Pip 2011-12 Ap NRHM

NATIONAL RURAL HEALTH MISSION – ANDHR APRADESH
THE PROGRAMME IMPLEMENTATION PLAN (PIP) 2011-12
EXECUTIVE SUMMARY
1. The state of Andhra Pradesh is situated on the globe in the tropical region
between 12014' and 19054' North latitudes and 76046' and 84050' East longitudes. It is
bounded on the North by Maharashtra, on the North-East by Orissa and Madhya
Pradesh, on the East by Bay of Bengal, on the South by Tamilnadu and on the West by
Karnataka States. The state has a long coastal line extending over 960 km from
Ichapuram sands in Srikakulam district to Pulicat lake in Nellore district.
Administratively, the state spreading over 2,76,814 sq.km. and has been divided into 23
districts, 1123 revenue mandals, having 29,994 villages and has 10 tribal notified areas
spread across the state.
2. The Government of Andhra Pradesh has demonstrated its commitment to

achieve sustainable improvement in the health status of its population with strong focus
on improving health outcomes for all sections of people, especially women, children and
vulnerable group of population such as Schedule Castes, Schedule Tribes, etc. During
the past few years, the Government of Andhra Pradesh has taken several new
approaches to improve access to quality health care.
3. Revitalisation of the Primary Health System: The Government‟s endeavour is to

strengthen the public health care system for effective prevention and efficient
management of diseases; provision of universal and comprehensive reproductive and
child health services; strengthening the referral system; and improving the quality of
hospital care in conformity with the Indian Public Health Standards (IPHS). In this
direction, the Government have converted two-hundred and three (203) Government
Dispensaries (GDs), Government Civil Hospitals (GCHs), Subsidiary Health Centres
(SHCs) and Mobile Medical Units (MMU) into Primary Health Centres (PHCs) /
Community Health Centres (CHCs) in the state. This measure has contributed to the
creation of a rational primary health structure in the rural areas of the state characterized
by three inter-related and hierarchically organized institutions of health care, i.e., sub-
centre, primary health centre and community health centre / Area Hospital. In this
process of primary health institutions‟ rationalisation, the Government have established
Three Hundred Sixty (360) Community Healthand Nutrition Clusters (CHNCs) across
the state with a view to provide comprehensive health services to population ranging
from one to three lakhs through a network of four to ten proximate PHCs and a Referral
Hospital – a CHC / Area Hospital / District Hospital / Teaching Hospital ; in order to
achieve the following objectives:
 Strengthen preventive, promotive, curative and referral health services through

rational deployment of human, material and infrastructure resources available
with the CHNC area;
 Strengthen first referral units (FRUs) – CHCs and Area Hospitals – and provide
them with comprehensive emergency obstetric and neonatal care service facility;
1
 Strengthen the Primary Health Centers by ensuring they function round the clock
throughout the year by providing additional human resources, infrastructure, etc.
 Strengthen the referral system, i.e., the linkage between the village, Sub-centre,
PHC, CHC / Area Hospital and the District / Teaching Hospitals;
 Establish an effective planning, coordination, facilitation and monitoring system
for a cluster of four to ten PHCs; and
 Strengthen community outreach through fixed day visit to sub-centres and
villages by the medical and para-medical staff;
4. Institutional Strengthening: The government has ensured for effective integration

of public health services, the government has created the post of Commissioner of Health
and Family Welfare with overarching responsibility over the Directorates of Public
Health, Family Health, Institute of Preventive Medicine, AP Vaidya Vidhana Parishad,
AP AIDs Control Society and the Indian Institute of Health and Family Welfare. At the
Government level, a single Principal Secretary has been assigned responsibility for all
primary and secondary health systems, ending decade long arrangement of dispersed
authority. The government is in the process of establishing a HR Directorate.
Concurrently, the six regional health directorates and twenty three DMHO institutions
are being strengthened through fundamental institutional reengineering.
5. Human Resources: The Government have commitment to strengthening the

health services, and rationalised all Specialists working in various health facilities and
posted them against the existing vacancies in the CHC/AH (FRU‟s). Further, to fill the
gaps 194 Specialists, 989 Medical Officers, 1700 Staff Nurses on regular basis and 691
Staff Nurses on contractual basis under NRHM have been appointed in the state. To
strengthen the Regional Directors a trained Bio-Statisticians have been posted as
Regional Data Managers to monitor NRHM activities in the region. All the DPMUs is
now headed by a Public Health Officer to support the DMHOs, to monitor IMNCI,
School health activities all districts have been established with IMNCI coordinators and
school health coordinators as envisaged in the PIP 2010-11.
6. Programme revitalization: The institutional reengineering has shown impact both

in terms of access and quality of health care at all levels. The organisational reform is
being accompanied by strategic realignment of programme design, implementation
methodology and monitoring systems. The programme implementation plan have been
aligned with the specific needs and requirements of the local communities. The strategic
focus will steadfastly remain on maternal and child health, disease prevention and
effective management and overall health promotion. Considering the diversity of the
state, the interventions and the delivery mechanism will be customised for the needs and
expectations of the target groups.
7. The NRHM Project Implementation Plan (PIP) for 2011-12 is a salubrious

document with the proposed programmatic realignment to achieve rapid but sustainable
improvement in the health outcomes. The PIP has its principal focus on improving the
reproductive and child health services and the resultant outcomes. However, equal
importance is accorded to disease control interventions; strengthening the human
resources, infrastructure, capacities and capabilities; strengthening of monitoring and
technical support systems, etc. Highest priority is assigned to addressing the needs of
tribal people living in remote and interior areas and to ensure effective health care
services to people vulnerable from the social, economic and nutrition angles.
2
The PIP 2011-12 have covered all the programmes / interventions including disease
control programmes, human resource, monitoring evaluation and situation analysis,
contents of the chapters structured with Executive Summary, Key Objectives, Critical
analysis and gap identification, Implementation Strategies, Expected Outcomes and
budget proposal so prepared duly quantifying the physical targets.
Sectoral Priorities – Budget Allocation
8. One of the objectives of NRHM is to increase the budget outlay for the health
sector to three percent of gross state domestic product (GSDP) and around eight percent
of state budget. The state budget outlay for 2011-12 is around 1.2% of GSDP and 4.0%
of the total budget outlay. However, it is significant that the state allocation for health
sector has increased from Rs.1587.54 crores in FY 2005-06 to Rs.4562.78 crores in FY
2011-12 (provisional), an increase of about Rs.3000 crores. NRHM allocation constitutes
about 30% of total state allocation for health and family welfare department.
9. The approved budget for NRHM during 2010-11 was Rs.961.13 crores, of which
an amount of Rs.670.01 crores was released – excluding the unspent balances. Of this,
an amount of Rs.593.22 crores has been spent. During 2011-12, state proposes a total
budget of Rs.1318.76 cores, which includes 15% state share. GoAP has already indicated
state share of Rs.158.61 towards implementation of NRHM activites during 2011-12.
The summary of budget is as follows:
(Rs. Crores)
Proposed % increase
SN Activity Budget over
2011-12 2010-11
1 RCH Flexible Pool 334.96 64.20
2 Mission Flexible Pool 510.36 69.47
3 Strengthening of Routine Immunization 24.93 35.97
4 National Disease Control Programme 67.93 16.76
5 Monitoring & Evaluation 11.97 100.00
6 Direction and Admn. (Treasury route) 346.61 24.41
7 Pulse Polio 22.00 9.13
Total 1318.76 49.79
3
CHAPTER-1
OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11
10. Andhra Pradesh is the fifth largest State in India in terms of geographical area
and population. The State has a population of 880.23 lakhs. The decadal population
growth rate of the state was 14.59 during 1991-2001 decade, compared to the national
growth rate of 21.54. The projected current population of the state is around 880.23
lakhs (1.10.2010 Estimates). With an area of 275,068 sq. kms, the state accounts for
approximately 8.37 percent of the total landmass of the country. The state is divided into
three distinct regions on the basis of homogeneity, contiguity and economic criteria for
the purpose of better planning and development. These regions are – Telangana,
Rayalaseema and Costal Andhra. The state has 23 districts, which are divided into
1,125 mandals.
11. As per Census 2001, the population density (per square kilometre) in the state has
increased from 242 in 1991 to 277 in 2001. Scheduled Castes constitute 16.2 percent of
population and Scheduled Tribes constitute 6.6% of population. According to Census
2001, the literacy rate in the state (60.5 percent) is lower than the national average (64.8
percent). The male and female literacy rate was about 70.3 percent and 50.4 percent
respectively, which is lower than the national average (75.3 percent for males and 53.7
percent for females). The sex ratio and child sex ratio (0-6 age group) of the state is 978
and 961 respectively, which is higher than the corresponding national figures of 933 and
927, indicating the prevailing gender norms in the state.
Socio-Demographic Profile of Andhra Pradesh
Rural Urban Total

1 2001 Census population (in lakhs) 554.01 208.09 762.10
2 Estimated Population (in lakhs) 639.89 240.34 880.23
3 % of population over total pop. 72.7% 27.3%
4 Male population (in lakhs) 323.49 121.50 444.99
5 Female population (in lakhs) 316.40 118.84 435.24
6 Sex Ratio (Females per 1000 males) 983 965 978
7 Sex-Ratio (0-6 children) 963 955 961
8 Growth rate (%) +13.94 +16.34 +14.59
9 % SC Population 18.4 10.2 16.2
10 % ST Population 8.4 1.8 6.6
Source: Registrar General of India, 2001
Rural Scenario
12. As per the 2001 census, there are 28,123 villages in the state out of which 26,613
are inhabited. Approximately 6 percent villages in the state had a population of less than
500 and another 20 percent villages had population in the range of 500-1250. Moreover
72.7% population live in rural area. However, districts like Hyderabad, Visakhapatnam,
Krishna, Guntur, Warangal have relatively large urban population.
4
Census Rural Percent of Rural Decadal growth
Year Population Population Rate
1961 2,97,09,447 82.56 15.62
1971 3,50,99,708 80.68 18.15
1981 4,10,61,673 76.68 16.99
1991 4,86,21,008 73.11 18.41
2001 5,54,01,007 72.70 13.94
Urban Scenario
13. Andhra Pradesh has undergone rapid urbanization over the past fifty years.
Census 2001 states that nearly 208.09 lakh people, which accounts for 27.3% of the
population, reside in urban areas. The corresponding figure in 1961 was nearly 62.74
lakhs accounting for 17.4 percent of the population.
Census Urban Percent of Urban Decadal growth

Year Population Population Rate
1961 62,74,000 17.40 15.76
1971 84,03,000 19.30 33.93
1981 1,24,88,000 23.30 48.61
1991 1,78,87,000 26.90 43.23
2001 2,08,09,000 27.30 16.34
Expected outcomes
Indicator NRHM Present status AP
by 2012 India AP Target
#
IMR (per 1000 live births) 30 50 49# 30
MMR (per 1,00,000 live births) 100 254** 154** 100
TFR (children per women) 2.1 2.7* 1.8* 1.7
Source: # SRS 2009; * SRS 2008; ** SRS Special Survey (2004-06)
 Achieve a cure rate (TB - DOTS) of – 85% by 2012

 Reduce prevalence rate of Leprosy to – 0.43 per 10,000 by 2012
 Increase Cataract operations to – 6 lakhs per annum by 2012 (AP).
 Reduce Malaria Mortality Rate to – 60% by 2012
 Reduce Filaria / Microfilaria rate to – 80% by 2012.
5
Progress over the years
Infant Mortality Rate Maternal Mortality Ratio

(per 1,000 live births) (per 1 lakh live births)
90 450 417
80
77 400 341
350
70 64
59 300
60 54 250 195
49 200 154
50
150
40 100
30 50
20 0
10 1992-93 1998-99 2001-03 2004-06
0 IIHFW IIHFW SRS SRS
SRS 1983 SRS 1993 SRS 2003 SRS 2007 SRS 2008
Source: Sample Registration System (SRS), RG, GOI
Total Fertility Rate Institutional Deliveries

(children per women)
5 4.6 80 71.8
68.6
5 4.0 70
4 60
4 49.8
3.0 50
3
2.3 40 34.3
3
2 1.8 30
2 20
1 10
1 0
0
NFHS-1 NFHS-2 NFHS-3 DLHS-3
SRS 1971 SRS 1981 SRS 1991 1998-99 SRS 2008
(1992-93) (1998-99) (2005-06) (2007-08)
(NFHS-2)
14. An attempt is made to analyze the current status of NRHM specific indicators of
Andhra Pradesh on HMIS reports (April and September 2010) in comparison with
NFHS- 3, DLHS-3 and CES, 2009.
Out come of surveys on Service Delivery
HMIS April–Sept
A - Child Health Surveys Source
2009-10 2010
1 Expected Live Births 1,525,239 1,551,727
New born breastfed in less than 1 hr of birth against
2 81% 81.3% 22.4% NFHS-3
Expected Live Births
3 Newborn weighed % against Expected Live Births 93% 92.8% 62.7% NFHS-3
4 Newborn weighed less than 2.5 kgs % 9% 7.1% 19.4% NFHS-3
B - Child Immunization
46.0% 68% CES,
5 Fully Immunized Children 99% 94.9%
NFHS-3 09
6 Children given BCG 101% 96.4% 92.9% NFHS-3
7 Children given 3 doses of OPV 99% 93.7% 79.2% NFHS-3
61.4% 89.9%,
8 Children given 3 doses of DPT 99% 94.0%
NFHS-3 CES,09
69.4% 90.4%,
9 Children given Measles 98% 95.2%
NFHS-3 CES, 09
6
C - Maternal Health
10 Pregnant women registered for ANC 108% 102% -- --
11 ANC registered in First Trimester 72% 67.9% 67.3% DLHS-3
89.4% DLHS-3
12 Antenatal Care 3 check ups 93% 89.0%
97% CES, 09
13 Home Deliveries (%) 8% 5.1% 27.7% DLHS-3
14 Home Deliveries assisted by SBA (%) 5% 3.5% 13.9% DLHS-3
71.8% DLHS-3
15 Institutional Deliveries (%) 90% 84.6%
94.3% CES, 09
16 Post natal check up within 48 hrs of delivery (%) 87% 97.0% 79.5% DLHS-3
NRHM /RCH-II Outcomes
A. Current status
15. Andhra Pradesh‟s MMR at 154 (SRS 04-06) has declined from 195 in SRS 01-03
and is the fifth lowest after Kerala, Tamil Nadu, Maharastra and West Bengal. The IMR
(SRS 2008) at 52 has reduced from 59 (SRS, 2003), but is nowhere close to the target of
30 for 2012. TFR at 1.8 (SRS 2008) is better than the national target for 2012. The early
neo-natal mortality (death within one week from child birth) recorded more than 50
percent of infant mortality in the state.
16. Andhra Pradesh‟s progress during the four- year period between DLHS2 (2002-
04) and DLHS 3 (2007-08) is varied:
 Universal antenatal coverage reported by mothers since 2002, mothers having
three or more ANCs increased marginally from 86% to 89.4% between survey
periods and to 97% by 2008 (CES, 2009).
 Mothers having full ANCs decreased from 44.2% to 37.9% during survey
period. However, the CES 2009 survey reported 46%.
 Significant increase in institutional deliveries from 59.4% to 71.8% between
the survey periods. It reached 94.3% by 2009 (CES, 2009).
 Early initiation of breast feeding ((< 1 hour) increased from 41.8% to 47.8%
but CES 2009 survey indicated 27.2%.
 Full immunization in children of 12-23 months increased from 60.2% to
67.1% while CES 2009 survey reported 68%
 Children with diarrhea receiving ORS has decreased from 57.8% to 43.3%
but has shown marginal increase of 54.5% as reported by CES (UNICEF)
2009.
Service Delivery Summary

2009-10 vs April to September 2010
April – April –
2009-
2009-10 Sept. Sept.
10
2010 2010
ANC
ANC Registration TT1 given to Pregnant
against Expected 108% 111% women against ANC 92% 88.9%
Pregnancies Registration
3 ANC Check ups 100 IFA Tablets given to
against ANC 86% 87.4% Pregnant women against 94% 93.9%
Registrations ANC Registration
7
Deliveries
Un-reported Deliveries HOME Deliveries( SBA&
against Estimated 2.2% 1.3% Non SBA) against 7.5% 0.6%
Deliveries Estimated Deliveries
Institutional Deliveries HOME Deliveries( SBA&
against Estimated 90.3% 90.9% Non SBA) against 7.7% 5.7%
Deliveries Reported Deliveries
Institutional Deliveries C Section Deliveries
against Reported 92.3% 94.3% against Institutional 19% 18.1%
Deliveries Deliveries( Pvt & Pub)
Births & Neonates Care
Live Births Reported
New borns weighed against
against Estimated Live 102% 98% 91% 94.8%
Reported Live Births
Births
New borns weighed less
Still Births (Reported) 12,193 6,245 than 2.5 kgs against 9% 7.7%
newborns weighed
New borns breastfed within
Sex Ratio at Birth 946 940 one hr of Birth against 79% 83%
Reported live Births
Child Immunization (0 to 11 months)
BCG given against Measles given against
101% 96.4% 98% 93.2%
Expected Live Births Expected Live Births
Fully Immunised Children
OPV3 given against
99% 93.7% against Expected Live 99% 94.9%
Births
DPT3 given against
99% 94.0%
A. Antenatal Care
I. More than 94% of pregnant women registered for ANC of which 87% availed
three ANC (the lowest reported in Warangal (70%) and the highest in Ranga
Reddy, Medak, Kadapa and Hyderabad districts (97 – 99 percent)).
II. 30% of Total ANCs (94%) have been registered as JSY beneficiaries during the
period April to September 2010 in the state. Vizianagaram, Mahabubnagar,
Khammam, Chittoor and Kadapa districts have been reported 42% of total JSY
beneficiaries registered.
III. The ANC registrations in first trimester by pregnant women remained at 67.3%
during the period April to September 2010 from 72% HMIS (2009-10). The
DLHS-3 (2006-07) survey reported two-thirds (67%) of ANCs registered during
first trimester of pregnancy. The proportion of first trimester ANC registrations
(66%) reported in Vizianagaram, East Godavari, Prakasam, Medak and
Mahabubnagar districts is less than the state average.
IV. 89% of pregnant women have received the First dose of TT immunization. The
districts that reported lower than 75% of TT-1 vaccination are Kurnool,
Nizamabad, Prakasam, Visakhapatnam, Vizianagaram and Warangal.
V. 93% of pregnant women received the second dose of TT immunization for the
current pregnancy. However, the proportion of second dose of TT reported in
8
Vizianagaram, Visakhapatnam, West Godavari, Warangal and Nizamabad
districts is below state aggregate (74 to 87 percent).
VI. About 3% of pregnant women are suffering with severe anemia (Hb<7). The
HMIS data upto Sept. 2010 showing that, an alarming situation of severe anemia
in districts of Vizianagaram (17.2%), Khammam (8.5%), Medak (5.9%) and
Adilabad (4.4%).
VII. Half of the pregnant women in Hyderabad, Khammam, Chittoor,
Visakhapatnam, and Vizianagaram districts reported Hemoglobin below 11. This
clearly indicates strengthening and monitoring of nutritional interventions in the
districts.
VIII. In the reference period, five percent of new cases among pregnant women at the
institutions were detected with high Blood Pressure (BP>140/90) in the state. In
the districts Srikakulam, Vizianagaram, West Godavari, Nellore, Chittoor and
Adilabad, more than 7% of new cases with High Blood pressure were reported.
IX. Nine out of ten (93%) pregnant women in every district received 100 IFA tablets.
A comparison of HMIS data with survey results indicates a lower percentage of
IFA consumption of 48% (DLHS-3; 2006-07). The RCH-II Baseline Survey
(2007) also indicated that the percent of pregnant women who received /
purchased 100 or more IFA tablets was 54% and consumption of all tablets stands
around 33.2%.
B. Delivery and Post Natal care
Surveys Home Public Private Total

DLHS-3 28.3 29.0 42.7 100.0
HMIS (April to 5.4 38.8 55.9 100.0
Sept, 2010)
a) The percentage of institutional deliveries increased to 94.6% as per HMIS data

(April to September 2010) from 92.3% HMIS (2009-10). A significant
improvement was recorded from 72% in 2006-07 (DLHS-3).
b) 56% of deliveries were conducted in private institutions (according to HMIS
data). The private sector deliveries recorded more than 75% in Karimnagar (83%),
Ranga Reddy (78%), Nellore (77%) and Guntur (76%) districts.
Trends in Institutional Deliveries in Andhra Pradesh

100 92.394.3
90
80 69 76
70 61.4 63.7
60 49.8
50
40 32.9
30
20
10
0
NFHS-1
NFHS-1
2002-04
2003 (EC
(NFHS-3)
(2009-10)
(2010)
(Baseline)
2005-06
HMIS
Survey)
(DLHS)
(92)
(98)
HMIS
2006
9
c) The percentage of mothers who received JSY benefit in the state worked out as
5.6% during the period April to September 2010 (Home based (0.25%), public
institutions (14.5%) and private institutions (0.12%) respectively.
d) Home based deliveries declined from 23% in 2007-08 (DLHS-3) to 5% (HMIS,

April to September 2010 HMIS data). More than 10% of home based deliveries
were reported in Adilabad, Kurnool, Mahabubnagar, Prakasam, Srikakulam,
Visakhapatnam and Vizianagaram districts. It is to be observed that only half of
the home-based deliveries in Mahabubnagar and Vizianagaram were attended by
skilled personnel.
e) Less than three-fourths (74%) women were discharged within 48 hours of delivery
from public health facility. However, the ratio of women delivered in public
institutions to total deliveries was recorded below 20% in Karimnagar, Ranga
Reddy and Nellore districts. As per JSY norms, a minimum stay at the institute of
48 hours is required both for newborn and the mother after delivery.
f) Out of institutional based deliveries in the state, three-fourths (76%) are normal
type delivery, 18% are C-Sections and 5.6% are complicated pregnancies.
g) 34% of C-Sections are conducted in private institutions as compared to 8.5% in

public health facilities. In the districts, deliveries conducted by C-Section are
sizeable with Srikakulam (26%), Guntur (28%), Nizamabad (31%), Nalgonda
(32%), Khammam (32%) and Karimnagar (48%) throwing light on the surging
rates of C-Section cases.
Delivery status
2009-10 April – Sept. 10

Total Population 82,893,403 88,023,000
1,551,727
Expected Deliveries 1,564,895 775,864
(April to Sept.10)
Home SBA 75,171 (5%) 29,702 (3.8%)
Home Non SBA 42,650 (3%) 14,023 (1.8%)
1,413,202
Institutional 721,674 (93.0%)
(90%)
Total deliveries reported 1,531,023 765,399
Unreported Deliveries 33,872 (2%) 10,465 (1.4%)
10
Home (SBA & Non SBA) & institutional Home (SBA & Non SBA) & institutional
deliveries to expected deliveries (%) deliveries to reported deliveries (%)
Unreported Home SBA

Deliveries 3.8 Home Non SBA Home SBA Home Non SBA
1.4 1.8 3.9 1.8
Institutional Institutional
93 94.3
Comparison of type of deliveries Comparison of institutional deliveries:

HMIS data and DLHS-3 survey HMIS and DLHS-3 survey
100 94.3 94.3 60
56.0
90
80 71.8 50 % 42.7
70 % 38.3
40
60
28.3 29.0
50
30
40 28.2
30 20
20 13.9
5.7 5.7 4.0 5.7
10 10
0
Home Deliveries Home Deliveries Institutional 0
assisted by SBA Deliveries Home Deliveries Public institutions Private Institutions
DLHS III HMIS (Apl-Sep, 2010) CES, 2009 DLHS III HMIS, Apl to Sep 2010
District-wise institutional deliveries to reported deliveries 99.7
100.0
99.5
99.3
99.3
99.1
98.3
98.2
97.6
96.7
96.3
95.8
95.5
94.3
100
93.3
92.8
92.5
89.0
89.0
87.7
87.7
85.6
83.9
90
81.6
80
70
60
50
40
30
20
10
0
Medak
Khammam
Nizamabad
Adilabad
Srikakulam
Kadapa
Hyd
Kurnool
Prakasam
Vizianagaram
MBNR
Vizag
Nalgonda
Krishna
Andhra Pradesh
Warangal
East Godavari
Chittoor
Anantapur
Nellore
Ranga Reddy
Guntur
West Godavari
Karimnagar
11
C - sections & complicated deliveries
Institutional Deliveries Institutional Deliveries

(Public) (Private)
April to April to
2009 –10 2009 – 10
Sept. 2010 Sept.10
Total Deliveries 663,713 293,285 749,489 428,389
C Section 70,570 24,918 204,290 138,690
C Section% 11% 8.5% 27% 32%
Complicated Pregnancies
47,380 24,404 31,286 18,534
attended
Complicated Pregnancies
7% 8.3% 4% 4.3%
attended %
C-Section, complicated & normal del. District-wise C-Section deliveries to institutional

against reported inst. Del. (Prt. & Public) deliveries
60
48.3
C-section 50
18.1%
40
Complicated
31.5
32.3
31.6
27.9
27.3
Pregnancies 30
26
attended
18.1
17.9
17.5
16.3
15.9
15.5
15.4
5.7% 20
16
16
10.8
10.6
10.4
9.7
Normal Deliveries
8.9
7.9
6.7
10
3.8
76.2%
0
Khammam
Karimnagar
Nizamabad
Prakasam
Chittoor
Kadapa
Anantapur
Vizianagaram
Srikakulam
Guntur
Krishna
Nalgonda
Adilabad
Medak
Hyderabad
MBNR
Kurnool
Warangal
Andhra Pradesh
West Godavari
East Godavari
Nellore
Vizag
Ranga Reddy
Treatment of complicated pregnancies and deliveries:

April to
2009 – 2010
Sept. 2010
Reported Deliveries 1,531,023 765,399
Reported ANC Registration 1,808,357 868,764
Complicated Pregnancies attended 78,666 42,938
Complicated Pregnancies Rate 5% 5.9%
274,860 138,690
C-Section Deliveries
(17.9%) (18.1%)
PNC Maternal Complications 21,139 9,625
Abortions 12,965 7,595
Still Births 12,193 6,245
Complicated Deliveries Treated with
23,887
IV Antibiotics 46,073
(55.4%)
IV Antihypertensive / Magsulph 1,755
6,491
Injection (4.1%)
16,864
IV Oxytocis 28,680
(39.2%)
12
April to
2009 – 2010
Sept. 2010
544
Blood Transfusion 2,028
(1.3%)
No. of Eclampsia cases treated 10,025 5,027
No. of severe anaemia (Hb<7) cases 25,129
70,906
treated (2.9%)
Duration of stay after delivery in public Duration of stay less than 48 hours after delivery
institutions in public institutions - 2009-10 vs April to Sept.
2009-10 vs April to Sept. 2010 2010
100.0
99.8
99.9
98.5
98.8
99.3
99.4
97.7
98.3
98.4
97.1
97.2
95.9
96.0
96.4
95.0
95.2
94.1
94.2
92.5
100
87.4
85.2
90
80.9
Stay for more than 48 80
hrs after delivery
70
26%
60
50
40
30
20
Stay for less than 48 10
hrs after delivery 0
Chittoor
Anantapur
G untur
Karimnagar
Prakasam
M BNR
Srikakulam
Khammam
Vizianagaram
Adilabad
Nizamabad
H yderabad
Andhra Pradesh
Nellore
Kurnool
Nalgonda
Kadapa
Krishna
Warangal
Vizag
M edak
West G odavari
Ranga Reddy
74%
Percent of mothers paid JSY incentive to District-wise mothers paid JSY incentive to
reported deliveries - 2009-10 vs April to Sept. reported deliveries (%) 2009-10 vs April to
2010 Sept.2010
55.6
25 22 60
55
46.8
20 50
43.7
14.5 45
15 40
35
10
24.9
30
23.9
22.3
20.5
3 25
5 3 14.5
14.3
20
13.5
13.0
12.3
11.1
0.03 0.12
10.8
15
0
10
5.8
4.9
4.9
Home Institutional (Public) Institutional (Pvt.)

3.3
3.3
2.7
2.6
5
0.0
0.0
0.0
2009-10 Apr-Sep 2010 0

Kadapa
Krishna
Karim Nagar
Kurnool
Khammam
Chittoor
Anantapur
Guntur
Nalgonda
Nizamabad
Hyderabad
Adilabad
Warangal
Medak
Srikakulam
Andhra Pradesh
Prakasam
East Godavari
Vizag
Vizianagaram
West godavari
MBNR
Ranga Reddy
Nellore
ANC services Pregnancy complications reported during ANC

2009-10 vs April to Sept. 2010 registration
2009-10 vs April to Sept. 2010
868764
900000
811172 816037
775864 772160
800000 759614 40
700000 35
579924 29.3
600000 30
500000 25
20
400000
258935
15
300000
10
200000 4.4
5 2.9
100000 0.6
0
0 Hypertensive cases Eclampsia cases managed ANC women having Hb ANC women having
Exp. Prg. Total ANC ANC Reg. ANC Reg. 3 ANC TT1 TT2 100 IFA detected at institution during delivery level<11 severe anaemia (Hb<7)
reg. 1st tri. JSY Checkups tab. Given treated at institution
13
Pregnant women registered for ANC in first Percent of pregnant women registered for ANC in
trimester first trimester
2009-10 vs April to September 2010 2009-10 vs April to September 2010
100
88.0
84.7
90
80.4
100
75.5
75.2
72.2
72.2
72.0
80
70.5
68.4
90
67.3
66.8
66.8
65.2
63.8
62.0
61.7
61.7
70
61.5
59.6
59.3
80
54.7
52.0
51.9
66.0 67.0 66.8 60
70 63.0
50
60 52.0
40
50
30
40
20
30
10
20
0
10
Srikakulam
Medak
HYD
Nellore
Ranga Reddy
Adilabad
Prakasam
Krishna
Nalgonda
Kadapa
Nizamabad
Andhra Pradesh
Guntur
Warangal
Vizag
Kurnool
Khammam
Chittoor
MBNR
Vizianagaram
Ananatapur
East Godavari
Karimnagar
West Godavari
0
NFHS-2 (1998-99) NFHS-3 (2005-06) RCH Baseline DLHS-3 (2007-08) HMIS (Apl-Sep
(2007) 2010)
% 3 ANC checkups against reported ANC Post natal checkup against reported deliveries:
registration - 2009-10 vs April to Sept.10 HMIS (April to Sept 2010)
120 95
100
87
HMIS-2009-10
90
100 HMIS Apl to Sept 2010
80
70
80
60
60 50
40
40 30 18
20
20 5
10
0
PNC within 48 hrs after deliveries PNC bet 48 hrs and 14 days of deliveries.
0
Warangal
Prakasam
Khammam
Visakhapatnam
Krishna
Srikakulam
Nizamabad
Vizianagaram
East Godavari
Guntur
West Godavari
Andhra Pradesh
Nellore
Chitoor
Mahabubnagar
Ananthapur
Kurnool
Nalgonda
Karimnagar
Ranga Reddy
Adilabad
Kadapa
Hyderabad
Medak
C. Newborn care and Breast feeding
h) The percentage of new born weighed at birth is universal across all districts.
However, the DLHS-3 survey reported only 63% in the state during 2006-07.
i) A wide gap is observed in case of new born weighted below 2500 grams between
the DLHS-3 survey (19%) and HMIS (9 %). It is noticed that, very high in
Karimnagar (67%) and Prakasam (24.8%).
j) A wide gap is reported between HMIS and survey data in terms of newborn
breastfed within one hour of child birth. Nine out of ten (93%) newborns were
breastfed within one hour of delivery as compared to 22.4 (DLHS-3, 2006-07) and
29.3% (CES-2009) surveys.
k) Nine out of ten (96% to 100%) of infants 0 to 11 months old received BCG, DPT
1-3, OPV 1-3 and measles vaccine in the state. A comparison of HMIS data with
survey data indicated wide gaps. The measles vaccine increased from 69.4%
(NFHS-3) to 88.6% (DLHS-3, 2007-08) and has lately reached 90.4% (CES, 2009)
in state.
14
Live Sex Abortion
Live Birth Live Birth Still
Birth - Ratio at ( Induced/
– Males - females Birth
Total birth Spontaneous)
802,176 758,726 1,560,902 946 12,193 12,965
Reported births: HMIS (April to Sept 2010) District-wise neonates weighing to reported live
775863
births (%) HMIS (April to Sept 2010)
800000 759551
719852
700000 630509
100.0
100.0
100.0
99.8
99.9
99.6
98.3
98.3
98.4
97.9
97.5
96.8
600000
94.8
94.8
94.0
93.7
93.5
93.5
92.2
90.5
90.2
100
86.5
85.9
81.5
500000
90
400000 80
300000 70
60
200000
50
100000 55455
40
0 30
Estimated Live Reported Live Newborns No. of Newborns 20
Births - Apr to Births - Apr to weighed at Newborns breast fed
10
Sep 2010 Sep 2010 birth having weight within 1 hour
less than 2.5kg 0
Khammam
Nellore
Adilabad
Prakasam
Nizamabad
Srikakulam
Hyderabad
Vizianagaram
Andhra Pradesh
Medak
MBNR
Ranga Reddy
Nalgonda
Kadapa
Krishna
Kurnool
Vizag
Anantapur
Chittoor
Warangal
West Godavari
Guntur
Karimnagar
East Godavari
Comparison of new born care characteristics: Immunization (0 to 11 months) against reported
live births:
95
100
90 83
80
76.9 96.4 94.0 94.0 95.0 95.0
63 100
70
60 90
50 80
40 31.6 70
30 22 19
20
17 60
8
10 50
Newborn breastfed in less Newborn weighed Newborn weighed less
than 1 hr of birth than 2.5kgs 40
30
RCH-Survey, 2007 NFHS III HMIS(Apr-Sept 2010) 20
10
BCG OPV3 Fully
Immunised
District-wise fully immunized (0-11 months)

children against reported live births (%) Child Immunization Comparison of HMIS
(April to Sept.10) and UNICEF (CES 2009)
Survey
110 99
99 96 101 99 98
100 95 94 95
94 90 90
90
80
68
70
60
50
40
30
20
10
Fully BCG OPV3 DPT3 Measles
Immunised
HMIS (Apr-Sept 2010) HMIS (2009-10) CES, 2009 (UNICEF)
15
D. Hospital Service delivery
l) Inpatients form just 5% of total outpatients. About 18% of the general admissions
in the in-patient department comprise children.
m) In the outpatient department, the share of AYUSH patients is 4.5% during the
period April to September 2010 as compared to 2.8% during 2009-10.
n) During the reference period, 3.7% underwent HIV test, 3.9% reported HIV
positive to HIV tests conducted and 1.56% of pregnant women tested for HIV in
the hospitals as positive.
o) Ten percent of total out patients reported severe anemia (HB<7 gm) in the
laboratory tests.
Hospital service delivery: HMIS (April to Sept.10)

Operation Operation AYUSH Dental Adolescent Total OPD Total IPD
major minor (No or Procedures counselling
(General and local services
spinal anaesthesia)
anaesthesia)
42,716 166,830 1,017,909 111,281 56,538 22,162,251 1,049,179
(Children
18%)
Operation Operation AYUSH as Dental Adolescent IPD as
major minor (No or %ge of Procedures as counselling percentage
(General and local OPD %ge of OPD services as of OPD
spinal anaesthesia) as %ge of OPD
anaesthesia) as %ge of OPD
%ge of OPD
0.2% 0.75% 4.5% 0.5% 0.3% 4.73%
E. Other Services
Performance of permanent family planning methods:
HMIS (April to September 2010)
% age of reported
2009-10 April to
Sterilization
September 2010
(Apl. to Sep 2010)
Total Sterilization 945,075 391,607 -
NSV 22,223 4983 1.3%
Laproscopic 105,256 39915 10.2%
MiniLap 523,081 175267 44.7%
Post Partum 294,515 171442 43.8%
Male Sterilisation 22,223 4983 1.3%
Female
922,852 386,624 98.7%
Sterilisation
Abortions April – September 2010

Total Abortions Abortion Rate
7595 1.0% (1.1% during 2009-10)
16
Abortions: HMIS (April to September 2010)
MTP less than
12 weeks MTP more
15% than 12
weeks
6%
Abortion(Spo
n&Induced)
79%
RTI cases reported in public & private institutions

Number of wet mount tests
Total OPD Total RTI/STI cases
conducted
22,162,251 330,209 (1.7%) 15871(4.8%)
RTI cases reported in public & private institutions:

Male
42%
Female
58%
Laboratory services in hospitals: HMIS (April to September 2010)

Total HB Total HIV Total
Total OPD
tested Tested Population
22,162,251 662,480 821,978 84,333,000
HIV
HB test HB<7gm as HIV test HIV positive as %age of
positive as
conducted as %age of HB conducted as HIV tested among pregnant
%age of
%age of OPD tested %age of OPD women
HIV tested
2.99% 9.2% 3.71% 3.9% 1.56%
Vaccine preventable childhood disease:

Tetanus Tetanus
Diphtheria Pertussis Polio Measles
Neonatorum others
39 0 0 0 0 151
17
Childhood Disease - Others - Apr'10 to Sept'10
Number admitted
Diarrhoea and
Malaria with Respiratory
dehydration
Infections
55,131 428 15,039
Reported infant & child deaths: HMIS (April to September 2010)

Child
Infant Infant Deaths Infant Deaths Child Deaths
Deaths
Deaths between 24hrs between 1 between 1
between
within 24 & under 1 week & under month &
1yr under Total
hrs of birth week 1 month under 1 year
5years Deaths
860 3953 2583 2706 2069 12171
Infant & Child deaths against reported infant & child deaths:
Child deaths Infant deaths

between 1 yr within 24 hrs of
under 5 yrs birth
15% 8%
Child deaths Infant deaths

between 1 month between 24 hrs &
& under 1 year under 1 week
22% 35%
Infant deaths
between 1 week &
under 1 month
20%
18
Causes of Infant & Child Deaths - April to September 2010
Sepsis Asphyxia LBW

Between 1 Between 1 Between
Up to 1 Up to 1
Up to 1 Weeks week & 4 week & 4 1 week &
Total Weeks of Total Weeks of Total
of Birth weeks of weeks of 4 weeks
Birth Birth
birth birth of birth
104 58 162 299 110 409 602 296 898
Pneumonia Diarrhoea Fever related
Between 1 Between 1 Between 1 Between 1 Between 1 Between
month and 11 year & 5 Total month and year & 5 Total month and 1 year & 5 Total
months years 11 months years 11 months years
111 33 144 39 51 90 76 153 229
Others Measles Others
Between 1
Between 1 Between 1 Between 1 Between
Up to 1 Weeks week & 4
Total month and year & 5 Total month and 1 year & 5 Total
of Birth weeks of
11 months years 11 months years
birth
1503 957 2460 6 1 7 1349 814 2163
Causes of Infant & Child Deaths against total reported causes of Infant & Child
deaths:
Sepsis Asphyxia LBW

3% 6% 14%
Pneumonia
2%
Diarrhoea
1%
Fever related
Others
4%
70%
19
Maternal Deaths & Causes – April to September 2010
Obstructed/prolonged
Abortion Severe hypertension/fits
labour
15-55 6-14 15-55 15-55
6-14 yrs Total Total 6-14 yrs Total
yrs. yrs yrs. yrs.
0 6 6 0 6 6 0 49 49
Bleeding High Fever Other Causes
15-55 6-14 15-55 15-55
6-14 yrs Total Total 6-14 yrs Total
yrs. yrs yrs. yrs.
0 59 59 1 11 12 0 265 265
Maternal Deaths & Causes against Total reported causes of Maternal Deaths
Obstructed/prol
onged labour
Abortion 1.5% Severe
1.5%
hypertension
12.1%
Bleeding
14.6%
Other causes High fever
65.6% 1.4%
High Fever
3.4%
20
CHAPTER-2
POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS
SN Strategic areas Issues that need to be addressed

1. HR policies for Doctors,  The government is contemplating one year
Nurses paramedical staff compulsory rural internship for all MBBS
and programme graduates and two years of mandatory assignment
management staff with secondary hospitals for all post-graduates
 Filling up of OBG, Paediatrition, Anaesthetist
posts has been taken up by way if redeployment of
specialists from PHCs to CHCs / A.Hs / D.H. and
balance vacancies by way of fresh recruitment in
FRUs i.e., CHCs, A.H. and D.Hs.
 Recruitment of Doctors and para medics is being
carried at District level based on demand for 24x7
hr MCH centres, FRUs, Blood Bank & Blood
Storage centres, for which a committee has been
constituted with the District Medical & Health
Officer, Addl. DM&HO and District Program
Management Officers (NRHM) to identify the
institutions where additional manpower is needed
for providing felt need services.
 The selection process of specialist Doctors & Staff
Nurses is being done in a transparent manner by
displaying merit lists of selected candidates in web
site.
 To impart professional development skills all the
Senior Medical Officers/ MO‟s are being trained at
IIH&FW, Hyderabad for 72 days.
 Rationalization of service areas of Sub-centres,
PHCs has been taken up.
 A policy has been devised to ensure continuance of
the tenure and sustainability of HR, transfers are
banned in respect of all contractual staff till the
project completed.
2. Accountability and  To ensure facility based monitoring necessary steps
Performance appraisal have been taken-up to sustain the functional
system HMIS has been extended to SHC level .
 For appointment & renewal pf contract period for
contractual employees under NRHM, through an
independent agency external evaluation of the
individual performance on the identified bench
marks to hike the wages and continuance of
services.
3. Policies on drugs,  The government has introduced a new policy for
procurement system and the streamlined procurement of medicines,
Logistics management consumables, medical and surgical equipments
21
with increased budget outlay. The government has
decided to procure and position only high quality
generic medicines in all health facilities through a
transparent and efficient manner. The government
will soon issue a comprehensive policy for
procurement of equipment and supplies. To
implement the procurement policies effectively, the
AP Health and Medical Housing and
Infrastructure Corporation (APHMHIDC) is being
strengthened. Twenty-three drug storage facilities
are being constructed across the state with an
outlay of Rs 55 Crores.
4. Equipments  Necessary steps are being taken up to monitor all
the equipments available and their functionality in
all the DH/AH/CH and teaching hospitals will
kept on website and will be monitored by
DM&HO‟s /DCHs concerned and will update the
website on regular basis.
5. Ambulance Services and  EMRI (108) Ambulance service provision for all
Referral Transport normal deliveries and complicated high risk
deliveries and provision of transport for dropping
back from institutions to village required and
necessary budget provision under NRHM.
 Control rooms at each district head quarters have
been established for timely response and provision
of services
6 Maintenance of buildings.  Special provisions have been made to maintain
Sanitation, Water, Sanitation, Bore facilities, protected water supply
Electricity, laundry, are assured.
kitchen  To provide diet kitchen arrangement have been
made
7 Diagnostics  Essential Standards for Medical Laboratory
Programme is being implemented in all the
Government Medical Laboratories in the state.
 The Standard Operating Procedures were
implemented in all laboratories.
 Internal control mechanisms are implemented to
assure the reliability of results.
 All laboratory equipments are being calibrated.
The trainings were provided to all laboratory staff
and MO.
8 Patient‟s feedback and  Patients feedback and grievance redressal
grievance redressal mechanism is present all hospitals.
 Complaint boxes are placed in most of the
hospitals and superintendent or MO in charge of
the hospital will take necessary action to patients
compliments.
22
9 Private Public Partnership  Emergency Medical Services are being carried out.
(PPP)  The Family Planning services are being provided
by the accredited private health institutions.
 Vaccines under UIP are being supplied to private
health institutions free of cost for child
immunization. Private institutions are involved in
RNTCP, NLEP, NBCP and other national disease
control programmes, by referring the cases to
Govt. FRUs
10 Intersect oral convergence  Effective coordination with key line departments
like Social Welfare, Education, AYUSH,
APSACS, ICDS, RWS, SERP & W&CWD etc is
being maintained in providing quality of health
services to rural poor.
11 Community mobilization  Active community participation will be ensured by
mobilizing community through ASHAs and
AWWs. Various contests to reward best
performers, to generate interest in particular
activity/practice.
12 IEC Comprehensive communication strategy is worked out
at districts on local issues and needs focusing on urban
slums, coastal and tribal areas and other settlements,
and envisaged to be integral component of the State
and Districts and has a critical role in achieving the
objectives of National Rural Heal Mission (NRHM).
 Make the leap from” Awareness to Behavioral
Change”
 From being “instructive” to being empowering and
 From taking the “Genetic approach” to
“individualized approach”.
13. Civil Registration System  Nodal Agency for Civil Registration System (CRS)
(CRS) is Director of Public Health in coordination with
tahsils and VOs in rural areas Municipal
corporations / municipalities in urban areas.
14. Supportive Supervision  Government of Andhra Pradesh has issued
detailed job responsibilities of all the staff. The filed
activities of the all field staff are being regularly
supervised by the next level of supervisory officer.
 The filed activities of the staff are also assessed
during the review meetings at various level.
Regular trainings are provided to field staff.
15. Monitoring and Review  Regular review meetings were conducted at
various levels to monitor and review all the health
programs. Core committee meetings are regularly
conducted by the Honorable Minister for Medical,
Health and Family Welfare.
 Senior Officers conference are conducted in every
23
month at the Commissionate of Health and Family
Welfare to review all the state and district level
health programmes.
16 Meetings of State Health  Governing Body and Executive Committee
Mission/Society/District meetings of the State Health & Family Welfare
Health Society Society as well as District Health & Family
Welfare Society are being held on a regular basis.
17 Medical Colleges (New  There are 13 Government & 23 Private Medical

