEC/BCC ACTIVITIES:


Year-wise Activities implemented:
Capacity training of MSS (Women Health 1617 members from 539 units in 5 districts of
Committee) members Kohima, Mokokchung, Tuensang, Wokha and
Dimapur were given training at their local
PHCs.
Orientation Training (OTC) of Community A total of 3123 community leaders (men,
leaders women, youth) participated in 110 OTCs
2006-07 organized in 11 districts
School-based IEC/BCC activities on topics of 161 programs in 165 schools in all 11 districts
hygiene, immunization, drug abuse, HIV/AIDS covering 7990 students were held.
etc.
Group meetings with mothers on maternal 330 sessions in as many villages were held
health, (ANC, INC, JSY, PNC) child health, where 7329 mothers participated
home sanitation etc.
Major activities carried out during the year: Routine activities of general awareness; collaboration
with MSS and VHCs in organizing village health days and village sanitation drives; observance of
2007-08 health-related important days/events; orientation of IEC officials on micro planning and
preparation/maintenance of monthly/daily calendar of activities.

Training on capacity building of 2 batches for 11 districts


IEC/BCC officials
Newspaper Advertisements on RCH themes In all local newspapers and
and NRHM goals of reducing TFR/MMR/IMR Dailies

2008-09 Radio jingles on NRHM goals and RCH In Nagamese and all Naga dialects
themes
Group interaction with women from eligible In 474 selected villages in stabilization
couples on maternal health, child health and
population all 11 districts

Health Melas organized in 10 districts.

Exhibition stalls set up during State Road shows where IEC/BCC materials were displayed and
distributed.
Capacity building done for all district IEC/BCC officials.

Regular advertisements published in local papers (including local dialect papers) under RCH
2009-10 themes, H1N1 flu, Tobacco control.
IEC materials (pamphlets, posters) made under RCH themes, H1N1 flu, Tobacco control.

Radio programme series (15 minutes, 12 episodes) and 5 jingles under RCH theme produced and
aired in All India Radio Kohima and FM Mokokchung.

Radio talks given on AIR, Kohima during important health days.


TV spots on H1N1 flu telecast on Doordarshan Kohima and local cables in various districts.

13. Other initiatives:


a. Village Health & Nutrition Day (VHND): NRHM envision holding of VHND once every on a fixed day in
each village to be an effective platform for providing first-contact primary health care. Efforts are on to
make VHND a platform where government departments and organizations can dovetail to make it more
vibrant and to avoid lose of time and resource of the villagers.
b. ARSH Clinic established in District Hospital Dimapur.
c. Reproductive Child Health (RCH) camps are being organized in all the blocks of the district to meet the
unmet needs of family planning.
d. Road shows are being held in the district headquarters to showcase Governmental schemes and programs.
During the Road Shows Multi-speciality Health Mela has always been a centric activity for the community.
e. The mission has been publishing a quarterly State NRHM news letter since April 2009.
f. The following activities are underway-
 Provision of maternity benefit of Rs. 500.00 to all BPL pregnant women.
 Tracking of pregnant women and under 5 Children.
 Skilled Attendance at Birth for all home deliveries.
 Provision of mobile phone to the ANMs all the 397 SCs.
 Provision of Data Card for web connectivity to all the 11 DPMU.
g. Avenues are being explored for coordination and cooperation with all private practitioners, Nursing homes
and Private Hospitals of Kohima, Mokokchung and Dimapur.

14. MONITORING and EVALUATION MECHANISM


Initiated strengthening- Designated state and district level monitoring teams at State, District and Sub-
District level and developed Integrated Check list for Monitoring and supervision. Constant and continuous
monitoring is a regular activity as per the Monitoring plan developed by the state. Social Audit/Community
monitoring through active participation of the community is an on-going activity.
• Regular Handholding supervision and Monitoring of Health Units at various levels.
• HMIS & FMR Reporting as per GoI guideline.
• Audit: Internal, Concurrent and Statutory as per GoI guideline.
• Community/Social Monitoring as per GoI guideline.

15. ASSESSMENT/EVALUATION OF NRHM


• Grass root level evaluation by Dept of Evaluation in 2009.
• Need Assessment of Doctors by CIHRS initiated during current FY.
• Community Need Assessment by NU initiated during current FY.

16. First Referral Health Unit & 24x7 Facilities:


Under NRHM, all CHCs and PHCs are to be upgraded to FRUs and 24x7 Facilities in phase manner. The
state has indentified the 11 DHs and 4 CHCs as FRUs and 17 CHCs and 33 PHCs as 24x7 Facilities.
Infrastructure development is being undertaken phase manner however due to shortage of key specialist only the
DHs are functioning as FRUs while the 4 CHCs could not be operatinalised as FRUs till date. All the 21 CHCs
are manned by 3-4 MOs (MBBS, AYUSH & Dental). 1-2 MBBS doctor is in position in all the 33 24x7 PHC.