Colleges and Up gradation Colleges for imparting training to the Medical
of existing ones) graduates.
 Of the total number of 4800 graduates passing
every year, 1,800 are from Government Medical
Colleges & 3000 are from Private Medical
Colleges.
 There are 24 Medical Colleges which are offering
PG Courses with 1948 seats, out of which 1094 are
in Govt. and 854 are in Private Colleges.
 Recently, one new Medical College has been
sanctioned in Niamabad. Presently every District
in AP is having at least one Medical College either
Govt. or Private Medical College
18 Nursing Schools State has 16 Govt. / 283 Private MPHA(F) Training
Schools, 14 Govt. Nursing Colleges / Schools.
Present training schools are catering the need of the
State.
19 Paramedical education Present no.of trainining schools are catering the need
of the State.
20 Capacity building  Prime objective of Capacity building under NRHM
is to upgrade the skills and knowledge of all health
Personnel.
 This is being achieved through integrated training
programmes that will further encompass the vast
training needs to address various issues in planning
and operationalisation of health facilities in the
State
24
CHAPTER-3
CONDITIONALITIES
a) Release of the first trench of funds:
1) A full- time Mission Director for NRHM (for States having resource envelop of
more than Rs 50 crores), other than the administrative Secretary. MD NRHM
would not hold additional charge outside the Health Department.
o A post of Mission Director exclusively for NRHM has been created and
the same has been filled up by an IAS officer in the rank of Director.
2) A full- time Director/Joint Director/Deputy Director (Finance) (depending on

resource envelop of State), not holding any additional charge outside the Health
Department, from the State Finance Services
o The post of Chief Finance Officer in the cadre of Joint Director on

deputation from Finance Department has been filled.
3) A commitment to increase State Plan Budget for 2011-12 by at least 10% over and
above the 15% State share under NRHM.
o Overall Health Budget for the last 5 years is as follows:
(Rupees in crores)
Year Budget % of Allocation
allotted Increase to primary
health
2005-06 1587.54 11.89 880.57
2006-07 1895.34 19.39 1000.94
2007-08 2509.10 32.38 1119.44
2008-09 3150.84 25.58 1218.48
2009-10 3542.50 12.43 1234.34
2010-11 3982.78 12.43 1408.54
2011-12 4633.17 16.33 1890.87
b) Release of second trench of funds:
1) HR POLICIES & SYSTEMS as mentioned at S.NO. 1 of the Management

imperatives, measures should be initiated to ensure rational deployment with
stability of tenure by way of a clear transfer policy and facility based monitoring
for results.
o State will take necessary steps to ensure the compliance of the GoI
Guidelines
25
2) DRUG POLICY & SYSTEMS, including a sound procurement and logistics
mechanism as mentioned at S.NO. 3 of the management Imperatives, with the
objective of minimizing out-of-pocket expenses.
o As far as Andhra Pradesh is concerned, the A.P. Health & Medical

Housing Infrastructure Development Corporation (APHMHIDC) is
identified as a nodal procurement agency. The Corporation is functioning
with No Profit and No Loss basis. No grants-in-aid are provided to the
Corporation and it is sustaining on its own resources by way of collection
of supervision charges on the works executed as per the GO MS 1357 dt.
19.10.2009
3) The compliance status in respect of the 31 Conditionalities mentioned below is

provided for the year 2010-11 in the prescribed format.
o The following Conditionalities that have been intimated in the previous

years will apply for this year also.
S. Conditionality Compliance Status

No
1. All posts under NRHM are on contract and As per NRHM Guidelines all posts should
based on local criteria. The contract should be on contract basis in respect of
be done by the Rogi Kalyan Samiti Paramedical and other contingent workers
/District Health Society. The stay of will be paid from NRHM funds, in case of
person so contracted at place of posting is Medical Officers, posts will be filled up on
mandatory. All such contracts are for a regular time scale of pay as per the State
particular institution and non transferable. Government Policy and pay will be drawn
The contracted person will not be attached through Treasury.
for any purpose at any place.
2. The state agrees to credit 15% of the State
share to the account of the State Health
Society in two installments. The State also State Government has agreed to fulfill the
aggresses to enhance the over-all conditionality
expenditure on health by the State
Government by a minimum of 10 percent
per year.
3. Blended payments comprising of a base Performanced benchmark have been fixed
salary and a performance based for individual institutions and if they have
component, should be encouraged. achieved more than benchmark will be
awarded performance incentive.
4. State Government must fill up its existing State has already initiated to recruit the
vacancies against sanctioned posts, existing vacancies against sanctioned
preferably by contract. Top most priority in posts located in backward districts,
contractual recruitments should be for difficult, Most difficult and inaccessible
backward districts and for difficult, most areas.
difficult and inaccessible health facilities.
5. Delegation of administrative and financial The Government has carefully reviewed
powers should be completed during the the situation and established an integrated
current financial year. If not already done. financial management system for NRHM
for effective, transparent, responsive
26
No
mechanism has been established at state
and district level to sustain the
standards of accounting and financial
management system, Wide G.O. Ms.
No.339, Dated:4-12--2010.
6. State shall set up a transparent and credible Already addressed, please refer the para in
procurement and Supply chain DRUG POLICY & SYSTEMS of second
management system and Procurement trench of funds
Management Information System
(PROMIS) State agrees to periodic
procurement audit by third party to
ascertain progress in this regard.
7. The State shall undertake institution At present, functional HMIS reporting
specific monitoring of performance of Sub system is being monitored the
Centre, PHCs, CHCs, DHs, etc. performances from district to state head
quarters.
This year system will extended to facility
level (SC/PHC/CHC) for qualitative
monitoring of performances
8. The State shall operationalise an on-line Already addressed
HMIS in partnership with MOHFW.
9. The State shall take up capacity building Necessary steps have been initiated to
exercise of Village Health and Sanitation address the issue
Committees, Rogi Kalyan Samiti and other
community /PRI institutions at all levels.
10. The State shall ensure regular meetings of Complied with, State and District Health
all community Organizations /District Mission meetings are being conducted
/State Mission with public display of regularly and all financial matters is
financial resources received by all health hosted in the Departmental web site.
facilities.
11. The State Govts. shall also make Necessary steps will be taken in
contributions to Rogi Kalyan Samiti and consultation with other concerned
transfer responsibility for maintenance of departments.
health institutions to them.
12. The State shall prepare Essential Drug lists Essentail drugs list have been prepared
of generic drugs and Standard treatment and implementing in the State, to
Protocols, and give it wide publicity. strengthen further GO is being issued.
13. The State shall focus on the health The issue is addressed and further focus
entitlements of vulnerable social groups like will be given to vulnerable groups.
SCs, STs, OBCs, Minorities, Women,
migrants etc.
14. The State shall ensure timely performance Necessary guidelines have been issued to
based payments to ASHAs/Community the Districts for effective and prompt
Health Workers. payment of performance based incentives
to ASHAs
15. The State shall encourage in patient care It is followed in Andhra Pradesh
and fixed day services for family planning.
27
No
16. The State shall ensure effective and regular It is being conducted at village level at
organization of Monthly Health and other stages modalities are being
Nutrition Days and set up a mechanism to workedout.
monitor them.
17. All performance based payments / It is being followed
incentives should be under the supervision
of Community Organizations (PRI)/RKS.
18. The State agrees to follow all the financial State has taken all the measures to
management systems under operation undertake Monthly District Audit and
under NRHM and shall submit Audit periodic assessment of the financial
Reports, FMRs, Statement of Fund system for onward transmission to GoI
Position, as and when they are due. State regarding NRHM funds
also agrees to undertake Monthly District
Audit and periodic assessment of the
financial system.
19. The State agrees to fast track physical To speed up the process, a special
infrastructure upgradation by crafting State organization called APMSIDC is already
specific implementation arrangements. established under the supervison of an
State also agrees to external evaluation of IAS office as Managing Director.
its civil works programmes.
20. The State Govt. agrees to co-locate Morethan 600 doctors are already
AYUSH in PHCs/CHCs, wherever working in the PHCs/CHCs
feasible.
21. The State agrees to focus on quality of Already two hospitals are accreditated
services and accreditation of government with ISO certification and this year state is
facilities. planning to go far all secondary grade
hospitals and laboratories of tertiary care
hospitals for ISO certification.
22. The State/UT agrees to undertake For this we are planning to conduct
community monitoring on pilot basis, community based social auditing in 1000
wherever not tried out as yet, and scale up villages and modalities are workedout and
with suitable model wherever piloted it will be commenced from June 2011.
earlier.
23. The State/UT agrees to undertake State is agrees to continue the medial and
continuing medical and continuing nursing nursing education
education.
24. The State agrees to make health facilitiesIt is already mandatory activity and to
handling JSY, women and child friendly to encourage 48 hours of stay in hospital,
ensure that women and new born children incentives to ANMs and ASHAs and to
stay in the facility for 48 hours. pregnant women / mother are being
provided.
25. The State Governments shall, within 45 Complied with and district level ROPs
days of the issue of the Record of will be prepared as per the conditionality
proceedings, issue detailed District wise
approvals and place them on their website
for public information.
28
No
26. The State agrees to return unspent balance There is no unspent balances are
against specific releases made in 2005-06, if available.
any.
27. The State is entitled to engage a second Are being addressed

ANM to the extent that it provides for
MPW (Male) or the contractual amount of
2nd ANM be paid out of State Budget and
Third functionary may be engaged from
NRHM Fund.
28. The State shall put in place a transparent State is following transparent HR policy
and effective human resource policy so that while recruiting.
difficult, most difficult and inaccessible
areas attract human resources for health.
29. The State agrees to fast track physical To speed up the process, a special
infrastructure up-gradation by crafting State organization called APMSIDC is already
specific implementation arrangements. established under the supervison of an
State also agrees to external evaluation of IAS office as Managing Director. List of
its civil works programmes. The State shall civil works taken up under NRHM have
provide names of all facilities where civil been already communicated to GOI.
works are undertaken and also certify that
the location of these facilities is such that
poor households can seek services from
them. Prior approval of place of
construction by GoI will be mandatory
before taking up new construction under
NRHM. Thrust must be on meeting
infrastructure gap in backward districts and
difficult, most difficult and inaccessible
facilities.
30. The State agrees that the provision for State is already following
EMRI operational cost to States will be on
declining basis. For first year operational
cost will be 60%, 2nd year 40%, 3rd year
20% and nil thereafter.
29
No
31. The State agrees to comply with the
following over a period of six months:

 System for assured and affordable referral Assured referral transport is functional
transport for pregnant women and sick
children/infants.
 Facility upkeep (including maintenance of Grievance redressal system and facility up
building – sanitation, laundry, water, keeping is effectively functioning.
electricity, kitchen) and grievance redressal
mechanisms.
 Performance benchmarks for staff prior to Performance evaluation is being taken up
renewal of contracts and incentives. before continuing the contracts and
 Availability of functional equipments at all incentives
facilities.
Failure to demonstrate strong evidence of progress on the above conditionality would

affect release of funds under NRHM.
30
CHAPTER – 4
SCHEME / PROGRAM UNDER NATIONAL RURAL HEALTH MISSION
A. RCH FLEXIPOOL
17. The National Rural Health Mission (NRHM) has been launched with the aim to
strengthen the architecture of the health system; enable effective management of
increased allocations; and promote policies that strengthen public health management
and service delivery. The Reproductive and Child Health II (RCH-II) Project forms an
integral part of NRHM, the goals of which include reduction of child and maternal
deaths as well as achieving population stabilization, gender and demographic balance.
RCH GOALS AND TARGET
RCH II Current Status Andhra Pradesh

GOAL Target for
2011-12
154
MMR <100
(SRS 2004-06)
49
IMR <30
(SRS 2009)
1.8 1.8
TFR
(NFHS-3) (sustained)
18. The Reproductive and Child Health Programme (RCH), addresses the issue of
reduction of Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate
through a varied range of initiatives. Key activity of RCH is to increase institutional
deliveries, by giving the incentives for pregnant mothers through Janani Suraksha
Yojana and training of ANMs and nurses for safe delivery and management of sick
children have also helped in a major way, Further to accelerate, 6 high focused districts
identified by the GoI, parallel to the above efforts, up gradation of 360 health facilities to
provide emergency obstetric care and to improve access to SBAs made a significant
difference to health outcomes, led to a huge increase in institutional deliveries during the
years 2005-10.
31
OVERVIEW OF RCH-NRHM PERFORMANCE (2005-11): FACILITY OPERATIONALISATION AND TRAINED SERVICE
PROVIDERS
Area Indicator Number of facilities/HR Service utilization* (average per month per
facility/ trained provider)
Planned Achievement % achmt. Plan for Services Based on Projection
(2005-11) (2005-11, till 2011-2012 performance for
30.11.10) during Apr- 2011-12
Nov 2010
Facility No. of FRUs 360 122 CHCs 50% 173 C-sections 3443 2600
Operationalisation Operationalised CHNCs 58 AH MTPs 156 209
7 MCH Male sterilizations 606 800
187 Total Female 7243 7500
sterilizations
No. of 24x7 PHCs 1200 800 67% 424 Normal deliveries 5411 9116
Operationalised MTPs - -
Male sterilizations 118 177
Female 3279 4918
sterilizations
IUD insertions 1292 1938
No. of sub-centres 0 0 0 284 Normal deliveries 0 852
operationalised as IUD insertions 0 568
delivery points
No. of SNCUs - - - - Newborns treated
operationalised
No. of NBSUs - - - - Newborns treated
operationalised
Capacity Building EmOC training - - - 60 C-sections
LSAS training - - - 20 C-sections
SBA 5000 2188 40.04% 1600 Deliveries
conducted
32
ANNEX 3b
MONITORABLE INDICATORS (1)
2010-11 2011-12
Baseline
Q1 Target Q2 Target Q3 Target Q4 Target Annual Target
SN. INDICATOR (Apr-Nov 2010)
HF State HF State HF State HF State HF State HF State
districts total districts total districts total districts total districts total districts total
A Maternal Health
A.1 Service Delivery 241046 1020516
% Pregnant women registered for
A.1.1 22.14 88.57 9.00 21.25 9.00 21.25 9.00 21.25 9.00 21.25 36.00 85.00
ANC in the quarter
% PW registered for ANC in the
A.1.2 16.82 67.31 7.25 21.25 7.25 21.25 7.25 21.25 7.25 21.25 29.00 85.00
first trimester, in the quarter
Institutional deliveries (%) in the
A.1.3 23.54 94.18 7.50 25.00 7.50 25.00 7.50 25.00 7.50 25.00 30.00 100.00
quarter
A.2 Quality
% unreported deliveries in the
A.2.1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
quarter
% high risk pregnancies identified - - - - - - - - - - - -
A.2.2 (a) % women having hypertension 0.53 0.81 0.25 0.50 0.25 0.50 0.25 0.50 0.25 0.50 1.00 2.00
(b) % women having low Hb level 21.02 35.00 7.88 13.12 7.88 13.12 7.88 13.13 7.88 13.13 31.53 52.50
% of Home Delivery by SBA (i.e.
A.2.3 5 20 1.00 4.00 1.00 4.00 1.00 4.00 1.00 4.00 4.00 16.00
assisted by doctor/ nurse/ ANM)
C-sections performed (%)
A.2.4 (a) in Public facilities 0.35 4.38 0.13 1.64 0.13 1.64 0.13 1.64 0.13 1.64 0.52 6.56
(b) in private accredited facilities 11.84 13.44 3.25 3.40 2.75 2.90 1.75 2.10 1.25 1.60 9.00 10.00
% of deliveries discharged after at
A.2.5 least 48 hours of delivery (out of 25.00 96.45 8.00 25.00 08.00 25.00 08.00 25.00 8.00 25.00 32.00 100.00
public institution deliveries)
A.2.6 % of still births 0.87 0.82 0.28 0.28 0.22 0.22 0.18 0.18 0.12 0.12 0.80 0.80
A.2.7 %age of maternal deaths audited 12.13 53.91 17.00 19.00 19.00 21.00 25.00 27.00 39.00 33.00 100.00 100.00
A.3 Outputs
% of 24x7 PHCs operationalised as
A.3.1 56.00 50.00 35.00 35.00 30.00 30.00 20.00 20.00 15.00 15.00 100.00 100.00
per the GoI guidelines
% of FRUs operationalised as per
A.3.2 53 232 13.25 58 13.25 58 13.25 58 13.25 58 53 232
the GoI guidelines
33
2010-11 2011-12
Baseline
% of Level 1 MCH centres
A.3.3 194 821 - - 44 266 - - 45 267 99 533
operationalised
A.3.4 234 562 - - 41 341 - - 41 341 82 682
operationalised
A.3.5 26 147 - - 22 70 - - 22 75 44 145
operationalised
% ANMs/ LHVs/ SNs trained as
A.3.6 - - - - - - - - - - - -
SBA
A.3.5 % doctors trained as EmOC 0 9 5 10 5 10 5 10 5 10 20 40
A.3.6 % doctors trained as LSAS 0 0 3 5 3 5 3 5 3 5
A.4 HR productivity
% of LSAS trained doctors giving - - - - - - - - -
A.4.1 - Nil Nil
spinal anaesthesia
Average no. of c-sections assisted by - - - - - - - - -
A.4.2 - Nil Nil
LSAS trained doctors
% of EmOC trained doctors - - - - - - - - -
A.4.3 - Nil Nil
conducting c-sections.
Average no. of c-sections performed - - - - - - - - -
A.4.4 - Nil Nil
by EmOC trained doctor
Average no. of deliveries performed
A.4.5 - - - - - - - - - - - -
by SBA trained SN/LHV/ANM
% of SBA trained ANMs conducting
A.4.6 10% 40% 4.75% 18.94% 4.75% 18.94% 4.75% 18.94% 4.75% 18.94% 18.95% 75.76%
deliveries
A.5 Facility utilization
A.5.1 % of FRUs conducting C-section 4.00 4.45 1.25 1.50 1.50 2.25 2.00 2.75 2.25 3.50 7.00 10.00
A.5.2 Average no. of c- sections per FRU 6091 30990 2284 11621 2284 11621 2284 11621 2284 11621 9136 46485
Average no. of MTPs performed in
A.5.3 455 1407 171 527 171 527 171 527 171 527 284 2108
FRUs
Average no. of deliveries per 24x7
A.5.4 14916 56352 5593 21132 5593 21132 5593 21132 5593 21132 22372 84528
PHCs
Average no. of MTPs performed per
A.5.5 - - - - - - - - - - - -
24x7 PHC
34
2010-11 2011-12
Baseline
% of SC conducting at least 5
A.5.6 - - - 2.5% - 2.5% - 2.5% - 2.5% - 2.5%
deliveries per month
35
A.2 Maternal Health
19. Under Maternal Health many initiatives have been implemented since
introduction of NRHM in 2005-06 to achieve reduction of IMR, MMR & TFR,
communicable diseases burden, ensuring availability of Medical Officers, specialists,
Staff Nurses, ANMs, improving infrastructure facilities at Sub-centre, Primary,
Secondary & Tertiary level institutions, availability of equipments & Drugs for all the
patient attending for safe delivery services.
Key Objective
20. Reduction of the currently estimated MMR of 154 per 100,000 live births in the
state to less than 100 per 100,000 live births by 2012, and commensurate reduction in
the maternal morbidity rate, particularly among the women in rural areas of the state;
and reduction in the prevalence levels of RTI/STI in the general population by 50% of
the levels existing in 2005.
RCH II Goal Andhra Pradesh

Current Status Target
10-11 11-12
MMR 154 <120 <100
(SRS 2004-06)
IMR 49 <42 <30
(SRS Jan 2009)
TFR 1.8 1.8 1.8 Sustained
(NFHS-3)
 To ensure access to quality comprehensive (basic and emergency) maternal and

reproductive health care to women in AP
 To provide a comprehensive package of maternal and nutritional health services
to the tribal, scheduled caste, coastal fishers, migrant labour and other identified
marginalized vulnerable women.
Situation analysis, critical gap identification:
21. Achievement of goals of NRHM for the state is not upto the expected level as
there are service gaps in the implementation of maternal health care services. The main
draw backs are lack of effective MCH tracking, assured referral services for high risk
pregnancies, inadequate functioning of 24x7 MCH centers, FRUs in Tribal & hard to
reach areas, high number of home deliveries, non adherence of 48 hrs stay after
delivery, inadequate post-natal care service, high percentage of anemia in pregnant
women, inadequate maternal death audit at the facility and in the field.
22. It is proposed to establish systems for improving MCH tracking, ANC

registrations, Institutional deliveries, quality MCH services at 24x7 hrs PHCs, FRUs for
decreasing delivery load at tertiary care hospitals, operationalizing more no. of Sub
Centres as delivery points in tribal & inaccessible areas, improving infrastructure
facilities, availability of human resources, skill upgradation of service providers,
effective monitoring & supervision system at facility level and community level. A new
36
comprehensive mother and child health card will be given to each registered pregnant
women at all Government Health Institutions and private hospitals recognized PVT
OBG specialists.
Gaps identified
 Still 30% deliveries are not at Govt/PVT institutions as the percentage of

institutional deliveries are 71.9%
 The following district have recorded high no of home deliveries such as
Srikakulam, Vizianagaram, Anantapur, Kurnool, Adilabad, Karimnagar,
Warangal, Khammam and Mahabubnagar.
 To address the problem the following interventions will be implemented in 2010-
11
o Special focus to operationalise more no of subcenters as delivery points in the
districts and to increase SBA assisted deliveries by using ASHA
services/indigeneous trained persons in tribal areas.
o Proposed to operationalise more no of CHCs / Area hospitals as FRUs in the
state to reduce the delivery case load at tertiary care hospitals and to increase
no of deliveries at primary and secondary level institutions.
o To utilize the scheme of Rs.600/- (Rs.200/- to ASHA + Rs.250/- for referral
transport + Rs.150/- for boarding and lodging to pregnant women in tribal
areas) to 100% level.
o Proposed outreach camps with obstetrician and pediatrician services to
reduce anemia in pregnant women, to identify high risk pregnant women and
plan for safe delivery at Govt institutions and to provide treatment and
nutritional counseling to children & pregnant women.
o Proposed to provide diet for atleast 3 days for all pregnant women and one
attendant coming for institutional delivery at 24x7 hrs PHCs and for 7days at
existing delivery waiting homes in ITDA areas.
o To implement VHNDs at all villages more effectively by synchronizing with
women and child welfare dept. at all levels and by community monitoring
along with mobile VHNDs in hard to reach areas.
o To reduce Maternal deaths proposed to implement MCH tracking more
effectively by way of up loading name based data of all registered pregnant
women, delivered women and children through on line mechanism and by
on line monitoring system.
o To implement MDR at facility level and community level in all 23 districts.
o Proposed to establish 10,20 & 10 bedded maternal emergency care unit in all
ITDA project areas and in high focus districts, either at CHC / AH / DH
which is nearer to the community.
37
Key Strategies of the Programme:
23. The following strategies will be implemented for achieving of the expected goals
of NRHM in 2011-12.
 100% ANC registration & 100% 3 ANC checkups by ANM & 1 checkup by
Medical Officer, identifying anemic pregnant women specially in tribal, interior
rural areas with specialist camps, provision of diagnostic services and drugs in all
the ITDA project areas and high focused districts where the MMR is high and
through fixed Day health services by PHC mobile services.
 Name based tracking of all pregnant women from habitation/village level to

State level by MCH teams at Village, Sub center, PHC, CHNC & District level
with Data management and on line tracking services from PHC to State level. A
separate Data management unit is to be established under Joint Director (M&E)
for receiving reports and sending to GOI at State level by integrating all
Statistical sections & Data management unit of NRHM.
 Linking JSY to Ante-Natal care, Intra-Natal care and Post-Natal care & to 48 hrs
stay after delivery for quality MCH services.
 Targeting SC/ST and other vulnerable groups in ITDA project areas and urban
BPL pregnant women for improved maternal health care services through
separate help line control rooms and monitoring units with PO ITDA &
concerned Additional DM&HO / Dy. DM&HO / SPHO..of ITDA areas.
 Improving Maternal Nutrition in 4,100 poor villages with High SC/ST

population through VHNDs by counseling on food habits/ NDCC with
coordination of SERP.
 The existing 156 CEMONC centres will be integrated into 360 CHNCs for
improved Maternal & child care services.
 Revitalization and rationalization of service areas of Sub centres, PHCs and

health functionaries at different level in all districts to improve the health care
services and accessibility to the community.
 Conversion of at least 75% PHCs into 24x7 MCH centres by March 2012 and
availability of at least 3 Staff Nurses and 1 MO at each of the 24x7 MCH centres.
 Operationalization of 360 CHNCs and FRUs referral services for improving the
functioning of sub centre, PHC level maternal health care services as well as safe
institutional deliveries as per IPHS standards at all FRUs.
 Ensuring 48 hrs stay in all categories of health institutions by each post delivery
woman by linking to JSY payment at all health institutions.
 Special outreach health camps in all tribal & high focused districts for pregnant
women & adolescent girls for reducing Anemia, Age at Marriage, personnel
38
hygiene, Birth planning, assured referral transport, promoting institutional
deliveries, complete PNC checkups and counseling services.
 Line listing of high risk pregnancies & increased monitoring & services for such
women for complete ANC coverage, assured Birth planning, assured referral
transport, institution delivery & PNC care & counseling services.
 Implementation of Rs.600/-to pregnant women in tribal districts (Rs.200 for

ASHA + 250 for referral support + 150 for boarding & lodging.
 Community monitoring of all pregnant and lactating mothers at VHNDs.
 Name based tracking of all mothers, 4 ANC cheakups 2 TT, 120 IFA days by
MCH teams of village / sub center / PHC / CHNC Mother & Child health and
Nutrition cards to all, Community celebration of mother and child days every
month and advanced birth planning and institutional deliveries and targeted
skilled birth attendance (SBA) for those unable to reach institutions.
 Diet provision for each pregnant woman & one attendant for 3 days at all 24x7
hrs PHCs (Rs.100 per day for 3 days) from untied component of RKS funds and
for 5/7 days at Birth Waiting homes in tribal ITDA projects.
 Assured Drop back transport facility for all delivered women (BPL) in all Tribal
ITDA project areas from the Rs.250/- component of Rs.600/-
 Ensuring safe abortion services at all FRUs by ensuring availability of specialist,

equipment and drugs along with trainings.
 RTI / STI Services at 24x7 hrs PHCs / CHCs / Sub Division hospitals / District
hospitals by ensuring trainings, counseling services and drugs.
 Establishing one NRC in each district on priority basis first in all other 18
districts including high focused districts by March 2012 in coordination with
Clinton foundation and Women & Child Welfare Dept., and NIN.
 Steps for operationalization of sub centres as delivery centres in hard to reach,

inaccessible, interior areas and tribal pockets of all the districts.
 Up gradation of 200 24x7 MCH centers for L1 to L2 facilities by March 2012.
 Up gradation of all CHNCs / Sub division hospitals to L2 to L3 facilities by

March 2012.
 Increasing skills of MOs in emergency OBG, Life saving, Anesthetic skills, SBA
training of ANMs & Staff Nurses, ASHAs training on module 6 & 7, MTP
training to MOs, RTI / STI trainings and trainings to the Staff Nurses,
Nutritionist of NRCs & MDR workshop‟s.
 Steps for reducing home deliveries by ensuring delivery services at all identified
sub centers FRUs & 24x7 hrs MCH centres by Birth planning of pregnant
women for institutional delivery, assured referral transport, free Iron folic acid,
39
T.T, HB, Urine investigations, free delivery services, PNC care & steps for
tracking unreported / missed out ANCs and unreported deliveries.
 Effective implementation of VHNDs at each village once in a month by ANM,

AWW & ASHA for 100% coverage of antenatal services, birth planning,
identification of FRUs for delivery services, timely payment of JSY & counseling
to all pregnant & lactating women on personnel hygiene breast feeding, nutrition
and common reporting system for health & Women & Child Welfare Dept., by
synchronization on geographical, functional and monitoring supervision areas.
 Better coordination & convergence with women & child welfare department,
Rural Development (SHGs), Panchyathraj institutions, tribal welfare, education
department for better MCH services.
 Compulsory review of MCH services at PHC, CHNC, district once in a month &
at State level on physical and financial components, infrastructure, HR,
equipment, drugs, trainings & quality of services.
 Weekly review of MCH services at PHC & CHNC & district level and monthly
at state level.
 Effective implementation of M.D.R. at district & State level by confidential

review of Maternal Deaths in coordination with Fogsi, UNICEF, IIHFW &
IMA.
Implementation Methodology
 Based on CBR of each district, the target for Antenatal pregnant women,
institutional deliveries are being communicated for each district by Dy. Director
(Demography) from the O/o CH&FW for 2011-12 based on mid year population.
 At district level the DM&HO is responsible for allotment of Targets to all PHCs
in the district facility wise targets community health centres, Area Hospitals and
district hospitals are allotted separately by Commissioner, APVVP.
 Targets tertiary care hospitals are not allotted by O/o CH&FW.
 In view of the above observations, it is proposed to integrate allotment of target
for ANC‟s institutional deliveries to PHCs / CHCs / AH / DH and teaching
institutions and for improving & capturing details of ANC registrations, ANC
check ups, Institutional delivery through HMIS at state level.
 To achieve this, detailed guidelines will be prepared & will be circulated to the
concerned HODs.
 After allotment of targets, the following review mechanism are proposed for
implementation in 2011-12.
40
At State Level:
 Once in 2 months performance review by Commissioner of Health & Family

Welfare with HODs, Addl. Director (MCH) & concerned Joint Director.
 Once in 3 months performance review by Prl. Secretary of HM&FW with
CH&FW, HODs/Addl. Director (MCH) & concerned J.D.
 Review once in 2 months with all DM&HOs & DCHS by CH&FW along with
HODs.
 Once in a month performance with all superintendents, OBG specialists of CHCs
/ AH/DH and Teaching institutions at district level by DM&HO / DCHS /
Suptd., of Teaching hospitals jointly.
 Quality cell at State & district level by DD (DEMO).
 At State - Addl. Director (MCH), JD (MHN), JD (M&E), Data Manager
Quality cell at District level:
 DM&HO, DCHS, OBG Specialist, Pediatrician, S.O (FW) and S.O USP,
DPMO / DPO to monitor quality of Maternal Health Care services for different
levels of Health institutions in the discuss every month
Quality cell at CHNC:
 SPHO, PHN and health educator to monitor for all PHCs and sub-center level
Maternal health care services every month
 The detail guidelines and formats will be circulated for implementation in 2011-
12
Scheme wise methodology:
 Tracking of all pregnant women and children up to 5yrs for habitation / village,
subcenter level, PHC level, CHNC level and district level will be monitored by
concerned MCH teams at different levels
 Physical progress of ANC registration, birth planning, high risk pregnancies,
institutional deliveries, assured referral transport and post natal care services will
be monitored at PHC/CHNC/Dist/State level every month by proposed quality
cells at different levels.
 Review of Maternal deaths at facility level & community level will be
implemented in all 23 districts in 2011-12.
 The performance under facility wise monitoring for normal deliveries, assisted
deliveries, caesarian sections, safe abortion services, RTI / STI cells & services
will be monitored by proposed review committees at various levels.
 The implementation of ASHAs scheme will be monitored & reviewed by
proposed ASHAs mentoring cells at state level & district level, CHNC level &
PHC level in 2011-12.
41
 The implementation of JSY scheme will be monitored by Addl. Director (MCH),
JD (MHN), JD (M&E) of S.P.O (NRHM), Nodal Officers (NRHM) for APVVP,
Nodal Officers (NRHM) of DME at state level.
 At district level the Addl. DM&HO / all programme officers, SPHOs are
responsible for monitoring & verification JSY implementation.
24x7 hrs PHC services:
24. The Addl. Director (MCH), JD(MHN), JD(CHI), JD(M&E), DD(DEMO) and
Data Manger (NRHM) will monitor physical performance & quality of services of 24x7
hr MCH centres in the state. The Addl. DM&HO/Programme Officers / SPHOs /
SO(UIP), DPMO / DPO are responsible for monitoring physical & financial
performance and quality of services at 24x7 hrs MCH centres at district level.
CEMONC centres:
25. The DM&HO/DCHS / Superintendents concerned CHCs / AH / DH, Addl.

DM&HO, SO(UIP), DPMO are responsible for monitoring the physical & financial
performance and quality of OBG services at district. The Addl. Director (MCH),
JD(MHN), JD(CHI), JD(M&E), CPO (NRHM), DD(DEMO) and Data Manger
(NRHM) are responsible for monitoring physical & financial performance & quality of
services in the state.
Blood Banks & Blood Storage Centres:
26. The CH&FW, PD (APSACS), Commissioner, APVVP, Director of Health, MD,

APHM&HIDC Drug control authority, JD (Blood Safety), State Secretary, IRCS,
JD(MHN), are the committee members proposed for monitoring the administrative
functioning and quality of Blood safety at state level every month necessary guidelines &
formats, MIS reporting will be implemented in 2011-12.
27. At district level under chairmanship of District Collector, DM&HO, DCHS,

District Secretary, IRCS, Addl. DM&HO (AIDS & Leprosy) will be monitoring team at
district level for review of physical & financial performance and quality of Blood safety
at district level.
Nutritional Rehabitation Centres (NRCs):
28. Review & monitoring Committee under NRC will be implemented every month
by CH&FW, Addl. Director (MCH), JD(MHN), JD(CHI), JD(M&E), Representatives
from UNICEF & Clinton Foundation at State level I 2011-12. At district level the
DM&HO / DCHS / PD, ICDS, Suptd., and Pediatrician, Nutritionist will monitor the
quality of services for NRCs.
29. All schemes allotted to JD (MHN) will be reviewed at State level by CH&FW,
MD (NRHM), Addl. Director (MCH), CPO (NRHM), JD (MHN), JD (CHI), JD
(M&E) once in 2 months at state level. For financial releases, the JD (MHN) will submit
requirements for releases of budgets & CFO will release the budgets for JSY, ASHAs
Performance Based Incentives, ASHA Day Meetings, Best ASHA Award, 24x7 MCH
42
centres, CEMONC centres, Blood Banks & Blood Storage Centres (if NRHM budgets
available), Budget, requirements of FRUs, NRC, MDR schemes.
RTI / STI
30. RTI/STI programme implementation plan as per NRHM PIP consist of the 2
broad activities viz., 1) Health facility strengthening for provision of RTI/STI services
through minimum infrastructure development, Supply of drug kits and consumables to
practice “Syndromic Case Management (SCM)” and 2) Training of Health care workers
such as Medical Officers, Staff Nurse, Lab. Technicians, ANM, ASHA and MPHA
(M&F) as per National Guidelines. The following are the responsibilities of SACS and
NRHM as per NACP-NRHM convergence guidelines.
Distribution of roles and responsibility among NRHM and NACP

Role of SACS Role of NRHM
 SACS will supervise and monitor  Order to all DM &HOs regarding
STI/RTI programme at state level in monitoring & supervision of the
close co-ordination with program, training, quality and access of
NRHM/RCH programme officer. services to community, health facilities
 SACS to provide technical support in to follow NACO approved standard
training, quality supervision and operative protocols, procurement of
monitoring of STI/RTI services at all colour coded drug kits by NACO
health facilities, this overseeing the through SACS
implementation.  NRHM/RCH programme officer will
 Jointly with NRHM review and develop annual PIP content of STI/RTI
refine information, supervision & services in consultation with SACS for
monitoring process for monitoring training and procurement needs.
access & quality.  Prepare list of health facilities with MO
 SACS to prepare feed back for & LT in place either regular or
NACO, NRHM and SPMU contractual
 Prepare list of facilities where MO & LT
are already trained on NACO modules
 Prepare list of facilities where MOs &
LTs are to be trained
 Forcasting of drug kits
31. Procurement and supply of drugs and testing kits for STI/RTI services fro
NRHM facilities will continue to be done by NACO with funding support of NRHM at
central level.
32. For tracking access, quality, progress and bottlenecks in RTI/STI programme
implementation, the common information & monitoring system developed by NACO
and NRHM is to be followed.
1. Health facilities for provision of RTI/STI services:
 Training should be as per the GoI guidelines on RTI/STIs.
43
 Holistic Plan including training of staff, provision of drugs, lab investigations and
convergence with the NACP (THROUGH SACS) is advised for comprehensive
RTI/STI services.
 Funds for strengthening of facilities for RTI/STI services have to be kept.
 Funds for heads like equipments, infrastructure etc. should be budgeted under
respective RCH II/ NRHM head.
 Ensure privacy and full treatment as per National Guidelines on Prevention,
Management and Control of RTI infections including STIs.
 Ensure that Wet Mount is available for Diagnosis at health Facilities.
 Funds should also be kept for monitoring the operationalisation of RTI/STI
services.
33. The Table showing the minimum required infrastructure & consumables at
PHC/CHCs for provision of Quality RTI/STI services
List of required infrastructure & consumables at PHC/CHCs

S.No Name of the Item Existing or Required Remark
Not Quantity
1 Wooden/Aluminum Not 1 May be done at PHC level
Partition for Privacy from NRHM/HDS funds
2 „U‟ cut examination Yes/Not 1 May be procured through
table with steps APHMHIDC & supplied
to the non available health
facilities from NRHM /
RCH II funds
3 Angle poised lamp Yes/Not 1 --do--
4 Steel Cusco‟s Vaginal Yes/Not 5+5+5=15 --do--
Speculums-Small (5),
Medium (5), Big (5).
5 SIMs speculums with Yes/Not 5+5+5=15 --do--
the retractors
6 Proctoscopes-Small, Yes/Not 5+5+5=15 --do--
Medium, Large
7 Sterilizer Yes/Not 1 --do--
8 Disposable Gloves, Yes/Not As per --do--
Syringes, Needles requirement
9 Waste disposal Yes/Not As per --do--
System requirement
10 Hand held Not 1 --do--
magnifying glass
11 RPR Kits Yes/Not As per --do--
requirement
12 VDRL rotator Yes/Not 1 --do--
13 Compound Yes/Not 1 --do--
Microscope
14 Glass slides & Cover Yes/Not As per May be purchased from
slips requirement NRHM/HDS funds at
local/Dt level.
15 PH paper NO As per May be purchased from
requirement NRHM/HDS funds at
local/Dt level.
44
Referral Linkages:
34. The RTI/STI patients who have not responded to Syndromic Case Management
after completion of the due course of the treatment shall be referred to State Reference
Centres linked to the districts for evaluation.
2. RTI/STI Training:
 State should plan to operationalise health facilities for RTI/STI services.
 State is requested to plan for RTI/STI training, as per GoI norms.
 Funds for the operationalisation and monitoring of RTI/STI services should be
kept.
 Training of sub district level health functionaries posted at FRUs/CHCs and
PHCs may be done by utilizing the training resources (faculty, training material)
of the NACP (through SACS). This is an agreed action under the convergence
framework.
The trainings shall be undertaken in the ‘CASCADE MODEL’.

 The PO-DTT, District RCH incharge officer/DPO-NRHM, ADMHO (A&L)
shall be given training at IIHFW, Vengalaraonagar, Hyderabad with and the
training will be facilitated by STD Component of APSACS under the financial
support from RCH II/NRHM.
 The trained team conducts the trainings at District level for the following health
care workers with the technical assistance of Regional Resource Faculty (RRF)
from Medical Colleges as Resource persons.
 The trained Medical Officers will give half day orientation to the MPHA (M&F),
ANM, APMO, DPMO & ASHA workers at PHC level.
35. The Regional Resource Faculty (RRF), District RCH incharge officer, ADMHO
(A&L) and PO-DTT shall be provided training by State Resource Faculty (SRF) at State
Level preferably at IIHFW, Hyd‟bad with financial sharing from NRHM & NACO
(SACS) funds. The STD component of APSACS will coordinate & facilitate the process
with NRHM & IIHFW.
CASCADE model of Trainings:-

The DPO-NRHM, PO-DTT & ADMHO (AIDS & The Regional Resource Faculty shall be
Leprosy) shall be trained at IIHFW, Hyd’bad trained at IIHFW, Hyd’bad by APSACS & SRF
The Medical Officers (2), Staff Nurse (1), Lab. Technician (1) shall be trained by RRF and
District officials
The MPHA (M&F), APMO, DPMO, ANM and ASHA workers will be Half day orientation by
Medical Officers
45
SCM Colour coded drug kits:
36. The Syndromic Case Management related 7 Colour coded drug kits shall be
procured centrally by NRHM, MoHFW, GoI and supplied to the O/o DMHO directly.
In turn the O/o DMHO should supply these kits to all PHC and CHC facilities in the
district.
Recording & Reporting:
37. The PHCs & CHCs should submit the one page STI/RTI reports to the DMHO
rd
by 3 of every month. The O/o DMHO will upload the same to the State NRHM office
by 5th of every month. The consolidated state report shall be shared with the SACS and
submitted to the NRHM, Govt. of India by 7th of every month.
The Monitoring Plan:
38. The quarterly/Half yearly monitoring aims at 1) Ensure the provision of Quality
RTI/STI services as mentioned in national guidelines, 2) Ensure the practice of
Syndromic Case Management across all health facilities and provision of Partner
Treatment, 3) Ensure that all RTI/STI attendees & ANC mothers are get tested for
RPR/VDRL and 4) Ensuring the referral Linkages with the other services.
The Monitoring team consists of the following personnel.
1. NRHM:-
a. JD-MHN
b. JD-M&E
c. DMHO
d. DPO-NRHM
2. SACS:-
a. JD-Basic Services Division
b. DD-STD
c. AD-STD
d. Sr.Cl officer – TSU, APSACS.
e. PO-STI services, TSU, APSACS.
f. ADMHO (A&L)
g. DPM
h. State Resource Faculty (SRF)
i. Regional Resource Faculty (RRF).
39. Each health facility shall be visited by any of the team member once in 6 months
totaling to 2 times in a year. During the visit, the official has to administer the
monitoring and grading tool and submit the filled in copy to the Medical officer, Supt. of
the hospital, District Head and with NRHM/SACS. The subsequent visiting official
shall follow upon the action taken to observations made and suggestions given by the
previous visited officer. By the end of FY 2011-12, it needs to be achieved that all health
facilities are reporting within the time limits and 80% of health facilities are coming into
the grade „A‟.
46
Risk Analysis: The Major challenges for reduction of MMR in A.P are
a) Reduction of home deliveries for 1,20,000 in 2010-11 to 60,000 especially in the

following districts.
b) Increasing operationalization of 24x7 hrs MCH centres & FRUs in the state. The
main problem in FRUs is lack of interest on the post of obstetricians,
pediatricians and Anaesthetists in majority of CEMONC centres at FRUs to fill
up the gap Additional Incentives may be considered for OBG, Pediatrician &
Anaesthetists and Staff Nurses in all CEMONC centres / FRUs where the posts
are vacant for 1 to 2 years.
c) Simultaneously focus may be given to improving the midwifery skills of Staff

Nurses, MPHA(F) for conducting normal deliveries at Sub centres, PHCs,
CEMONC centres, FRUs in hard to reach, inaccessible & interior areas.
d) Special consideration / quota for local MPHA(F) trained candidates in ANM

MPHA(F) training schools.
e) Ensuring of 48 hrs stay by all delivered women at institutions to achieve this diet
provision for at least 3 days at all 24x7 hrs MCH centres & CEMONC centres is
to provided for delivered women & one attendant.
f) Reduction of Anaemia in pregnant women is an important indicator. As per

NFHS-3 survey among between 15-49 years age pregnant women 51.7% are
anemic in rural area & 58.2% in Urban area, 100% distribution of IFA tablets to
all adolescent girls, pregnant women is to ensured along with follow up services
for recovery.
g) Assured referral transport for all pregnant women is essential through 108
services. At present the coverage through 108 services is 20-25% of pregnant
women. This is to be increased to at least transport services to 50% of all pregnant
women.
h) Ensuring availability of Blood components, equipment for caesarian section,

specialist doctors is critical for safe delivery services.
i) Ensuring effective 3 to 6 post-natal visits to all post-natal women at down level is

important to reduce post-natal complications & maternal deaths.
j) Effective Maternal deaths audit at community level in all 23 districts and

improving under reporting of Maternal deaths is to be addressed by way of proper
sensitization of all health functionaries at DH / AH / CHNCs / PHCs & Sub
Centres.
47
Maternal Health outputs:
Sl. Particulars Achievement Target for Addition

No. in 2010-11 2011-12 during the
year
1) ANC registration >95 >98 3%
2) Institutional Deliveries >91% >95% 4%
3) 24x7 MCH centres 1200 424 25%
4) Functional FRUs 17 DH 23 DH,
117 AH 117 AH
(58+59), 121 CHC
121 CHC 360 CHNC
5) Functional Sub Centre as delivery points 533 284
6) NRCs 5 7 33%
7) MCH Tracking of pregnant women & 23 23
children (0-5 yrs)
8) Maternal Death Audit at districts 23 23
9) VHNDs 18940 20144
Special Features for 2011-12:
 Partograph recording at all CHCs/AH/DH & Teaching hospitals in delivery

rooms is not implemented at present; this will be implemented 2011-12 at all 24x7
MCH Centres and FRUs, DH & Teaching hospital.
 Monitoring of post training service delivery activities by trained MOs, Staff

Nurses, MPHA(F) is not being monitored at State & District level to be
implemented in 2011-12.
 Exact requirement, Drugs for all institutions based on D.P & I.P services is not
submitted by PHCs / CHCs / AH / District Hospitals.
 Lack of specialist care services at CHCs/AH/DH after 2.00 P.M except for
attending call duties and most of the delivery cases diverted to Pvt. Hospitals.
Contributing to high number of caesarian sections in the state. Necessary
guidelines will be prepared in consultation .
 Lack of effective coordination between DCHS & DM&HOs and between MOs of
PHCs & Superintendents of FRUs.
 Lack of adequate information on inclusion of procedures under Arogyasri

Insurance scheme at PHC, CHC, AH, DH levels in the district.
 Lack of optimum utilization of space in the various hospitals.
 Lack of inventory management at PHC, CHC, AH & DH levels and

condemnation of unused equipment & furniture is not being done.
 Lack of periodic Drug stores verification by district level programme officers.
 Prescription of drugs out side inspite of availability in the hospitals.
48
 No Bin Cards are maintained for each drug.
 Ayush doctors services mainstreaming, Ayush medical officers services may be

utilized either for FDHS & School Health services in the field.
 Effective coordination between CH&FW & APHM&HIDC at state level & at

district level.
 Review meetings once in a month at State & District level to review progress of
budget utilization for construction of all health facilities, repairs etc.,
Budget Proposed under Maternal Health Strategy for 2010-11
SN Activity Unit Rate No.of Annual

(Rs/Unit) posts / total
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Referral Hospital Strenthening
a) Salaries to Obstetrician
Specialists
i) Specialist doctors in Small towns Salary 38000 74 337.44
ii) Specialist working in Remote & Salary 45000 45 243.00
Interior rural areas
iii) Specialist working in Tribal areas Salary 50000 62 372.00
iv) Salaries to Staff Nurses Salary 12910 525 813.33
b) Salaries to Theatre Assistants Salary 6700 326 262.10
c) Honororium to Anesthetist for Honorarium 1000 12000 120.00
conducting C-Sections
Total 2147.87
2 24-hours MCH Centres
a) Salaries for Staff Nurses Salary 12910 2200 3408.24
b) Salaries for Contingent Workers Salary 4900 2200 1293.60
c) Dietary support to Maternity 50 132000 66.00
Waiting homes in PHCs
Total 4767.84
3 Janani Suraksha Yojana
a) Total Rural BPL deliveries Beneficiaries 700 305288 2137.02
b) Total urban BPL deliveries Beneficiaries 600 138507 831.04
c) 5% Administrative expenses 148.40
d) ASHA Performance Based Incentives 200 583240 1166.48
incentives for Pregnant Women
having Institutional Deliveries in
Govt. Hospital / PHC
Total 4282.94
4 Maternal Death Review(MDR):
a) Maternal Death Audit
i) Monitoring & Review Review 600 2000 12.00
mechanism
Total 12.00
b) Infant Death Audit
49
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
i) Monitoring & Review Review 300 49000 147.00
mechanism
Total 147.00
5 Mother & Child Tracking Tracking 100.00
6 MTP Services Services 10.60
7 RTI/STI Services
a) District Officers Training 94250 2 1.89
b) Medical Officers Training 258000 23 59.34
c) Staff Nurses Training 129000 23 29.67
d) ANM Training 7125 2000 142.50
Total 233.40
8 Midwifery Training for ANMs, Training 100.00
Staff Nurse & MOs
Blood Bank & Blood Storage
9 Centres
a) Apparatus & Equipments Maintenance 1950000 19.50
b) Civil Works Maintenance 2000000 20.00
c) Training and Capacity Building Maintenance 2000000 20.00
d) Contingencies including Annual Maintenance 13550000
Maintenance 135.50
e) Hiring of Transport Vehicles Vehicle 4480000 44.80
Total 239.80
Maternal Health Total 12041.45
50
A3: CHILD HEALTH
The Objectives of the child health interventions include:
1. Universal access to quality comprehensive neonatal health care services.

2. Provision of comprehensive health and nutritional services to all infants.
3. Access to comprehensive health and nutritional services to 1-5 year old children.
4. Special health and nutrition package of services to the tribal, Schedule caste and
other vulnerable children.
1. IMR (SRS 2009) 49

2. Goal Overall NRHM 2012 30
Situation analysis:
2.1 Mortality NFHS 2 NFHS 3 SRS 07 SRS 08 SRS 09 Trend

Indicators Analysis
Neonatal 43.8 40.3 33
Mortality Rate
Infant Mortality 65.8 53.5 54 52 49
Rate
There has been a decrease of six points since 07 in the IMR and to bring it down to 30 by 2015
(MDG4) would require an annual drop of 5 points.
Under Five 85.5 63.2
Mortality
Child Mortality 21.0 10.2
Process indicators:
2.2 ANEMIA NFHS2 NFHS 3 CES 09 Trend Analysis

Percentage of children (under 72.3 79.0 -- --
5 years) of age with anemia
Slight improvement in NFHS 3 over NFHS 2
2.3 IYCF NFHS 2 NFHS 3 DLHS 2 DLHS 3 CES 09 Trend

analysis
Children under 3yrs breastfed 10.3 22.4 41.8 47.8 27.2
within one hour of birth
There is a major difference between DLHS 3 and CES 09 and this is an area of concern which needs to
be addressed.
Children age 6 months and NA NA 41.9 32.3 52.2
above exclusively breastfed
for at least 6 months
Though an improvement over DLHS 3 nearly 50% children are still not exclusively breastfed.
Children aged 6-24 months 9.4 63.7 NA 55.0 66.4
received solid/ semisolid
foods and are still breastfed
Improvement of 11 points in CES 09 over DLHS 3
Children aged 0-5 months 74.6 62.7 NA NA 75.7
exclusively breastfed
51
2.4 DIARRHOEA & ARI NFHS 2 NFHS 3 DLHS 2 DLHS 3 CES 2009 Trend
analysis
Children with Diarrhea in the 39.6 36 57.8 43.3 54.9
last two weeks who received
ORS
There has been an improvement in use of ORS over the years. However it is still below 60
Children with Diarrhea in the 69 61.4 86.0 68.9 74.6
last two weeks who were
given treatment in any
facility
Recent CES 2009 shows an improvement in the treatment of diarrhea at facilities over the DLHS 3
Children with ARI or fever in NA 66.6 80.4 74.0 88.2
the last two weeks who were
given treatment at facilities
Significant improvement (14 points) in treatment of ARI from DLHS 3 to CES 09.
Training under child health
4.1 Progress till date - no. of trainings conducted/ Planned for Held/ Trained (till
health persons trained / districts covered 2010-11 Dec 2010
IMNCI
- No. of trainings 14
- No. of persons trained 324
- No. of Districts implementing 13 2
Pre- Service IMNCI
- No. of persons trained Not Planned 24
- No. of Districts implementing 1
F-IMNCI
- No. of persons trained Not Planned 80
- No. of Districts implemented
Navjaat Shishu Suraksha Karyakram (NSSK)
- No. of persons trained 661
- No. of Districts implemented 23
Strategies:
40. Facility Based New Born care: The state has an IMR of 49 per thousand live
births (SRS 2009) and majority of these deaths are contributed by the neonatal deaths.
The state initiated major community based and facility based neonatal care interventions
to address this issue. The state has started the process of establishing a three tier facility
based new born care system which includes the setting up of special care neonatal units,
neonatal stabilization units and new born care corners. The state health officials with
support from UNICEF Hyderabad visited Madhya Pradesh to study the facility based
new born care set up. Following this visit UNICEF Bhopal provided hand holding
support in designing the first two SCNUs in Warangal. Two teams were formed
52
involving the officers who visited Madhya Pradesh along with the Executive engineers
from APMSIDC and UNICEF‟s child health consultant. These teams visited the
identified health facilities and prepared draft designs for the SCNU which was finalized
by the APMSIDC architects in AutoCAD. UNICEF Hyderabad provided the financial
and technical support for this activity. The state will be following the three tier facility
based new born care as shown in the flow diagram below. Special Care New Born Units
will be established in all tertiary care hospitals, new born stabilization units (NBSUs) in
all area hospitals and CHCs and a new born care corner in every delivery room in the
state.
Facility Based Neonatal Care
At Delivery Facility Sick newborn
SPECIAL CARE NEW

DISTRICT HOSP BORN UNIT
Four beds for every
1000 deliveries. 36 “20
bedded” SCNUs and 8
“12 bedded” SCNUs in
NEW BORN CARE CHNC /FRU Tribal Areas
corner
(1 bed) NEONATAL
STABILISATION UNIT
Radiant Warmer, PHC 24X7 (4 beds)
Suction
Machine,
Neonatal
Resuscitator
(Ambu Bag) COMMUNITY
Laryngoscope,
Oxygen Hood,
Facility Newborn care in Public Sector
SCNUs:
41. The state has decided to set up twenty bedded SCNUs in select level III MCH
facilities having an annual delivery load of more than 4000 deliveries. However in view
of having at least on SCNU in every district this norm of 4000 deliveries was relaxed for
a couple of districts viz. Karimnagar and Medak (Sangareddy). The state has decided to
set up/ strengthen 44 SCNUs. 36 of these SCNUs would be 20 bedded and eight SCNUs
to be set up in tribal areas will be 12 bedded. The SCNUs will be set up in hospitals
under the Directorate of Medical Education and the Andhra Pradesh Vaidya Vidhan
Parishad as shown in table I.
Table I: Distribution of SCNUs in various hospitals:
Hospitals under Director Medical Education APVVP Total

Region TH with Ped TH with TH with RIMS APVVP
Department. OBGY Both
Department. Departments.
Telangana 1 3 3 1 10
Andhra 0 1 4 2 10
Rayalseema 1 1 2 1 4
2 5 9 4 24 44
TH - Teaching Hospital, RIMS – Rajiv Gandhi Institute of Medical Sciences,
APVVP – Andhra Pradesh Vaidya Vidhan Parishad
53
Table II: List of Hospitals identified for establishing SCNUs
Type of Hospital Name

Directorate of Medical Education
Teaching Hospital with only MGM Hospital Warangal, and Ruia Hospital SVRR Thirupati
Pediatric Dept.
Teaching Hospital with only GMH Warangal, CKM Warangal, GMH Koti, Hyderabad
OBGY Dept. Victoria Hosp Vizag and GMH Thirupati Chittoor
Niloufer Hospital, Gandhi Hospital, Modern Maternity
TH with both Pediatrics and
Pitluburz, KGH Vizag, GGH Guntur, RMC Kakinada (EG),
Obstetrics Department.
SMC Vijayawada (Krishna), GGH Anathapur, GGH Kurnool,
RIMS ( Rajiv Gandhi RIMS Adilabad, RIMS Ongole, RIMS Srikakulam, RIMS
Institute of Medical Kadapa
Sciences)
Andhra Pradesh Vaidya Vidhan Parishad (APVVP)
DH Khammam, AH Bhadrachalam, DH Karimnagar, DH
Nizamabad, DH Mehaboobnagar, DH Tandur (Rangareddy),
Telangana Region
DH Sangareddy (Medak), DH Nalgonda, AH Utnoor (Adilabad)
AH Eturnagaram (Warangal)
DH Tenali, MCH Nellore, MH Vijayanagaram, DH Rajamundry
(EG), DH Eluru (WG), DH Machilipatnam (Krishna), AH
Andhra Region
Paderu (Vizag), AH Parvathipuram (Vijayanagaram), AH
Narsipatnam (Vizag), Rampachodavaram (EG),
DH Nandyal (Kurnool), DH Produttur (Kadapa), DH Hindupur
Rayalseema Region
( Ananthapur), AH Srisailam (Kurnool)
42. The establishment of SCNUs has been planned in two phases. The state has
committed to initiate setting up 25 SCNUs in Phase I under the NRHM PIP 2010-11.
The 8 tribal SCNUs and 11 non tribal SCNUs i.e. 19 SCNUs will be set up in Phase II
under the PIP 2011-12
Current status:
43. At present there are 14 hospitals under the department of Medical and Health in
the state providing Level II /III new born care services. Out of these functional 14
SCNUs the state has committed to start the strengthening of 7 SCNUs* and set up 18
new SCNUs through the budget sanctioned in the NRHM PIP 2010-11. The state has
also committed to provide essential new born care through 121 New Born Stabilization
Units and 540 NBCCs. The district wise list of institutions selected for strengthening /
setting up SCNUs in Phase I (2010-11) is given in the table below
List Of Institutions for setting up SCNUs in Andhra Pradesh in Phase I (2010-11)

Sl Districts Name of Institution Status Ped Control
1 Warangal MGM Hospital Old Yes DME
2 CKM Maternity Hospital New DME
3 GMH Maternity Hospital New DME
4 Khammam Dist. Hospital Khammam New APVVP
5 Medak Sangareddy Dist Hospital New APVVP
6 Karimnagar Dist. Hospital Karimnagar New APVVP
7 Mehaboobnagar Dist Hospital New APVVP
8 Adilabad RIMS Adilabad Old Yes DME
9 Nalgonda District Hospital Old APVVP
54
10 Nizamabad Dist. Hospital Nizamabad New APVVP
11 Hyderabad Maternity Hospital Koti New DME
12 Rangareddy Dist Hospital Tandur New APVVP
13 Guntur GGH Guntur Old Yes DME
14 Vizianagaram Maternity Hospital New APVVP
15 Visakhapatnam King George Hospital Old Yes DME
16 Victoria Maternity Hospital New DME
17 SPSR Nellore MCH Hospital New APVVP
18 East Godavari Dist HQ Hospital Rajahmundry New APVVP
19 Rangaraya Med. College, Kakinada Old Yes DME
20 West Godavari District HQ Hospital Eluru New APVVP
21 Krishna Dist. HQ Hospital Machilipatnam New APVVP
22 Chithoor GMH, Thirupathi New DME
23 Kurnool Government General Hospital Old Yes DME
24 Kadapa District Hospital Produttur New APVVP
25 Ananthapur Srikrishna Devaraya Med. College New Yes DME
Con
Hospitals
trol Existing New Total
Teaching Hospital with Only Pediatric Dept 1 0 1
DME
Teaching Hospital with Only Obstetric Dept 0 5 5

Teaching Hospital with both Departments 5 1 6
District Hospitals / Area Hospitals under APVVP 1 12 13
Total 7 18 25
44. The state has 14 operational SCNUs which are being run through the available
resources and need to be further strengthened in terms of renovation, human resources
and equipment. The strengthening of 7 SCNUs has been included in Phase I and 6*
SCNUs in Phase II in the FBNC plan of the state. (*The SCNU in RSP Children‟s
Hospital Nellore to be shifted to the MCH Hospital and hence not included in
strengthening)
The statistics of neonatal admissions and mortality in these 14 SCNUs is given below.
Sl Name of Hospital District Control Admissions Deaths

No 2009 2010 2009 2010
1 SVRR Medical College & Rui Chittoor DME 1963 2030 356 356
Hospital Thirupati
2 Rangaraya Medical College & East Godavari DME 1403 1882 347 390
General Hospital Kakinada
3 Modern Maternity Hospital Pitluburz Hyderabad DME 4046 4284 227 190
OMC
4 Niloufer Hospital OMC Hyderabad DME 14173 14820 2233 2307
5 Gandhi Medical College & Hospital Secunderabad DME 2110 2391 460 317
6 Kakatiya Medical college & MGM Warangal DME 2798 2750 438 474
Hospital
7 Siddhartha Medical college & Krishna DME 930 1150 212 258
Hospital Vijayawada
8 Andhra Medical College & King Vishakhapatnam DME 1995 2029 231 250
George Hospital
9 Guntur Medical College & General Guntur DME 1850 2167 478 649
Hospital
55
10 Kurnool Medical College & General Kurnool DME 2072 1939 647 700
Hospital
11 RIMS Kadapa Kadapa DME 720 784 NR NR
12 RIMS Adilabad Adilabad DME 839 893 121 130
13 District Hospital Nalgonda Nalgonda APVVP 1056 810 46 37
14 RSP Children's Hospital Nellore Nellore APVVP 267 383 88 57
TOTAL 36222 37528 5884 6115
45. There are 12 SCNUs operational under the Director of Medical Education and
two SCNUs under the Andhra Pradesh Vaidya Vidhan Parishad. These SCNUs in these
facilities have to be strengthened to the Indian Public Health Standards. The state has
committed to start the process immediately. The table above indicates that the 14
SCNUs are admitting nearly 36000 - 38000 neonates every year with nearly 6000
neonatal deaths (16.6% case fatality rate). These facilities are saving nearly 30000- 32000
neonates annually. With the establishment of all the forty four SCNUs and the NBSUs it
is expected that the state would be able to save more new borns every year and with
quality management the case fatality rate is also expected to come down.
46. The list of institutions for setting up SCNUs in Phase II (PIP 2011-12) is given
below:
List Of Institutions for setting up SCNUs in Andhra Pradesh in Phase II

Sr Ped
No Districts Name of Institution Status Dept Control
1 Hyderabad Modern Maternity Hosp Pitluburz Old Yes DME
2 Gandhi Hospital Old Yes DME
3 Niloufer Hospital Old Yes DME
4 Guntur DH Tenali New APVVP
5 Srikakulam RIMS Srikakulam New Yes DME
6 Krishna Siddhartha Medical College Old Yes DME
7 Prakasam RIMS, Ongole New Yes DME
8 Chithoor SVRR, Thirupati Old Yes DME
9 Kurnool District HQ Hospital Nandyal New APVVP
10 Kadapa RIMS, Kadapa Old Yes DME
11 Ananthapur District Hospital Hindupur New APVVP
List Of Institutions in Tribal Areas for setting up SCNUs in Andhra Pradesh

1 Warangal AH Eturnagaram New APVVP
2 Khammam AH Bhadrachalam New APVVP
3 Vishakhapatnam AH Narsipatnam New APVVP
4 AH Paderu New APVVP
5 Vijayanagaram AH Parvathipuram New APVVP
6 East Godavari AH Rampachodavaram New APVVP
7 Adilabad AH Utnoor New APVVP
8 Kurnool AH Srisailam New APVVP
Control Hospitals Existing New Tribal

DME Teaching Hospital with Only Ped. Dept
Teaching Hospital with Only Obst. Dept
Teaching Hospital with both Departments 6 2 0
APVVP District Hospitals / Area Hospitals 0 3 8
Total 6 5 8
56
Action Plan:
47. In continuation with the facility based new born care activities started in the
previous years under NRHM the state has proposed to be set up thirteen new SCNUs
(Eight 12 bedded SCNUs in tribal areas and five 20 bedded in non-tribal areas) and
strengthen six SCNUs this year under the NRHM PIP 2011-12. Thus the state will have
a total of 44 SCNUs (25 under PIP 2010-11 and 19 under PIP 2011-12)
48. The details of the activities and processes involved in setting up and
operationalizing these SCNUs are given below.
49. Renovation: The renovation of the facilities and the procurement of new born
care equipment will be done by the Andhra Pradesh Medical services infrastructure
development corporation (APMSIDC).
Human Resource:
Pediatricians:
50. Teaching Hospitals with pediatric departments (15 SCNUs): For sustainability
of the new born care services and long standing requests by medical colleges the state has
proposed to set up an additional unit for neonatology in these hospitals. These units
would have an associate professor, two assistant professors and four senior residents.
The Director Medical Education will start the process for getting approval for the same.
Till these units are set up the existing faculty from the pediatric department will oversee
the functioning of the SCNU which will have four pediatricians (senior residents)
working round the clock and their remuneration would be supported under NRHM.
They would be paid a monthly remuneration of Rs 40000/- The state will recruit 60
pediatricians for the 15 SCNUs in these hospitals.
51. Other Non Tribal SCNUs (21 SCNUs): In all other 21 non tribal SCNUs under
APVVP and DME (without pediatric department) the state will recruit four pediatricians
for each SCNU to provide round the clock services. Each pediatrician will be paid a
salary of Rs 50000/- per month. The state will require 84 pediatricians for these 21
SCNUs.
52. SCNUs in Tribal Area Hospitals (8): The state has planned to set up 12 bedded
SCNUs in these eight hospitals which are highly remote and tribal. The state will place
two pediatricians in each of these units and will pay a monthly remuneration of Rs
90000/-. The state will recruit 16 pediatricians for these eight SCNUs.
53. Staff Nurses: There will be 12 staff nurses in the 36 “20 bedded” SCNUs and six
staff nurses in the eight tribal SCNUs for providing round the clock services and they will
be paid a monthly remuneration of Rs 13000/-. The state will thus recruit 432 staff
nurses in the 36 nontribal SCNUs and 48 staff nurses in the eight tribal SCNUs, i.e. a
total of 480 staff nurses.
57
54. Support staff: There would be three support staff for round the clock cleaning
and housekeeping, three security personnel, one lab technician and one data entry
operator in each of the 44 SCNUs.
55. Maintenance: The 36 non tribal SCNUs will be given an annual budget of Rs
10.00 Lakhs for maintenance and the eight tribal SCNUs Rs 5.00 Lakhs as annual
maintenance.
56. New Born Stabilization Units (NBSUs): The state has planned to set up four
bedded NBSUs in Level III facilities excluding those which will have SCNUs and other
Level II MCH Facilities. This too will be done in two phases viz. the in the first phase
121 NBSUs will be set up and the remaining 233 NBSUs will be set up in phase II and
are included in this year‟s PIP 2011-12. The sick neonates will be stabilized in these
units for the initial few hours and referred to the nearest SCNU for further treatment. If
the baby stabilizes it could be managed in the NBSU as well.
57. Renovation: The setting up of NBSUs involves renovation (civil works and
electrical works) of the identified space (Approx 400-600 sft) within the existing facilities
near the labour room. Sample design for setting up NBSUs in a CEmONC center and
setting up a NBSU in a ward have been developed by APMSIDC. Budget of Rs five
Lakhs has been earmarked for each NBSU for renovation. This will include aluminum
partitions, flooring, roofing with Gypsum POP, air conditioners, blinders for the
windows and electrical works for the equipment.
58. Equipment: The new born care equipment for the NBSUs will be procured by
APMSIDC as per the specifications and built in maintenance for three years. (Annexure)
Human Resource:
59. Pediatricians: The state has 115 pediatricians working in the 121 facilities
identified for setting up of NBSUs. These pediatricians who are at present attending the
routine pediatric work will also be responsible for operationalizing the 115 NBSUs. The
deficiency of six pediatricians in the identified facilities will be filled by APVVP on
priority basis.
60. Staff Nurses: The state will be appointing one staff nurse for every NBSU. She
will however be a part of the hospital staff and will work along with the labour room
staff nurses in rotation. The hospital superintendent will ensure that one staff nurse will
be available for the NBSU round the clock.
61. Support staff: The support staff available with the hospital will also be
responsible for the housekeeping of the NBSU on a regular basis.
62. New Born Care Corners: All health facilities where deliveries are taking place
will have a new born care corner in the labour room. All Level III MCH facilities will
have additional NBCCs in operation theatres as well. The state has committed to set up
540 NBCCs in the first phase i.e. by August 2011 and 758 NBCCs in the year 2011-12
(PIP 2011-12).
58
The equipment required for the NBCCs to be procured by APMSIDC. The existing
health staff in the hospitals will be responsible for utilization and maintenance of the
NBCCs.
Budget for Child Health activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
I Special Care New Born Units
(SCNU)
1 SCNUs in Other Areas
a) Maintenance and consumables Maintenance 1000000 21 210.00
b) Pediatricians Salary 50000 84 504.00
c) Staff Nurses Salary 12910 252 390.40
d) Data entry operator Salary 9500 21 23.94
e) Lab Technician Salary 9000 21 22.68
f) Support Staff Salary 6700 63 50.65
g) Security Salary 6700 63 50.65
Total 1252.32
2 SCNUs in Teaching Hospitals
with Paed. & Both
(OBG+Paed) Departments
Total 822.52
3 SCNUs in Tribal Areas
Total 343.51
SCNU Total 2418.35
II New Born Stabilization Units
(NBSU)
1 Staff Nurses Salary 12910 378 585.60
2 Maintenance Maintenance 175000 378 661.50
NBSU Total 1247.10
III New Born Care Corners
1 Maintenance Maintenance 20000 1405 281.00
Total
281.00
59
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
IV Nutritional Rehabilitation
Centers
1 Human Resources
a) Social Worker Salary 8000 23 22.08
b) Staff Nurses Salary 12910 138 213.79
Nutritionist / Data entry Salary
c) 10000 23 27.60
Operator
d) Cook / Care Taker Salary 6700 46 36.98
2 Compensation / Incentives
a) Care givers and Patients
Wage loss compensation + Food Compensation
i) for each mother during inpatient 150 6900 124.20
care (15 beds for 20 days)
Wage loss compensation for Compensation
ii) 100 460 5.52
follow-up visit
Cost of food for caregiver and Food
iii) 50 920 5.52
child at follow-up visit
Cost of Transportation for Transport
iv) 200 920 22.08
inpatient treatment ( to and fro)
Cost of Transportation for follow- Transport
v) 200 460 11.04
up after discharge
b) Incentives for Pediatricians Incentives 5000 46 27.60

c) Incentives-Community Workers Incentives 100 460 5.52
Maintenance / Contingency Maintenance
3 5000 23 13.80
Fund
515.73
Child Health Total 4462.18
60
A4: FAMILY PLANNING
63. The State is implementing the Family Planning scheme since 1952 and
formulated its Population Policy in the year 1997-98. Even though the State has
relatively poor socio economical status compare to the other southern states of India the
effective implementation of the State specific Population Policy resulted in reduction of
TFR to below replacement level i.e. 1.8 (NFHS-3).
64. In the Andhra Pradesh among the couple who utilizes family planning services
the female sterilization contributes 63%, male sterilization contributes 3% and all spacing
methods put together 1.1%. The age at marriage of the State 16.1 years and 18% of the
women become pregnant before 19 years are the major concerning factors of the state.
Hence the state now formulating the new Population Policy by focusing holistic need
based Family Planning methods to sustaining the TFR at the present level and giving
more emphasis on Age at Marriage/ spacing and limitation method/ Advise on sterility
/Planning for arrival of the 1st child/ Sex Education / Education of parenthood /
Nutrition/ Genetic / Marriage Counseling.
Objective:
 Sustain the present TFR – 1.8

 Strengthening the facility based human resource and infrastructure to Shift
the Camp sterilization approach to fixed day approach at facility level.
 Intensive Campaign to promote age at marriage.
 Proper spacing and limitation of Births by providing Sex Education /
Education of parenthood & Nutrition to the acceptors and special focus on
IUCD.
 Increasing the male participation from current level 4% to 5%.
 Safety & Quality assurance to the Family Planning acceptors.
 Insurance coverage to the acceptors and service providers to improve the
confidence among the acceptors.
 Addressing the problem of Infertility.
 Monitoring & Evaluation for effective implementation.
Implementation of Family Planning in A.P. - Situation analysis:
65. As per 2001 census, the population of A.P was 762.10 lakhs with decadal growth
of 14.59, it accounts for 7.42% of India‟s population. Midyear estimated population of
A.P for 2010 is 866.9 lakhs.
The Status of Total Fertility Rate in AP
NFHS – 1 NFHS – 2 NFHS – 3 Target

(2012)
A.P. 2.59 2.25 1.79 1.5
India 3.39 2.85 2.68 2.1
61
Other vital Population indicator of A.P
Indicator A.P India

Birth Rate (SRS 2009) 18.3 22.5
Infant Mortality Rate (SRS 2009) 49 50
1997-1998 197 398
1999-2001 220 327
Maternal Mortality Ratio (SRS)
2001-2003 195 301
2004-2006 154 254
Total Sex Ratio (Census 2001) 978 933
Child Sex Ratio (Census 2001) 964 927
Contraceptive prevalence Rate (NFHS III 2005-06) 67.6 56.3
% of girls marrying below 18 years (DLHS -3) 28.7 21.5
AP Family Planning indicators DLHS-2 Vs DLHS-3:
Indicator DLHS-2 DLHS-3

(2002-04) (2007-08)
Family Planning
 Any method (%) 62.8 65.3
 Any modern method (%) 62.4 65.1
 Female sterilization (%) 58.2 60.3
 Male sterilization (%) 3.1 3.9
Maternal and Child
 Mothers who received antenatal checkup (%) 94.3 95.9
 Mothers who had at least one TT injection (%) 86.5 93.4
 Institutional deliveries (%) 59.4 71.8
 Safe delivery (%) 67.8 75.6
 Children 12-23 months fully immunized (%) 62.0 67.1
Status of Family Planning -DLHS-III

(All in %)
Use of Any Total
Sl. Female Male
Districts Family unmet need
No. Sterilization Sterilization
Method in FP
1 West Godavari 78.7 74.7 2.8 4.4
2 East Godavari 78.5 71.4 3.8 7.2
3 Khammam 74.1 70.6 3.1 4.3
4 Guntur 72 69.9 0.5 8.4
5 Krishna 71.6 66.4 3.7 7.3
6 Warangal 70.5 55.5 14.5 7.7
7 Vizianagaram 70.4 62.5 9 9.5
8 Prakasam 70.3 68.3 0.9 8
9 Karimnagar 68.7 49.3 18.7 10.8
10 Srikakulam 67.3 63.5 2.5 7.7
11 Visakhapatnam 67.2 41.8 21.6 10.3
12 Chittoor 65.5 63.9 0.4 10.7
13 AP 65.3 8.5
14 Anathapur 64.6 62.2 0.4 9.6
15 Hyderabad 64.6 60.3 2 10.1
16 Nalgonda 62 60.2 1.7 8.6
62
17 Nellore 61.8 59.6 1 8.2
18 Rangareddy 59.9 58 0.6 8.1
19 Nizamabad 58.6 56.1 1.9 11.5
20 Kurnool 57.7 56.5 0.3 9.5
21 Adilabad 57 53.4 2.6 13.8
22 Mahabubnagar 54.1 53.5 0.1 11.1
23 Medak 53.3 51.9 0.8 10
24 Kadapa 51.4 49.6 0.5 15.1
Strategy:
66. A.P has achieved the replacement level of population by bringing down the TFR
to 1.8 (NFHS-III) which is equal to the developed countries. The achievement comes
because of state commitment to implement the state specific Population Policy to
stabilize the population of state in spite of having relatively low economic & social
development index. It is achieved through the commitment of the implementing agency
by providing the permanent method on camp mode and institution based fixed day
service.
67. Presently the state would like to shift its approach from the permanent method to
Age at marriage/ spacing and limitation method/ Advise on sterility /Planning for
arrival of the 1st child/ Sex Education / Education of parenthood / Nutrition/ Genetic
/ Marriage Counseling. As the state having average age at marriage is around 16.1 years
ultimately increased the span of reproductive period among the married women, the
literacy and social status of the population compelled the state to adopt permanent
method on need basis.
1. Age at marriage
68. Age at marriage is influenced by many complex economic, social and health
factors. The NFHS-III reveals that the average age at marriage in A.P. is 16.1 years and
18% of the women become pregnant before 19 years is one of the most concern factor for
the maternal health and population stabilization because it is linked with higher total
fertility rates and early childbirth. It poses increased risks of maternal and newborn
mortality or morbidity. Hence, Health and Family Welfare Department planning to
work in convergent with the Women and Child Development Department, Education
Department, Rural Development and committed NGOs that working in the rural areas
of Andhra Pradesh to delay the age at marriage to achieve the improved health and
nutrition status.
Strategy planned:
69. Even though the Illiteracy and Poverty are the major reason for the age at
marriage we believe that the awareness, sensitization in the tribal and rural areas along
with capacity building of the health staff on counseling can bring the change in the mind
set of the people in long run on marriage age of the women. Hence the following
strategies are proposed.
63
Building the awareness:
 Promoting awareness on various health problem that arising out of the early
marriage among all stakeholders including parents, relatives, panchayat members,
through the Health workers, NGOs, social workers, Community Based
Organizations (CBOs), school teachers, Aganwadi workers, Accredited Social
Health Activist (ASHAs), Religious, Political leaders. And also involving
electronic and printing media.
 Design, develop and use Information, Education and Communication (IEC)
materials and Behavior Change Communication, which helps creating negative
associations with child marriage; can create „new social norms‟
 Using the mass media, community media; conducting puppet shows, street plays,
theatre wall writings.
 Initiate campaigns on Stop Early Marriage conduct discussions in public forums,
meetings, training programmes (starting at the Gram Panchayat level) essay
competition in the schools and also in the rural women.
 Generating awareness among organizers of mass-marriages by ensure that these
marriages are registered.
Sensitization
 Initiate consultation meetings with stakeholders at grass roots - with parents,

teachers, Anganwadi workers, ASHAs, SHG and Panchayat members, NGOs,
religious leaders and Politicians.
 Counsel parents and encourage the involvement of mothers, elder daughter and
elder sons in campaign against the early marriage.
 Sensitizing Gram Panchayat, caste leaders, religious leaders regarding the
importance of avoiding the early marriage.
 Initiate a state wide movement (through rallies, marches, meetings) involving
grass root level women‟s group to bring the awareness on the age at marriage etc.
To achieve the above 4- Workshop proposed on sanitization at the PHC level through
the identified NGOs.
Capacity Building
 Conduct workshops, consultations and trainings for ANM, ASHA, and other
medical staffs.
 Train all Health Staffs at the PHC and SC level on the issue of age at marriage
and rights of the girl child.
 Encourage girls at the Schools to say „NO‟ to marriage; make girls themselves
aware of the evil effects of early marriage, their right to pursue education/
vocational training, etc. to shape up their future by themselves through
64
Govt./NGO‟s by taking incentive IEC campaign through the Bala Arogya
Raksha.
 To build the capacity of the field staffs regarding the all kind of the medical and
legal drawbacks of early marriage and its result in population growth.
 To improve the capacity of the field staff TOT at the state level, district level
proposed in turn they can train the field staffs at PHC level.
 The recourse agency to conduct the training and proper monitoring may be
through identified NGO or the IIHFW.
One Day TOT at the State Level.
SN Participants training load

1 PODDT+PHN/CHO 3 Officials per districts X
+Add. DMHOs 23districts =69 Officials
Workshops at the PHC level

S. Participants Training load
N
1 ANM+ASHA 50 participants per PHC
X 1624 PHCs
2. Sterilization services
70. The Commissionerate of Health and Family Welfare, A.P. is implementing all
the centrally sponsored Family Planning Interventions with additional support from
State Government under State Specific Population Policy. The objective of the
programme is to cover all eligible couples protecting their reproductive rights and
improvement of services of their choice.
71. As per the requirement of the acceptors the following services are provided:
a. Mini Lap services at fixed days in the F.P Service Centers.

b. Camp based DPL services where the fixed day services are weak.
c. Camp & Service Centre based NSV services to the male F.P acceptors.
Present Service coverage based on the report received form the Districts:
Sl. Year Total Vasectomy Tubectomy

No Sterilizations Achmt. % of Achmt. % of
achmt achmt.
1 2 3 4 5 6 7
1 2003-04 830812 31804 3.83 799008 96.17
2 2004-05 736417 28808 3.91 707609 96.09
3 2005-06 744271 26683 3.59 717588 96.41
4 2006-07 769253 26266 3.41 741327 96.37
5 2007-08 725217 28505 3.93 696712 96.07
6 2008-09 700273 29763 4.25 670510 95.75
7 2009-10 665400 22867 3.44 642533 96.56
65
72. Total sterilization ELA proposed for the year 2011-12 is 7.00 lakhs which is
estimated based on the birth order of 2 and above in the districts.
73. To implement the programme the Government of India provides incentives to the
permanent method acceptors, surgeons and staff. The Government of Andhra Pradesh
have been providing additional incentives to Family Planning Acceptors (BPL / SC /
ST), apart from Govt. of India package the total package provide as follows:
SN Categories Vasectomy Tubectomy Tub.

CSS NSP Total CSS NSP Total (APL
(All) (BPL/ (BPL/ (BPL/ only)
SC/ SC/ST) SC/ST
ST)
1 Acceptor 1100 350 1450 300 280 580 -
2 Motivator 200 200 75 75 -
3 Drug & Dressing 70 50 - -
4 Surgeons charges 100 100 75 75 -
5 Anesthetist 0 0 25 25 -
charges
6 Staff Nurse 15 15 15 15 -
7 OT technician 15 15 10 10 -
Total 1500 350 1850 500 280 780 -
(NGO /PMP Facilities/Voluntary Organisation)
SN Procedure To Facility To Motivator Total

(CSS) (CSS)
1. Vasectomy (All) 1300 200 1500
2. Tubectomy (BPL/SC/ST only) 500 - 500
Providing Facilities to Sterilization held on Fixed Days at Health Facilities.
74. The following facilities proposed to the 1094 Family Planning Service Centers
which are providing the sterilization services on fixed day basis to ensure the basic
amenities and hospitality to the acceptors.
1. Generator with POL.