17. Mother & Child Health (MCH) Centres:


All the 11 DHs are providing Comprehensive Emergency Obstetrics Care (CEmOC) services while 21
CHCs and 33 PHCs are providing Basic Emergency Obstetrics Care (BEmOC) services and 5 SCs are
functioning as Delivery Points.

18. Name Based Tracking System (NBITS) / Mother & Child Tracking System (MCTS):
Completed training of district trainers for MCTS, nodal officers at district and state identified and notified,
designing and printing of MCTS registers and formats completed and dissemination to districts underway. To
operationalise by Mar 2011.

19. Maternal Death Review (MDR)


Training of district trainers for Maternal Death Review (MDR) is completed and the district/state nodal
officers identified and notified, designing and printing of registers and formats completed and dissemination to
districts underway. To operationalise by March 2011.

20. Communization:
The primary health care approach lays emphasis on health care provision by the people. The State
government recognizing the need for Community Participation as a fundamental requirement to achieve health
and sustainable development, initiated measures to harness its rich social capital to vitalize the public
institutions by launching the “Communitization Policy” with the enactment of Nagaland Communitisation of
public institutions and services Act in 2002.

As an approach to strengthen the health systems, health institutions were communitized under the Act by
fostering partnership with the community and transferring the ownership and management of health institutions
and services to the community. It also paved way for active participation of community in preventive and
promotive measures, contributing their share to make health a reality in their own community.

The communitization policy resulted in strengthening and revitalization of the dismal health system in the
State. However, its rudimentary infrastructure and services is still unable to meet the expectations and needs of
the people.

Ongoing Initiatives:
 Provision of Decentralised Funds- Medicine & Emergency Funds.
 Infrastructure strengthening.
 Training and capacity building of the various Committees to sustain Communitisation
 Annual Convention of Health Committees being organised.
 Award for Best performing Communitised village has been budgeted
 Monitoring & Evaluation of the implementation of the Communitisation process

Outcome:
The decentralization has led to empowerment of the community with transparency in the form of financial
management, planning, implementation, monitoring and social auditing. Besides development of health
infrastructure, community led adoption of resolutions relating to health promotion and prevention, such as:
 Compulsory check-up of pregnant mothers & delivery at hospitals/should be attended by trained health
personnel.
 Compulsory immunization of children and participation in health programs.
 Health Education on Sanitation and various health issues such as Confinement of pet animals.
 Active participation in Village Health and Nutrition Day.
Table: SC building Construction undertaken under Communitization (State).
District State
No of SC Completed 2009-10 Total
Kohima 40 5 2 7
Mokokchung 51 5 2 7
Tuensang 39 4 1 5
Phek 44 3 0 3
Mon 50 3 1 4
Wokha 37 2 1 3
Zunheboto 47 3 1 4
Dimapur 47 3 1 4
Peren 16 3 1 4
Kiphire 19 3 1 4
Longleng 8 2 0 2
State Total 398 36 11 47

21. Public Private Partnership (PPP):


Recognizing the importance of Health in the process of economic and social development and
improving the quality of life of our citizens, the State Government, in spite of many constraints, is putting in
sustained effort in augmentation of health manpower, accelerating infrastructure development and strengthening
of monitoring and handholding supervision to enhance quality of care and accountability. Besides, the
Government has also taken major initiatives in the Public Private Partnerships to tap the much needed resources
and technical assistance to ensure adequate health services are available, accessible, affordable and acceptable to
all at the right time and right place. Under the PPP venture, several significant projects have been undertaken by
the state during 2010-11, which as follows:

a. The setting up of the North East Regional Paramedical Institute at Dimapur wherein the MoU was jointly
signed on 22nd September 2010 between the Ministry of DoNER, Government of India and the Nagaland
Government and the Christian Institute of Health Sciences and Research (CIHSR) in the presence of the
Union Minister of DoNER and Mines, Shri B.K. Handique.

b. Under the CIHSR tripartite Memorandum of Association (MoA), CHC Dhansaripar was adopted by CIHSR
For innovative community health programmes, Conducting periodic training programmes to all categories
of the staff, To improve the quality of data collection and its utilization for effective management, To
conduct health education in schools and community, To assist in the implementation of all the National
health programmes and To use the Health Centre as centre for field work for various training programmes
of the CIHSR.