2. Hospitality and basic amenities
3. Washing of cloths and maintain the cleanness.
Family Planning Consumables and Repairs:
75. To meet the annual ELA of sterilization supply of the following sterilization
accessories proposed for the year 2011-12. FP accessories proposed for the year 2010-11
caries 10% increase from the previous year incurred expenditure by taking care of
inflation and variation in price:
66
 Family Planning consumables
o Supply of 20 types of consumables approved by the technical
committee and budget incurred as per the Rate Contract of APHM
 Family Planning Surgical Instruments:

o Supply of 14 types of surgical instruments approved by the technical
committee and budget incurred as per the Rate Contract of APHM
&HIDC
 NSV Kits:
o Supply of 2000 kits approved by the technical committee and budget
incurred as per the Rate Contract of APHM &HIDC
 Laparoscopic accessories and repairs

o Accessories to the laparoscope is supplied to the districts in accordance
with the need and also repairs of the accessories under taken every year
to ensure the availability of instruments in time to avoid the hindrance
to the programme implementation.
3. Spacing Methods
Revitalization of IUD services in the Districts.
76. As per the recent DLHS – 3 survey the contraceptive prevalence rate in Andhra
Pradesh is 65.1% where just 1.2% are using spacing methods among which IUD users is
only 0.4 %. It is highly disturbing even though the state achieved to bring down the TFR
1.8.
77. The state now determined to shift it approach in Family Planning by emphasizing
on offering high quality contraceptive services to eligible couples on a voluntary basis
through the spacing methods. However, the acceptance of spacing methods still remains
low in this State.
Major identified difficulties in providing IUD services.
 Lack of awareness on importance and conveniences of spacing method

 Dogmas or social constrains in the adoption of the method.
 Limited access to skilled service providers.
 Low insertion skills among the providers resulting in higher complications
leading to non – acceptance.
Strategy
78. The State initiating the targeted intensive campaign and ToT was scheduled
(conducted for 3 districts) for the skill development under the State Population Policy in
the districts. Ones the training is completed the implementation will be taken up on the
following manner.
IUD services at PHCs
67
 Proposing fixed day services in the service centers.
 Proposed to train one identified person as councilor to promote the intervention.
 IEC activities.
IUD services at Sub Centres

 IUD services will be also provided on fixed days.
 ANM may be designated as councilor.
 Incentive proposed to the ASHAs / ANMs for motivation.
 Expenses towards infection prevention etc. would be met from the untied grant.
 IEC activities will also be implemented to popularize the clinic day.
Providing IUCD on Camp mode: It is proposed to conduct 1380 camp in the state
covering all the 23 districts @ 5 camps per month.
Providing Incentive to ASHAs: It is proposed to provide the incentive to the ASHA if

the acceptors not becoming pregnant at least for one year from the date of IUD insertion.
4. Training and Capacity Building
79. Minilap training : Mini-Lap training programme is one of the components of

Family Welfare programme and its main objective is to enhance the quality of service
and ensure the trained and validated surgeons (as per the GOI guidelines) present in all
the service centers to meet the demand. The training is imparted by Senior Surgeon at
district Head Quarters Hospitals of the districts.
80. The Medical Officer, Staff nurse and MNO/Theatre Assistant of PHCs and other
institutions are trained by Senior Surgeon at training centers for 12 days. Each trainee
and trainer will be supplied with required subject material. A training calendar is
proposed for every year to complete the training programme of Medical officer in Mini-
Lap techniques. From the year 2001-02 to 2010-11 (up to Nov.) 456 Medical Officers
and same number of Staff nurse, theater assistants were trained.
81. DPL training: The Medical Officers (OBG Specialists and M.S. General Surgery)
of PHC‟s and other institutions are trained by approved DPL training centres for 12
days. Each trainee and trainer will be supplied with required subject material. A
training calendar is proposed for every year to complete the training programme of
Medical officer in DPL techniques. At present there are 3 identified training institutions
(GMH, Sultan Bazaar, Hyderabad, GMH, Nayapool, Hyderabad and Gandhi Hospital,
Secunderabad) for imparting training to medical officers.
From the year 1997-98 to 2010-11 (up to Nov) 403 medical officers and equal number
of staff nurse and theater assistants were trained.
Training load and budget proposed for the year 2011-12 as follows.
68
TOT for DPL
One TOT at the state level to all the DPL surgeons of the districts is proposed to
upgrade the skill and orient them toward the programme.
3. NSV training
82. At present there are 4 training centers in Karimnagar. Imparting training in NSV
since 1998 and (2) more training centers are identified to impart training in NSV
programme at Adilabad.
83. The Medical Officers of PHCs and other institutions are trained in 7 trainning
institution for 5 days and the entire trainees and trainers are supplied with required
subject material.
TOT: out of 150 validated surgeons (18) medical officers were identified as State
Trainers.
From the year 1997-98 to 2010-11 (up to Nov.) 549 medical officers were trained
TOT for NSV
One TOT at the state level to all the NSV surgeons of the districts is proposed to
upgrade the skill and orient them toward the programme.
4. Quality assurance in FP service delivery:
84. To ensure the quality in FP service delivery the state emphasis the quality
assurance in sterilizations by providing awareness & training to the medical officer and
the staff nurses.
85. The Government of India communicated Standard Sterilization Manuals (2) the
TOT Training for State Officers was initiated. Directions of RSS Division, MoH&FW,
and workshops on Standard Sterilization Guidelines – QAC measures have been
organized in co-ordination with IIH&FW successfully in the year 2007-08.
86. In 2007-08 TOT has been organized in IIH&FW for District Level Officers and
District Level dissemination workshops were conducted successfully.
 Total No. of Districts … 20

 Total No. of Doctors Trained … 1354
 Doctors to be trained … 2000
 Printed 10,000 manuals and distributed to all the Districts.
87. The Staff Nurses who are in charge of operation theatres of FP Service Centres /
PP Units are most important people in implementing the guidelines issued under
Standard Sterilization manuals and QAC measures.
69
88. In co-ordination with IIH&FW the training have been organized effectively
involving the eminent Gynecologists, Microbiologists as Resource Persons, @ 2
districts per batch i.e. 50 to 60 Staff Nurses
Number of persons trained
SN Year Doctors Staff Nurse

1 2007-08 1354 nil
1 2008-09 446 297
2 2009-10 … 217
Proposed Training on Quality Assurance
89. Now the state initiating to conduct the reorientation training workshop to the
medical officer and the staff nurses on Quality Assurance. All the new recruiters and the
old will be covered in the training programme.
5. World Population Day Celebrations
90. World Population day celebrated every year on 11th July at the Districts level and
12th July at State level. On that day at the state and districts level initiates various
IEC/BCC activities on the Family Planning and presents awards to the Districts, F.P.
Surgeons, Staff for the best performance under various categories and also Cash
incentives to eligible couples.
Budget Proposed under A.P. State Population Policy
1 Camp Expenditure for DPL/VAS /IUD- (under SPP) 97.8

2 FP Trainings (under SPP) 50.33
3 FP Consumables / Laparoscopic accessories / Repairs 270
4 World Population Day Celebration (under SPP) 76.00
Total 494.13
6. PC&PNDT activities
Workshops on Effective Implementation of the PC&PNDT Act
Sl.No. Particulars Budget

(in Rs.)
1 Training Kit (Folder, pad, pen, etc.) Rs. 500 x 35 persons 17,500
2 Boarding & Lodging @ Rs. 350 per participant x 35 persons x 2 Days 24,500
3 Honorarium for guest lecture @ Rs.1000 per session x 10 sessions 10,000
Lunch for Guest faculty & Coordinator@ Rs. 250 per faculty x 4 2,000
persons x 2 Days
4 Facilities charges:
1 Lecture Hall + Demo room charges @ 2500/- per day x 2 5,000
5 Typing & Photocopying of Training Material @ Rs.1000 x 35 35,000
6 Contingency & Transportation @ Rs. 5000 5,000
70
Sub Total 99,000
7 Institutional overheads @ 15% 14,850
8 TA & incidentals @ Rs. 1500 per participant x 35 participants 52,500
9 DA @ Rs. 200 Per day x 25 x 2 days 14,000
Grand Total 1,80,350
91. The above budget may be met from state share receive from the district collected
as registration fee for registration of scan centers, Genetic counseling centers, ART
centers and other related bodies.
PC&PNDT Dissemination Workshops for Supporting Staff
Sl.No. Particulars Budget

(in Rs.)
1 Training Kit (Folder, pad, pen, etc.) Rs. 150 x 30 persons 4,500
2 Boarding & Lodging @ Rs. 350 per participant x 30 persons x 2 Days 21,000
3 Honorarium for guest lecture @ Rs.1000 per session x 10 sessions 10,000
Lunch for Guest faculty & Coordinator@ Rs. 250 per faculty x 4 2,000
persons x 2 Days
4 Facilities charges:
1 Lecture Hall + Demo room charges @ 2500/- per day x 2 5,000
5 Typing & Photocopying of Training Material @ Rs.1000 x 30 30,000
6 Contingency & Transportation @ Rs. 5000 5,000
Sub Total 77,500
7 Institutional overheads @ 15% 11,625
8 TA & incidentals @ Rs. 1500 per participant x 30 participants 45,000
9 DA @ Rs. 200 Per day x 30 x 2 days 12,000
Grand Total 1,46,125
92. The above budget may be met from District share collected as registration fee for
registration of scan centers, Genetic counseling centers, ART centers and other related
bodies.
93. Budget proposed for IEC activities to create awareness on PC&PNDT Act @
1.00 Lakh per District for 23 Districts towards Hoardings, Printing of Brouchers,
Phamplets, Wall writings and Kala Jathas
Budget @ 1.00 lakh X 23 districts =23.00 Lakhs (from NRHM Funds)
71
Budget for Family Planning activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 FAMILY PLANNING
MANAGEMENT
a) Review meetings on Family Meetings 10000 4 0.40
Planning performance and initiatives
at the state and district level
b) Monitoring and supervisory visits to Monitoring 3000 12 0.36
districts/ facilities
c) Orientation workshops on technical
manuals of FP viz. standards, QA,
FDS approach, SOP for camps,
Insurance etc.
i) Orientation workshops Workshops 150000 1 1.50
ii) Printing of Manuals Printing 50 2000 1.00
iii) Workshops (District Level) Workshops 25000 23 5.75
Sub-Total 9.01
2 TERMINAL/LIMITING
METHODS (Providing
sterilisation services in districts)
a) Plan for facilities providing Compensation 6000 1094 65.64
FEMALE sterilisation services on
fixed days at health facilities in
districts
b) Compensation for sterilisation Compensation 500 450000 2250.00
(Female)
c) Compensation for sterilisation NSV Compensation 1500 40000 600.00
(male)
d) Accreditation of NGOs / Voluntory Compensation 500 50000 250.00
Organizations for sterilization
services
Sub-Total 3165.64
3 SPACING METHOD (Providing
of IUD services by districts)
a) IUD services at health facilities in Incentives 20 470000 94.00
districts
b) Compensation to ASHA for 100% Incentives 100 200000 200.00
retention of IUD by clients
Sub-Total 294.00
4 Workshop on Population
Stabilization
a) State level Conference Conference 500000 1 5.00
b) District level Conference Conference 100000 23 23.00
5 BCC/IEC IEC/BCC 10000 360 36.00
activities/campaigns/melas for
family planning
Sub-Total 64.00
6 Implementation of PC&PNDT Act 23.00
Family Planning Total 3555.65
72
A5: ARSH Programme
94. Adolescents constitute 22% of the population and its age group is 10 to 19 years.
It is not a homogenous group, vary in age, sex , marital status ,culture ,their level of
education. Hence their health status will have tremendous impact on mortality ,
morbidity, population growth scenario, and on health status of India .
95. ARSH strategy has been approved as a part of the National RCH – II program
implementation Plan. This strategy focuses on Adolescent Reproductive and Sexual
Health. Steps are to be taken to ensure improved service delivery for adolescents.
Services include Counseling, promotive, preventive, curative and referral services. In
order to provide these services selected facilities in the district must be in a position to
provide prescribed package of services under ARSH strategy.
Key objectives:
96. Influencing the health seeking behaviour of the adolescents through existing
Public health system and services & Achieving the following
 To provide services to all school going and out of the school children.
 Reducing the age at marriage.
 Reducing the teen age pregnancies
 To facilitate them in reducing the MMR and TFR.
 Reducing the incidence of nutrition related diseases eg: Anaemia.
 Reducing the incidence of STI RTI and HIV & AIDS in adolescents.
Situation analysis:
 At present there are no focussed services to reach these groups. No special
trainings or special services ere provided to adolescents through existing health
care system. So there is ignorance, lack of health education and no good food
habits among these adolescents. This will leads to malnutrition, anaemia, and
high prevalence of STIs/RTIs and other communicable diseases. It was analysed
that 68% of girls and 30% boys are anaemic in Andhra Pradesh as per NFHS
survey.
 This ignorance has led to early marriages, population explosion, high MMR, and
high IMR.
 Due to non availability of counseling services at crucial times they are prone for
committing crimes and suicides. They are also exploited by the society by many
ways.
Key strategies:
 GoI has recognized that the „Adolescent and reproductive and sexual health
needs‟ as one of the national health challenges. Special strategies are evolved &
implemented under RCH-II and NRHM.
 GoAP has taken up the essential steps to provide ARSH services effectively
– while rationalizing the health services and strengthening of primary and
secondary health systems by constituting the 360 CHNCs,
– Strengthening school health program, Jawahar bala arogya raksha.
73
– constituting the MCH teams at habitation , Subcenter , PHC levels under
MCH
– By working in the direction of achieving functional convergence of Rural
development ,WDCW dept,,PR,
– Strengthening the monitoring system by creating a M&E cell at CFW with
a dedicated Joint director heading it.
– Constitution of Behavioural change communication, Information
Education & Communication Bureau at state level.
Program Components:
 Counseling at schools and AFHS at schools in convergence with RRC and
JBAR,
 .Training of all MOs, PHNs, MPHA(F) &(M), ASHA, AWW,
 Area specific IEC/IPC and BCC ,
 Monitoring and evaluation.
Implementation methodology:
97. A.P state ensures improved quality reliable adolescent friendly health service
delivery for adolescents through,
Service delivery
 MCH teams at habitation and sub center level.
 Medical officer and PHN at PHC level.
 Obstetrician and Gynecologist services at CHNC level.
 Tertiary care through Area hospitals / Teaching Hospitals.
 Jawahar bala Arogya raksha for Adolescent school children.
Trainings: 1st Stage:

Training to programme managers.
 Duration: 1 day
 Material: Orientation programme for Medical Officers to provide
Adolescent Friendly Reproductive and Sexual Health Services – Facilitators
Guide and Handout
 Printing of Material: Handout for Medical Officers and Facilitators guide for
LHVs, ANMs
 Venue: IIHFW
 Sensitization programme for DM&HOs, POs of ICDS, Dist. Education Officers
ND
2 Stage
The proramme managers will train Medical Officers using Facilitators guide and
handouts
 Duration: 3 days
 Material: Orientation programme for Medical Officers to provide Adolescent
Friendly Reproductive and Sexual Health Services – Handout for Medical
Officers and Facilitator guide for ANMs and LHVs
 Printing of Material: Handout for LHVs, ANMs
 Translation: Facilitator guide and Handouts for LHVs and ANMs
 Venue: DTTs
74
3rd Stage:
Medical Officers would train ANMs, LHVs
 Duration: 5 days
 Material: Orientation programme for ANMs & LHVs to provide Adolescent
Friendly Reproductive and Sexual Health Services – Handout for ANM and
Facilitator guide for ANMs and LHVs
 Printing of Material: Handout for LHVs, ANMs
 Translation: Facilitator guide and Handouts for LHVs and ANMs
 Venue: DTT s and RTC
98. Risk Analysis: 40% of MMR and IMR is contributed by teenage adolescent
mothers. Unless ARSH is implemented it will be difficult to reduce MMR and IMR.
They may do experimentation on sex, promiscuity and may results in high prevalence of
HIV/AIDS.
Expected out comes:

We can provide services to all school going and out of the school children.
 Age at marriage can be increased.
 Teen age pregnancies can be prevented and this results in reduction of MMR<
IMR and TFR
 Nutrition and nutrition related diseases eg: Anaemia can be prevented.
 Incidence of STI RTI and HIV & AIDS in adolescents will become low..
Training implementation cascade method

State level master trainer
(Faculty MOHFW)
District level Trainer

(PODTT, Paediatrician, Gynecologist, Psychologist and Faculty IIHFW)
Mandal level Training to Medical Officers, ANMs and LHVs
Establishment of Clinics and Service Provider

The programme would be implemented in the districts where age at marriage is low.
2. MENSTRUAL HYGIENE:
99. The Scheme on Menstrual hygiene is part of Adolescent Reproductive and Sexual
Health. The Scheme aimed at promotion of menstrual hygiene among adolescent girls by
creating awareness and a form for discussion on age at marriage, nutrition, gender
issues, contraceptives, self esteem and negotiation skills. In view of lack of safe sanitary
facilities the girls face several problems during menstruation. In order to increase
availability of sanitary facilities at affordable cost the GOI has initiate the present scheme
with the following objectives.
100. The program will be focused in rural areas with the following objectives:
75
 To increase awareness among adolescent girls on menstrual hygiene, build self-
esteem, and empower girls for greater socialization
 To increase access to and use of high quality sanitary napkins by adolescent girls
in rural areas.
 To ensure safe disposal of sanitary napkins in an environment friendly manner
101. In order to achieve the objective the state is proposed to conduct trainings at
different levels which will be monitored by the program officers
Budget for Adolescent Health activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Establishment of Health Clubs Clubs 5000 1984 99.20
2 Fixed Day Health Clubs with Specialist Clinics 100 18720 18.72
Services & Consellers
3 Printing of Booklets & IEC activities 21.75
Urban Health Total 139.67
76
A6: SCHOOL HEALTH
102. The Government of Andhra Pradesh launched a revitalised School Health

Programme under the name Jawahar Bala Arogya Raksha (JBAR) on 14th Nov last year.
This initiative has resulted in basic health screening of about 10% of the state‟s
population who are studying in the government and government aided schools and the
consequential referral services, as appropriate. The programme includes issue of
comprehensive Student Health and Education Record (covering ten years of health and
education details), booster immunisation, vitamin-A supplementation and bi-annual
deworming. The health department is working in close collaboration with the school
education department and Sarva Siksha Abhyan (SSA) to develop an institutional
framework for effective implementation of school health programme with proactive
teacher and parent participation.
103. Objectives of CHIP: is the prevention of illness as well as the promotion of health
and well being of the students through:
 Early detection and care of students with health problems

 Development of healthy attitude and behaviour amongst the students
 Ensure a healthy environment for children at school
 Prevention of communicable diseases
 Increased learning capabilities because of good health and nutrition
104. Progress in 2010-11: After the successful launch of JBAR, the following activities
were undertaken:
 Trainings on School Health were conducted at the State, District and Mandal
levels.
 The Student Health and Education Records were also sent to all schools.
105. Currently, health screening is in progress for students across the state. By 10 th of
April 2010, all children in Ashram Schools, Residential Schools, schools in tribal areas
and high schools will be covered. If time, resources and funds are available primary and
upper primary schools will also be covered.
106. Implementation Strategy: The implementation will be in two phases:
a. Intensive Phase is between 1st and 10th April, 2011
77
b. For Ashram Schools/ Residential Schools, it may be planned that the MO
and his/ her team reside in the school itself for the 2/3 day period. The
School Headmaster/ Principal/ concerned Management will ensure all
logistics of the team in the campus.
107. ‘Deworming and Personal Hygiene Day’: This will be celebrated on 24th of
February 2011 in campaign mode in order to mass deworm and spread awareness about
the importance of personal hygiene. This activity will cover all 82 lakh students studying
Government and Government Aided Schools in Andhra Pradesh. Highlights of this
campaign will be as follows:
a. All students between the ages 5-15 years will receive Mebendazole (500 mg)
or Albendazole (400 mg) for deworming.
b. All school staff, hostel staff and Mid-day Meal cooking staff must also be
administered Mebendazole (500 mg) or Albendazole (400 mg) for deworming.
c. Treatment for students suffering from scabies and lice infestation will also be
provided.
d. Spread awareness about personal hygiene like hand washing, cutting nails,
discourage use of common soap/towel etc.
Continuation Phase:
a) From the next academic year ie. June 2011, Thursdays will be School Health Days.
Thus, the PHC and the schools are aware of this day.
b) The Medical Officers of PHC, with the team, will visit the schools in their area at-
least twice a year. In the first visit, the School Health Team will undertake a
thorough medical check-up of all children in the school and in the second visit, only
high-risk children will be checked.
c) The MPHA (Male and Female) will visit the school once in every month. He/she
will follow-up children who have been absent from school for more than a week and
ensure that the child receives medical attention, if required.
d) The teacher will regularly monitor the programme on a day-to-day basis. They will
also follow the monthly „Theme Schedule‟ that will be provided to them for Health
Education.
e) Every Tuesday is School Health Referral day at higher medical centers. Children
requiring specialist services can avail of referral services on this day. A special
78
counter will be available for School Health referrals. ANM/ Teacher will follow-up
the referral cases.
108. In the years following 2011, as all children would have been screened, the
programme will have only the continuation phase.
Expected beneficiaries
 School going adolescent boys (10 to 19 years of Age): 92,86,668
 School going adolescent girls (10 to 19 years of Age): 86,16,384
 Out of school youth working in various Industries, Agriculture & Labours:
1,43,336 boys and 1,32,991 (numbers need to be verified and corrected)
Innovations for the year 2011-12
109. SWASTHH (School Water and Sanitation towards Health and Hygiene)
Program: Through this programme, we will try to bring focus on health and hygiene for
adolescent girls. The highlights of SWASTHH will be:
 Training for health and education staff on Adolescent Problems

 An ANM will be trained on adolescent hygiene and she will impart the same
to adolescent girls during the regular school health visit.
110. FRESH (Focussing Resources Effectively for School Health) Day Celebration:
In order to increase participation of parents, community and teachers in improving
health of the children, FRESH days will be celebrated across the states in all schools on a
particular date. On this date, a festive mood will be created and information about health
and hygiene will be imparted. Parents will be invited to suggest/ contribute to improving
health and hygiene in schools/ homes.
Budget for School Health activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 One time capital cost:
i. Weighing scale W.Scales 500 16000 80.00
ii. Height measurement instrument Instruments 100 16000 16.00
Total 96.00
2 Student health cards, referral
cards, 2 registers per year
i. Students Health Cards per annum Cards 6.00 1800000 108.00
1st year entry students.10 Lacs +
6th class entry students 8 Lacs total
18 Lac students
ii. Referral cards for 1 Lac children @ Cards 1.50 100000 1.50
Rs.1 each X 1 times
iii. Habitation Health Register Registers 50.00 20000 10.00
iv. Sick registers Registers 40.00 100000 40.00
v. Student Health Referral Register Registers 40.00 2000 0.80
79
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
vi. Referral follow up Register Registers 40.00 2000 0.80
vii. School wise Sick Register Registers 40.00 12600 5.04
maintained at Sub centre level
viii. Monthly reporting formats Formats 0.20 600000 1.20
Total 167.34
3 Travel cost for referral (0.1% of all Mobility 100.00 10000 10.00
screaned) @Rs.100 per referral
4 IEC activties IEC/BCC 94.00
5 Training of Master Trainers at 0.00
state level
a) Honorarium to master trainers Honorarium 2500 6 0.15
b) Refreshment Refreshments 250 96 0.24
c) T.A. & DA TA/DA 1000 96 0.96
d) Stationery Stationary 150 96 0.14
e) Miscellaneous (Training hall rent Others 15000 3 0.45
and others)
Total 1.94
6 Training of Mandal trainers at
Distrcit level
c) T.A. & DA TA/DA 150 5800 8.70
and others)
Total 29.58
7 Mandal level trainings
c) T.A. & DA TA/DA 50 125000 62.50
and others)
Total 387.50
8 School Health Program Mobility Mobility 900 64960 584.64
support to Medical Teams
9 Monitoring & Evaluation M&E 25.00
10 Swasthh: School Water and
Sanitation towards Health &
Hygiene
a) Menstrual Hygiene 10 500000 50.00
b) TA & DA 100000 22 22.00
c) Vehicle decoration 50000 22 11.00
d) Hiring of the Vehicle / POL 50000 22 11.00
Total 94.00
11 Fresh Programme 50000 22 11.00
12 Urban School Health Programme 1000 1000 10.00
13 Specialist Camps at the Divisional 25000 198 49.50
level
School Health Total 1560.50
80
A7: URBAN HEALTH
111. There has been a progressive rise of urbanization in the state of Andhra Pradesh
over the last decade. The primary health care infrastructure, particularly, in the urban
slum areas is relatively fragile, and rapid urbanization is throwing up complex challenges
to the health system. There exist multiple issues which limit the reach of basic provisions
of health and basic services to all the people living in urban slum areas. Their low socio-
economic status combined with high incidence of illiteracy deprives them of the basic
health care they need. Hence it is felt that extension & outreach services in the urban
slum areas are provided with special focus on maternal and child health care besides
preventive, promotive and curative health care services to one and all.
112. Under NRHM, the state of Andhra Pradesh has been providing primary health
care services to the people living in urban slum areas since 2005-06. A total number of
80 Urban Health Centres are presently functioning in the urban slum areas of the state
which are being run through selected local NGOs. The continuation of these 80 Urban
Health Centres for the year 2011-12 will be implemented at an estimated cost of
Rs.817.52 lakhs.
Key objectives
 To provide an integrated and sustainable system for primary health care services
in the urban slum areas, with emphasis on preventing and controlling
communicable diseases;
 To promote reproductive and child health among the urban population, especially
the urban poor and the slum migrant population.
 To increase availability and utilization of Health Services in urban slum areas.
 To build up an effective referral system from the Urban Health Centres to the
FRUs.
 To achieve 90% coverage of all pregnant women with comprehensive ante-natal

services such as TT immunization, regular periodical check-up, administration of
vitamin & iron supplements, counseling about nutrition, screening of high risk
cases etc.
 To increase institutional deliveries within the slum areas to at least 90% of the
total deliveries.
 To increase coverage of children upto 100% with immunization against the seven
vaccine preventable diseases and administration of Vitamin‟A”.
 To bring a substantial decrease upto 25% of the present level in infant and child
mortality occurring due to diarrhea and acute respiratory infections.
 To bring an increase in the age at marriage of girls in the jurisdiction of the UHC
to at least 18 years of age for at least 80% of the total marriages.
81
 To increase in the couple protection rate upto 70%.
 To increase utilization of spacing methods, both by men and women, to reach at

least 15% of the total couple protection rate.
 To increase number of vasectomy cases upto 15% of the total number of

sterilization cases.
 To implement all National Health Programmes and campaigns in the allotted

area from time to time.
 To increase overall health awareness and better health-seeking-behaviour among

the slum dwellers, reflected in reduced morbidity pattern, better management of
diarrhea and acute respiratory infections in children in the slum areas.
Key strategies of the programme
Universalizing Access:
113. Surveys, Studies and Action Research: Andhra Pradesh is urbanizing at a faster
pace and is likely to have 40% of its population in the urban areas by 2020. The
dynamics of urban primary health care is not fully understood, as it has been assumed
that the private sector would address the health needs of the urban people. This,
however, is nowhere near reality. Therefore, the state proposes to undertake series of
surveys and studies to understand the specific vulnerabilities of the urban poor; identify
pockets of urban poor, map the slums, estimate disease burden, health profile and service
availability. This will provide a firm ground for planning specific and targeted
interventions for the urban poor. The survey will cover the municipal corporations and
Grade-1 municipalities during 2010-11.
114. Structural Reforms: The Municipalities would identify a suitable place for
construction of UHC buildings on par with state government UHC buildings since the
present 80 UHCs under NRHM are being run in rented buildings. Further, there is a
scope to take up the establishment of new UHCs in the remaining Municipalities /
Municipal Corporations which do not have Urban Health Centres.
ii) Strengthening Infrastructure:
115. The UHCs are currently ill equipped and will therefore be upgraded with
adequate infrastructure, equipments and complementary facilities.
(iii) Partnerships:
116. Inter-sectoral Coordination: The department will work closely with the
Municipal health systems to address issues pertaining to environmental hygiene and
health, disease outbreak and provision of health services. A sub-committee has been
constituted at the state level to improve coordinated action.
82
117. Private sector: The UHC staff will work towards improving institutional
deliveries by referring the cases to Government hospitals which are very much available
in urban areas.
118. Mahila Aarogya Sanghams: Instead of Self Help Groups the UHC staff will
utilize the services of Mahila Aarogya Sanghams (MASs) members who are actively
associated with Urban health related programmes.
Implementation plan
(i) Expected beneficiaries:

 Uniform structure for delivery of urban health services will be extended to
targeted urban poor.
 Integrated & sustainable health care, with more emphasis on improved Family
Planning and Child Health services will be provided in the small urban towns in
the state, with special focus on the urban poor and other vulnerable groups,
especially those living in slums.
(ii) Facilities Upgraded

 Construction of buildings for existing 80 UHCs under NRHM will be taken up.
 Establishment of required number of new UHCs under NUHM may be taken up
in the high focused districts i.e Mahaboobnagar, Khammam, Nellore and left
wing extremist areas.
(iii) Package of Services:
 Early Ante-Natal Care registration at 12 weeks.
 Effective antenatal Health Package delivery (Administration of TT immunization
and IFA tablets)
 Three antenatal check-ups with regular follow up.
 Identification of High risk ANC cases and referring to higher institutions.
 Full immunization of children against 7 vaccine preventable diseases.
 Identification of infant related diseases like Diarrhoea, ARI and referring them to
the Higher institutions)
 Motivation of eligible camps for temporary and permanent methods of F.P. with
focus on male participation.
(iv) Training Requirements :
o Annual Training for the staff of UHC excluding class IV employees for updating
their skills and knowledge regarding maternal, child health & immunization and
other communicable and non-communicable diseases
o Quarterly training to the Mahila Aarogya Sangham members and to age at
marriage (Kishore) girls and to mother and antenatal women.
Monitoring & reporting systems
119. There is provision of (6) Regional Co-ordinators to streamline the system of

monitoring of functioning of UHCs as per prescribed guidelines. The Regional Co-
ordinators who are retired experienced doctors inspect the functioning of UHCs
regularly and guide the NGOs in carrying out the activities as per the aims and objectives
of the scheme. The NGOs are submit at the end of every month physical performance
83
and financial performance reports to the Municipal Commissionrs concerned in the
prescribed formats.
Special features for 2010-11
120. It is proposed to appoint one Additional ANM and one Laboratory technician per
UHC in view of proposed implementation of programmes for malaria, TB, AIDS and
other communicable and non-communicable diseases. These programmes will be linked
with District concerned programmes officials. Additional ANM is required to cope up
with the increasing population within the jurisdiction of the UHCs. This, in turn, will
bring improvement in the delivery of health care services.
Budget for Urban Health activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Medical Officer Salary 16000 80 153.60
2 ANMs (3) Salary 5200 240 149.76
3 Laboratory Technician (1) Salary 6500 80 62.40
4 Community Organizer (1) Salary 4500 80 43.20
5 Assisting Staff (3) Salary 3900 240 112.32
6 Project Coordinator to NGO (1) Salary 3000 80 2.40
7 Contingencies Contingencies 3000 80 28.80
8 Drugs & Consumables Drugs 10000 80 96.00
9 Community & Staff Training Trianing 24000 80 19.20
10 Rents, Water & Electricity charges Others 4000 80 38.40
Total 706.08
Other Initiatives
11 Administrative costs (Recurring)
a) Regional Coordinators Salary 25000 6 18.00
d) Vehicle hiring Vehicles 17000 6 12.24
c) TA / DA for RCOs TA/DA 10000 6 7.20
12 Non-Recurring
a) Preparation of Urban Helath Plan Action Plan 10000000 100.00
b) Prining of Registers Printing 10.00
Total 147.44
84
A8: TRIBAL HEALTH
121. Total tribal population in Andhra Pradesh state is 50.24 lakh and consists of 35
major tribal groups, and many minor subgroups. They constitute 6.6% of total A.P state
population.60 to 75% of the ST population lives in a continuous belt of in accessible hilly
forest areas extending from Adilabad district in north Telangana to Srikakulam district in
north costal Andhra Pradesh, spread over the geographic area of 31,485.34 square
kilometers. Nine ITDAs are established to achieve integrated development in these tribal
areas. In spite of various interventions initiated the improvement in health indicators
status very low.
122. Human development indicators are very poor in these areas. MMR and IMR are
almost double in the tribal areas.
123. This has drawn the attention of the GoAP & it is realized that focused region
specific, group specific interventions are required for improving the health status of the
ST population and reduction of IMR and MMR. The NRHM PIP 2011-2012 aims at
achieving institutional strengthening, inter department coordination, functional
convergence, improvement of the staff performance, strengthening the program
implementation and establishment of effective monitoring systems.
Key objectives:
 To implement an integrated and sustainable system for primary health care
services delivery in the nine ITDA (Integrated Tribal Development Agencies)
areas.
 To implement alternate MCH service delivery models for hard to reach areas in
the tribal region by construction of ANM quarters and Sub center complexes at
one hundred locations in deep forest and difficult to reach areas.
 To provide, food & stay facility and compensation of loss of daily wages for the
tribal pregnant women to encourage institutional deliveries by strengthening birth
waiting homes.
 Strengthening of 184 primary health centers by providing with necessary
equipment in addition to those provided regularly (additional cots for obstetric
use, Delivery tables, Generators, solar power etc.) to make 24 x 7 services
effective.
 Provision of integrated institutional tertiary health care to the ST s belonging to
primitive tribal group of CHENCHU community in Srisailam ITDA area.
 BCC & IEC in local tribal languages in to wean them from superstitious health
seeking behavior.
 Inter department coordination, functional convergence with tribal welfare
department, and WDCD departments and establishment of special Tribal health
project monitoring units at The State and ITDA level (as proposed by the Tribal
welfare department).
 To encourage the MPHA (f) for conduction of deliveries in remote and unreached
sub center areas.
 Provision of mobility (preferably suitable hired vehicle) to the PHC medical
officers and the CHNC medical officers.
85
 Identification and utilization of Tribal Health Volunteers Male (THV-M) after
giving training on identification of communicable diseases and reporting to the
concern PHC MOs in time.
 To provide emergency health facility for borders of tribal hostels.
Situation Analysis:
 Many gaps exist in the primary health system in the tribal areas. Especially many
vacancies exist for the specialist posts.
 It is observed that there are no permanent Sub center buildings or ANM quarters
constructed at the most of the sub centers in tribal areas especially in difficult to
reach areas .
 Thirty seven birth waiting homes are constructed in tribal areas and handed over
to the PHCs and other health institutions. Their potential could not be utilized as
the tribal women depend entirely on their day to day earnings. Pregnant women
also go to the work till one or two days before the delivery or incapable of
working. The family members are more inclined towards daily earning for
survival.
 Compared to plain area tribal PHCs require additional support and facilities like
solar power, electric generators, additional equipment, cots and beds for ensuring
the availability of 24 x 7 MCH services at PHCs.
 The disease prevalence rates, IMR and MMR are very high and integrated
institutional tertiary health care services are not available to the ST s belonging to
primitive tribal group of CHENCHU community living in Srisailam ITDA area.
The patients are often referred to hospital located at very distant places resulting
in mortality.
 Tribes of AP speak their own specific languages. Very few BCC & IEC programs
are designed in local tribal languages. The health messages are not reaching the
ST population effectively. Superstitious health seeking behavior is prevalent
among these tribes resulting in very high IMR MMR.
 It is also identified that the supervision over the health program management is
very poor in tribal areas. The inter department coordination & program
management is ineffective. The commissioner tribal welfare proposed that „Tribal
health state project management unit‟ at the commissioner of Tribal welfare office
and „ITDA level Tribal health project monitoring units‟ at nine ITDAs be
established.
 There is no recognition or incentives for the efforts put up by the PHC staff in
conducting deliveries in remote and unreached sub center areas. Morale of the
staff is very low. They need to be encouraged.
 The vehicles are provided 20 - 30 years back to the PHCs and are not in working
condition. Medical officers and supervisory staff is not mobile in tribal areas as
the alternate transport is rarely available. The public health emergencies are
poorly attended.
 Specialist services are not available in tribal areas. Tribal citizens have to travel
long distances for seeking specialty care and have to spend money for travel.
 There are many interior and hard to reach areas where communication is difficult
to pass on and information about communicable diseases is reaching late. Many
posts of MPHA (M) are vacant due to pending court cases.
86
 There are many Tribal hostels having 500 to 700 students who needs emergency
medicare in times acute emergency. At present trained ANMs are providing first
aid in the hostel.
Key strategies:
 To Create & strengthen the integrated and sustainable system of primary health
care in the nine ITDA (Integrated Tribal Development Agencies) areas.
 Construction of ANM quarters and Sub center complexes at one hundred
locations in deep forest and difficult to reach areas to provide essential MCH
services at difficult to reach tribal areas.
 Operationalization and improvisation of birth waiting home facilities by
providing food & stay facility and compensation of loss of daily wages for the
tribal pregnant women to encourage institutional deliveries.
 Strengthening of 184 primary health centers by providing additional cots for
obstetric use, additional Delivery tables, Generators, solar power, regular water
supply, safe drinking water source etc to make 24 x 7 services effective.
 Construction of a multi specialty hospital at Srisailam for providing of integrated
institutional tertiary health care to the 50,000 ST s belonging to primitive tribal
group of CHENCHU community living in Srisailam ITDA area.
 BCC & IEC in local tribal languages in to wean them from superstitious health
seeking behavior.
 Establishment of „Tribal health state project management unit‟ at the
commissioner of Tribal welfare office and „ITDA level Tribal health project
monitoring units‟ at nine ITDAs.
 Provision of performance based incentives to encourage the MPHA (f) for
conducting deliveries in remote and unreached sub center areas.
 Provision of mobility (preferably suitable hired vehicle) to the PHC medical
officers and the CHNC medical officers to attend the public health emergencies,
epidemics, routine regular monitoring.
 To provide specialist services in tribal areas. Tribal citizens need not travel for
longer distances for specialist services.
 To get timely information on occurrence of communicable diseases it is proposed
to identify THV-M in remote and hard to reach areas.
 Provision of Emergency Medical to tribal hostel students.
Program Components:
 Construction of ANM quarters and Sub center complexes at one hundred

locations.
 Operationalization and improvisation of birth waiting home & providing food &
stay facility and compensation of loss of daily wages for the tribal pregnant
women.
 Providing additional cots for obstetric use, additional Delivery tables, Generators,
solar power, regular water supply, safe drinking water source etc to make 24 x 7
services effective.
 Construction of a multi specialty hospital at Srisailam for primitive tribal group of
CHENCHU community living in Srisailam ITDA area.
 BCC & IEC in local tribal languages.
87
 Establishment of „Tribal health state project management unit‟ at the
monitoring units‟ at nine ITDAs.
 Provision of performance based incentives to the MPHA (f).
 Provision of mobility (By purchasing suitable vehicles and suitable hired vehicle)
to the PHCs & CHNCs.
 Organising specialist camps in tribal area under the supervision of SPHO, with
experts.
 Providing THV-M in remote and unreached areas to inform about occurrence of
communicable diseases to the PHCs. Selection will be need based and will be
identified by MO of PHC in consultation with local sarpanch for a remuneration
of Rs 400/month.
 For attending emergency calls and for providing treatment in times of acute
illness Medical officer will be provided incentives.
 All the funding will be done under NRHM during the year 2011.
 Construction agency authorized by the GoAP will takeup ANM quarters and
Sub center complexes at one hundred locations.
 Funds will be released to the PHCs/CHCs or health institutions for
operationalization and improvisation & providing food & stay facility and
compensation of loss of daily wages for the tribal pregnant women where birth
waiting homes are present.
 APHMIDC will supply additional cots for obstetric use, additional Delivery
tables, Generators, solar power, regular water supply, safe drinking water source
etc to make 24 x 7 services effective.
 Construction agency authorized by the GoAP will take up construction of a multi
specialty hospital at Srisailam for primitive tribal group of CHENCHU
community living in Srisailam ITDA area.
 BCC & IEC in local tribal languages will be done by BCC cell in collaboration
with Tribal cultural research institute ( A govt agency).
 Government of AP will issue necessary orders and guidelines for the
establishment of „Tribal health state project management unit‟ at the
monitoring units‟ at nine ITDA districts.
 Funds will be released to the tribal PHCs for the provision of performance based
incentives to the MPHA (f) & will be monitored by SPHO of CHNC.
 New vehicles will be purchased by the state as per the procurement policy existing
in the state and funds will be released to PHCs for mobility for hiring suitable
vehicle.
 Funds will be released to Senior Public Health Officer (SPHO) for organizing
specialist camps in are hospitals /Community Health Centers. SPHO with the
support of PO ITDA and district collector will get specialists from medical
colleges/APVVP hospitals. Superintendents of concerned hospitals will support
the SPHO where the camps are conducted.
 Providing THV-M in remote and unreached areas to inform about occurrence of
communicable diseases to the PHCs. Selection will be need based and will be
identified by MO of PHC in consultation with local sarpanch for a remuneration
88
of Rs 400/month. He will also be utilized for other works like spraying operations
conducted in NVBDCP and remuneration for that will be paid as per the
guidelines issued time to time.
 Names of the Doctors (along with phone number) who can attend for emergency
cases will be displayed in front of the hostel. At times of emergency these doctors
will be called on phone and after completion of treatment incentive will be paid to
the doctors.
Monitoring and reporting system for assessment the performance M&E wing:
 Periodic component wise progress and performance will be assessed by the
„ITDA level Tribal health project monitoring units‟ at nine ITDA districts and
„Tribal health state project management unit‟ at the commissioner of Tribal
welfare office.
 Joint director tribal health will ensure the effective program implementation and
enforcement of government policy implementation by various administrative
interventions through Commissioner Family welfare.
Risk analysis:
 Unless the proposed interventions are implemented and health program
management is closely monitored the IMR and MMR cannot be brought down or
the incidence of epidemics cannot be controlled in tribal areas.
Expected out comes:

 Sustainable system for primary health care services delivery in all the nine ITDA
(Integrated Tribal Development Agencies) areas established.
 Permanent Sub center complexes and ANM quarters will be in place at one
hundred locations in deep forest and difficult to reach areas.
 Food & stay facility and compensation of loss of daily wages for the tribal
pregnant women to encourage institutional deliveries.
 184 primary health centers will have necessary equipment in addition to those
provided regularly (additional cots for obstetric use, Delivery tables, Generators,
solar power etc.) to make 24 x 7 services effective.
 Integrated institutional tertiary health care to the ST s belonging to primitive
tribal group of CHENCHU community in Srisailam ITDA area will be in place.
 BCC & IEC in local tribal languages will be available.
 Special Tribal health project monitoring units (SPMU – TH) at The State and
ITDA level PMU-ITDA (as proposed by the Tribal welfare department).
 To encourage MOs/SNs/ MPHA (f) for conduction of deliveries in remote
PHCs.
 Suitable vehicles will be available to MOs to attend emergencies at any time and
hired vehicles will be available to remaining PHC medical officers for field visits.
 Specialist services will be available in CHNCs.
 Incidence of communicable diseases can be notify early and effective measures
can be taken immediately to arrest the diseases by having THV-M at remote and
hard to reach areas.
 Emergency services can be provided to hostel students.
89
Special features in 2010 -11 proposals:
 Integrated hospital at Srisailam
 Establishment of one „Tribal health state project management unit‟ and nine
„ITDA level project management units‟
 One hundred Permanent sub center building complexes with ANM quarters.
 Food and accommodation through birth waiting homes & compensation for loss
of wages to the tribal pregnant women.
 Incentives and awards for effective performers (MPHA- f ).
 Transport through permanent vehicles and hired vehicles for PHCs.
 Specialist services will be available in Tribal areas.
 Early detection of diseases in remote hard remote areas.
 Emergency services will be provided to hostel students.
Budget for Tribal Health activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Human resources
a) Contracting Specialist Services Doctors 45000 54 291.60
b) Additional Staff Nurses SN 12910 60 92.95
Total 384.55
2 BCC- IEC activities
a) BCC in Tribal native languages –in ITDA 500000 9 45.00
collaboration with Tribal research
and cultural institute –to change
superstitious health seeking
behaviours & promotion of
utilization of MCH services
3 Addl.Drugs & Supplies
a) CHNCs CHNC 100000 30 30.00
b) Additional Supply of medicines to SC 125000 184 230.00
Subcenters through PHCs
c) PHCs PHC 50000 184 92.00
Total 352.00
4 Implementation of Tribal RCH
activities
a) Strengthening & providing
connectivity & Mobility
i) Hired vehicle services for PHC Vehicles 20000 124 297.60
Medical Officers
ii) Purchase of new vehicles for 60 Vehicles 600000 60 360.00
PHCs
iii) POL for each vehicle POL 5000 60 36.00
iv) Repairs and maintenance of vehicle Repairs 5000 60 3.00
v) Driver on daily wages Salary 200 1800 43.20
b) Incentives for the staff
i) Special performance based Incentives 200 1840 44.16
incentives for MO, SN, ANMs for
90
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
conducting deliveries above base line
of 10 cases
ii) Cash award for best performing Incentives 12000 30 3.60
MO/SN/ANMs Rs 4000/each
selected from each CHNC
c) Operationalization of birth waiting
homes provision of food and
compensation of loss of wages
i) For ensuring Hospital delivery and Incentives 100 3700 44.40
to stay in Birth waiting
Homes(BWH) for 5 days for ANCs
ii) Patient attendant (Loss of Wages) Compensation 100 3700 44.40
for following the ANC and 5 days
stay in BWM
iii) Travelling for drop back the patient Transport 200 740 17.76
at home
d) Specialist Camps
i) Specialist camps in CHCs bi- Camps 55000 180 99.00
monthly one camp
Total 993.12
5 Other Tribal RCH
Strategies/Activities
a) 8500 Male Tribal Health Volunteers Incentives 400 8500 408.00
b) Orientastion training for Male Tribal Training 200 8500 51.00
Health volunteers
Total 459.00
6 Emergency Visits to Hostels in Incentives 100 920 11.04
Tribal Area by MO
Tribal Health Total 2244.71
91
A9: VULNERABLE GROUPS
124. There is strong evidence that certain social groups, especially SCs and STs, and
other vocational groups like coastal fisher folk, stone breakers, landless labourers,
weavers, etc. are distinctly disadvantaged when compared to others. Their health
outcomes are far worse than the general population. About 92% of the STs and 83% of
the SCs live in the rural areas of the state. More than one third of the SCs live in five
districts (East Godavari, Guntur, Krishna, West Godavari and Chittoor). ST population
is covered by the Tribal plan under NRHM. It is also recognized that the loss of
employment and other similar circumstances resulted in mass migration of citizens from
rural areas to urban settlements. Most of this population lives in urban slums and
temporary settlements.
125. The women of these groups are most vulnerable and are aware of the MCH
service availability nearest to them. Present public health system is not able to identify
them and provide them these essential services. This results in high infant and maternal
mortality which is often unrecorded. Most of the children of these groups are either un -
immunized or partially immunized.
126. The poverty, ignorance, exploitation and lack of social security and inaccessibility
to legal protection make these women more vulnerable and are sexually exploited. STI &
RTI prevalence is very high among these groups. Inability to have the access to the
curative services and lack of affordability resulted in decreased life expectancy. Street
children, Orphaned children, and children engaged in child labour is another most
vulnerable group to whom public health services need to reach.
Objectives:
127. Considering the fact that the overall health outcomes of the state are unlikely to
improve without targeted attention to the most vulnerable group of people:
 To identify the above mentioned vulnerable groups by the concerned public

health staff of PHCs /UHCs/Sub centres, register and provide health services.
 Designing special packages and targeted interventions for these groups to ensure
improved access to health services to address their specific health care needs
 Senior public health officers of the CHNCs may be identified as nodal officers
and funds may be release to them to support the PHCs to maintain effective
surveillance and monitoring to ensure service delivery to vulnerable groups.
 To provide MCH and nutrition services to vulnerable groups at their door steps
mobile services will be established with a mobile medical team consisting of MO,
staff nurse and a nutrition counselor along with necessary drugs.
128. Situational analysis and critical gap analysis: Scope of vulnerability in the state
cannot be assessed at present as no mapping exercise was carried out by the health
service providers.
129. The following vulnerable groups neither given sufficient attention nor policy were
made to address their health needs:
92
 People living in hard to reach areas
 Areas which are predominantly populated by SC/ST.
 Groups with low standard of living and literacy rates.
 Large migrant floating population with no constant source of
income/employment. eg: migrants, temporary settlers, nomadic communities,
destitute & beggars.
 Street children, orphans, children forced in to hard labour.
 Homeless single women without family or social support or employment,
 Fisherman communities along the costal belt and either side of rivers, islands.
 MCH and nutrition services are not reaching to vulnerable groups, IEC activities
what are being done are also not reaching in an effective way.
Key strategies:
 Identifying the pockets of vulnerability
 Improving Quality of Care
 Strengthening MIS
 Strengthening Facilities
 Community Engagement
 Mobile MCH services will be provided.
 Nutritional services will be provided.
Program components:
 Identification and registration of vulnerable groups in sub center PHC CHNC
areas.
 Incentives for the ASHAs MPHA (f)
 Community sensitization in association with Rural development department.
 Additional inputs to PHCs and sub-centers for service delivery to these identified
groups.
 Strengthening of MIS for monitoring the program.
 Provision of MCH and nutritional services.
Implementation methodology
(i) Identifying the pockets of vulnerability: A mapping exercise will be carried out
by the Public health service provider institutions and consolidated at CHNCs to
define the scope of vulnerability in the state. This will ensure adequate and
authentic information for planning inputs and activities.
The following will be the criteria for identification of vulnerable groups:

o People living in hard to reach areas
o Areas which are predominantly populated by SC/ST.
o Low service utilization pattern and health outcomes.
o Low standard of living and literacy rates.
o Low availability of health providers.
o Large migrant floating population with no constant source of
income/employment. Eg:migrants, temporary settlers, nomadic
communities, destitute & beggars.
93
o Street children, orphans, children forced in to hard labour.
o Homeless single women without family or social support or
employment,
o Fisherman communities along the costal belt and either side of
rivers , islands.
o MCH and Nutritional services will be provided by mobile MCH
services
(ii) Improving Quality of Care: Special focus will be placed on providing quality of
care to these groups by the primary health system. The entire health machinery
will be sensitised and organised to respond to the specific needs of these groups.
Measures will be taken to address the needs of these groups by local
PHCs/CHNC. The Addl. DM&HO (NRHM/RCH) at the district level will be
nominated a District Nodal Officer to maintain these services.
(iii) Strengthening MIS: The ANM collects disaggregated data on several

components of health care, for the vulnerable group , becomes aggregated by the
time it reaches the districts. Mo at PHC and SPHO atCHNCs will pay incentives
to the performers and necessary records will be maintained at these levels.
(iv) Strengthening Facilities: The identified health facilities (PHCs and CHCs) will
receive additional focus and resources to strengthen health facilities through
infrastructure support, drugs, manpower, and mobility support and close
monitoring.
(v) Community Engagement: A comprehensive behavior change communication

strategy will be implemented for the vulnerable groups in coordination with rural
development department.
130. Monitoring and reporting systems: A monitoring and reporting system will be
designed to be an integral part of the regular reporting system which measures the
performance in various components institution wise, CHNC & district wise.
131. Risk analysis: As the service delivery to the target group is a challenge to the
public health care system, meticulous and accurate methods are to be adopted to assess
the physical and financial progress of the program implementation.
Expected outcomes:
 vulnerable groups will be identified by the concerned public health staff of PHCs
/UHCs/Sub centers, register and provide health services.
 Special packages and targeted interventions for these groups will improve access
to health services and can provide specific health care needs
 Senior public health officers of the CHNCs may be identified as nodal officers
and funds may be release to them to support the PHCs to maintain effective
surveillance and monitoring to ensure service delivery to vulnerable groups.
 District wise beneficiary list will be available at Addl DM&HO (RCH).
 It will give a better focus on these groups for better future planning.
 Mobile services and referral linkages can be developed and can reduce IMR and
MMR.
94
Special features of 2011-12
 Certain level of clarity is attained in identifying these vulnerable groups, and

proposed probable roles at various levels to provide health care services.
 Service delivary will be ensured to those who are at risk and not supported by any
other schemes.
 MOs can take a decisive role to handle such needy cases.
 Institutional deliveries and full immunization to children can be improved.
 Incentive for hospital stay can facilitate ANCs for admission in hospital.
 Community can encourage vulnerable groups to get admitted in the hospital for
services.
 State as protector will do the best through this scheme.
 Mobile health services to these vulnerable groups regularly.
 Develop linkages with referral centers and ICDS.
 Special IEC activities will be done.
Budget for Vulnerable Groups activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Temporary Settlers / migrants
(payment for beneficiaries)
a) Pregnancy Registration to follow-up Incentives 500 5520 27.60
the Institutional Deliveries
b) Mobile RCH services in 100 CHNC
clusters in exclusivly remote
unreachble areas
2 Hiring of Vehicle Vehicles 20000 100 240.00
3 Medical Officer on Contract Basis Salary 30000 100 360.00
4 Staff Nurse on Contract Basis Salary 12000 100 144.00
5 Drugs Drugs 50000 100 600.00
6 IEC on MCH services in those areas IEC/BCC 5000 100 60.00
7 Nutrition Councellor Salary 8000 100 96.00
Vulnerable Group Total 1527.60
95
A10: HIGH FOCUSED DISTRICTS
132. Considering the fact that the overall health outcomes of the state are unlikely to
improve without targeted attention to the service delivery activities in high focus
districts:
 to ensure improved access to health services through special packages and targeted
interventions;
 to secure equity in provision of services and health outcomes among the most
vulnerable populations in the state; and
 to improve monitoring of targeted groups by revising and strengthening MIS;
regular evaluations and mapping exercises.
 The following 6 districts are identified as high focus districts by GOI Adilabad,
Mahabubnagar, Warangal, Khammam, Ananthapur & Nellore.
Strategies
i) Identifying the pockets of most difficult and hard to reach areas:
133. A mapping exercise will be carried out to define the scope of vulnerability in the
state. This will ensure adequate and authentic information for planning inputs and
activities. Without awaiting the mapping exercise results, the following will be the
criteria for identification of vulnerable geographical locations:
 Hard to reach areas

 Areas which are predominantly populated by SC/ST/ and vulnerable groups
 Low service utilization pattern and health outcomes
 Low standard of living and literacy rates
 Low availability of health providers
134. There are currently 184 such PHCs areas in the four high focus districts and 300
in the other districts of AP. In addition, the AP-SERP has identified 4,100 habitations for
intensive coverage of all SC and ST population with economic development and health-
nutrition interventions.
(ii) Improving Quality of Care
135. Special focus will be placed on providing quality of care to these groups by the
primary health system. The entire health machinery will be sensitized and organized to
respond to the specific needs of these groups. The performance of the health
functionaries will be judged by their ability to address the health needs of these groups.
136. A special task force for monitoring health care service delivery in high focus
districts will be established at state level with one Maternal Health consultant and
Nutritional consultant. At district level a monitoring unit with DM&HO / Addl.
DM&HO, PD, ICDS, PD, DRDA & Programme Officers & SPHOs of CHNCs will be
established to monitor MCH service delivery activities and nutrition component.
96
(iii) Strengthening Facilities
137. The identified health facilities (PHCs and CHCs) will receive additional focus and
resources to strengthen health facilities through infrastructure support, drugs, manpower,
and mobility support and close monitoring. Further actions include:
 Expedited recruitments and contracts will be undertaken to fill vacancies in the

identified facilities.
 To address the issue of absenteeism a biometric attendance system will be
introduced in the identified remote inaccessible and far to reach areas of AP for
maintaining discipline and promoting positive work culture.
 The identified facilities will be the focus of infrastructure development and
upgradation.
 Additional allocation for improving the mobility of the MO is also proposed.
 Monitoring of PHC performance through key performance indicators. This has
been piloted in the state and will be scaled up to cover all vulnerable areas. The
indicators pertain to service provision – OPD and in patient, outreach activities
and management of PHC.
 Based on performance a package of incentives is being proposed as well.
(iv) Community Engagement
138. A comprehensive behavior change communication strategy will be implemented

for the vulnerable groups. A special package of incentives is also proposed for enhancing
community participation.
Implementation Plan:
i) Service coverage: By providing comprehensive Family Health Package

 Name based tracking of all registered pregnant women and 0-5 years children.
 Distribution of comprehensive Mother & Child health card to each mother.
 Reduction of home deliveries by making availability of SBA trained attendant in
habitations.
 Providing diet to each pregnant woman and one attendant for 3 days at the time
of delivery at 24x7 hrs MCH centres.
 To operationalize more functional FRUs in high focus districts along with
provision of specialists and blood component facilities.
 To increase free transport facilities through 108 ambulances for all normal and
complicated deliveries to nearest FRUs.
 To organize birth planning for safe Institutional delivery for each pregnant
woman through VHNDs.
 In addition to ensure the availability of SBAs in tribal and remote areas to
encourage safe deliveries.
 Providing maternal nutrition through identified nutritional centres.
97
ii) Suggested Approaches
 Strengthening of identified 50 PHCs, 10 CHCs by Ensuring Patient Friendly
functional facilities by giving fixed incentives to service providers based on
performance bench marks. Rs.50,000/- to each PHC and Rs.75,000/- to each
CHC in a year.
 Mobility Support to MOs in identified 50 PHCs for monitoring.
 Provision of CUG mobile phones to ANMs in identified areas to have
effective communication:
 To facilitate the ANM to intimate the name based ANC particulars for
registrations at SC level
 To intimate maternal and infant deaths
 To intimate adverse conditions of pregnancy of an ANC to MOs
 To assure better monitoring at all levels
 Transportation of ANC to delivery through 108
 To inform nearby FRU for immediate medical / surgical attendance
 Special Nutrition support to pregnant and lactating women through NDCCs
 Strengthening of HMIS and TALLY ERP 9.0 in identified areas
 Ensuring presence of staff by introducing Bio Metric attendance system
Budget for High Focused Districts activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Mobility for MOs in interior and Vehicles 18000 50 108.00
remote areas
2 Special out reach camps for pregnant Camps 6000 100 6.00
women
3 Assured referral transport to 108 Transport 25000 250 62.50
uncovered villages / habitations with
drop back transport facility
4 Incentives for MCH services beyond
benchmarks
a) PHCs in High Focus Districts Incentives 2000 279 66.96
b) CHCs in High Focus Districts Incentives 5000 57 34.20
c) Area Hospitals in High Focus Incentives 7500 17 15.30
Districts
Total 292.96
98
A11: TRAININGS:
139. The National Training Strategy aims to ensure integrated training programs to
encompass the vast training needs and expanded training universe, address issues
pertaining to training in synchrony with planning and operationalization of health
facilities. The strategy will clearly define the role of each of the stakeholders involved in
training like State Program Managers; Director, IIHFW; Director of Public Health &
Family Welfare; Commissioner of Health & Family Welfare; Commissioner. APVVP;
Director of Medical Education; Project Director, APSACS; Principals of Medical
Colleges; Nursing Colleges & Schools, Para-medical Training Centers; NGOs involved
in healthcare; Commissioner, AYUSH; Director IPM; DG, Drug Control
Administration; Director, HMHMIDC; Principals of Regional Training Centers,
District Medical & health Officer, Project Officer – District Training Team in preparing a
Comprehensive Training Plan and Training Calendar for the State as well as the
Districts, so that the health facilities at sub-district and primary level could be
operationalised with improved quality of care by the providers.
Situation Analysis
140. Under NRHM, the GoAP is undertaking Induction Training, In-service Training
and Refresher Training for various categories of health functionaries – Doctors/Medical
Officers; Paramedics – Community Health Officers, Multipurpose Health Extension
Officers, Multipurpose Health Supervisors, Auxiliary Nurse Midwives, Pharmacists, Lab
Technicians, etc. In addition, District officials like the DM&HOs, Addl. DM&HOs,
Program Officers, Statistical Officers & Asst. Statistical Officers, District Education
Media Officers, etc, NGO representatives; private providers are also being trained.
141. The State has a database of healthcare training institutions to enable optimal
utilization of all available facilities for training. The Commissioner, Health & Family
Welfare is playing an active role in steering ToTs and other trainings and is making
funds available for training under different components of NRHM. She is ensuring that
training is an agenda item in all meetings with State as well as District officials. Sincere
attempts are on to build a system for monitoring and evaluation of in-service training
using available training infrastructure available at the State, Regional and District level
and develop a District wise database of trained manpower to prevent duplication and
gaps in training of personnel and facilitate their posting in appropriate health facilities.
Comprehensive Training Plan
142. Efforts are being made to prepare a comprehensive annual training calendar for
the State at IIHFW. It is also envisaged to bring RTCs & DTCs under the purview of
IIHFW to strengthen the quality of trainings. To further strengthen the available training
infrastructure it is also contemplated to have a single pool of trainers/faculty for all the
facilities and relocate the RTCs at other District headquarters for equity and accessibility
of training facilities. It is envisaged that this type of arrangement will facilitate
implementation of capacity building programs not only for the State but also at the
District & sub-district level.
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143. The IIHFW will also be responsible for induction trainings for all professionals
prior to assuming charge in administrative posts at State as well as District level. The
trainings shall also incorporate skill up gradation in managerial (administrative &
financial) as well as technical aspects (public health, disease control, maternal health,
child health, etc).
144. Like the apex training institute, the RTCs under the guidance of IIHFW should
prepare an annual calendar for all trainings in consultation with DTCs. The RTCs
should train MOs, SNs, ANMs & other para-medical personnel as per the guidelines of
GoI.
145. At the District level the DM & HO may nominate PO DTT as the District
Training Coordinator who will be responsible for all trainings conducted at the District
level. The District Training Coordinator shall plan, conduct and coordinate integrated
training programs of all related schemes and ensure coordination with the RTCs, other
training institutes and IIHFW. S/he shall establish liaison between health and other
related/allied departments in the District. The District Training Coordinator and his
team shall be responsible for undertaking Training Needs Assessment for all health
personnel working in his/her District to assess extent of skill up gradation and plan for
periodic in-service training. The District Training Coordinator shall monitor and
evaluate the trainees‟ performance periodically as per the guidelines of the government.
Need for Strengthening IIHFW, RHFWTCs (RTCs) and DTCs
146. The Indian Institute of Health and Family welfare (IIH&FW), the State level
apex training institute is the collaborating centre for all the trainings in the State. It
undertakes clinical as well as management related trainings. For the clinical trainings,
the institute coordinates its activities with the medical colleges.
147. In addition to the apex training institute, there are 8 Regional Health and Family
Welfare Training Centers (RHFWTC), 22 DTTs, 16 ANM Training Centers, 4 LHV
promotional training centers. Each RHFWTC is responsible for the training activities in
the Districts allotted to them. There is one District Training Team at each district
headquarters with field practice and demonstration areas (FPDAs) to impart practical
training to the trainers at PHC, and sub-centre level. In addition, to the above
government institutions, there are six training schools (Srikakulam, Cuddapah,
Khammam, W. Godavari, Nizamabad & Karimnagar) for Health Assistants (M) which
used to offer a one-year foundation course along with the RTCs (M) and are in the
process of being revived. The 16 ANM training schools offer the eighteen months
foundation course for the Health Assistants (F).
148. Apart from these institutions there are grant-in-aid institutes and more 250 private
institutes which offer trainings to Health Assistants (F).
149. Although AP has a good network of training institutes set up under IPP VI (1992)
and RCH I (1997- 2003) which provided in-service training to a large contingent of
health functionaries working in PHCs. However, the gaps with regard to staffing,
physical infrastructure, quality of faculty, and management of training programs need to
be addressed on a war footing. The existing training institutions need strengthening not
only in terms of physical infrastructure but also the trainers who hold the key to success
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of any training program. Building capacity of the existing trainers needs to be given top
priority. Funds required for strengthening of infrastructure facilities will be provided by
NRHM.
150. Presently, the existing training infrastructure (IIHFW, RTCs, and DTTs) is
grossly underutilized for various reasons. These training institutions are meant for use by
all sub-departments and not just the Department of Public Health and Family Welfare
alone.
Training in 2010-11
151. Most of the trainings planned in 2010-11 have been initiated. However their
initiation was delayed. Details of total numbers trained are attached in the training plan.
Since these issues have been addressed, trainings are being conducted and will continue
in 2011-12.
Implementation plan for 2011-12
152. For the year 2010-11 IIH&FW has been identified as a nodal body to coordinate
with other trainings institutions and other agencies for design and implementation of
trainings allover the state. The training programmes planned for year 2010-11 are
included in the section below
153. Indian Institute of Health and Family Welfare (IIHFW) has conducted 2-day
workshop on Capacity Development of Medical, Health and Family Welfare dept. on 3 rd
& 4th August, 2010 for all Principals of, RTCs and PODTTs of all the districts and
IIHFW faculty to develop training action plan and assess infrastructure and facilities
requirement for the respective institutions. From the inputs provided by the participants
it has been inferred that budget required for strengthening the training institutes in the
state as follows
Maternal Health Trainings:
Key Objectives
 To upgrade the skills and knowledge and to empower health workers for some
Basic Em.O.C interventions such as using of emergency drugs to prevent PPH
and before referral, to plot partographs and to assist vaginal dlivery.
 To upgrade the skills and knowledge of the health care providers in early
detection and complete treatment for the clients with RTI/STD.
Expected outcome
154. Functionalizing all the identified PHC and CHC in providing 24x7 services, thus
facilitating the districts to increase the institutional delivery to 90% by the end of 2011-
2012, which further facilitates in reducing the maternal morbidity and mortality.
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1. Skill Birth Attendance (SBA) Training:
155. In view of implementation of SBA training the sufficient number of trainers was
trained to provide training at district level. The state has identified 86 training facilities as
per the norms of GOI. A total of 4 ANMs/SNs will undergo training in each identified
training facility at a time. During the year 2010-11 the state could provide training to
SNs (1000) working in 24 x 7 hospitals / PHCs. The preference was given to SNs who
conduct delivery in their working area. During 2010-11 three rounds of SBA training
could complete in the state. Till now the State has given training for 2203 health
functionaries.
156. The state is proposing to conduct SBA training to remaining SNs (600) and
ANMs working in 24 x 7 PHCs and who are conducting deliveries (1000) during the
year 2011-12. The duration of training programme will be 21 days as per the GOI norms.
2. BEMOC Training for Medical Officers:
157. In order to enhance the skills of Medical Officers for conducting deliveries as well
as timely referral 10 days training programme is proposed as per the norms of GoI.
Initially the training will be imparted to Medical Officers working in 24x7 PHCs of
remote areas (Tribal & High Focused Districts)
3. Emergency Maternal Obstetric Care (EmOC) training:
158. The high MMR is a major concern in the country. To reduce MMR & IMR
provision of timely EmOC & LSAS has been recognized globally as a most important
intervention of saving lives.
159. The MBBS doctors from the needy district will be given EMOC training for 16
weeks in coordination with AVNI EmOC and FOGSI, followed by posting and placing
them at identified FRU & Govt. Hospitals where the specialist service for Obstetrics is
not available.
160. Preference shall be given to the Medical Officers from High focus districts and
Tribal areas for the year 2011-12.
4. Life Saving Anaesthesia Skills (LSAS) Training :
161. The high MMR is a major concern in the country. To reduce MMR & IMR
provision of timely EMOC & LSAS has been recognized globally as a most important
intervention of saving lives.
162. The Govt. of India has communicated guidelines for conducting Training
Programme in Medical Colleges having sufficient case load and perform sufficient
number of cesarian sections and recognized by MCI & DNB were identified by Govt. of
Andhra Pradesh are:
1. Osmania Medical College, Hyderabad,

2. Kakatiya Medical College, Warangal,
3. Andhra Medical College, Visakhapatnam,
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4. Guntur Medical College, Guntur,
5. Kurnool Medical College, Kurnool.
163. Orientation of Master trainers for LSAS was given to 24 Anesthetists from Five
Medical Colleges at IIH&FW, Hyderabad by National Level Trainers in March 2010
164. Further, the Master Trainers shall provide 18 weeks training in Anesthesiology,
14 weeks in identified teaching hospitals & 4 weeks in concern district hospitals to the
MBBS Doctors working in FRUs&CHCs where Anesthetists are not available.
Preference shall be given to the Medical Officers from High focus districts and Tribal
areas for the year 2011-12.
5. Training in MTP by using MVA: to provide safe abortion services at CHC and
FRU‟s, Medical Officers from these institutions will be trained and they will be
provided with required equipment after the training.
6. RTI and STI training to MO, Lab technician, Staff nurses and field ANM will be
under taken with the help of APSACS and as per the NACO guidelines. Trainings are
being conducted by APSACS for Medical Officers, Staff Nurses and Lab – Technicians
working in District/ Area Hospitals & CHCs. For the year 2011-12 trainings are
proposed to be conducted for Medical Officers, Staff Nurses & Lab- Technicians from
PHCs. Preferably for high focused and ITDA districts.
7. IMEP training: Medical and paramedical personal working at Sub-centre, PHC,

CHC and FRU‟s and also other major institution will be trained under Infection
Management and environment pollution so as to manage the biomedical waste safely.
(Trainings are proposed to be conducted along with RTI and STI trainings)
OTHER TRAININGS
8. Midwifery Skills Training:
165. CAMT is established on 5th May 2007to improve the Midwifery services through
pre services & in services trainings under Sida Project in collaboration between Govt. of
A.P and ANSWERS through IIM, Ahmedabad as nodal agent along with other
partners. After completion of the project on November2009, CAMT was taken up by
Govt., budget was allotted under PIP 2010-2011.with the aim of improving midwifery
services both in ANM/GNM Schools and labour rooms of the hospitals as per the
proposed objectives and functions of CAMT.
The objectives of the CAMT are:

 Review the foundation of midwifery practice.
 Strengthen knowledge and skills in midwifery through a review of maternal and
newborn health care in the home and hospitals.
 Enhance personal and professional capacities of teachers.
 Update knowledge and skills in midwifery practice in terms of latest changes in
policies national and international programmes and research training.
 Develop proficiency in theory and practical teaching including clinical guidance
of students in midwifery.
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166. One of the main functions of CAMT is to provide technical inputs on midwifery
and maternal and newborn care to training institutions, hospitals and health centers
Action plan for 2011 – 2012
167. Three Types of activities are planned for the academic year 2011 to 2012, namely
A. Follow up of labour rooms and staff nurses in CHC/Area Hospitals under

commissioner APVP and Teaching Hospitals under the control of DME and
Medak District until they are handed over to proposed District Change
Teams.
B. Seminar/ Workshop
1. Strengthening safe motherhood - One day seminar;
2. Improving the labour rooms & MCH services in the state through District
change team (DCT) – 2days
C. Trainings for various levels of Midwifery personnel
9. REFRESHER TRAINING FOR ACCREDITED SOCIAL HEALTH ACTIVISTS

(ASHAS) IN AP
168. To improve the health situation especially among poor and vulnerable sections of
population, Government of Andhra Pradesh has also opted for ASHA intervention and
included in its first Program Implementation Plan (2005-06). At present there are 70,700
ASHAs placed in rural areas appointed at the rate of 1 per 1000 population.
Training of ASHAs
169. MoHFW has come out with ASHA Moudles 6th and 7th focusing on skills that
save lives. These modules cover areas whose content is already familiar to the ASHA. In
addition, these modules include the development of specific competencies in healthcare
for mothers and children. A companion communication kit for the ASHA to use when
she conducts home visits and village meetings has also been developed.
170. As per the national guidelines IIHFW has drawn 10 day ToT for district level
trainers and 5 day skill development training for 19,806 ASHAs located in 6 high
focused districts in the 1st phase: Anathapur, Mahabubnagar, Adilabad, Warangal,
Nellore and Khammam.
171. In the second Phase ITDA districts i.e. Srikakulam ( Seetampet), Vizianagarm (
Parvathipuram), Vishakapatnam( Paderu), East Godavari (Rampachodavaram), West
Godavari (K.R. Puram) and Kurnool ( Srisailam) the total of 5037 ASHAs shall be
covered.
Monitoring and Evaluation
172. Formative and summative evaluation of training will be carried out, using pre-
tested tools to measure the outcome of the inputs given in the training. In addition,
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IIHFW faculty will undertake monitoring of district level trainings and submit the report
regularly.
Child Health Trainings:
1. Navjaat Shishu Suraksha Karyakram (NSSK)
173. Neonatal deaths contribute to nearly 45% of the under five mortality. Birth
asphyxia and severe infections together contribute to nearly 70% of the deaths. With
more & more deliveries occurring at health institutions it becomes important that the
large number of health professionals attending to births, are trained in neonatal
resuscitation & new born care at birth. This will help in making a significant dent in the
IMR by saving new born lives. The Ministry of Health and Family Welfare, Govt. of
India has therefore launched the NSSK – Navjaat Shishu Suraksha Karyakram a new
programme on Basic New Born Care and Resuscitation.
174. This program addresses important interventions of care at birth i.e. Prevention of
Hypothermia, Prevention of Infection, Early initiation of Breast Feeding and Basic
Newborn Resuscitation. The NSSK is two day skill based training. As per the
programme implementation guidelines, each district would require four trainers – two
pediatricians and two gynecologists.
IMNCI and F-IMNCI:
175. IMNCI strategy is the centre piece for Child Health in NRHM. Till the 2 nd
quarter of 2010 297 districts from 14 states have rolled out IMNCI. This involves the
capacity building of grass root level health and nutrition workers in skills to identify signs
of illness in neonates and infants and provide treatment and early referral. Facility based
IMNCI (F- IMNCI) is an integration of the existing IMNCI package and the Facility
Based Care package in to one package. The integrated approach of IMNCI and Facility
based care; (F-IMNCI) therefore provides a continuum of quality care for severely ill
newborns and children from the community and to the facility.
176. Majority of the health facilities (24x7 PHCs, FRUs, CHCs and District hospitals)
do not have trained pediatricians to provide specialized care to the referred sick
newborns and children, the F-IMNCI training will therefore help in skill building of the
medical officers and staff nurses posted in these health facilities to provide quality health
care to the sick neonates and children. The revised strategy which integrates both the
facility based care and the IMNCI to provide the optimum skills needed at the facilities
by the medical officers.
177. The introduction of F- IMNCI will help to bridge the shortage of pediatricians.
Progress and Achievements in 2010-11:
178. NSSK: The Indian Institute of Health and Family welfare, Hyderabad rolled out
NSSK in the state with support of the Indian Academy of Pediatrics (IAP) and
UNICEF. Four TOTs were conducted and 111 trainers (Pediatricians and obstetricians)
were trained.
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179. Following the TOTs 18 batches have been conducted in the state and two more
batches per district have been planned to be taken up in March and April 2011.
180. Till date 550 health staff has been trained in NSSK in the state and till end of
March/April 2011- 1380 health workers will be trained.
181. IMNCI: Govt. of Andhra Pradesh initiated IMNCI in Medak and Warangal
districts which support from UNICEF in 2006 and 2007 respectively.
DISTRICTS MO MPHS MPHA SNs ICDS AWWs Others Total

Warangal 85 209 1012 52 126 3353 36 4873
Medak 47 270 604 16 27 2227 3 3194
Other Districts 1381 63 1444
Total 1513 479 1616 131 153 5580 39 9511
182. Till the end of March 2010 the state had trained 9511 workers with grass root
level workers trained only in two districts. The state had proposed to start IMNCI in 15
districts in 2010-11 however the IMNCI basic trainings were conducted only in
Warangal and Medak.
183. Warangal completed 11 batches of IMNCI basic training (i.e. 251 workers) and
two batches of follow up training (48 workers) from April 2010 till Dec 2010. IMNCI
trainings were restarted in Medak after a gap of two years. Medak could complete three
batches of basic IMNCI trainings (87 participants), three IMNCI Follow up training for
supervisors (73 participants) and two batches of facilitation technique training (42
participants trained).
184. Thus till date the state has trained 9849 workers in IMNCI basic training and 360
supervisors in the IMNCI follow up training.
F-IMNCI: Facility Based IMNCI:
185. IIHFW with support from UNICEF conducted four batches of the five days F-
IMNCI TOT in Hyderabad. Pediatricians, faculty from the PSM department and
Regional Training centers were involved. 64 participants were trained in these four
batches. The DME AP deputed 16 participants from various government medical
colleges form the department of Pediatrics and PSM to New Delhi for the eleven days F-
IMNCI training. This was supported by UNICEF Hyderabad. The state thus has 80 state
level trainers in F-IMNCI. UNICEF will be supplying the required training kits for F-
IMNCI to the identified nine medical colleges.
State action plan for 2011-12:
186. NSSK: Training Load: With the training load of 8520 (2176 Medical Officers,
896 Staff Nurses and 4608 ANMs in 24X7 PHCs) and @32 trainees per batch there will
be 240 batches.
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First Quarter
Sl. Category Load Total Batch Duratio Unit Cost Total Cost
No. (for the Batches n in Lakhs per quarter
Qtr)
1 MOs 544 17 32 2 1.08 18.45
2 Staff Nurse 224 7 32 2 1.08 7.60
3 ANMs 1152 36 32 2 1.08 39.06
Total 1920 59 65.11
Second Quarter
Sl. Category Load (for Total Batch Duratio Unit Cost Total Cost
No. the Qtr) Batches n in Lakhs per quarter
1 MOs 544 17 32 2 1.08 18.45
2 Staff Nurse 224 7 32 2 1.08 7.60
3 ANMs 1152 36 32 2 1.08 39.06
Total 1920 59 65.11
Third Quarter
1 MOs 544 17 32 2 1.08 18.45
2 Staff Nurse 224 7 32 2 1.08 7.60
3 ANMs 1152 36 32 2 1.08 39.06
Total 1920 59 65.11
Fourth Quarter
1 MOs 544 17 32 2 1.08 18.45
2 Staff Nurse 224 7 32 2 1.08 7.60
3 ANMs 1152 36 32 2 1.08 39.06
Total 1920 59 65.11
Note: Each District is expected to conduct 2-3 batches per quarter.
187. Monitoring Plan: The Department will involve IIH&FW along with
professional associations like IAP & NNF for monitoring of the trainings &
implementation in all the districts. A team will be constituted at the state level, which
will visit the training sites every month. The team will visit 2 centers every month thus
covering all the districts. The estimated budget for the monitoring of NSSK trainings
would be Rs. 16.56 Lakhs (@Rs. 3000 per visiting 2 centers every month in 23 districts).
188. F-IMNCI Training: The state has identified nine Government Medical Colleges
who will conduct the F-IMNCI training for the medical officers and staff nurses from the
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districts. The regional training centers will assist the medical colleges in conducting these
trainings.
189. Resource Persons: The State has a pool of 80 facilitators for F-IMNCI. These
facilitators will be utilized to train the District Level Medical Officers. UNICEF has
supplied mannequins required for F-IMNCI training to IIH&FW Hyderabad. UNICEF
will also be procuring training kits for the identified nine Medical Colleges.
190. The list of medical colleges along with the timelines for F-IMNCI trainings is
given below.
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Sr. Medical College Regional DISTRICT Medical Officers Staff Nurses Total 1st qtr 2nd 3rd 4th Total
No for F-IMNCI Training Training Batches Training Batches batches Apr- quarter quarter quarter to be
Training center Load Load per Jun July- Oct- Jan- trained
center 11 Sep 11 Dec 11 Mar 12 in
2011-
12
1 Osmania Medical RTC Hyderabad 108 7 180 12 19
college and Hyderabad Medak 202 13 207 13 26
Niloufer Hospital Male Adilabad 185 12 100 7 19
64 6 3 3 3 15
2 Gandhi Medical RTC Nalgonda 203 13 225 14 27
College and Hyderabad Nizamabad 121 8 166 11 19
Hospital Female Rangareddy 106 7 127 8 15
61 5 3 3 3 14
3 Kakatiya Medical RCH Warangal 168 11 104 7 18
College and Training Khammam 182 12 141 9 21
MGM Hospital Center GMH Karimnagar 213 14 180 12 26
Warangal Hanamkonda
65 6 3 3 3 15
4 Government RTC Male Kurnool 214 14 99 7 21
Medical College Mehboobnagar 237 15 190 12 27
and GGH RTC Female Ananthpur 232 15 145 9 24
Kurnool
72 5 3 3 3 14
5 Government RTC Male Guntur 197 13 128 8 21
Medical College RTC Female Prakasam 202 13 100 7 20
and GGH Guntur
41 5 3 3 3 14
6 Siddhartha Krishna 201 13 166 11 24
Medical College W. Godavari 204 13 191 12 25
Vijaywada
49 5 3 3 3 14
7 Andhra Medical RTC Male Vishakhapatnam 203 13 95 6 19
college and KGH RTC Female Srikakulam 175 11 114 8 19
Vizag Vijayanagaram 278 18 113 8 26
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Sr. Medical College Regional DISTRICT Medical Officers Staff Nurses Total 1st qtr 2nd 3rd 4th Total
No for F-IMNCI Training Training Batches Training Batches batches Apr- quarter quarter quarter to be
Training center Load Load per Jun July- Oct- Jan- trained
center 11 Sep 11 Dec 11 Mar 12 in
2011-
12
64 6 3 3 3 15
8 Rangaraya East Godavari 165 11 202 13 24
Medical College
& GGH Kakinada
24 6 3 3 2 14
9 SVRR Medical RCH Chitoor 256 16 257 16 32
college and Ruia Training Nellore 199 13 154 10 23
Hospital Thirupati Center GMH Kadappa 196 13 138 9 22
Thirupati
77 6 3 3 3 15
TOTAL 4447 288 229 517 50 27 27 26 130
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Resource Persons:
191. The Medical Officers mainly Pediatricians, Community Medicine experts, and
faculty of Regional Training Centres are trained at State level by the National level
Master trainers in F-IMNCI. 4 batches of state level TOTs are conducted at IIH&FW,
Hyderabad during 2010-11 and one batch of 16 participants trained in F-IMNCI at New
Delhi through UNICEF support. The State has a pool of 80 facilitators for F-IMNCI.
The State level trainers in turn would train the District Level Medical Officers.
192. UNICEF has supplied mannequins required for F-IMNCI training to IIH&FW.
UNICEF will also be procuring training kits for e identified Medical College.
3. IMNCI Training
193. IMNCl for Health Workers and Anganwadi Workers at district level
 The State of Andhra Pradesh has decided to train Health Workers and
Anganwadi Workers in basic IMNCI to release budget to the IIHFW for conduct
of TOTs in the six regional hubs for the five high focus districts followed by in the
all the districts.
 The Districts trainers will train ANMs/AWW in 3 to 4 training centres in each
district.
 Status of IMNCI in Andhra Pradesh
194. Govt. of Andhra Pradesh initiated IMNCI in Medak and Warangal districts
which support from UNICEF in 2006 and 2007 respectively. IIH&FW, Hyderabad also
trained basic IMNCI for Medical Officers, Staff Nurses and Faculties from various
districts and Medical College in 2007 and 2008 total 1381 Medical Officers and 63 Staff
Nurses are trained. UNICEF have conducted 2 workshops at Warangal on MN-CHN
activities by involving all heads of the districts PODTTs and CDPOs and prepared
Action plan to roll out IMNCI trainings for ANMs/AWWs all over state. Total 84
Trainings centres are identified in 23 districts.
Cadre wise IMNCI Basic Training completed
DISTRICTS MO Health MPHA Staff CDPO/ AWW Others Total

Supervisor Nurse Supervisor
Medak 45 840 12 1541 120 2568
Warangal 83 205 1023 51 126 3252 36 4776
Other districts 1381 63 1444
Total 1509 205 1863 114 138 4793 156 8788
Hyderabad 111 46 157
Action Plan for Andhra Pradesh;
195. The Health and Medical department Government of Andhra Pradesh has
included the following strategies under NRHM to address the issue of infant morbidity
and mortality.
1. Formation of IMNCI cell in every district manned by a CAS as the IMNCI

Facilitator and supported by a paediatrician from the DH/ Medical College
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Hospital as the IMNCI coordinator. The IMNCI cell would be responsible for the
capacity building in IMNCI of all the health and ICDS workers and to ensure
effective implementation, monitoring and supervision. The cell would also be
involved in capacity building of all medical officers and staff nurses in F-IMNCI
and NSSK. Being skill based trainings the teaching hospitals and medical colleges
would be involved in the training program.
2. The state is focussing on facility based new born care and will be establishing
SCNUs (Special care New Born Units), Neonatal stabilization units and New
born care corners in various health facilities including teaching hospitals.
Capacity Building of Staff Nurses, Pediatricians in these centres would undergo in
house SCNU training and the Govt. plans to involve NNF and UNICEF to
support this activity.
3. Pre Service IMNCI is an important component of the state PIP.
SN District Training Batches 1st quarter 2nd 3rd quarter 4th quarter Total No.
Load April - quarter Oct-Dec 11 Jan-Mar batches in
June 11 July- 12 2011-12
Sep 11
1 Hyderabad 961 40 12 12 16 40
2 Medak 3340 139 Complete
3 Nalgonda 4819 201 18 18 42
17 Nizamabad 3189 133 18 18 18 54
18 Rangareddy 2582 108 18 18 36
4 Warangal 5196 217 Complete
5 Adilabad 4415 184 18 18 18 18 72
6 Khammam 4430 185 18 18 18 18 72
19 Karimnagar 4564 190 18 18 36
7 Kurnool 4238 177 18 18 18 54
8 Mehbubnagar 5632 235 18 18 18 18 72
20 Ananthpur 4708 196 18 18 18 18 72
9 Guntur 5556 232 18 18 18 54
10 Prakasham 4826 201 18 18 18 54
11 West Godavari 4635 193 18 18 36
21 Krishna 4637 194 18 18 36
12 Vishakptnam 4290 179 18 18 36
13 Srikakulum 4189 175 18 18 18 54
14 East Godavari 6106 255 18 18 18 54
22 Vizianagaram 3654 152 18 18 36
15 Chitoor 4406 184 18 18 18 54
16 Nellore 4104 171 18 18 18 18 72
23 Kadapa 3948 165 18 18 36
Total 98425 4106 90 228 372 376 1066
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 Five Districts (Adialabad, Khammam, Mahabubnagar, Anathapur and Nellore)
to start IMNCI Trainings in the first quarter.
 Eight Districts (Chittoor, East Godavari, Srikakulam, Prakasam, Guntur,

Kurnool, Nizamabad and Hyderabad ) in the second quarter.
 Eight Districts (Kadapa, Vizianagaram,Vishakhapatnam, Krishna, West

Godavari, Karimnagar, Rangareddy and Nalgonda) in the third quarter.
 By the end of March 2012 - All districts will have rolled out IMNCI.
 Each districts will identify three training centers and are expected to complete two
batches in each center every month i.e. 6 batches per month in one quarter.
 The districts can thus complete 18 batches in every quarter.
 Each district will complete 54 batches in one year i.e. 1296 participants will be
trained in one year in a district.
Innovations in Implementation of IMNCI:
1) Tracking of every new born baby with the help of IMNCI Tracking Chart distributed
to all the Anganwadi Workers trained in IMNCI.
2) Parallel reporting of IMNCI implementation by the DWD&CW & the Health
Department.
3) Development of IMNCI software with support of NIT Warangal with scope for
scalability throughout the state. This will help minimize the human error in reporting
of No. of babies visited with in 24 hrs, No. of babies visited 3 times in 10 days and
the No. of babies assessed. It will also have an online component which will help real
time entry of the visits by the frontline workers and the status of the baby in future.
Plan to give unique ID Number to every new born baby and also the health and
nutrition workers and Medical Officers.
4. Pre service IMNCI:
196. AP has the distinction of being one of the states with the largest number of
medical and nursing colleges. The state has 33 Allopathy Medical Colleges (13
government and 20 Private) and 191 BSc Nursing colleges (6 Government and 185
Private) admitting 4850 students for MBBS and 10372 students for BSc Nursing
respectively every year. Approximately 10000-15000 of these students graduate every
year, and join the public or private health services. Building the capacities of these
students in the skills required for saving neonatal and infant lives would help the state in
bringing down the IMR and NMR. The students are receptive and ready to learn new
skills and IMNCI can be taught by including it in the MBBS and BSc Nursing
curriculum. The paediatrics department and the PSM department can share the
responsibility of teaching IMNCI to the students in their sixth semester.
113
197. UNICEF supported the piloting of pre service IMNCI in Andhra Medical College
Vishakhapatnam and shared the details with Dr NTR University of Health Sciences. The
NTR UHS has decided to include IMNCI in the undergraduate teaching curriculum and
UNICEF Hyderabad and WHO India country office will support the state in rolling out
Pre Service IMNCI.
198. The NTR University of Health Sciences has formed the steering committee. The
steering committee prepare the Pre service IMNCI operational guidelines which will be
issued by the NTRUHS to all the Medical and Nursing Colleges in the state.
199. WHO India Country office and UNICEF Hyderabad have committed to support
the orientation workshop and the first two TOTs for the state. Gandhi Medical College
which has been identified as the nodal center for Pre service IMNCI will conduct the
training of faculty members of all medical colleges and nursing colleges.
Budget details for Pre service IMNCI:
Sl. Activity Batch Batches Rate Total Total

No. size / Units Load cost
1 State level Workshop (Supported 1 2.00 2.00
by UNICEF and WHO)
2 TOT for faculty from select 16 2 2.00 32 4.00
medical colleges (UNICEF)
3 Training of Faculty from medical 20 20 2.40 400 48.00
& Nursing Colleges
Budget required for Pre service IMNCI is 48.00 Lakhs.