c. To augment the training programmes, the CIHSR Dimapur has been designated as a Training Centre under
the tripartite of MoA CIHSR. Through this initiative the CIHSR will be providing its technical support in
various training programmes beginning from the current FY. The training cost will be borne by NRHM as
per GoI guideline.
The first activity of this partnership will be short term multi-skilling training for doctors on LSAS &
EmOC and nurses OT Techniques at CMC Vellore for a period of 3 months and 2 months respectively.
Also to take the opportunity, the following programmes- Lap ST, Mini Lap, NSV, Safe abortion & IUCD
insertion for the doctors and SBA and & IUCD insertion for the Nurses will be incorporated in the training
programme. A team of doctors and nurses will be selected from identified CHCs so that on completion of
the training a readymade team will be in position for immediate operationalization of the health facility.
The training for the first batch will commence from 1st Feb 2011.
In the Second phase beginning from 2011-12, CIHSR will also provide the following in-service
training programmes on SBA, Lap ST, Mini Lap, NSV, Safe abortion and IUCD insertion. Besides, the
Institute will also support the state in the induction training of various categories of health personnel. All
the training programmes under this Institution will be residential.

d. Another important milestone is the partnership with the Medecins Sans Frontieres (MSF) on the other for
collaboration to improve access and provision of quality health care services in Mon District through the
District Hospital. The MoU was signed between the two on 21st July 2010.
The progress made so far through this initiative has brought tremendous changes for the first time in the
district and is benefitting scores of underserved people.

e. As approved by NPCC in the RoP 2010-11 under „Weaving a Dream: a People‟s Initiative for Health Care‟,
the MoU between DoHFW and Eleutheros Christian Society (ECS) for the management of the Langpong
Health Centre was signed.
The purpose of the collaboration between and ECS is to collaborate in the management of the
Langpong Health Centre presently managed by ECS, as a 24x7 PHC facility to promote and provide
universally acceptable, accessible, equitable and quality health care services for the population of
Changsang Range and Tuensang district in general. Remarkable community participatation in promotion
health is exempleray under this project.

f. The Department of Health & Family Welfare (DoHFW) also entered into a partnership with the Police
Department for effective and collective utilization of its available manpower which resulted strengthening
the Central Hospital Chumukedima to a First Referral Unit (FRU) for delivery of quality health care. The
Police Central Hospital was inaugurated on 17th December 2010. This partnership will also incorporate the
National Disease Control Programmes in the services delivery and participation in the Health Information
Management System (HMIS) in all the Health Units under Police Department.
The facility has started to function as FRU.

g. Partnership with private & NGO players:


 With the financial support @ Rs. 5.00 Lakhs each from the NRHM, the 3 Mission Hospital at Wokha,
Mokokchung and Zunheboto the performance has been very encouraging delivery health care in the
underserved areas. The department proposes to continue the financial aid at the same rate to these 3
Mission Hospitals.
 Zion Hospital, Dimapur has adopted Athibung PHC of Peren district for regular outreach activities.
Currently 3 MNGOs are working effectively in four districts in the unreached areas. 7 more MNGOs
for the remaining districts have been inducted during the year.
 To enable universal access on JYS and Family Planning, the department has entered partnership with
private nursing homes in Dimapur (3 nos), Kohima (1 no) and Mokokchung (1 no).

22. Output Indicators:

Indicator 2010-11(April-
2008-09 2009-10
October)

BCG 76.0% 100.0% 63.8%


DPT 67.0% 92.4% 55.3%
1. Immunisation* OPV 70.0% 94.7% 57.3%
Measles 66.0% 97.8% 59.1%
Fully immunised 66.0% 97.8% 59.1%
Prophylaxis Against Blindness – 1st
Dose 48.4% 45.0% 38.1%
Prophylaxis Against Blindness –
2ndose 35.2% 23.5% 21.1%
Prophylaxis Against Blindness –
3rdDose 30.4% 17.8% 15.0%
ANC Registration against Expected
Pregnancies 56.3% 88.0% 43.5%
TT1 given to Pregnant women against
ANC Registraion 23.4% 41.1% 20.0%
Tetanus Immunisation (Expectant
Mothers) 22.4% 35.0% 17.0%
3 ANC Check ups against ANC
Reigtrations 14.0% 26.0% 14.0%
100 IFA Tablets given to Pregnant
2. Maternal and Child women against ANC Registraion 6.5% 23.0% 19.1%
Health Pregnant women detected with
hypertension 0.0% 1.1% 0.4%
Pregnant women detected with
anaemia 0.0% 2.5% 1.8%
HOME Deliveries( SBA& Non SBA)
against Estimated Deliveries 9.0% 13.4% 7.5%
Institutional Deliveries against
Estimated Deliveries** 27.9% 33% 25.8%
C Section Deliveries against
Institutional Deliveries( Pvt & Pub) 0.7% 2.4% 1.0%
Live Births Reported against
Estimated Live Births 26.5% 44.0% 22.4%
Still Births (Reported) 1% 1% 0%