Budget of Six Lakhs for activity one and two will be supported by UNICEF and WHO.
5. Management of Severe Acute Malnutrition Training:
200. The state will be setting up NRCs in all district headquarter hospitals to manage
children with severe acute malnutrition. The state has committed to set up 23 NRCs –
one in each district through the funds available under NRHM PIP 2010-11. CHAI
(Clinton Health Access Initiative) is supporting the state in setting up the first five NRCs
in teaching hospitals and in designing the remaining 18 NRCs in the State. CHAI will
also support the supply of F75 and F-100 to all the 23 centers till March 2012. The
doctors, staff nurses and nutritionists recruited in these NRCs will be trained in the
management of SAM children using the Kalawati Saran Children‟s Hospital (KSCH)
adaptation of the WHO module on SAM.
Sl Training Units / Unit cost Training Total

No Batches load Cost
1 State level TOT for Pediatricians ( 20 1 4.94 20 4.94*
participants for 3 days)x(1 batch)
2 Training of medical officers/ 5 3.09 100 15.45
Pediatricians from Phase 1& 2 NRCs (
20 participants for 3 days)x (5 batches)
3 Training of staff nurses and 8 1.63 80 13.04
nutritionists from Phase 1 and Phase 2
114
NRCs ( 20 participants for 3 days)x(8
batches)
4 One day sensitizations of PGs at Phase 6 0.25 120 1.50
1 facilities
*UNICEF supported
Family Planning Training:
1. Repositioning of IUD in Family Welfare Program: An Alternative Methodology of

Training for IUCD Services & Postpartum IUCD
Key Objective
 To promote spacing method
 To orient health care providers with the knowledge, attitudes and skills associated
with the competent delivery of IUCD (380-A) services
By the end of orientation programme the participants will be able to
1. Explain how copper bearing IUCDs prevent pregnancy, health benefits, risk and
common misconceptions about IUCD.
2. Counsel a client interested in using CuT 380 A (IUCD).
3. Insert the IUCD gently and safely using no touch technique
4. Provide appropriate client education counseling following IUCD insertion
5. Remove the IUCD gently and safely using no touch technique
6. Provide routine follow-up services to IUCD users and appropriate management
of side effects and potential problems
Outcome
To provide IUCD services at PHCs, CHCs & FRUs safely by the end of 2011-12 and
to encourage spacing methods.
Strategy
201. The Commissionerate of Health & Family Welfare, Govt. of AP is taking the
responsibility to train the service providers for 6 days as per the norms laid down by John
Hopkins University & GoI. In order to cover health functionaries in the state for this
year it is proposed to conduct the following category of trainings ion the state of Andhra
Pradesh.
1. Training of Trainers Workshop on Alternative Methodology of Training for

IUCD Services for Health personnel working at AHs & DHs
2. Training of Trainers Workshop on Alternative Methodology of Training for
IUCD Services Program Officers & OBG specialists.
3. Training Workshop on Alternative Methodology of Training for IUCD Services
for Health functionaries
4. Trainings in IUCD Immediate Postpartum Intrauterine Contraceptive Device
(PPIUCD)
115
Other Trainings
1. ARSH Training
202. ARSH strategy has been approved as a part of the National RCH – II program
implementation Plan. This strategy focuses on Adolescent Reproductive and Sexual
Health. In order to meet the reproductive and sexual health needs of adolescents, the
strategy focuses on reorganizing the exiting Public Health System at various levels. To
provide these services, steps are to be taken to ensure improved service delivery for
adolescents during routine checkups at different levels on Fixed Days and Timings. This
is to be in tune with the Outreach Activities. These activities include promotive,
preventive, curative and referral services. Inorder to provide these services selected
facilities in the district must be in a position to provide prescribed package of services
under ARSH strategy.
Training implementation cascade method

State level master trainer
(Faculty MOHFW)
District level Trainer

(PODTT, Paediatrician, Gynecologist, Psychologist and Faculty IIHFW)
Mandal level Training to Medical Officers, ANMs and LHVs
Establishment of Clinics and Service Provider

The programme would be implemented in the districts where age at marriage is low.
2. MENSTRUAL HYGIENE:
203. The Scheme on Menstrual hygiene is part of Adolescent Reproductive and Sexual
Health. The Scheme aimed at promotion of menstrual hygiene among adolescent girls by
creating awareness and a form for discussion on age at marriage, nutrition, gender
issues, contraceptives, self esteem and negotiation skills. In view of lack of safe sanitary
facilities the girls face several problems during menstruation. In order to increase
availability of sanitary facilities at affordable cost the GOI has initiate the present scheme
with the following objectives.
204. The programme will be focused in rural areas with the following objectives:
 To increase awareness among adolescent girls on menstrual hygiene, build self-

esteem, and empower girls for greater socialization
 To increase access to and use of high quality sanitary napkins by adolescent girls
in rural areas.
 To ensure safe disposal of sanitary napkins in an environment friendly manner
205. In order to achieve the objective the state is proposed to conduct trainings at
different levels which will be monitored by the programme officers
116
3. Training Workshop on HMIS & Reports
206. Given the understanding of the role of statistics and the statisticians in planning
and overall developmental process, the objectives of the training are
1. To orient the Sate, District and sub-district level persons dealing with data on
their job role and responsibilities in Health and Family Welfare
2. To brief on Health Management Information System under NRHM
3. To Monitor and Validate data at each level
4. To support district and state level authorities in supplementing information
related to District and Sub-District Planning.
4. Reorientation workshops for Sub-district Appropriate authorities on Effective

Implementation of the PC&PNDT Act
Participants:
 The District and sub-district appropriate authorities and district level legal
advisories.
Objectives of the training

a. Sensitize the Private Medical practitioners on provisions of the Act
b. Enhance their knowledge on
 Registration of centres under PC&PNDT act
 Maintenance of Records
 Violations under the Act and Penalties.
 Administrative measures in implementing the Act.
5. Sensitization Workshop on Gender, Health and Development for State and

District Level Officers
207. Understanding the existing gender disparities in health, one of the main focused
in NRHM is the promotion of gender equity in health care. While the Government is
taking utmost care in providing health services with gender sensitivity with respect to
timings, ailments etc., equally it is essential to sensitize the health providers on
differential gender needs to achieve the over all health goals of NRHM. The present
workshop is a beginning in this direction.
Objectives
 Deconstruct the knowledge on gender and construct the meaning and importance
of gender in Health
 Differentiate the differences between sex & gender; its impact of health goals
under NRHM
 Elaborate the role of gender as an impediment in achieving the specific health
programmes.
 To sensitize and enhance the knowledge of health personnel for operationalizing
Gender Approach in the health system
117
6. Induction Training for PHC Medical Officers in Andhra Pradesh
 Sensitize PHC Medical Officers to the National Rural Health Mission (NRHM),
its vision, goals and strategies,
 Orient the Medical Officers to their roles and responsibilities they have to
perform at the Primary Health Center, Sub-center and at the level of the
community.
 Provide training in office administration and management for effective delivery
of primary health care in the community.
208. A total of 929 Medical Officers from all Districts were trained in 2008 out of 1367
deputed at various training centers (IIHFW, RTCs & FPAI). After the initial
recruitment, a second round of recruitment took place recently, and it has been decided
to conduct induction training for the new recruits including those who were recruited in
the first round but did not undergo training.
7. Program on Management Training for District Coordinators of Hospital Services

& Hospital Superintendents of APVVP
209. The main of purpose of the training is to orient & sensitize the DCHS and
Superintendents of Secondary Hospitals to various management aspects in order to
strengthen capacity and institution building.
 Sensitize the officials to the National Rural Health Mission (NRHM), its vision,
goals and strategies
 Orient them to their roles and responsibilities in the light of the present Health
Sector Reforms under way in the State.
 Provide training in office administration and management for efficient &
effective delivery of quality services at the District level.
Budget Proposed under Training Strategy for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Skill Birth Attendance
a) Skill Birth Attendance district level Batches 111000 150 166.50
Training to Staff Nurses
b) Skill Birth Attendance district level Batches 111000 250 277.50
Training to ANMs
Total 444.00
2 BEMOC
a) BEMOC to Medical Officers Batches 190000 30 57.00
Total 57.00
3 EmOC
a) Training of MOs in Emergency Batches 150000 40 60.00
Obstetric Care
b) Training of MOs in Life saving Skills Batches 600000 5 30.00
118
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
in Anesthesia
Total 90.00
4 NSSK Training
a) District level to 2176 Medical officers Batches 108000 68 73.44
b) District level to 896 Staff Nurses Batches 108000 28 30.24
c) District level to 4608 ANM Batches 108000 144 155.52
Total 259.20
5 F-IMNCI Training
a) District level to Medical Officers (5 Batches 180000 50 90.00
days)
b) District level to Medical Officers (11 Batches 250000 40 100.00
days)
c) Training for Staff Nurses (11 days) Batches 200000 40 80.00
d) Modules Printing, Chart & Photo Printing 750 2000 15.00
booklets
Total 285.00
6 IMNCI Training
a) Trainign of Trainers (528) Batches 200000 22 44.00
b) Basic Training for 25584 Health and Batches 109000 1066 1161.94
Nutrition workers
c) Follow up Training for 3840 Batches 60000 160 96.00
Supervisors (Health& ICDS)
d) Monthly Implementation Meetings at Meeting 1000 360 3.60
CHNCs
e) IMNCI Training Material & IMNCI
Implementation Logistics
i) Log books for AWWs and ANMs Printing 30 30000 9.00
ii) Log books for Medical officers Printing 30 2000 0.60
iii) AWC Reporting books ( 100 sheets Printing 30 25000 7.50
perforated)
iv) Sub center Reporting books ( 100 Printing 30 4500 1.35
sheets perforated)
v) PHC Reporting books ( 100 sheets Printing 30 1000 0.30
perforated)
vi) Supervisors formats for Follow up Printing 30 4000 1.20
Supervision
vii) Tracking Charts 6 X 4 feet Charts 200 25000 50.00
viii) Modules, Chart & Photo-booklets, etc. Others 200 30000 60.00
Total 1435.49
7 Pre Service IMNCI
a) Training of Faculty from medical & Batches 240000 20 48.00
Nursing Colleges
Total 48.00
8 Capacity Development FBNC
a) Capacity Development of Doctors Batches
144000 14.40
(160 MOs) 10
b) Capacity Development of Staff Nurses Batches
106000 30 31.80
(480 SNs)
119
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
c) Honorarium for Resource Hospitals Batches 48000 106 50.88
Total 97.08
9 Training in Management of SAM
Training of 140 MOs / Pediatricians Batches
309000 5 15.45
from Phase 1 & 2 NRCs
Training of 160 Staff Nurses and Batches
163000 8 13.04
Nutritionists from Phase 1 & 2 NRCs
One day sensitizations of PGs at Phase Batches
25000 6 1.50
1 facilities
Total 29.99
10 IUCD
a) Orientation Workshop Training to Batches 184000 2 3.68
APVVP Doctors (Specialists
b) TOT for Medical Officers Batches 210000 8 16.80
c) District trainings to Mos/ SNs/LHVs Batches 175000 138 241.50
d) PPIUCD Batches 69000 12 8.28
Total 270.26
11 ARSH Trainings
a) ARSH ToT Batches 356000 1 3.56
b) ARSH District level Trainings to Mos Batches 90000 40 36.00
c) ARSH District level Trainings to Batches 135000 260 351.00
ANMs, AWWs & LHVs
d) Printing of Modules for ARSH 10.00
Trainings
Total 400.56
12 Menstrual Hygiene Trainings
a) ToT to DPHNO, Supervisors of Batches 140000 3 4.20
ICDS, APO (DRDA) and PHN
b) District Level Trainings to ASHAs, Batches 40000 46 18.40
AWWs & ANMs
c) Printing District Level Trainings Printing 3.00
Menstrual Hygiene
Total 25.60
13 Induction Trg. for PHC MOs Batches 450000 32 144.00
14 Capacity Building Trainings & BCC
Workshop
a) State Level officers on communication Batches 140000 1 1.40
skills, BCC and Media Management
b) DM&HOs training on communication Batches 120000 1 1.20
skills, BCC and Media Management
c) Workshop on BCC strategies and Batches 124000 6 7.44
material development in association
with National and International
Agencies
d) Sensitiszation of journalists on health Batches 124000 3 3.72
issues in collaboration with AP Press
Academy
e) TOT for RTC faculty Batches 128000 2 2.56
120
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
g) DEMOs/Dy.DEMOs training on Batches 227000 3 6.81
capacity enhancement on BCC under
NRHM
h) Capacity Enhancement on BCC for Batches 108000 12 12.96
HEOs to be posted in CHNCs under
NRHM
i) Capacity Enhancement on BCC for Batches 110000 20 22.00
MPHEOs under NRHM
Total 58.09
15 Orientation Training to Cluster / 50.00
District / State level Management
Units SPMU/DPMU Trainings
Training Total 3694.27
121
A11: PROGRAMME MANAGEMENT
210. In addition to SPMU and DPMU have been established under NRHM at the
state, the district levels and block level units i.e. 360 Community Health & Nutrition
Clusters also established respectively for the management of NRHM activities.
211. While the external and internal technical/programmatic assistance under

APHSRP and HIV program has brought velocity to overall reforms under the NRHM
umbrella, the assistance has been limited to either identified diseases or a few priorities of
the department so far. The assistance has not encompassed the range of inputs the health
sector may require in ensuring that basic services reach the remotest corners and to the
most marginalized.
212. The state therefore proposes the following strategies to ensure the momentum
gathered under the reforms program is sustained and that all initiatives that are at
different stages of implementation are fully integrated under the unified umbrella of
NRHM.
213. The Regional Directors (RD) – six of them across the state in the rank of
Additional Director of Health – who hitherto performed administrative functions are
being assigned programme coordination responsibilities over three to five districts.
Regional Data Managers (Bio-Statisticians) will support the RD in overall coordination
and monitoring of NRHM activities in the region.
214. The DPMUs is headed by a Public Health Officer who have completed their
DPH course from PHFI (IIPH) will support the DMHOs with their responsibilities. The
institution of DMHO is being strengthened with two additional DMHOs and physical as
well as functional integration of all programme officers under one umbrella.
215. To ensure effective monitoring and sustained backstopping at the cluster hospital
level, 360 CHNCs have been established and with a community PMU to support the
Community Health Officer. A Deputy Civil Surgeon who is hereby designated as the
„Senior Public Health Officer‟ (SPHO), supported by the following staff, who shall be
positioned through redeployment: a) Community Health Officer; b) Deputy Para-
Medical Officer (DPMO - Leprosy); c) Public Health Nurse (PHN); d) Health Educator;
e) MPHEO / Sub unit officer (Malaria); f) Ophthalmic Officer; g) LD Computer; and h)
one Senior Assistant.
Budgetary Requirement
Project Management Unit:
Sl. Cadre Mode of Proposed Remuneration Cost per

No. Appointment Strength Per month annum
(in lakhs)
1 Mission Director Deputation 1
2 Chief Programme Deputation 1
Officer (CPO)
3 Chief Administrative Deputation 1
122
(in lakhs)
Officer (CAO)
4 Chief Finance Officer Deputation 1
(CFO)
State Health System Resource Centre (SHSRC)

(in lakhs)
1 Public Health Contractual 1 50,000 6.00
Specialist /
Epidemiologist
2 Health Economist Contractual 1 50,000 6.00
3 HMIS Specialist Contractual 1 50,000 6.00
4 HR Specialist Contractual 1 50,000 6.00
5 Technical Advisor Contractual 1 50,000 6.00
(Emergency Medical
Services)
6 Supporting Staff Contractual 6 8,400 6.05
Sub-Total 36.05
State Project Management Unit (SPMU)

(in lakhs)
1 Consultant (MH) Contractual 1 50,000 6.00
2 Consultant (CH&I) Contractual 1 50,000 6.00
3 Consultant Contractual 1 50,000 6.00
(Population
Stabilization)
4 Consultant (School Contractual 1 50,000 6.00
Health)
5 Consultant (Public Contractual 1 50,000 6.00
Health &
Epidemiologist)
6 Consultant (HMIS) Contractual 1 50,000 6.00
7 Consultant (SDS / Contractual 1 50,000 6.00
BCC/ IEC)
8 Consultant (PPP) Contractual 1 50,000 6.00
9 Consultant (Trainings Contractual 1 50,000 6.00
/ Capacity Building)
10 Consultant (HR) Contractual 1 50,000 6.00
11 Consultant (Nutrition) Contractual 1 50,000 6.00
(Convergence)
Sub-Total 72.00
123
Human Resource Management Unit (HRMU)

(in lakhs)
1 Consultant (HR) Contractual 1 50,000 6.00
(Organization
Development)
Sub-Total 12.00
Project Management Unit for ITDA Areas

(in lakhs)
1 Consultant (Tribal Contractual 1 50,000 6.00
Health)
2 ITDA Program Contractual 10 30,000 36.00
Manager
3 Supporting Staff Contractual 2 10,000 2.40
4 Hiring of vehicles 1 20,000 2.40
5 Administrative 2500000 25.00
Overheads
Sub-Total 71.80
State Finance Management Unit (SFMU)

(in lakhs)
1 State Finance Officer Deputation / 1 50,000 6.00
Contractual
2 Accounts Manager Contractual 1 45,000 5.40
3 Assistant Accounts Contractual 2 25,000 6.00
Managers
4 Accountants Contractual 4 18,000 8.64
5 Audit Fees 10,00,000 10.00
6 Concurrent Audit 1 25,000 3.00
(State)
7 Concurrent Audit 23 6,000 16.56
(Districts)
Sub-Total 55.60
Information System Unit (ISU)

(in lakhs)
1 IT Specialist Contractual 1 50,000 6.00
2 System Administrator Contractual 2 30,000 7.20
3 Sr. Software Contractual 2 25,000 6.00
Engineers
124
(in lakhs)
4 Jr. Software Engineers Contractual 2 20,000 4.80
Sub-Total 24.00
Project Management Unit Supporting Staff

(in lakhs)
1 Personal Secretary to Contractual 1 25,000 3.00
Mission Director
2 Personal Assistants Contractual 3 15,000 5.40
3 Superintendents Contractual 2 20,000 4.80
4 Computer Project Contractual 4 15,000 7.20
Assistants
5 Computer Operators Contractual 8 12,000 11.52
6 Computer Assistants Contractual 8 10,000 9.60
7 Projectionist Contractual 1 10,000 1.20
8 Refrigeration Contractual 8 10,000 9.60
Mechanics
9 Junior Assistants Contractual 10 9,000 10.80
10 Office Subordinate Contractual 18 7,500 16.20
11 Drivers Contractual 10 8,500 10.20
12 Hiring of Vehicle to 1 40,000 4.80
Mission Director
14 Administrative 2000000 20.00
Overheads
Sub-Total 123.92
District Programme Management Unit

(in lakhs)
1 District Project Deputation 23
Officer
2 District School Health Deputation / 23 40,000 110.40
Coordinator Contractual
3 IMNCI Coordinator Deputation / 23 40,000 110.40
Contractual
4 Asst. District Project Contractual 23 27,000 74.52
Officer
5 Accountant Contractual 23 20,000 55.20
6 MIS Assistant Contractual 23 15,000 41.40
7 Computer Assistant Contractual 23 10,000 27.60
8 Office Subordinate Contractual 46 6,700 36.98
Sub-Total 384.74
125
Community Health & Nutrition Clusters (CHNC)

(in lakhs)
1 Cluster Health Officer Deputation 360
2 MIS Assistant Contractual 360 8,000 345.60
3 Accounts Assistant Contractual 360 8,000 345.60
4 Hiring of vehicle 360 18,000 777.60
Sub-Total 1468.80
BUDGET ABSTRACT
SN Activity Budget
proposed
1 Strategy Planning & Innovation Unit (SPIU) / State 36.05
Health System Resource Centre (SHSRC)
2 State Project Management Unit (SPMU) 72.00
3 Human Resource Management Unit (HRMU) 12.00
4 State Finance Management Unit (SFMU) 55.60
5 Project Management Unit for ITDA Areas 71.80
6 Information System Unit (ISU) 24.00
7 Project Management Unit Supporting Staff 123.92
8 District Programme Management Unit 384.74
9 Community Health & Nutrition Clusters (CHNC) 1468.80
Total 2248.91
126
A10: BEHAVIOUR CHANGE COMMUNICATION
216. The Government have established an integrated IEC/BCC Unit directly under
the Commissioner of Health & Family Welfare to prepare and launch a Comprehensive
Behavior Change Communication strategy, by merging the MEM Unit of
Commissioner of Health & Family Welfare and the State Health Education Bureau
(SHEB) of the Director of Public Health & Family Welfare. District IEC/BCC Bureau„s
in 23 O/o District Medical & Health Officers and 360 Cluster IEC-BCC Bureau‟s in 360
Community Health & Nutrition Clusters (CHNC‟s) have also been established. The
Government is committed to strengthen the infrastructure in this direction. The
Government vide.GO.Ms.No.276 HM & FW(B1)dept dt.06-10-2010 redesignated the
post of Joint Director SHEB as the Joint Director IEC-BCC Bureau to carry out all IEC-
BCC activities related to NRHM, Family Welfare, Public Health and HIV/AIDS
through the IEC –BCC bureau only.
217. The IEC-BCC bureau will make efforts to improve access quality health care
through newly formed CHNC systems. Through IEC –BCC strategy the department will
ensure convergence of all stake holders in achieving the state health goals. There will be
special focus on tribal areas, high focus districts and efforts will be made to promote
social and gender equality in health services. The Health Melas will be organized in
urban slums, peri urban areas, tribal areas and high focus districts. Efforts will be made
through IEC-BCC to decrease gender ratio in coordination with Education,Women and
Child Welfare, Panchayat Raj and Tribal Welfare departments and medical
organizations like IMA,FOGSI, APNA.
218. Additional activities on health promotion and prevention like awareness &
counseling through mobile exhibits at public gatherings like Rajiv Arogyasri screening
camps will be undertaken . School health (JBAR) a new programme Class I to X will be
supported by IEC-BCC activities for it sustained and successful implementation. Pilot
programmes like well Hyderabad on NCD‟s will be studied and scaled up in all urban
slums and other areas. The bureau is also planning to publish in house journal to be
distributed amongst health facilities and Panchayat including ASHA‟s. Receiving only
Terminals(ROT) of Mana TV(AP Govt satellite channel) will be established at all health
facilities for conferencing with staff, PR leaders and for telecast of health programmes to
the public)
Key Objectives
219. Behavioral Change Communication (BCC) is envisaged to be integral component

of the State and District PIP and has a critical role in achieving the objectives of National
Rural Heal Mission (NRHM).Keeping in view of the above situation and the paradigm
shift in Communication strategy is focusing on Behavioral Change Communication
(BCC)
 Make the leap from” Awareness to Behavioral Change”

 From being “instructive” to being empowering and
 from taking the “Genetic approach” to “individualized approach”.
127
Situation analysis, critical gap identification
220. The various IEC and BCC cells in the different departments are making efforts in
isolation and thus loosing the opportunity of synergy through concentric efforts. IEC
wings of Health and Family Welfare like SHEB under the DPH & FW and MEM wing
under the CH & FW,APVVP and JD – IEC APSACS, are carrying the IEC activities
independently with out knowing each other on the IEC materials producing by each
wing under the each HOD.
221. Resources were underutilized and not shared leading to lack of efficiency.
Programme Officers under the Director of Public Health and Family Welfare producing
the IEC materials by themselves without involving the media experts available in State
Health Education Bureau which is established to carry out the IEC activities on Health
programmes.
222. The IEC material produced by the State Programme officers of Director of Public
Health and Family Welfare is directly sent to the respective District programme officers
at the district level. The Lack of coordination due to absence of a common strategy of the
state for IEC/BCC, DEMO‟s are not aware of the IEC materials produced on various
Health Programmes and supplied to the districts.
223. Lack of supervision and monitoring and evaluation of the activities under IEC
and BCC bureau. No coordination at the State level with other media agencies like
department of Field Publicity, Song and Dram Division of Department of Audio Visual
Publicity of Govt of India.
Key strategies of the programme
224. State level BCC bureau will be the focal point for conceptualizing, integrating,
developing communication strategy implementing, monitory and evaluation of BCC
activities.
225. The State level Communication Strategy, developed in consultation with various
stake holders, will focus on awareness generation using Mass Media Channels like
Radio, Print, TV and films. The strategy will consider using new emerging media like
Radio, Print, TV and films. The strategy will consider using new emerging media like
satellite communication, internet, mobile, for effective, dissemination of messages etc.
The communication strategy will involve building up a conducive environment for
particular health issues through campaign and program mode. The state communication
strategy involves designing Mass media Campaigns on critical health intervention. It will
also develop media Strategies during the out breaks and epidemics and list out steps to
handle emergency and crisis situations .More emphasis will be given for inter personal
communication (IPC) through individual / group approach.
Programme components
 To establish the IEC bureau at the State level merging SHEB, MEM, and the IEC
wings of APVVP and APSACS for comprehensive planning and implementation
of IEC activities in an effective manner by implementing the orders issued vide
Go.Ms.No.186 HM & FW (D1) Dept.
128
 Constitute an expert/advisory committee consisting of media experts, subject
specialist‟s academicians to guide the BCC bureau.
 To assess the BCC needs and requirements –both soft ware and hard ware of all
twelve wings of H&FW and to pool up the budget allocations meant for carrying
out IEC/BCC activities for these wings. To utilizing the services of all IEC
personnel available under various heads of the department in IEC bureau.
 To workout a detailed BCC action plan along with the budget for incorporating
the same in the 2011-12 state PIP plan.
 To strengthen the infrastructure and equipment facilities at district and cluster
level for effectively carrying out IEC/BCC activities. To construct a new building
for establishment of IEC bureau in the space available in the campus of
Commissioner of Health and Family Welfare on par with other states with
adequate for storing of IEC material and Library .The building of IEC bureau in
Maharashtra located in Pune was funded by UNFPA similarly the Government
of A.P can have a separate building for IEC bureau. Allocation of exclusive audio
visual vans with all the facilities for carrying out field level BCC activities for each
institute.
 To provide guidance and leadership to district and clusters IEC units
 Designing of area specific, programmes specific, and issue specific BCC strategies
linked with the delivery system
 Strengthening of documentation process to learn lessons from best practices and
as well as failure stories.
 Develop a sound monitoring and evaluation mechanism to study the media wise
impact of BCC interventions among the community members. Hold regular by
monthly review meetings with Demo‟s. To develop IEC-BCC monitoring tools at
all levels.
 To set up Learning Resource Centers (Ware House) bringing all the IEC material
produced by different agencies and develop programme specific and Media
specific IEC/BCC kits. To developing area specific IEC materials keeping in view
the local beliefs and socio cultural practices.
 Enhance capacities of BCC personnel and other programme officers from time to
time so as to update them with current disease patterns and media trends and
technologies.
 Ensure timely and adequate release of budget and IEC material to District and
Cluster units in order to carry out BCC activities effectively. To make provision
for transportation of IEC material to the Cluster/PHC /SC level. The Key
functionaries under IEC bureau are not to be entrusted with other activities which
are likely to affect the effective implementation of IEC activities
 To interface with Media agencies – both Private and Government-to strengthen
health promotional activities by organizing sensitization work shop from time to
time.
 To appoint a media advisory committee at the State level involving the IEC
Officers concerned of different HOD‟s, department of Field Publicity Song and
Drama division, Govt of India, Information & Public Relation Dept, Private
Media agencies and active NGO‟s working on Health & Family Welfare like
UNICEF etc..
 To carry out internal and external evaluation studies impact of IEC/BCC
interventions.
 To redefine the Job chart of all IEC functionaries right from state to PHC level.
129
 To ensure effective coordination with all the line departments to avoid
duplication of
 IEC /BCC activities.
 Document best BCC practices /Success stories in Health and Family Welfare.
 Letters of appreciation, awards etc. for the best performing district IEC staff.
 The Health Educators possessing PG diploma in Health Education now working

at few PHC‟s level are deployed to CHNC‟s .The Health Educators are made
responsible to plan, implement and monitor IEC/BCC activities in the CHNC
area with the involvement of local Health personnel.
 KAP studies will be carried out on the existing the health problems in the CHNC
area and the BCC activities will be planned and implemented accordingly
 The implementation methodology of the IEC /BCC activities will be area specific
language specific and problem specific.
 The Dy.DEMO‟s and DEMO‟s of the district IEC bureau will guide the Health
Educators of CHNC‟s and provide leadership to the Health Educators for
effective implementation of IEC/BCC activities in the district.
Monitoring & Reporting Systems
226. The monitoring and reporting system on IEC/BCC will be at the CHNC, District
and State level
 The IEC/BCC activities carried out by the CHNC‟s, District and State level.
 CHNC‟s: The IEC/BCC activities carried out by the health personnel such as
MPHA,MPHS,MPHEO/CHO will be monitored by the Health Educators of the
CHNC‟s and the monitoring report will be submitted to the district bureau.
 District level: The DEMO and Dy. DEMO‟s of the IEC bureau will monitor the
IEC activities carried out by the Health Educators and submit the evaluation
report to the State IEC bureau State level.
 The Technical Officers, HEEO and DD MEM will monitor the IEC/BCC
activities by the District and provide feed back.
Risk Analysis
227. Behavior Change is a complex process. Study of the individual, group,

community on behavioral pattern towards the particular health behavior is very
important so as to plan suitable and appropriate communication interventions. KAP
studies will be carried out for different population groups to inform the IEC/BCC
activities
Expected Outcomes
 Community involvement in implementation of H & FW programmes

 Reduction of disease burden through behavioral change.
 Optimum utilization of H & FW services provided by the government.
130
QUARTERLY BUDGET ALLOCATIONS PROPOSED FOR 2010-11
SN Detailed activities Quarterly budget allocations

Q1 Q2 Q3 Q4 Total
1 Setting up and development of IEC/BCC unit -- 50.00 -- -- 50.00
at the state level/ district level
2 Develop IEC/ BCC strategy -- 50.00 -- -- 50.00
Streamline objectives/ identify communication
tools/identify media mix as per target
audience/ frame monitoring evaluation
indicators
Identify external agency / Advertising agency
for the task ( if needed)
3 Media Mix
Develop a strategic media mix as per the
target population and issues ( Child Health,
Maternal Health/ Family Planning)
a) Interpersonal communications
 Counselling at FRUs,PHCs etc -- 12.50 -- 12.50 25.00
 One to one interaction by -- 12.50 -- 12.50 25.00
ASHAs/ANMs/AWWs -- 12.50 -- 12.50 25.00
 Group discussions at village/ -- 12.50 -- 12.50 25.00
block/Panchayat level -- 12.50 -- 12.50 25.00
 Community meetings
 Workshops at Panchayath/ block/
district level
b) Community media
 Folk arts -- 12.50 -- 12.50 25.00
 Street plays -- 12.50 -- 12.50 25.00
 Health melas -- -- -- -- --
 Rallies -- 12.50 -- 12.50 25.00
 Social mobilization programmes -- 12.50 -- 12.50 25.00
c) Outdoor media
 Banners 12.50 12.50 12.50 12.50 50.00
 Bus boards 12.50 12.50 12.50 12.50 50.00
 Bulletin boards 12.50 12.50 12.50 12.50 50.00
 Sign ages / hoardings 12.50 12.50 12.50 12.50 50.00
d) Television spots 12.50 12.50 12.50 12.50 50.00
e) Radio programmes 7.50 7.50 7.50 7.50 30.00
f) Newspaper advertisements 12.50 12.50 12.50 12.50 50.00
g )Print materials
 Pamphlets 12.50 12.50 12.50 12.50 50.00
 Posters 12.50 12.50 12.50 12.50 50.00
 Flip charts 12.50 12.50 12.50 12.50 50.00
 Flash cards 12.50 12.50 12.50 12.50 50.00
 Calendars and danglers - - - 20.00 20.00
Total 875.00
131
BUDGET ABSTRACT FOR RCH FLEXIBLE POOL
(Rupees in lakhs)
SN Activity Budget
proposed
2011-12
I Maternal Health
1 Referral Hospital Strenthening 2147.87
2 24-hours MCH Centres 4767.84
3 Janani Suraksha Yojana 4282.94
4 Maternal Death Review(MDR): 159.00
5 Mother & Child Tracking 100.00
6 MTP Services (Trainings) 10.60
7 RTI/STI Services (Trainings proposed) 233.40
8 Midwifery Training for ANMs, Staff Nurse & MOs 100.00
9 Blood Bank & Blood Storage Centres 239.80
II Child Health
1 New Born Care Corners 2418.35
2 New Born Stabilization Units (NBSU) 1247.10
3 Sick New Born Care Units (SNCU) 281.00
4 Nutritional Rehabilitation Centers 515.73
III Family Planning Strategy
1 Family Planning Management 9.01
2 Terminal / Limiting Methods
a) Plan for facilities providing FEMALE sterilisation services on fixed days 65.64
at health facilities in districts
b) Compensation for sterilisation (Female) 2250.00
c) Compensation for sterilisation NSV (male) 600.00
d) Accreditation of NGOs / Voluntory Organizations for sterilization 250.00
services
3 SPACING METHOD (Providing of IUD services by districts)
a) IUD services at health facilities in districts 94.00
b) Compensation to ASHA for 100% retention of IUD by clients 200.00
4 Workshop on Population Stabilization 28.00
5 BCC/IEC activities/campaigns/melas for family planning 36.00
8 Spacing Methods
IV Adolescent Health
1 Establishment of Health Clubs 99.20
2 Fixed Day Health Clubs with Specialist Services & Consellers 18.72
3 Printing of Booklets & IEC activities 21.75
Adolescent & School Health Total 139.67
V School Health Programme
1 School Health Programme 1560.50
VI Urban Health Strategy
1 Urban Health centres 706.08
2 Other initiatives 147.44
132
SN Activity Budget
proposed
2011-12
VII Tribal Health Strategy
1 Tribal RCH 2244.71
2 Special Package to the identified Institutions
3 Maintenance of Birth Waiting Rooms
VIII Vulnerable Groups
1 Special Package to the identified Institutions 1527.60
Vulnerable Groups Total 1527.60
IX High Focused Districts
1 High Focused Districts 292.96
X Training Strategy
1 Skill Birth Attendance Training to Staff Nurses and ANMs 444.00
2 BEMONC 57.00
3 Training of MOs in Emergency Obstetric Care 60.00
4 Training of MOs in Life saving Skills in Anesthesia 30.00
5 NSSK Training 259.20
6 F-IMNCI Training 285.00
7 IMNCI Training 1435.49
8 Pre Services IMNCI 48.00
9 Capacity Development FBNC 97.08
10 Training in Management of SAM 29.99
11 IUCD Training 270.26
12 ARSH training 400.56
13 Menstrual Hygiene 25.60
14 Induction Training for PHC Medical Officers 144.00
15 Capacity enhancement on BCC 58.09
16 Orientation Training to Cluster / District / State level Management 50.00
Units
Training Strategy Total 3694.27
XI Programme Management Unit 2248.91
XII Behaviour Change Communication (BCC) 875.00
Total RCH Flexible Pool 33496.43
133
B: NRHM FLEXI POOL
B.1 CORE ACTIVITIES
181. The National Rural Health Mission (NRHM) seeks to achieve well-defined health
outcomes by 2012. The programme‟s objective is to establish an effective primary health
care system that caters to the health needs of the entire rural population. The NRHM
supports a female health activist in every village; ownership of the village community in
effective management of its health and sanitation needs; strengthened primary health
and the referral systems; integration of all vertical health and family welfare programme
activities; and efficient utilisation of funds and infrastructure to strengthen health
delivery system.
B.1.2 ASHA:
182. ASHA Incentives: The rural Andhra Pradesh consists of 22,912 Gram
Panchayats, 26,586 revenue villages, and 67,561 habitations. 70,700 ASHAs have been
positioned during the first three years of the Mission as Health Resource Persons, who
constitute the first call of the community for all maternal and child health services,
disease prevention and health promotion activities. Of the 70,700 ASHAs, 55,400 are in
the rural areas, 10,000 in the tribal areas and 5,300 in the peri-urban / urban areas of the
state.
183. The ASHA is the principal link between the community and the formal health
system. She is a voluntary worker who is rewarded for her contribution to the
furtherance of well being of the community. Her focus however will be on women and
children and those affected by communicable diseases. The revised ASHA incentives is
as follows:
SN Incentive item 2010-11

1 Registration during the first trimester of pregnancy 30
2 Completion of 4 antenatal checkups, 2 TT immunization and 120 120
days of IFA tablets to pregnant woman
3 Pregnant woman having institutional delivery in government health 150
institution
4 Pregnant woman having institutional delivery in private health 75
institution
5 Postnatal Care and Newborn Care for mother and neonate (each visit 150
Rs 25)
6 Referral of Post-Partum Complication to a CEMONC Centre 50
7 Referral of Sick New Born baby to a SNCU 50
8 Complete Immunisation - All doses of immunization for BCG, DPT, 150
OPV, Measles, and Hepatitis-B and Vitamin A Supplementation
9 Reporting of new born child with birth weight of less than 2,000 100
grams to the sub-centre and PHC (Rs 25); and follow-up progress on
weekly basis in coordination with Anganwadi until the weight-for-age
stabilizes.
134
SN Incentive item 2010-11
10 Providing health and nutrition counseling to the parents and family 50
members in close coordination with the Anganwadi worker and
ensuring the child completes 12 months of age in a health state.
11 Referral of Severely Acute Malnutrition cases to Nutrition 50
Rehabilitation Centres and follow-up
12 Maternal Death Reporting to Sub-centre and PHC 50
13 Infant Death Reporting to Sub-centre and PHC 50
14 Organization of Monthly Village Health & Nutrition Day 50
15 Counseling and motivation of men for Vasectomy/NSV operation 100
and follow up visit.
16 Counseling and motivation of women for Tubectomy /DPL surgery 50
and follow up visit of the cases.
17 Motivation and Counseling for successful IUCD insertion and 100
retention for at least one year and intake of contraceptive Pills for one
year.
18 Pulse Polio Campaign (Rs 75 per day) 225
ITDA Project Areas
19 Ensuring Skilled Birth Attendance at delivery and for 48 hours after 100
delivery in ITDA areas
20 Referral of pregnant mother to Birth Waiting Homes a week before 100
EDD; and ensuring safe institutional delivery in ITDA areas
21 Referral and admission of Severely Acute Malnourished (SAM) Child 50 for
in Nutrition Rehabilitation Centre (NRC) and monthly follow-up admission
in NRC;
and 25 /
month for
follow-up
22 Compensatory Incentive for ASHA / Community Health Worker in
the ITDA areas, considering the small population and widely
scattered habitations, if the incentive package falls below Rs.400 per
month.
Communicable Disease Control Programmes
23 Identification of Malaria case, successful treatment and follow-up of 10 / case
the patient for 3 months in ITDA areas
20 Leprosy:
PB – after confirmation and completion of course of treatment 300
MB – after confirmation and completion of course of treatment 500
21 Identification and successful completion of DOTS for Tuberculosis 300
184. ASHA will be rewarded for good performance on the maternal and child health
and disease prevention front. The best ASHA will be identified for each PHC,
Community Health and Nutrition Cluster, district and state levels and will be rewarded
with cash grant at the annual Health Day. Any ASHA failing to ensure cent per cent
ANCs, PNCs, Immunisation, and failure to take measures to prevent and report any
case of IMR / MMR will be censured, including removal if the failure is gross or wilful.
135
185. The details of budget requirement for the payment of incentives under Maternal
Health to ASHAs are as follows:
 Expected No. of Pregnant women to be registered … 17,24,000

 Expected No. of live births … 15,67,000
 Expected No. of Institutional deliveries … 14,99,800
 Expected No. of Inst. deliveries in Govt. hospitals … 8,99,880
 Expected No. of Private accredited hospitals … 5,99,920
 Expected No. of Home Deliveries … 67,200
 Expected No. of PNC cases … 15,67,000
Expected no.of BPL cases

 Expected No. of BPL Pregnant women to be registered … 6,48,045
 Expected No. of BPL ANC cases … 6,48,045
 Expected No. of BPL Inst. deliveries in Govt. hospitals … 3,53,417
 Expected No. of BPL Private accredited hospitals … 2,94,628
 Expected No. of BPL PNC cases … 6,48,045
Review and Monitoring
186. Village Organisations: The effectiveness of ASHA‟s performance as a link

worker between the community and the health delivery system – and not as the last
functionary of the health care system – will be reviewed every week by the VOs. The
ASHA along with the Anganwadi Worker and the ANM will attend the review meeting
of the village organizations. The PHC Medical Officer will join as many such meetings
as possible depending on the fixed-day schedule for the PHCs. The feedback from the
Nirupeda VOs will be critical in determining the effectiveness of ASHA‟s role. The
services to be provided by the health system will be publicized amongst all residents of
the village through the VOs and also by writings on the wall. As mentioned above, VOs
will receive and disburse ASHA incentives from hereafter.
187. Primary Health Centre: The capacity building of ASHA is a continuous

process. For this purpose, ASHA meetings are conducted on the last Tuesday of the
month in all PHCs across the state. This ASHA-DAY, which is a review-cum-capacity
building intervention, brings together all PHC functionaries for a monthly review and
feedback of their work. This is also an opportunity to decide the work plan for the
following month. ASHA day will not be used for incentive disbursement for but
monitoring the VOs role in incentive administration. At the CHNC level, the Senior
Health Officer will periodically review the work of PHCs every month. Once a quarter,
all functionaries of the health department will brought together at the cluster level for
information sharing and for disseminating best practices.
188. District Level: The DMHO has the overall responsibility for monitoring
and coordination of all NRHM activities in the district under the leadership and
guidance of the district collector. The District Public Health Nursing Officer (DPHNO),
who has formerly worked as the District Training Manager (DTM) in the ASHA
training programme, is the Nodal Officer for facilitating and supporting the entire mid-
wifery team, including the ASHA, ANM and the Staff Nurses. The DPHNO will be
136
provided mobility to undertake field visits and galvanizes the functionaries responsible
for safe motherhood and child survival.
Budget for ASHA activities 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 ASHA Performance Based
Incentives
a) Registration of early pregnancy Incentives 30 648045 194.41
b) Completion of 4 ANCs and ensuring Incentives 120 648045 777.65
TT & IFA tablets
c) Postnatal Care & Newborn care for Incentives 150 648045 972.07
mother and neonate
d) Referral of Post-Partum Complication Incentives 50 93499 46.75
to a CEMONC centre
e) Providing health and nutrition Incentives 50 583240 291.62
counseling to the parents and family
members in close coordination with
the Anganwadi worker and ensuring
the child completes 12 months of age
in a health state
f) Referral of Severely Acute Incentives 50 56417 28.21
Malnutrition cases to Nutrition
Rehabilitation Centres and follow-up
g) Maternal Death Reporting to Sub Incentives 50 2000 1.00
centre & PHC
h) Infant Death Reporting to Sub Centre Incentives 50 49000 24.50
and PHC
i) Organization of Monthly Village Incentives 50 70700 424.20
Health & Nutrition Day
j) Incentives to the ASHA for Incentives 600 13121 78.73
promoting Institutional delivery in
tribal areas
k) Reporting of new born child with Incentives 100 51844 51.84
birth weight of less than 2,000 grams
to the sub-centre and PHC (Rs 25);
and follow-up progress on weekly
basis in coordination with Anganwadi
until the weight-for-age stabilizes
Total 2890.98
2 Best ASHA Awards
a) PHC Level Best Performer Awards 1000 1624 16.24
b) Cluster Level Best Performer Awards 2000 360 7.20
c) District Level Best Performer Awards 5000 23 1.15
d) State Level Best Performer Awards 10000 1 0.10
Total 24.69
3 ASHA Day review & others
a) ASHA Conventions Conventions 100 70700 848.40
b) Providing Saree to ASHAs (2 sarees) Saree 200 70700 282.80
137
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
Total 1131.20
4 Ashas Training TOT (6&7 Modules) Training 9434 60 5.66
5 Training for ASHAs Training 97000 497 482.09
6 Translation and Printing of ASHAs Printing 2000000 20.00
modules
ASHA Total 4554.62
B.1.3 Village Health and Sanitation Committee:
189. Under NRHM, a village health and sanitation committee has been established in
every gram panchayat of the state to: (i) ensure optimal use of health service in the
village; (ii) improve participation of village health and sanitation committees in
maintaining quality health and sanitation services; and (iii) prevent occurrence of
epidemics in the villages.
190. The VHSC grant would be released in two installments based on the performance
of the VHSC duly ensuring that not less than 30% of the VHSC grant is spent in
improving sanitation in the SC and ST habitations. Closer and stronger links will be
forged with the rural water supply and sanitation department (RWS &S) to ensure more
effective solid waste management, potable water supply and sewage disposal. Training
would be conducted for Panchayat Secretaries in sanitation and health linkage. In
addition, IEC/BCC campaigns would be conducted in every village using popular folk
media to improve sanitation, prevent water and food-borne diseases, ensure quality of
drinking water, and eliminate vector breeding sources. The best performing Panchayat in
each Cluster would be awarded a cash grant of Rs 10,000.
Activity Cumulative
Achievements so far
No. of Revenue Villages 28,123
Number of Village Health & Sanitation committees constituted 21,916
No. of Joint Account opened 21,916
Budget for VHSC Strengthening 2010-11

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
4 Village Health Sanitation Committees
a) Cash Grant of Rs 10,000 for each GP 1 10000 21916 2191.60
b) Awards for best performance 1 10000 360 36.00
Total 2227.60
138
B.1.4 Untied Funds:
191. Sub-Centre Strengthening: Every sub-centre is given Rs 10,000 annually under

NRHM for undertaking activities that would contribute to NRHM objectives. This grant
would be utilised for improving effectiveness of sub-centres through improved patient
care infrastructure for maternal and child care; organising village health and nutrition
days; provision of essential services that would prevent and help manage epidemics;
increased effectiveness of ASHAs through supportive supervision; and monitoring of
village health and sanitation committees; etc. These funds will be utilised essentially for
strengthening the maternal and child health services at the sub-centre level and for
organising IEC / BCC campaigns for preventive and promotive health.
Total Budget required for 12,338 Sub-centers is Rs. 1233.80 lakhs.
192. PHC Strengthening: Under NRHM, every PHC is provided an amount of

Rs.25,000 per annum for improving the responsiveness and the effectiveness of the
health system.
Total Budget required for 1,624 PHCs is 406.00 lakhs.
193. Each CHC is provided Rs 50,000 under NRHM every year for strengthening the
responsiveness and efficiency of the health system at the CHC level. These funds will be
used for the common needs, including referral and transportation of patients in
emergency situations.
Total Budget required for 309 CHCs is Rs 154.50 lakhs.
(Rs in lakh)
Facility level Number of Total amount Total amount Unspent
facilities released so far utilized balance
Untied Fund for SCs 12338 1239.37 206.03 1033.34
Untied Fund for PHCs 1624
245.91 76.17 169.74
Untied Fund for CHCs 309
Untied Fund for DH 16 -- -- --
Budget for Untied Funds - 2010-11
S Activity Unit Rate No.of Annual

N (Rs/Unit) posts / total
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Sub Centres 10000 12338 1233.80
2 Primary Health Centres 25000 1624 406.00
3 Community Health Centers 50000 309 154.50
Total 1794.30
139
B.1.5 Annual Maintenance Grants:
194. Maintenance Grant for SHC, PHC, CHCs: In addition to the above
provisions, every sub-centre, PHC and CHC is provided an annual maintenance grant of
Rs.10,000, Rs.50,000, and Rs.1,00,000 respectively, for improvement and maintenance
of physical infrastructure. These grants are utilised through the HDS for undertaking
minor repairs, provision of water supply, toilets, sanitation and maintenance.
(Rs in lakh)
Facility level Number of Total amount Total amount Unspent
facilities released so far utilized balance
AMG for SCs 12338 -- -- --
AMG for PHCs 1624 290.31 127.43 162.88
AMG for CHCs 309 -- -- --
AMG for DH 16 -- -- --
Budget for Annual Maintenance Grants - 2010-11

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Sub Centres 10000 3387 338.70
2 Primary Health Centres 50000 1230 615.00
3 Community Health Officeer 100000 284 284.00
Total 1237.70
B.1.6 Rogi Kalyan Samitis:
195. The NRHM provides one time corpus grant, the RKSs of 1,624 PHCs in the state
would require about Rs 1,624 lakhs during the current financial year. Similarly, one lakh
rupees is provided to each RKS of the CHCs and Area Hospitals.
Budget for HDS - 2010-11

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Primary Health Centres 1 100000 1624 1624.00
2 Community Health Officeer 1 100000 309 309.00
3 Area Hospitals 1 100000 54 54.00
4 District Headquarters Hospitals 1 500000 17 85.00
Total 2072.00
140
B.2 HEALTH CARE INFRASTRUCTURE:
B.2.1 Civil Constructions
Budget for the Construction of Health Facility buildings - 2010-11

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Sub Centres (including Tribal Construction 900000 500 4500.00
SCs)
2 Primary Health Centres Construction 4000000 100 4000.00
3 Community Health Centres Construction 7500000 25 1875.00
4 Developing the Project hospital Construction 20000000 1 200.00
at Srisailam ITDA in to a
multi specialty hospital for
Primitive tribal Chenchu
citizens.
5 Rennovation of SCNUs (18
SCNUs)
Strengthening of existing Construction 3800000 5 190.00
a)
SCNUs
b) New SCNUs ( 20 bedded) Construction 3800000 5 190.00
New SCNUs ( 12 bedded) ( Construction 3000000 8 240.00
c)
Tribal)
6 New Born Stabilization Units
a) Refurbishment Refurbishment 500000 264 1320.00
Total 12515.00
B.2.2 Strengthening of Community Health and Nutrition Clusters (CHNCs)
196. The rural Andhra Pradesh is being carved into Community Health and Nutrition
Clusters (CHNCs), with each cluster providing integrated primary health services to
about one to two lakh population. At the centre of the CHNC is the first referral unit
(FRU) – a Community Health Centre (CHC) or an Area Hospital (AH) – that will
support four to ten Primary Health Centres (PHCs). The cluster hospital will also house
a Senior Public Health Officer (SPHO) who will facilitate, support, co-ordinate and
monitor the functioning of all primary health institutions – PHCs and Sub-centres –
within the cluster. It is expected to integrate the ICDS institutions with the CHNC over a
period of time to integrate the much needed nutrition component with the health.
197. NRHM will support efforts to strengthen the CHNCs, which are expected to
make dramatic impact on the quality of public health in the rural areas of the state. In the
coming years, the CHNC is likely to become the fulcrum for organising primary health
services in the state. In this direction, it is proposed to construct an extension to the CHC
/ Area Hospital that would house the office of the Senior Public Health Officer (SPHO)
in charge of all health and nutrition activities in the CHNC and who would be the
principal officer responsible for NRHM implementation in the cluster. The SPHO will be
assisted by a number of functionaries, including a Public Health Nurse, Sub-Unit Officer
141
(Leprosy), Assistant Malaria Officer (AMO), Ophthalmic Officer, a Senior Assistant and
an HMIS unit with a MIS officer, Data Entry Officer, and an Accountant. During the
current year, it is proposed to strengthen offices of one hundred SPHOs with an outlay of
Rs 5 Crores.
Budget for the Construction of Health Facility buildings - 2010-11

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Strengthening of Community 500000 100 500.00
Health and Nutrition Clusters
B.3 MANPOWER
Salaries of Additional Auxiliary Nurse Mid-wife (ANM) & MPHA(M)
198. In January 2011, the Pay Revision Commission is enhanced the salaries of
regular ANMs, accordingly, contract 2nd ANM salary have also been enhanced from
Rs.5200 pm to Rs.100,20 therefore, Of the 12,338 sub-centres currently functioning in
the state, 10,384 are financed by the central government, and the remaining 1,954 are
funded by the AP government. Therefore, 10,600 sub-centres require the services of the
second ANM.
199. Action has been initiated to divide the service area of operation between the two
ANM, so that each can provide focused attention to the people under her jurisdiction.
Moreover, the mid-wifery skills of both ANMs would be upgraded within a period of
eighteen months. Both ANMs will actively move around the area of their operation and
provide an effective link between the PHC and the community in providing
comprehensive preventive, promotive and curative health services.
200. As per the Govt. of India guidelines, it is proposed to recruit 2067 MPHA(Male)
and will be placed at Sub-centres.

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Salaries of Second ANM Salary 10020 10600 12745.44
2 Salaries for MPHA (Male) Salary 10020 2067 2485.36
B4. Nutrition Support Interventions:
B4.1 Village Health and Nutrition Day:
142
201. It is proposed to conduct VHNDs in 20,144 Villages in the state in 2011-12 is
provide comprehensive MCH services in the community to increase awareness on age at
marriage, registration of all pregnant women at 12 weeks, 3 times check up by MPHA
(F), one time by M.O, Birth planning at 5th month of pregnancy, promotion of
institutional deliveries, Post-natal care services to be delivered women & new born child,
breast feeding practices, immunization services, promotion of spacing methods,
sterilizations, vasectomies. Awareness on availability of services for communicable &
non-communicable diseases, Adolescent health, school health services etc.,
202. It is proposed to conduct in the following number of villages based on their

population.
1. For 500 – 2000 population villages once in a month at Anganwadi centre / Sub
centre as per availability of good accommodation.
2. For 2000 – 5000 population – VHNDs will be organized twice in a month.
3. For 5000 to 10000 population – VHNDs will be organized thrice in a month.
a. Total no. of villages with a population between 500 – 2000 10,949

b. Total no. of villages with a population between 2000 – 5000 6,915
c. Total no. of villages with a population between 5000–10000 and above 2,286
Total 20,144
Budget required:
1) Incentives to Anganwadi teacher – Rs.50 per VHND
50 x 20144 x 12 … Rs.120.86 laklhs
2) Incentives to ICDS Supervisor – Rs.75 x 20144x12 … Rs.181.30 lakhs
3) Incentives to Anganwadi helper Rs.25x20144x12 for
mobilization of community … Rs.60.43 lakhs
Budget for Logistics:

1) Banner for each VHNDs Place – 200 x 20144 … Rs.40.29 lakhs
2) Drinking Water facilities – 500 x 20144 … Rs.100.72 lakhs
3) Examination table, four fibre chairs 1500 x 20144 … Rs.302.16 lakhs
4) Registers & Reporting formats 100 x 20144 … Rs.20.14 lakhs
5) Other investigation logistics (Uristics, Haemoglobinometer,
B.P. Apparatus) - to be arranged from untied funds to sub
centres of Rs.10,000/- component
6) Community growth monitoring charts 300 x 20144 … Rs.60.43 lakhs.
Total … Rs.886.33 lakhs
B4.2 Nutrition Rehabilitation Centers:
203. To improve the nutritional status of the children under five and reduce the Infant
Mortality Rate and under five mortality rate
143
Objectives:
1. To bring down the incidence of SAM and MAM through quality facility based
management of malnourished children in the Nutritional Rehabilitation Centers.
2. To develop a self sustainable model of community based management of
malnourished children for providing a continuum of care from the NRCs to the
community with interdepartmental coordination.
Facility Based Management of SAM - Setting up of Nutritional Rehabilitation

Centers
204. The progress on under-nutrition amongst women and children is relatively slow
in the state of Andhra Pradesh in spite of several schemes and programmes implemented
through the Departments of Health and Family Welfare, Women Development and
Child Welfare (WDCW), and Rural Development. The NFHS-3 (2006) revealed that 30
percent of women (15-49 Years) have a BMI below normal, 62.7 percent of women are
anemic and 79.6 percent of children between 6 to 59 months are anemic. Similarly,
among children under three years – 38.4 percent are stunted, 14.9 percent are wasted,
and 29.8 percent are underweight.
205. To address the problem of under-nutrition, the Government of Andhra Pradesh is

working at two levels – (a) at the community level through ICDS, Village Health and
Nutrition Days (VHND), IMNCI, IKP etc; and (b) at the facility level through Facility
Based IMNCI (F-IMNCI) and Nutrition Rehabilitation Centers (NRCs).
206. The facility level interventions are specifically aimed at treating severe acute
malnutrition (SAM) cases amongst children. All these interventions except NRCs are
described in detail at other sections of the PIP – only the NRC component is explained
here in detail.
Severe Acute Malnutrition (SAM)
207. India carries the highest burden of Severe Acute Malnutrition (SAM) worldwide.
Of all Indian children under 5 years of age, 6.8% 1 are severely wasted according to the
NFHS -3, equating to more than 8 million children. The number of Indian children with
SAM comprises over 40% of the total global prevalence. Andhra Pradesh is the fifth
most populated state in India with more than 76 million people. With a statewide SAM
prevalence of 3.8%2, an estimated 297,000 children in AP are suffering from SAM.
208. Government of India has approved the national guidelines for F-IMNCI which
includes specific protocols for facility based treatment of SAM. However,
implementation of the treatment protocols has not yet been fully rolled out in any states.
209. The majority of children with SAM in AP silently suffer without access to
appropriate treatment that can prevent mortality. Currently, some facilities provide
children with SAM food, such as eggs or fresh milk. While well-intended, the
1
http://www.who.int/nutgrowthdb/database/countries/who_standards/ind.pdf
2
http://www.who.int/nutgrowthdb/database/countries/who_standards/ind.pdf
144
unregulated amounts of nutrients in these foods, such as sodium, iron, and protein, can
increase the risk of mortality in these children and are contrary to both national and
international standard of care. The F-IMNCI and Indian Academy of Pediatrics (IAP)
recommendation for therapeutic feeding of SAM children is Formula 75 (F75) for
stabilization and then Formula 100 (F100) for transition and rehabilitation. F75 and
F100 is also inpatient standard of care for SAM indicated by the WHO. These
therapeutic milks have all of the nutrients needed for a child with SAM to achieve a
recommended weight gain of 10 g/kg/day during rehabilitation. Currently, however,
these therapies are not available at any facilities in AP.
Government of AP Initiatives
210. In light of these facts, the Department of Health, Medical and Family Welfare,
Government of Andhra Pradesh has issued guidelines to establish 23 Nutrition
Rehabilitation Centers (NRCs) throughout AP, enabling this life saving treatment to
become a part of the state health system and has released funds and begun renovations
on the same.
211. The ultimate goal of this initiative is to ensure that children with SAM in AP
have access to treatment as defined in F-IMNCI and the WHO Guidelines for inpatient
treatment through a sustainable and scalable system. There is currently a gap between
what SAM treatment protocols recommend in the aforementioned guidelines and the
current management of SAM in AP. It is envisaged that the improved provision of
treatment according to these standards will decrease the mortality rates of children due
to SAM.
Progress to Date
212. A task force was formed and an Operational Plan developed to supplement the
initial proposal for SAM treatment. The Operational Plan describes the organizational
structure for the project and gives a framework for development and implementation by
outlining processes for staffing, refurbishment, protocol finalization and training, supply
chain, M&E development, and SAM referral systems. Roles and responsibilities of
various departments have been outlined and progress is being made. Site review and
identification have been conducted at Medical College Hospitals across AP to assess sites
for treatment capacity. The GoAP has released funds for establishment of these centers
and started the renovation and equipment procurement for 23 centers across the state.
Methodology
213. Technical staff from Clinton Health Access Initiative, along with officials from
CHFW, DME, APVVP, APHMHIDC, UNICEF, and Task Force members have been
visiting government medical college hospitals and district hospitals to identify
appropriate space close to pediatric units for the NRCs, in consultation with the Hospital
Superintendent and Head of Department (HOD) Pediatrics of respective facilities. A list
of Phase 1 facilities was finalized, with 5 Government Medical College Hospitals in
Thirupati, Kakinada, Warangal, Vizag, and Hyderabad being selected; Hyderabad has
been chosen as the Nodal Center for the program and will serve as a training hub for
future NRCs. It is expected that the first five NRCs shall be operational by April 2011
and the renovation and operationalization of the remaining 18 centers will be completed
145
shortly thereafter, creating one NRC per district and a total of 23 NRCs. Priority is
being given to the remaining focus districts under NRHM (Adilabad, Khammam,
Mehaboobnagar, Ananthapur, Srikakulam, Nellore and Prakasam) that have high under-
nutrition rates amongst children, depending on infrastructure capacity noted during site
assessments.
214. Renovation of the NRCs includes refurbishment of a separate 15-30 bedded ward
isolated from non-SAM children treated at the hospital, creation of SAM treatment
specific kitchen facilities for meal preparation and storage space for food. Several other
items like medical equipments and materials are being procured to make the space
functional (e.g. measuring equipment, kitchen materials, etc).
Proposed Plan
215. The Government of Andhra Pradesh has committed the expenditure for setting-
up the NRCs involving renovation work, equipment procurement etc from the funds
available under NRHM PIP 2010-2011. The work will start and is expected to be
complete by July 2011.The funds required for operationalization of these NRCs,
recruitment of human resources, capacity building, incentives, food supplements and
maintenance are being requested in this year‟s PIP 2011-12. CHAI i.e. Clinton Health
Access Initiative along with UNICEF will be providing technical assistance for the
program. The Clinton Health Access Initiative has committed to funding the SAM
treatment food (F75 and F-100) till March 2012. The Government would take an
informed decision regarding funding of the therapeutic food in the NRCs after March
2012 following discussions with the concerned departments and development partners.
Further details on all aspects of the proposed operational costs are included below.
Staffing of NRC
Following is the proposed staffing for a 15-30 bedded NRC.

1) Pediatric Specialists cum In-charge (2)
2) Nutritionist cum-data-entry operator (1)
3) Social Worker (1)
4) Staff Nurses (6)
5) Cook cum- caretaker (2)
216. Except for the pediatrician (who will be given an honorarium) all other staff for
the NRC will be hired on a full time contract basis under NRHM.
217. In places where the NRC is located in a teaching hospital, the Medical
Superintendent and HOD of Pediatrics will make sure that the NRC is mainstreamed
into the existing pediatric department. All pediatric units shall admit SAM patients to
the NRC and follow them on a unit by unit basis. The state will support the required
staff for the NRC, except the pediatrician who will be drawn from existing cadre of
DME for teaching hospitals or APVVP for district hospitals.
Food
218. As per treatment timelines, the stabilization phase of SAM treatment where
complications are resolved and F75 is administered takes approximately 3-7 days.
146
Rehabilitation with F100 can take anywhere from 15-25 days on average. As per
UNICEF consumption data, average consumption for a 7 kg child over the course of
treatment is 2 sachets of F75 and 8 sachets of F100. Clinton Health Access Initiative
(CHAI) will support the cost of this ready to use food for the NRCs until March 2012.
After that time, GoAP will decide regarding the funding of the therapeutic food given in
NRCs.
Training
219. The health care staff recruited in the NRCs will be trained on the stabilization and
treatment of SAM children and the administration of F75/F100. WHO has prepared a 5
day training module on the Inpatient Treatment of SAM, which has been condensed into
a 3 day version by Kalawati Saran Children‟s Hospital (KSCH), New Delhi. The
doctors, staff nurses and nutritionists who will be working to stabilize and treat SAM
patients in the NRC will undergo the SAM training.
220. A Training of Trainers (TOT) would first be held in Hyderabad at Niloufer

Hospital over a period of three days and conducted by national resource trainers. This
will be followed by training the remaining pediatricians, staff nurses and nutritionist
from all chosen sites at Niloufer Hospital, so that first-hand exposure to an existing NRC
can be experienced. The post graduates of the pediatric departments where the NRCs
will be established will undergo a one day sensitization on SAM management at their
respective hospitals. Further details for these trainings are given in the Child Health
Training section.
Incentives
1) Caregiver Incentives
221. An incentive of Rs 100 per day for wage loss, Rs 25 per day for food, and Rs 200
for transportation compensation will be provided to caregivers, who accompany and stay
with the children during the period (approximately 21 days) of treatment. In addition
similar wage, food and transportation reimbursements for patients and caregivers will be
given for 4 follow up visits.
2) Community Worker (AWW / ASHA/ any other) Incentives
222. In order to strengthen linkages from the community to the SAM treatment
facility, an incentive of 100 INR will be given to the community worker who brings the
mother-child duo for admission to the NRC and whose child gets admitted.
3.) Physician Incentives
223. Teaching Hospital: The budget for the NRC including the honorarium for
pediatricians (Rs 10000/- per month @Rs 5000/- per pediatrician) will be transferred to
the HOD of Pediatrics. The HOD of pediatrics will be responsible for the smooth
functioning of the NRC.
224. District Hospital: The Superintendent of the hospital will identify two
pediatricians who will be responsible for the day to day rounds, admissions and
discharge of the SAM children. Each of these pediatricians will be paid an honorarium
147
of Rs 5000/- per month. The budget for the NRC will be transferred to the
superintendent of the concerned hospital.
Monitoring
225. CHAI and UNICEF will provide technical assistance to develop tools for
monitoring cases admitted to NRCs as well as overall programmatic assistance. The data
collected from NRCs will be collated at state level and reviewed on a quarterly basis.
Budget
226. The following is a list of the budget requirements needed to maintain the 23
NRCs over the course of the next fiscal year.
A. Operational Cost
1) Food Cost: Costs of F75/F100 used for in-patient SAM treatment and associated
transport costs of product
2) Human Resources: Salaries for all staff members of the NRC
3) Training: Training of NRC staff on stabilization and treatment of SAM patients
4) Incentives: Wage and transport reimbursements to parents of SAM patients and
frontline health functionaries assisting SAM patient –AWW and ASHA; an
additional monthly stipend for physicians who volunteer to be In-charge and
maintain the NRC.
5) Contingency: A small monthly sum to each facility to replace small
items/equipment that may become damaged or missing from the NRCs.
227. NGO partners at the Clinton Health Access Initiative and Balasahyoga will be
supporting Food costs of F75/F100 for the centers until March 2012. The GoAP has
released funds for Renovations and Equipment, and will bear operational costs viz.
Human Resources, Training, Incentives, and Contingency costs for the 23 centers.
Summary of the Operational budget requirement for one year for 23 NRCs ( until March
2012)
CHAI GoAP
Line Item
(Cost in Lakhs) (Cost in Lakhs)
(A) Operational Cost
1) Food cost 92.05
2) Human Resources 301.94
*Included in Child
3) Training
Health Training Section
4) Incentives 201.48
5) Contingency 13.80
GRAND TOTALS CHAI: 92.05 NRHM: 517.12
*Details in Annexure
Annexure:
OPERATIONAL COSTS FOR NRCs (RE-CURRING)
148
A.) HUMAN RESOURCES
A Cost for Human Resources

Unit Cost
Cost per
Sl per Number of Number of Total Cost
Human Resources Quantity Facility per
No Month Facilities Months ( Lakhs)
Month (INR)
(INR)
1 Social Worker 1 8,000 8,000 23 12 22.08
2 Nurse 6 13,000 78,000 23 12 215.28
3 Nutritionist/Data Entry Operator 1 10,000 10,000 23 12 27.60
4 Cook/Caretaker 2 6,700 13,400 23 12 36.98
Total Human Resources Cost (Lakhs) 1.09 301.94
B.) INCENTIVES
B Cost for Incentives

BI Caregiver Incentives
Sl Incentives-Caregivers and Patients Units Unit Cost Cost per Number of Number of Total Cost
No (INR) Facility per Facilities Months ( Lakhs)
Month(INR)
1 Wage loss compensation + Food for 300 150 45,000 23 12 124.20
each mother during inpatient care( 15
beds for 20 days)
2 # of days Wage loss compensation for 20 100 2,000 23 12 5.52
follow-up visit
3 Cost of food for caregiver and child at 40 50 2,000 23 12 5.52
follow-up visit
4 Cost of Transportation for inpatient 40 200 8,000 23 12 22.08
treatment ( to and fro)
5 Cost of Transportation for follow-up 20 200 4,000 23 12 11.04
after discharge
Total Caregiver Incentives Cost ( Lakhs) 0.61 168.36
BII Physician Incentives

Cost per
Unit Cost
Sl Facility per Number of Number of Total
(INR)
No Incentives-Physicians Units Month (INR) Facilities Months (Lakhs)
1 Incentive for the Pediatricians 2 5,000 10,000 23 12 27.60
Total Physician Incentives Cost (Lakhs) 0.10 27.60
BIII Community Incentives

Quantity Cost per
Sl Unit Cost Number of Number of Total
Incentives-Community Workers (per Facility per
No (INR) Facilities Months (Lakhs)
month) Month (INR)
Incentive to Community worker to bring
1 mother and child who qualifies to the 20 100 2,000 23 12 5.52
NRC for admission and follow up
Total Community Incentives Cost (Lakhs) 0.02 5.52
Total Annual Incentive Costs for 12 facilities (Lakhs) 201.48
C.) CONTINGENCY FUND

C Maintenance/Contingency Fund
Quantity Cost per
Unit Cost Total Cost
Sl (per Facility per Number of Number of
(INR) ( Lakhs)
No Maintenance/Contingency Fund month) Month (INR) Facilities Months
1 Monthly fund for miscellaneous items 1 5,000 5,000 23 12 13.80
Total Maintenance/Contingency Costs (Lakhs) 0.05 13.80
D.) FOOD COSTS *paid for by CHAI

D Cost for Food Supplementation ( F75/F100)
149
Unit Cost
Sl Quantity / Facility/ Number of Number of Total Cost
Description
No (per month) Month Facilities Months ( Lakhs)
1 Cost for Food Supplementation (F75/F100) 1 33,350 23 12 92.046

*Estimated Total for Food Supplementation (F75/F100)*Supported by CHAI (Lakhs) 92.05
E.) TRAINING ON SAM TREATMENT *included in Child Health Training section
Total Supported by CHAI (Lakhs) 92.05

*Total Requested Support by NRHM (Lakhs) 517.22
GRAND TOTAL (crore) 609.27
Budget required for this scheme is Rs.609.27 lakhs
B.5 ADDITIONAL FUNDS FOR COMMUNICABLE DISEASES:
Sl. Activity Proposed

No. Budget
(Rs/lakhs)
1 2 3
1 RNTCP 143.00
B.6 Quality Assurance Cell for monitoring MCH activities & Trainings
228. A quality assurance cell for monitoring MCH & nutrition activities will be
established comprising of JD (MHN), JD (M&E), JD (CHI) and State Consultants
(Maternal Health, Child Health & Nutrition). For this a sum of Rs.18.00 lakhs budget is
proposed (3 JD‟s x Rs.50,000/- per month x 12). The 3 consultants will be funded by
UNICEF under SPIU. These funds will be utilized for extensive MCH monitoring to the
field.
229. In the similar way district Quality Assurance Cell will be formed comprising of
Addl. DM&HO, S.O, PO DTT & DIO. These team will closely monitor MCH services
and VHNDs at village level and review this services at Sub-centre and PHC level, for this
a sum of Rs.8,000/- per person in normal districts and Rs.12,000/- in high focus / Tribal
districts per district (3 x Rs.8,000/- x 9 months = Rs.2.16 lakhs & 3 x Rs.12,000/- 3
months = Rs.1.08 lakhs)
1) State Quality Assurance Cell monitoring Rs.18.00 lakhs

2) District Quality Assurance Cell monitoring Rs.3.24 lakhs
Total Rs.21.24 lakhs
B.7 MAINSTREAMING OF AYUSH
230. Recognizing the importance of Health in the process of economic and social
development and for improving the quality of life of our citizens, the Government of
India has resolved to launch the National Rural Health Mission (N.R.H.M) improving
the availability of and access to quality health care by people, especially for those
residing in rural areas, the poor, women and children and to carry out necessary
architectural correction in the basic health care delivery system. The Mission adopts a
150
synergistic approach by relating health to determinants of good health viz. segments of
nutrition, sanitation, hygiene and safe drinking water. The NRHM aim to revitalize local
health traditions and mainstream AYUSH (including manpower and drugs) to
strengthen the Public Health System at all levels.
231. The Plan of Action includes increasing public expenditure on health, reducing
regional imbalance in health infrastructure, pooling resources, integration of
organizational structures, optimization of health manpower, decentralization and district
management of health programmes, community participation and ownership of assets,
induction of management and financial personnel into district health system, and
operationalizing community health centers into functional hospitals meeting Indian
Public Health Standards in each Block of the Country.
232. With respect to AYUSH Department, the important goals of National Rural
Health Mission (NRHM) is „Co-location of AYUSH at PHCs/CHCs‟ and
„Mainstreaming of AYUSH‟. N.R.H.M envisages creation of AYUSH facilities in all the
PHCs/CHCs in the State. The framework for implementation of NRHM is 2005-2012.
The approvals for NRHM are through Programme Implementation Plan (P.I.Ps) and
N.R.H.M promotes decentralized planning and the States are free to prioritize within the
resource envelope provided to them. The intent of co-location and mainstreaming of
AYUSH is to increase the choice to patients in health care.
233. In A.P. state, it is proposed to provide AYUSH Facilities in all the PHCs and
CHCs. Before the NRHM Scheme came into existence, AYUSH facilities have been
created in (253) PHCs and (39) CHCs. Therefore it is proposed to cover the remaining
PHCs/CHCs in a phased manner over a period of (3) years i.e., 2007-08, 2008-09 and
during 2009-10. Accordingly, notifications for recruitment of (491) Medical Officers,
Compounders and Sweeper cum Nursing Orderlies have been issued for the years 2007-
08 and 2008-09 and staff recruited.
234. As on today the following is the status of AYUSH Dispensaries established under
NRHM Scheme in the state:
Phase-I (2007-08)
Ayur. Unani Homoeo. Naturo. Total
Sanctioned
Sanctioned
Sanctioned
Sanctioned
Sanctioned
Working
Working
Working
Working
Working
Zone
I 34 23 5 0 20 16 7 4 66 43
II 35 21 5 1 20 15 7 5 67 42
III 32 23 6 3 21 14 7 4 66 44
IV 44 34 9 4 29 26 8 3 90 67
V 47 37 12 7 23 18 8 4 90 66
VI 54 47 12 7 35 31 11 7 112 92
Total 246 185 49 22 148 120 48 27 491 354
Phase-II (2008-09)
Zone Ayur. Unani Homoeo. Naturo. Total
151
Sanctioned
Sanctioned
Sanctioned
Sanctioned
Sanctioned
Working
Working
Working
Working
Working
I 34 23 13 2 18 15 3 2 68 42
II 33 20 13 2 17 12 4 2 67 36
III 34 32 14 6 16 16 4 2 68 56
IV 45 37 17 9 23 17 4 4 89 67
V 45 37 18 10 22 16 4 4 89 67
VI 54 48 23 13 27 24 6 5 110 90
Total 245 197 98 42 123 100 25 19 491 358
Grand
491 382 147 64 271 220 73 46 982 712
Total
235. Each AYUSH facility is provided with the following staff on contract basis with a
consolidated pay as shown against the post:
Sl. Name of the contract post Consolidated

No. pay
per month
1. Medical Officer Rs.9300/-
2. Compounder Rs.4800/-
Sweeper cum Nursing
3. Rs.3900/-
Orderly
236. In this connection it is since a long time, the contractual staff are requesting to
enhance their pay w.r.t the recent Pay Revision Commission (PRC) recommendations. It
is proposed to enhance their consolidated pay to the minimum of the pay scale for the
corresponding post as per P.R.C 2010. Accordingly, in this office letter
No.3793/NRHM/2009, dt.14/12/2010, the Commissioner & Mission Director
(NRHM), Hyderabad has been requested to recommend the Govt. of India for
enhancement of the pay as shown below:
No. of
Enhanced
Sl. persons
Designation Present pay pay
No. working as
proposed
on today
1. Medical Officer 9300 18030 712
2. Compounder 4800 9200 678
3. Sweeper cum Nursing Orderly 3900 6700 834
 The present P.I.P for the year 2011-12 has been prepared taking into
consideration the enhanced pay.
The other components for each PHC/CHC are:

Medicines (recurring) Rs.40,000/- per year
Contingency (recurring) Rs.24,000/- per year
Equipment & Furniture (non-recurring) Rs.30,000/- per year
152
237. The notification for recruitment of (491) Doctors for the year 2009-10 i.e., 3rd
phase has been issued during December 2009, applications received and scrutiny over. In
this connection, it is submitted that, the P.I.P for the year 2010-11 was submitted by this
Department for Rs.3297.96 taking into account the staff to be recruited under NRHM
Phase-III (2009-10) and filling up of all the vacant posts of Phase-I and Phase-II i.e., for
(1473) AYUSH Facilities. However, as per record of proceedings of NRHM Programme
Implementation Plan for the year 2010-11, an amount of Rs.2074.00 lakhs only has been
approved under Mainstreaming of AYUSH.
238. Further, during the brain storming session on preparation of State PIP 2011-12 on
28/11/2010, the Principal Secretary, HM&FW Department has instructed that no
further expansion of AYUSH Department. Therefore, the present P.I.P for the year
2011-12 does not take into consideration the staff to be recruited under the 3rd phase and
the vacant posts existing presently.
Coordination issues between AYUSH and Allopathic staff – G.O issued:
239. After establishment of AYUSH Facilities in PHCs/CHCs, certain coordination

issues arose between the AYUSH and Allopathic staff. On this Govt. vide
G.O.Ms.No.202, HM&FW (R.2) Department, dt.17/09/2009 have issued certain
instructions for streamlining the working of newly crated AYUSH units in PHCs/CHCs.
Among other points, according to the G.O the Incharge PHC/CHC should provide
leadership and supervision to the AYUSH Unit.
Compounder Training programme:
240. By the end of Jan. 2010, (548) Compounders recruited under NRHM Scheme
(Phase I & II) have been provided (2) weeks training programme in the AYUSH
Colleges. Steps are being taken to provide training to the Compounders who have not
yet trained.
Doctors Training programme:
241. All the AYUSH Doctors recruited under NRHM scheme are being provided (4)
days training programme at Indian Institute of Health and Family Welfare Department,
Vengalrao Nagar, Hyderabad in batches of (35) Doctors, system-wise. The approximate
expenditure towards training of each batch is Rs.1.00 lakh. So far (13) batches of the
training programmes are over and (403) Doctors have been trained (215-Ayurveda, 62-
Unani, 92-Homoeo., 34-Naturo.) on “Mainstreaming of AYUSH”. The remaining
Doctors will be trained during 2011.
242. A summary of budget as per the broad functional head is given below. This
proposal is only for the activities which are to be taken up with the assistance from
NRHM Flexi-pool to be sanctioned by Dept. of Health, Ministry of Health and Family
Welfare, Govt. of India. The other components ex. Medicines, equipment, furniture, contingency
etc. will be projected to Dept. of AYUSH, Ministry of Health and Family Welfare, Govt. of India.:
S. Main Heads Components Budget

No. Amount
(Rs in lakh)
153
1. Human Payment of AYUSH Medical Officers (712 1540.48
Resource Doctors x Rs.18030/- x 12 months)
Payment to other AYUSH staff:
Payment to AYUSH Compounders (678 748.51
Compounders x Rs.9200/- x 12 months)
Payment to AYUSH S.N.Os (834 SNOs x 670.54
Rs.6700/- x 12 months)
2. Other Mission Nil -
activities
Total 2959.53
OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11
Activity Financial Physical

2009-10 2010-11 2009-10 2010-11
(upto 30/09/2010)
Amount Exp Amount Exp Expecte Achiev Expect Achieve
Approve Approve d ements ed ments
d d Output Output
Mainstre 1722.10 1168.67 2074.00 561.01 - 22.21 - 11.10
aming of lakhs lakhs
AYUSH avg. avg.
POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS:
HR policies for Doctors, Nurses paramedical staff and programme management staff:
243. As mentioned earlier, each AYUSH Dispensary is provided with one Medical
Officer, one Compounder and one Sweeper cum Nursing Orderly (S.N.O).
244. Before the NRHM scheme was implemented, the post of Nursing Orderly and
Sweeper cum Scavanger were existing as two different posts. However as it was
proposed to allot only (3) category of personnel for each AYUSH Dispensary, the post of
Sweeper cum Nursing Orderly was created.
245. While filling of all the posts, the Presidential Orders on zone-wise reservations
and roster points were followed. The recruitment of Medical Officers was done in the
Commissionerate office itself and the (6) Regional Deputy Directors who are the
appointing authorities for the posts of Compounders and Sweeper cum Nursing
Orderlies completed the recruitment process.
246. All the appointments were made on contract basis and their contract is being
renewed every year for another.
Accountability and Performance appraisal:
247. The AYUSH staff are working in the PHCs/CHCs. With a view to solve the
coordination issues that arose between the AYUSH staff and allopathic staff, the Govt.
vide G.O.Ms.No.202, HM&FW (R.2) Department, dt.17/09/2009 have issued certain
instructions for streamlining the working of newly crated AYUSH units in PHCs/CHCs.
154
Among other points, the Incharge PHC/CHC should provide leadership and supervision
to the AYUSH Unit. The attendance certificates to the AYUSH staff is also being issued
by the concerned I/c. PHC/CHC.
Policies on drugs, procurement system and Logistics management
248. It is proposed to provide medicines worth Rs.40,000/- to each AYUSH

Dispensary established under NRHM scheme. Further there are (3) Pharmacies one each
in Ayurveda, Unani and Homoeopathy functioning under the control of this
Department.
249. A Committee was constituted for making recommendations for purchase of

medicines, furniture and equipments to be supplied to the newly established units under
the NRHM scheme. As per the recommendations of the Committee and after obtaining
permission from Govt. orders were placed for supply of Ayurvedic medicines on
IMPCOPS, Chennai and for supply of Unani medicines on Indian Medicines
Pharmaceutical Corporation Ltd (IMPCL), Almora, Uttaranchal as the Govt. Indian
Medicine Pharmacies Ayurveda and Unani expressed their inability to manufacture and
supply the medicines required for the NRHM Dispensaries. However, Homoeo.
Medicines are being supplied through the Govt. Homoeopathy Pharmacy,
Ramanthapur, Hyderabad.
Equipments:
250. A Committee was constituted for making recommendations for purchase of

furniture and equipments to be supplied to the newly established units under the NRHM
scheme. The Committee proposed to procure the furniture and equipments from
A.P.Health Medical Housing Infrastructure Development Corporation (APHMHIDC),
Hyderabad. Accordingly the essential functional equipments were supplied through the
APHMHIDC.
Ambulance Services and Referral Transport
251. Ambulance services and referral transport facilities are not provided by this
Department.
Maintenance of buildings, Sanitation, Water, Electricity, laundry, kitchen
252. The AYUSH Dispensaries are established in the premises of the existing
PHCs/CHCs. The Govt. have ordered the Incharge of the PHC/CHC to provide space
around 800 Sq. ft. to the AYUSH Dispensaries. The maintenance, sanitation, water,
electricity etc., is being looked after the PHC/CHC only.
Diagnostics:
253. The AYUSH Doctors practice their own systems of medicine, and if required and
the situation warrants may prescribe diagnostic tests.
155
Patient’s feedback and grievance redressal
254. Govt. in G.O.Ms.No.202, HM&FW (R.2) Dept., dt.17/09/2009 while

addressing the coordination issues among other things have made the I/c of the
PHC/CHC as the overall Supervisor and also to provide the leadership to the AYUSH
units. The grievances will be received by the I/c. of the PHC/CHC. However the
Regional Deputy Directors are the immediate controlling Officers for the Dispensaries. If
any grievance is received by them it is promptly attended to.
IEC
255. In all the P.I.Ps for the three phases 2007-08, 2008-09 and 2009-10 the component
„Preparation and distribution of IEC material on AYUSH‟ has been approved for
Rs.15.00 lakhs. However funds were not released therefore the IEC activities have not
been taken so far. However the same is proposed to be taken up shortly.
Monitoring and Review
256. Regular meetings are held at regional levels by the Regional Deputy Directors of
this Department.
AYUSH Manpower
Manpower Component Continuing New proposed Cumulative for
from previous during 2011-12 2011-12
year
Institution (2010-11) Number Amount (Rs Number Financial
in Lakhs) (Rs in Lakhs)
AYUSH Doctors PHCs 639 - - 639 1382.54
CHCs 73 - - 73 157.94
DHs - - - - -
Paramedical Staff PHCs Comp. 608 - - 608 671.23
(AYUSH) SNO. 746 - - 746 599.78
CHCs Comp. 70 - - 70 77.28
SNO. 88 - - 88 70.75
DHs - - - -
Training of AYUSH Manpower
Name of Category Trained Year 2010-11

Training till date No. of Duration Training Load Financial
Batches (in Lakhs)
Mainstreaming Medical 403 13 4-days 35 Doctors per batch Rs.1248517/-
of AYUSH Officers
Compounder Compounders 548 33 2-weeks Approx. 16 Rs.1395749/-
Training Programme Compounders per
batch
Total 951 46 Rs.2644266/-
156
Support from Department of AYUSH for PIP 2011-12:
Co-location under NRHM:
S. Centre One time assistance Recurring assistance Total