Sex Ratio at Birh 993 928 947


3.Births & Neonates Care New borns weighed against Reported
Live Births 57.4% 74.1% 68.1%
New borns weighed less than 2.5 kgs
against newborns weighed 12.3% 9.0% 5.0%
New borns breastfed within one hr of
Birth against Reported live Births 0.8% 51.0% 62.0%
Post-partum check-up within 48 hrs
4.Post Natal Care after delivery 9.3% 30.0% 32.2%
Post-partum check-up between 48 hrs
and 14 days after delivery 17.1% 18.3% 23.5%
Condom-User 36.0% 96.0% 84.4%
Oral Pill Users 15.2% 25.5% 12.1%
IUD Insertions 2.0% 6.5% 2.7%
5. Family Planning
Sterilisation 1.4% 4.0% 2.0%
Tubectomy 1.2% 3.8% 2.0%
Vasectomy
0.1% 0.1% 0.0%
OPD 523090 336959 341265
IPD 63805 54532 346683
Major Operations 158 853 1482

6.Other Services Minor Operations 124 4474 6074


Number of villages 1278
No. of VHND Conducted 5 329 997
Number of times the Ambulance was
used for transporting patients 15 424 457
Pertussis 0 2 7
7.Childhood Diseases Tetanus neonatrum 1 0 0
Tetanus others 0 13 17
Measles 938 2443 970
Diarrhoea & Dehydration 7801 11315 6399
Malaria 1530 3675 1221
Respiratory infections 6497 4571 2201
23. Bottlenecks in the Implementation of NRHM:
i. Manpower shortage.
The state is unable to provide quality health care due to want of Speciality Doctors and Nurses and
Paramedics.
Reasons:
a. Lack of Institution for Medical Education: Except for 2 GNM and 1 ANM Nursing school, there is
no Medical College, Nursing College or Paramedical Institute in the state. The state is fully
dependant on the GoI quota for MBBS and Specialists Quota of the RIMS Imphal. Annually, the
state gets about 35-40 MBBS and 6-7 PG seats.
b. Brain Drain due to low remuneration & difficult working conditions in the rural areas, doctors in
particular are not coming forward to serve in the public sector. For instance- under NRHM the
monthly remuneration for GDMO is Rs. 20000.00 whereas in private institutions the current
monthly salary Rs. 30000.00 and above while NEIGRIMS Shillong is paying Rs. 40000-450000.
During the year 16 contractual MOs have resigned opting for private sector for the same reason.
In this regards, the state has submitted a proposal to the GoI for enhancement of the
monthly remuneration for key health manpower under NRHM and to sanction necessary funds to
meet the proposed enhancement vide letter no: NRHM/NL/DPMU/STAFF/2010-11/159/ dt
18.08.10. The reply is still awaited.
c. Also due to blanket ban on creation of post by the state government, the department is unable to
create new posts.

ii. Limited Financial Resources


Under NRHM, there has been a quantum development in the health infrastructure. However, due
to limited of Financial Resources, the state is unable to provide proper building to its health units,
quarters to the key health staff. Also, for the same reason, the state is unable to establish health units as
per population criteria.
Reasons:
a. Poor physical Infrastructure:
o 143 SC, 51 PHC, 7 CHC and 3 DH require immediate new building.
o Majority of the PHC/CHC/DH do not have adequate staff quarters.
b. Health Facility gap.
o 397 SC against 663 as per the population criteria.
o 21 CHC against 25 as per the population criteria.

iii. Accessibility and communication problems.

24. State Specific Needs:


i. Limited Financial Resources:
a. Annual fund allocation is Pre-decided by GoI prior to NPCC approval. Instead fund should be
allotted as per absorption capacity.
b. Matching contribution 15% is on the higher side for a state like Nagaland.
c. Flexibility of allocation of funds for civil works beyond the prescribed limit of 33%.

ii. Up-scaling MCH and FP services.

iii. Mentor VHND for delivery comprehensive health care.

iv. Accelerating the reversal of communicable diseases with special attention to vector borne diseases.

v. Intensify Partnership to universalize health care services.

vi. Accelerating capacity building programme including multiskilling training through partnership.

vii. Strengthening supportive supervision and monitoring.

viii. Forward Linkage with the DoNER ministry:


a. To formulate specific guidelines for proposal/activities.
b. Allocation & release of fund should be need base and equitable.
c. Activities not approved under NRHM should be considered for forward linkage.
ix. Provision for procurement of vehicles for monitoring, reason being shortage of vehicles in the State.