No. No. of Amount New Old Cumulative Amount
Units Units Units Amount
1. PHC 117
Rs.12.60 Rs.12.60
2. CHC 11
crores crores
3. DH -
Total 128
Note: An amount of Rs.12.60 crores is released by Govt. of India for relocation of (128)
AYUSH units established under NRHM scheme. The amount has been deposited in the
P.D account of the APHMHIDC and construction work of the buildings is under
progress.
Upgradation of AYUSH Hospitals:

One time assistance Recurring assistance
S. Total
Centre No. of New Old Cumulative
No. Amount Amount
1 - 17 Rs.706.00 - - - Rs.706.00
lakhs lakhs
Note: In this office letter No.2430/Bg.IV/2010-2, dt.06/09/2010 proposals have been

sent to the Govt. of India for release of grant-in-aid towards upgradation of AYUSH
Hospitals. The release of funds is awaited.
Up gradation of AYUSH Dispensaries:

(Rs. in lakhs)
One time assistance Recurring assistance
S. Total
Centre No. of New Old Cumulative
No. Amount Amount
1. 1039 10390.00 - 103.90 103.90 10493.90
Note: In this office letter No.2430/Bg.IV/2010-2, dt.06/09/2010 proposals have been

sent to the Govt. of India for release of grant-in-aid towards upgradation of AYUSH
Dispensaries. The release of funds is awaited.
i) Establishment of Programme Management Unit (AYUSH)/HMIS

S. State One time assistance Recurring assistance Total Amount
No.
1 A.P. 2009-10 – GOI - Rs.1.25
share – Rs.1.25
2010-11 – GOI - Rs.5.00
share – Rs.5.00
Total Rs.6.25
Note: Govt. of India have sanctioned 2.50 lakhs and 10.00 lakhs as grant-in-aid under
the C.S.S for Mainstreaming of AYUSH under NRHM for the setting up of P.M.U for
157
(12) months for the years 2009-10 and 2010-11 and released an amount of Rs.1.25 lakhs
and 5.00 lakhs respectively as 50% central Govt. share for implementation of the scheme
towards setting up of Programme Management Unit (PMU). The Commissioner, Family
Welfare has been requested to release this amount to this Department. The State Govt.
has also been requested to release its share
ii) Procurement of Essential Drugs for AYUSH Hospitals and Dispensaries
S. Unit Stream Recurring Total Amount

No. assistance
1. 990 Ayurveda - 465.25
2. 517 Homoeo. -
3. 354 Unani -
Budget proposed under AYUSH program for 2011-12
SN Main Heads Components Budget

Amount
(Rs in lakh)
1. Human Payment of AYUSH Medical Officers (712 1540.48
Resource Doctors x Rs.18030/- x 12 months)
Payment to other AYUSH staff:
Payment to AYUSH Compounders (678 748.51
Compounders x Rs.9200/- x 12 months)
Payment to AYUSH S.N.Os (834 SNOs x 670.54
Rs.6700/- x 12 months)
2. Other Mission Nil -
activities
Total 2959.53
B.8 CUG Mobile connection to Tribal areas ANMs

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 CUG Mobile connection to Tribal 500 2050 123.00
areas ANMs
158
B.9 NACP (APSACS)
Expansion of ICTC and PPTCT services to all 24 X 7 health facilities:
257. AP has a total number of 1624 PHCs, of which 266 already have the Nurse
practitioner model ICTC and 295 have Facility Integrated ICTC. The remaining 1063 24
PHCs don‟t have any services of ICTC. Below table indicates the situation analysis of
PHCs with ICTC facility.
Expansion of ICTC & PPTCT services to all PHCs-Situational
Analysis
S.No PHCs Number of facilities
1 Total PHCs in the state 1624
2 PHCs covered by Nurse Practitioners 260
PHCs covered by Facility integrated
3 295
ICTC
4 PHCs not covered by any kind of ICTCs 1063
Need of Standalone ICTCs in 429 priority mandals:

Currently there are three categories of ICTCs in the State:
a. Standalone ICTCs where a Full time Counsellor and Lab technician is placed.
There are 411 Standalone ICTCs in the state of AP
b. Facility Integrated ICTC (Government & Private) Sites (where an existing lab
technician is trained in HIV testing and existing Staff nurse is trained in
counseling). There are 225 in private and 295 in Govt FICICT ICTCs in the state
of AP
c. Mobile ICTC: Where a full time counselor cum lab technician is placed in the
mobile van to provide ICTC services. There are 23 Mobile ICTCs in the state of
AP
 Nurse Practitioners Model project of APSACS:

o NPs and Standalone ICTCs: This was taken up as PHC enhancement
project in 10 high prevalent districts where the Nurse practitioners
(NPs) were placed in 266 PHCs, providing comprehensive HIV/AIDS
services which include HIV/AIDS counselling, testing, PPTCT and
outreach services. PPTCT services include HIV Counselling and
testing of pregnant women and administration of prophylactic
Nevirapine to HIV +ve pregnant women and their babies in order to
prevent the peri-natal transmission of HIV along with outreach
activities in the periphery. All the 266 PHCs were standalone ICTC
where uniquely the nurse does HIV testing, counseling and provide
PPTCT services and outreach.
o NPs Standalone ICTCs converted to FI-ICTCs: NPs model transitioned into
Integrated with NRHM as :In view of the overall policy to integrate
HIV/AIDS into the general health system, services of all the 266 Nurse
Practitioners were taken up by NRHM and placed at different PHCs and CHCs
in the state. All the 266 standalone ICTCs were converted to FI-ICTCs where
NPs were given the role of HIV counseling and doing more regular PHC taks.
o FIICTC model is not functioning effectively compared to standalone
ICTC:
159
 Based on the data in the year 2010 it was evident that the
FICICT model (facility integrated) is not functioning as
effective as standalone ICTCs, which is reflecting adversely on
the overall performance of testing and counseling services in the
state.
 The data of HIV testing at PHCs manned by NPs (Now as staff
nurse) is studied for the last one year and observed that the
performance has reduced drastically (the number of testing
reduced by 90 %). In Nov and December 2009, the average
35457 tests have been conducted when the NPs managed
facility were functioning as standalone ICTC and average of
3360 HIV tests conducted during the corresponding period
(Nov-December of 2010) when the services converted to facility
integrated ICTCs.
 There is a decrease in non ANC testing to the extent of 25,000
per month from 1 lakh and ANC testing dropped from 85,000
to 65,000 test per month. As the Nurse Practitioners were engaged
only in HIV counseling and they were assigned many other regular
and general tasks at the PHCs.The data presented below is
captured for the corresponding period during Nov 2009
(Standalone model existing) VS Nov 2010 (Facility integrated
model existing).
o At this rate of HIV testing it will be difficult to achieve the annual

target for testing and keeping in view the crucial juncture where state is
showing the down trend in the HIV prevalence it is important to
sustain the response for at least next 2 years so that the program
achievements can be consolidated.
Convergence Plan 2011-12:
 Selection of 429 Standalone ICTCs: The criteria for selection of high
priority mandals for standalone ICTC and list of mandals
o Mandals which are not having standalone ICTC currently and meeting
at least one of the following mentioned criteria:-
 1) ANC positivity 1% or more (with minimum 200 pregnant
women tested in reference period)
160
 2) Pre-ART registration of 100 or more
 Above mentioned criteria suggest us the mandals with
established epidemic and hence would be a priority for testing
facilities scale up.
o Overall 429 mandals were identified based on need for ICTCs scale up
which is supported by CMIS data (National MIS). Table summarizes
district wise scale up while mandals details are in Annexure II. More
detail planning will be done by identification of the health facility for
scaling up of testing and counseling services.
Table 1:- District wise Priority Mandals
SN District Priority S N District Priority
Mandals Mandals
1 Adilabad 3 13 Nalgonda 29
2 Anantapur 15 14 Nellore 19
3 Chitoor 12 15 Nizamabad 20
4 East Godavari 34 16 Prakasam 38
5 Guntur 40 17 Ranga Reddy 14
6 Kadapa 14 18 Srikakulam 12
7 Karimnagar 25 19 Vijayanagaram 1
8 Khammam 19 20 Visakhapatnam 20
9 Krishna 37 21 Warangal 9
10 Kurnool 13 22 West Godavari 35
11 Mahabubnagar 5 Grand Total 429
12 Medak 15
258. The detail analysis of the village and mandal wise data indicates that the
existence of key villages in priority and low-priority mandals varies but important to
control the epidemic. However, in view facility availability and controlling the epidemic
the expansion of the facility is important. The figures below indicates the distribution of
key villages in the priority and low-priority mandals which is evident to show the spread
of HIV infected.
Priority mandals with key villages Low-Priority mandals with key villages
259. Proposal for 2011-12 is to Establish 429 stand alone ICTCs : Out of the total
429 ICTCs proposed, the existing 266 NPs would continued under NRHM funds where
they provide HIV counseling, testing and outreach alone and have limited interface in
161
the day to day duties of a staff nurse and appoint NPs in the remaining 163 ICTCs. (
429= existing NPs 266+ New 163 NPs).
Budget
260. The detail budget for both the models is presented below. The budget only
includes the cost of human resource and the basic maintenance of the center. Till the
time of overall convergence with NRHM APSACS will continue to provide the testing
kits and the necessary training.
Budget
Component/Activity Units Amount in lakhs
429 x 12,000 per head per month x 12
i. Salaries of NPs months (continue 266 existing NPs 61,776,000
+163 new NPs to be recruited)
B.10 Strengthening of RCH services through CHNC
261. Each CHNC will be provided a lumpsum of one lakh for addressing local needs
and emergencies. An additional of four lakhs to be provided to each CHNCs where IMR
and MMR is high. 100 such CHNCs with more number of poor performing mandals will
be provided with this additional budget. These were identified based on the list of poor
performing and mandal with high mortality rates as provided as by planning department,
Govt of AP.
B.11 PHC mobile for strengthening RCH services
262. To strengthen RCH services and to generate demand for deliveries at public
health facilities, PHC mobile is being operationalised. This Mobile PHC will visit every
village at least once a month to provide MCH services, Review MCH team performance
at village level, tracking of pregnant women and children, supportive supervision to the
services provided by MCH team at Village level. This Mobile PHC will comprise of MO,
CHO (F)/PHN, ANM & LT. For this Rs 220 per Village (Rs 70 for doctor and 50 for
other staff) is budgeted.
B.12 PG Diploma Course in Public Health
263. The government is in the process of amending its service rules to make it
mandatory for any member of the AP Health Service to possess PG diploma / degree for
appointment as DMHO/ Additional Director / Director of Health Services. In this
direction, it is proposed to train doctors in one year PG Diploma in Public Health
Management course at IIPH, Hyderabad in two batches. The cost of training is expected
to be about Rs 150 lakhs, of which 50% will be financed from NRHM.
162
BUDGET ABSTRACT FOR RCH FLEXIBLE POOL
(Rupees in lakhs)
SN Activity Budget
proposed
2011-12
1 Strengthening the Role of ASHA
a) ASHA Performance Based Incentives 2890.98
b) Best ASHA Awards 24.69
c) ASHA Conventions 848.40
d) Providing Saree to ASHAs (2 sarees) 282.80
e) Ashas Training TOT (6&7 Modules) 5.66
f) Training for ASHAs 482.09
f) Translation and Printing of ASHAs modules 20.00
2 Village Health Sanitation Committees 2227.60
3 Untied funds
a) Sub Centres 1233.80
b) Primary Health Centres 406.00
c) Community Health Officeer 154.50
4 Annual Maintenance Grants
5 Hospital Development Societies (HDS)
a) Primary Health Centres 1624.00
b) Community Health Officeer 309.00
c) Area Hospitals 54.00
d) District Headquarters Hospitals 85.00
6 Construction of Health Facility Buildings
c) Community Health Centres 1875.00
e) Developing the Project hospital at Srisailam ITDA in to a multi specialty 200.00
hospital for Primitive tribal Chenchu citizens.
f) Strengthening of existing SCNUs 190.00
g) New SCNUs ( 20 bedded) 190.00
h) New SCNUs ( 12 bedded) ( Tribal) 240.00
i) Refurbishment of New Born Stabilization Units 1320.00
7 Strengthening of Community Health and Nutrition Clusters 500.00
8 Salaries of Second ANM 12745.44
9 Salaries for MPHA (Male) 2485.36
10 Procurement of Equipment & Medicines 4022.25
11 Nutrition Support Intervention
a) Village Health & Nutrition Day 886.33
b) Establishment of Nutrition rehabilitation centers (SAM) 609.27
12 RNTCP 143.00
13 Quality Assurance Cell for monitoring MCH activities & Trainings 21.24
14 Mainstreaming of AYUSH 2959.53
15 CUG Mobile connection to Tribal areas ANMs 123.00
16 Salaries of NPs (Nurse Practioners) 617.76
17 Strengthening of RCH services through CHNC 760.00
18 PHC mobile for strengthening RCH services 686.40
19 PG Diploma Course in Public Health 75.00
Total NRHM Flexible Pool 51035.80
163
C. IMMUNISATION
Executive Summary
264. To bring down IMR from 49 to 30 we are proposing in Child Health Component
Rs.74.26 crores to provide new born care to cut short neonatal deaths by implementing
NBCCs, NSUs and SCNUs in Subcentres, PHCs, CHCs, district hospitals, area hospitals
and medical colleges in a phased manner.
265. To strengthen the routine immunization in the state we are proposing Rs.32.93
crores for vaccine delivery, proper cold chain maintenance, and for programme
implementation.
Key objectives defined in specific measurable units
 IMR (SRS 2010) - 49 per thousand live births

 Goal Overall NRHM 2012 - 30 per thousand live births
 Goal Annual 2011-2012 - 44 per thousand live births
266. To cover all the children especially focusing on vulnerable groups who are
missing routine immunization such as beggars community, fishermen community,
nomadic tribes, migratory families, construction labour, urban slum dwellers, residents
of peri urban areas, overlapping surrounding Panchayats, new colonies out side the
towns, tourist groups, families with working hours that do not coincide with the team
visits, agricultural families living/working in the fields
Situational analysis of the State Immunization Programme:
267. Andhra Pradesh follows the 7-vaccine schedule. The prescribed Immunization
schedule is to be completed before the child completes one year. In A.P. State the
Immunization is implemented as a part of Routine Immunization. The Immunization is
being provided to the children through 1624 PHCs / 12522 Sub Centers under the
supervision of Medical Officers. At the secondary level through hospitals i.e. area
hospitals and district hospitals which are functioning under the control of A.P. Vaidya
Vidhana Parishad and specialized treatment is being provided through teaching
hospitals. The ANMs conducts a large percentage of the Immunization in rural areas on
designated days i.e. Wednesday (SC headquarters sessions) and Saturday (outreach
sessions) every week. Every ANM is supposed to cover 5000 population. The expected
pregnant women (1737000) and infants (1493000) are going to be benefited by
immunization programme.
268. The performance on the Immunization front has been showing a steady
improvement due to the activities undertaken under NRHM. The ASHAs are also
playing vital role in mobilization of children to the Immunization sites to ensure timely
immunization and to sustain high coverage of immunization by contributing their share.
164
Current scenario of implementation of Immunization Programme:
a) State-level coverage as per District-Level Household Survey DLHS-3, Coverage

Evaluation Survey 2009, and reported coverage for 2009-10, 2010-11 upto
December 2010.
SN Coverage Fully immunization

1. DLHS-3 67.1%
2. CES (UNICEF-2009) 68.0%
3. Reported coverage (2009-10) 100.16%
4. Reported coverage (2010-11) upto December 96.09%
b) District-wise coverage level of all antigens for 2009-10, 2010-11 up to December

(including Hep-B and J.E.).
SN Antigen 2009-10 2010-11 up to

December
No. % No. %
1. BCG 1524311 102.83 1049376 99.16
2. OPV 3rd dose 1496934 100.98 1021658 96.54
3. DPT 3rd dose 15009199 101.25 1023007 96.67
4. Hep-B 1496838 100.97 999462 94.44
c) Reasons for shortfall
269. Though the achievement is 100% over target in the districts as per the reports
received from the districts, there are some PHCs and SCs where the performance is low
due to various reasons such as vacancy of posts, irregular supplies of vaccines, natural
calamities, and sudden absence of field staff for various reasons. However, the sessions
are being conduct by hired ANMs in the areas where the posts are vacant to improve
immunization coverage. The matter is being reviewed in the meetings of DIOs and
through video conferences for improvement of immunization coverage in the low
performing units.
d) Reporting and incidents of VPDs:
270. There were no outbreak of Diphtheria, Pertusis, and Tetanus. The incidents of
Diphtheria, Pertusis, Tetanus and Measles have come down due to successful and
effective implementation of routine immunization activities.
e) Reporting and Response to outbreaks and AEFIs:
271. The state-level and district-level committees have been formed under AEFI.
Instructions were issued to convene district-level AEFI committees once in three
months. During the year 2008 eleven number of AEFI cases have been reported from
different districts. In every case the Expert Committees from medical colleges formed as
per the G.O.Ms.No.596 dt.14.12.2007 have been requested to investigate the cause of
death. Line Listing Formats on AEFI for the 2008-09 (up to August) are furnished in the
enclosed statements. In respect of the cases for which investigation was made the cause
of death was declared not due to immunization.
165
1) Strategy for further improving routine immunization:
a) The target of immunization coverage for this year is 14,94,000.
b) Districts identified for poor access in the A.P. state are – Adilabad, Khammam,
Mahabubnagar, Warangal, Anantapur and Nellore. The districts are covered hard
to reach, scattered, remote areas and the migratory population from neighbour
districts also more. Special focus is being given to the above districts for
improving routine immunization by covering migratory population.
c) One of the reasons for drop outs reflected by DPT3 coverage is migration, in
addition to deaths occurred if any. However the DMHOs have been requested to
instruct the field staff to record the status of providing DPT3 in their records who
got DPT3 vaccination in other places. In case of permanent migration, the details
of DPT3 administration will not be available.
d) The awareness among community regarding immunization is being given to all

the parents through the ANMs, AWWs, ASHAs and ITDA staff. In addition to
that emphasizing the importance of immunization through IEC.
e) The following steps have been taken for effective implementation of

immunization programme.
 Reviewing immunization activities frequently with DMHOs / DIOs and also

visiting the allotted districts by state officers for monitoring the immunization
activities in the districts.
 Conducting village health day in the villages once in a month for providing
immunization and treatment for minor ailments.
 Organizing immunization catch-up campaigns in tribal districts.
 Organizing Measles and AFP surveillance campaigns.
 PPI campaigns etc.,
 By publicizing through IEC activities to bring awareness in all sections of

public about the immunization particularly in the SC/ ST and weaker section
areas, habitations and outreach areas.
 In addition to the Health staff 70,700 ASHA workers are also actively
involved in mobilization of children and pregnant women to the
immunization sites.
 Hiring the services of retired / pvt. ANMs for conducting Immunization

sessions wherever the regular ANM post is vacant in sub-centres.
 Hiring the services of retired / pvt. ANMs for conducting Immunization

sessions in slum and underserved in urban areas.
166
 Japanese Encephalitis vaccination is introduced in routine immunization in
the districts where campaign is over.
 Hiring the services of Refrigeration Mechanics in the vacancies caused due to

death / promotion / removal of services etc.
3. Micro plans have been updated in all the districts in the state for the year 2010-11.
4. Roles and responsibilities of ANMs.
Wherever 2nd ANM posts are filled up the area has been demarcated among both
the ANMs and the services to be provided are one and same. The responsibilities
of ANMs are
 To register pregnant women and to be given ANC and track the drop out
pregnant women to provide ANC.
 List of all eligible children below 1 year to be prepared and given

immunization services including drop out children.
 To update the service register and immunization card.
 To administer Vitamin-A along with Measles.
 Every child is to be weighed and suggest the parents of the baby who is under
weight about nutrition, post-natal care, breastfeeding / complimentary
feeding, diarrhea and home management, ARI, safe drinking water, sanitation
etc.
5. Mechanism of coordination between AWW and ASHA.
272. The immunization sessions will be conducted mostly in AWW centres where the
ANM, AWW and ASHA will participate. The ASHA worker always coordinates with
ANM and motivate the parents to get their children to immunization sessions for
vaccination. ASHA will be made available the list of children to be brought to the
session on par with ANM. The ASHA and ANM performs door to door visit to update
the list of children with newborns. Name based registry is in practice in the state to track
all the children for immunization.
6. Alternative vaccine delivery system.
273. The ANM or Health Worker will carry the vaccines to immunization sites by
local means such as cycle, motorbike, boats, etc. by paying Rs.50/- per session.
274. It is observed that immunization coverage is low in the areas where the
vulnerable groups like beggers, fishermen community, nomadic tribes, migratory families
are living. To improve coverage in the above areas, it is proposed to engage two vehicles
per PHC per month to conduct immunization sessions.
167
2) Status of RIMS implementation:
275. The RIMS data from the districts and state hqrs. could not be uploaded due to
technical problems in the software. This has been brought to the notice of GOI by the
district / state hqrs. authorities for rectification. The problem still exists.
276. The RIMS training was provided to all the DIOs, SOs (UIP), Computer
Assistants of all districts during the year 2006. Many posts of DIOs and SOs (UIP) are
filled up by promotion and they are required training on RIMS. If orientation training to
the newly posted DIOs, SOs (UIP) and Computer Assistants and reorientation training
to other staff is provided that would be helpful in uploading data of RIMS.
3) Partner agencies:
277. The immunization activities are being implemented in the state with the support of
following partner agencies.
i) National Polio Surveillance Project (WHO)

ii) PATH India
iii) UNICEF.
iv) Rotary International
v) Care, etc.
Supervision and Monitoring:
 The Joint Director (Child Health & Immunization) and State EIP Officer is the state
programme officer for implementing and monitoring immunization activities under
the head of Commissioner of Health & Family Welfare.
 All the Program Officers of this office have been allotted certain districts to supervise
and monitoring the Immunization Programs.
 In all Health Campaigns such as PPI, Measles, Vitamin – A, the monitoring cells are
being established in the districts. All Program Officers of this office including RDs,
SMOs, will be monitoring the Health Campaigns.
 At district level the District Immunization Officer is implementing and monitoring

immunization activities in addition to the other programme officers such as Addl.
DMHOs, District Leprosy Officers, District Malaria Officers, etc.
 The DIOs review meetings are being conducted almost every month and reviewed
the progress of Immunization.
 Regional review meetings with DIOs are also being conducted as and when it was
felt necessary.
 Reviewed in Video Conferences fortnightly along with other NRHM activities.
168
 Medical Officers are implementing and monitoring immunization activities at PHCs
and sub-centre level by field visits and reviewing the progress in weekly meetings of
supervisors, ANMs, etc.
 The District Collectors and DMHOs will review the progress of immunization in the
monthly medical officers meeting.
 The ANMs are maintaining survey registers duly updating the information of new
cohorts for all vaccines and stock registers and conduct the immunization sessions by
carrying the vaccines and AD syringes as per the beneficiaries available in survey
registers.
 The ASHAs and Anganwadi Workers also prepare a list of beneficiaries to be

mobilized for immunization sessions.
o Every Wednesday and Saturday the state hqs. contacts the DIOs regarding the
sessions conducted at the grass root level on the fixed days.
o The name-based tracking system will be strengthened to enable effective monitoring

of all immunization activities.
o It is also proposed to establish a State Monitoring Cell at state hqs. To track and
monitor all immunization activities.
Risk analysis
 Vaccine vans in almost all districts are in condemned stage as they were supplied to
districts long back and chain of letters addressed to Govt. of India to supply new
vaccine vans.
 The vehicles of DIOs are frequently going out of order and need major repairs. Some
vehicles are beyond repairs and need replacement or the DIOs are to be permitted to
hire the vehicles. However certain amount has been projected in the PIP for the
repairs of DIO vehicles.
 Generators supplied to district and regional stores long back and requires frequent
repairs and also budget to be released for procurement of fuel particularly in summer.
The spare parts are not available in the local market and needs replacement of
generators in the districts.
 The Vaccine carriers along with spare Ice packs are also supplied to the districts three
years back and there is demand from districts for supply of new vaccine carriers. As
per GOI norms the shelf life of vaccine carriers is only three years. Hence new
vaccine carriers in large quantity is required for the state. The vaccine carriers are to
be supplied either by Govt. of India or to permit the state to procure vaccine carriers
through rate contract firms of GOI with the financial support of GOI.
 The vaccines such as Measles, Hep-B and some times OPV are not being supplied by
Govt. of India regularly inspite of several letters addressed to GOI due to which the
full immunization is not up to mark.
169
 AEFI - Certain deaths are being reported from the districts about which the parents
are alleging that the deaths are occurred due to vaccination of various vaccines and
the AEFI Expert Committee committees constituted in govt. medical colleges are
proceeding to the scene of occurrence and investigating the cause of death. The
paediatricians are requesting to make arrangements for payment of DA and engaging
vehicle for their travel to avoid delay in investigation. Therefore the budget is
projected in PIP.
Expected outcomes
 The state remained polio free from 2008.

 Neonatal Tetanus has been eliminated and Certified by WHO.
 Measles cases being reported but much less than what it used to be.
 A.P. is the first state to include Hep-B (in RI), AD Syringes, Disposable Syringes,
Waste Management Systems - sustaining it with the support of GOI.
 IMR - reduced from 59/1000 (2003 SRS) live births to 49 / 1000 live births as per
SRS (2010). By 2012 it is proposed to reduce IMR to 30 / 1000 live births.
 However, the state is not content still and is on path to achieve total coverage and
NRHM objectives with the financial support of Govt. of India.
Special features
278. Certain new interventions are proposed in the PIP to fill up the gaps noticed
earlier and also budget proposals prepared by giving special focus to high focus districts.
Budget analysis
279. The NRHM activities are introduced in the middle of 2005 and the expenditure
was very less. From 2006 onwards the expenditure went on increasing. Though all the
activities are being implemented in the districts the reporting of expenditure was poor
due to non collection of expenditure particulars from periphery levels. However, the
expenditure particulars are available with NRHM monitoring section.
Basic information of the State/UT related to Immunization Programme
Position Name & Designation Contact No./Email

State Immunization Officer Dr. T. Neerada 9849902229
Joint Director (CH&I) 040-24606378
jdchicfw@yahoo.co.in
State Cold Chain Officer Sri M.M. Jaya Rao 9849902227
Cold Chain Officer 040-24734579
cco.chfw@gmail.com
State Level Data Assistant Sri P.A.R. Kumar 9849807900
Computer Program Assistant 040-24606378
District Immunization Officers 23 23
(DIO)
Systems of ensuring stability of tenure for these key officers should be elaborated
170
Beneficiaries details of pregnant women and children
SN Beneficiaries Target
2009-10 2010-11 2011-12
1 Pregnant women 1739100 1737000 1724000
2 0 to 1 yr infants 1482400 1494000 1486000
3 1-2 yr 1294900 1307000 1365000
4 5 yr 1894700 1912000 1380000
5 10 yr 2364000 2406000 1447000
6 16 yr 1722900 1739000 1640000
C.4 Details of Routine Immunization Sessions
State Abstract
SN Routine Immunization Sessions 2009-10 2010-11 2011-12
1. Total Sessions planned 613397 523531 571082
2. Total Sessions Held 600003 886383 308267
3. No. of Outreach Sessions 299588 262367 270434
4. No. of Fixed site sessions 306437 281756 286040
5. No. of Sessions in Urban Areas 80726 72493 84470
6. No. of Sessions in Rural Areas 560988 479183 514953
7. No. of sessions in hard to reach areas 10555 9830 5769
8. No. of session with hired vaccinators* 7857 5837 7473
9. No. of hired vaccinators* 283 271 648
10. No. of villages where sessions are held 66046 61920 23227
monthly
11. No. of villages (smaller) where sessions 354 387 415
are held on alternate months
12. No. of villages where sessions are held 64 70 78
quarterly
Existing Support to the States
Sl Item Stock Requirement Remarks

No (functional) 2009-10 2010-11 2011-12
as on 31st
Dec'10
1 Cold Chain Equipments -
a Walk-in-Coolers -32 Cu.M.
CFC 1 0 0 0
NCFC 1 0 1 0
Walk-in-Coolers - 16.5 Cu.M
CFC 6 0 0 0
NCFC 6 0 1 0
b Walk-in-Freezers - 32 Cu.M.
CFC 0 0 0 0
NCFC 1 0 0 0
Walk-in-Freezer - 16.5 Cu.M.
CFC 0 0 0 0
NCFC 1 0 3 2
c Ice-Lined Refrigerator
(Large)
171
Sl Item Stock Requirement Remarks
No (functional) 2009-10 2010-11 2011-12
as on 31st
Dec'10
CFC 24 0 0 0
NCFC 135 0 5 5
Ice-Lined Refrigerator
(Small)
CFC 1081 0 0 0
NCFC 1470 0 500 434
d Deep Freezers (Large)
CFC 18 0 0 0
NCFC 102 0 13 5
Deep Freezers (Small)
CFC 289 0 0 0
NCFC 1707 0 350 284
e Cold Boxes (Large) 2591 100 100 100
Cold Boxes (Small) 742 50 50 50
f Vaccine carriers 51120 12646 6400 6400
g Ice Pcks 217700 50000 25000 25000
h Vaccine Vans (Large) 2 1 1 0
Vaccine Vans (Medium) 6 3 2 1
Vaccine Vans (Small) 7 16 4 3
2 Vaccine stock and requirement (including 25% wastage and 25% buffer)
a) TT 126.07 126.67 108.65
b) BCG 77.4 77.04
c) OPV 95.3 96.24 96.81
d) DPT 126.79 128.02 119.75
e) MEASLES 24.65 24.84 24.71
f) Hep B 73.93 74.51 74.12
g) JE (Routine)
3 Syringes including wastage of 10% and 25 % buffer
a) 0.1 ml 20.38 20.54 20.44
b) 0.5 ml 290.55 292.82 270.63
c) Reconstitution Syringes 12.67 12.67
4 Hub Cutters
*Note: DPT is to be given instead of DT at 5 yrs once the current stock of DT Vaccine is
exhausted
172
District –wise Coverage reports (in numbers)
Yearly Target OPV - 1st Dose OPV - 3rd Dose DPT - 1st Dose DPT - 3rd Dose
BCG Coverage
S. (2010-11) Coverage Coverage Coverage Coverage
Name of District
No Pregnant
Infants 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*
Women
1 Srikakulam 48118 56289 28630 48414 28540 48414 28858 48414 28762 48414 28854 48414
2 Vizianagaram 43763 47723 25405 44013 40679 44013 40679 44013 40679 44013 40679 44013
3 Visakhapatnam 70371 81822 54556 70375 53837 70375 54583 70375 53837 70375 54583 70375
4 East Godavari 74758 86450 54966 74356 54751 74356 52390 74356 54751 74356 52390 74356
5 West Godavari 57691 66395 52605 57106 48108 57106 48252 57106 48108 57106 48252 57106
6 Krishna 73330 84220 55784 72438 58105 72438 55381 72438 58105 72438 55381 72438
7 Guntur 72785 84134 55818 72364 54732 72364 53250 72364 54732 72364 53250 72364
8 Prakasam 55234 64189 45817 55209 45621 55209 44480 55209 4562 55209 44480 55209
9 Nellore 48506 56340 36462 48459 36218 48459 35911 48459 36218 48459 35911 48459
10 Chittoor 80180 93083 55612 80061 56651 80061 55623 80061 56651 80061 55623 80061
11 Kadapa 58095 67514 38797 58069 38879 58069 40547 58069 38879 58069 40547 58069
12 Anantapur 72833 85077 57625 72831 58468 72831 58752 72831 58468 72831 58752 72831
13 Kurnool 77461 90533 56533 77867 55822 77867 49368 77867 55822 77867 49368 77867
14 Mahabubnagar 73675 86367 52901 74284 53984 74284 53451 74284 53984 74284 53451 74284
15 Rangareddy 103120 113439 71830 97569 69740 97569 70704 97569 69740 97569 70704 97569
16 Hyderabad 87246 95976 59820 82549 60705 82549 59300 82549 60705 82549 59300 82549
17 Medak 60036 70280 41027 60448 40752 60448 40729 60448 40752 60448 40729 60448
18 Nizamabad 46065 53902 35358 46362 34438 46362 32704 46362 34438 46362 32704 46362
19 Adilabad 57941 67808 41273 58322 31242 58322 41227 58322 31242 58322 41227 58322
20 Karimnagar 81325 80107 45286 68901 45527 68901 45283 68901 45286 68901 45286 68901
21 Warangal 71433 82877 47143 64795 47143 64795 43358 64795 47143 64795 43358 64795
22 Khammam 45191 52846 33331 45453 34052 45453 33304 45453 34052 45453 33304 45453
23 Nalgonda 63352 74125 45320 63755 43413 63755 45126 63755 43413 63755 45126 63755
TOTAL 1522509 1741496 1091899 1494000 1091407 1494000 1083260 1494000 1050329 1494000 1083259 1494000
173
District-wise coverage reports (in numbers)
TT2+Booster Hep B - Birth Dose Hep B - 1st Dose Hep B - 3rd Dose JE-routine
Measles Coverage Coverage Coverage (Wherever Coverage (Wherever Coverage (Wherever (Wherever
S N Name of District
applicable) applicable) applicable) applicable)
2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*
1 Srikakulam 28752 48414 33332 77968 15391 48414 15363 48414 28218 48414
2 Vizianagaram 26044 44013 27757 70881 12510 44013 23124 44013 23307 44013
3 Visakhapatnam 53411 70375 58790 113334 23900 70375 53837 70375 54583 70375
4 East Godavari 52582 74356 58955 119746 17497 74356 45588 74356 44124 74356
5 West Godavari 46971 57106 50846 91966 17003 57106 48108 57106 48252 57106
6 Krishna 53130 72438 61604 116657 14726 72438 50985 72438 50213 72438 63371
7 Guntur 53002 72364 59468 116538 12733 72364 53484 72364 52126 72364
8 Prakasam 43380 55209 45532 88911 2990 55209 45621 55209 44480 55209
9 Nellore 34655 48459 40641 78040 36412 48459 36218 48459 35911 48459 42393
10 Chittoor 55517 80061 65071 128934 36515 80061 56651 80061 55623 80061
11 Kadapa 39177 58069 41345 93516 17183 58069 38879 58069 40547 58069
12 Anantapur 57685 72831 60394 117289 50532 72831 58468 72831 58752 72831
13 Kurnool 47396 77867 56373 125401 49738 77867 55822 77867 49368 77867 11050 12155
14 Mahabubnagar 51999 74284 56152 119631 18372 74284 53651 74284 53003 74284 64955
15 Rangareddy 69700 97569 77500 157129 22214 97569 69142 97569 62490 97569
16 Hyderabad 59184 82549 65840 132941 38237 82549 60705 82549 59300 82549
17 Medak 40542 60448 47579 97348 14107 60448 40752 60448 40729 60448 52882
18 Nizamabad 32376 46362 37299 74663 35358 46362 34438 46362 32704 46362 40559
19 Adilabad 40662 58322 48952 93924 31242 58322 31562 58322 41227 58322 51022
20 Karimnagar 44955 68901 50590 110961 46783 68901 45527 68901 45527 68901
21 Warangal 43266 64795 43770 104349 47143 64795 40695 64795 43350 64795 12105 126700
22 Khammam 33141 45453 37669 73199 14109 45453 34052 45453 33304 45453 87000
23 Nalgonda 44117 63755 51242 102674 34961 63755 43413 63755 45126 63755 55775
TOTAL 1051644 1494000 1176701 2406000 609656 1494000 1036085 1494000 1042264 1494000 23155 596812
#
Coverage for 2010-11 till Dec‟10
174
Budget for Routine Immunization activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Mobility support for DIOs for supervision
a) High Focused Districts 1 10400 6 7.49
b) Other Districts 1 8000 17 16.32
c) State level 1 25000 1 3.00
2 Review meetings for the DIOs 1 59600 6 3.58
3 Alternative Vaccine Delivery 1 50 50088 300.53
4 Vaccine transport
a) High Focused Districts 1 19500 6 14.04
b) Other Districts 1 15000 25 45.00
5 Support for Computer Assistants to DIOs 1 10000 23 27.60
6 Support for two Computer Assts. to 1 12000 2 2.88
JD(CH&I)
7 Repairs and maintenance of cold chain
equipment
a) Central Vaccine Store 1 80000 1 0.80
b) Regional Vaccine Stores 1 220000 6 2.20
c) District Vaccine Stores 1 460000 23 4.60
d) Cold Chain points 1 1000 2556 25.56
8 Printing of immunization cards and 1 5 3000000 150.00
registers
9 Focus on slum & underserved areas in 1 350 9696 33.94
urban areas
10 Mobilization of children by ASHAs 1 150 70700 1272.60
11 Cold Chain electricity charges
a) Central Vaccine Store 1 70000 1 8.40
b) Regional Vaccine Stores 1 11000 6 7.92
12 Hiring services of MPHA(F) in vacant 1 350 28800 100.80
places of SCs
13 Minor repairs of Vaccine Delivery Vans 1 10000 39 15.60
14 Loading and unloading Charges of 1 500000 5.00
vaccines / injection safety / other CC
items etc
15 Training to Health Workers on 1 770 47380 364.83
Immunization
New interventions proposed
16 Maintenance of Data Loggers to 1 5000 12 0.60
WICs/WIF at state headquarters
17 Adverse Events Following Immunization 312500 3.13
18 Supportive supervision from state-level 1 50000 46 23.00
19 Providing fuel to Generators at CVS, RVS 1 25000 34 8.50
& Districts
20 Procurement of Spare Parts 1 150000 23 34.50
21 Procurement of Vaccine Carriers 1 372.27 2500 9.31
22 Procurement of Spare ice packs 1 10 12500 1.25
Total 2492.96
175
D. DISEASE CONTROL PROGRAMS
D.1 National Vector Borne Disease Control Program (NVBDCP)
280. Andhra Pradesh is a known high risk and vulnerable State for Malaria,
particularly the areas like tribal areas located in Eastern Ghats are highly endemic
for the disease. However the disease was kept under control by adopting various
strategies by the state. Dengue which was sporadic up to 2002 has started in
reporting cases in considerable and alarming numbers in most of the districts of
the state. The Incidence reached its peak in the year 2010 is appearing high
numbers in certain Districts like Krishna, Guntur, Prakasham, Karimnagar,
Warangal, Khammam, MahabubNagar, Hyderabad and Rangareddy districts.
The reasons for increase in the incidence may be due to virulence of virus,
vectorial capacity of the Aedes Aegypti and availability of the susceptible
population, increased surveillance and diagnostic facilities are the another
contributing factor for recording more number of cases during the year 2010.
281. Similarly Chikungunya has suddenly appeared in the year late 2005 and in
2006. However the disease is now limited to certain pockets of the districts of
Mahaboobnagar, Nizamabad, and Khammam. AES Surveillance has been
intensified in the state a total 143 AES screened for JE virus out of them only 7
are found to be confirmed JE cases. On screening the samples from districts of
Karimnagar, Warangal and Nalgonda by NIV Pune, 8 Chandipura virus cases
detected. However the incidence is limited only to the above 3 districts.
Objectives:
Major objectives Sub Objective Assumptions

Malaria
1. To reduce the Annual Strengthening of surveillance The Objectives can possibly
Parasitic Incidence in further by increasing the ABER achieved if the logistics like budget,
2010 is 0.39 (33218 cases) by 1% of 2010 (10.60) and materials (insecticides, Larvicides,
to 0.31 (26404) by 2011- sustaining the ABER above 10% RDT, ACT etc.) are provided by the
12. across all the high endemic 1st week of April 2011. Additional
districts. Tribal Malaria Surveillance
Workers from local tribal youth to
strengthen surveillance with
performance based incentives from
April to Nov.
Increase in the capacity building The Objectives can possibly achieve
activity related to EDCT by if the logistics like budget, are
providing training to ASHAs positively approved in PIP of 2011-
(6000 in 2011-12 as against 4100 12.
could be trained in 2010) and
Medical officers (375, as against
300 in 2010) in 2011-12 especially
in 6 high endemic districts.
2. To totally prevent Sentinel hospitals of the high risk Support for strengthening the
Malaria mortality areas will be made fully sentinel hospitals from GOI by
functional. providing logistics and Capacity
building (Training the sentinel sites
MOs and additional LTs in high
176
risk areas)
Dengue
1. Compared to 2006 1) Strengthening of the reporting If additional support in the form of
dengue related mortality, system from all the sentinel site Kits and maintenance budget is
we could already achieve hospital for taking up prompt and released by NVBDCP to all existing
the target of less than effective containment measures to 10 and additional 13 centres
50% in 2009& 2010, and interrupt the transmission proposed
we would like to sustain
and continue the
reduction of mortality
further.
2) Strengthening the active
surveillance for early detection
and referral to functional sentinel
hospital.
3) Capacity building of the Support for strengthening the
Human resource of the SS sentinel sites from GOI (Training
hospital for strengthening the case the sentinel sites MOs and LTs)
management to avert mortality.
4) Enhancing the social IEC/BCC budget provided on time
mobilization activity through the by GOI.
appropriate IEC/BCC.
Chikungunya
1)50% Reduction of 1) Strengthening of the
morbidity caused due to Chikungunya reporting system
Chikungunya further in 2011-12.
2) Morbidity reduction by
effective case management.
3) Enhancing the social IEC/BCC budget provided on time
mobilization activity through the by GOI.
JE
1. Compared to 2006 JE 1) Providing all support to the
related mortality, we Sentinel hospitals for effective
could already achieve the case management.
target of less than 50% in
2009&2010, and we
would like to sustain and
continue the reduction of
mortality further.
2) Making JE vaccination as a
part of routine immunization.
3) Strengthening the surveillance
activity for early case detection
and prompt treatment.
4) Enhancing the social
mobilization activity through the
Filaria
1) With MDA we are 1) Accurate Line listing of LF for
able to achieve < 1% of home based morbidity
Mf rate for last 4 years, management and surgical
the reduction of Mf rate treatment of Hydrocele cases is
will be maintained planned for 2011-12.
177
further.
2) In East Godavari, Nellore,
Chittore, Mahabubnagar and
Nizamabad districts, 200
Hydrocele cases are planned for
surgery in 2011-12
3) Home based morbidity
management training camps will
be taken up extensively in all
endemic districts.
Disease Situation in the State in Year 2009-2010
Year Malaria Malaria Dengue Dengu Chikungunya AES/ AES/JE Microfilaria

Cases Deaths Cases Deaths cases JE Deaths Positive
Cases cases
2009 25152 3 1190 11 117 56 / 11 / 0 492
35
2010 33218 20 776 3 41 143/7 5/0 374
List of Districts having vector borne diseases as major public health problem.
 Malaria is endemic in (7 No.) districts viz; Srikakulam, Vizianagaram,

Vishakapatnam, East Godavari, Adilabad, Khammam and Prakasham
 Dengue is endemic in (4 No.) districts viz; Warangal, Prakasham, Guntur,
Krishna,
 Chikungunya is endemic in (4 No.) districts viz; Mahaboobnagar,
Adilabad, Khammam, Nizamabad
 AES including JE is endemic in (8 No AES / 3 No JE .) districts viz;
Mahaboobnagar, Medak, Nalgonda, Hyderabad, Rangareddy, Nizambad,
Karimnagar and Warangal .
 Filaria is endemic in (16 No.) districts viz; Srikakulam ,Vizianagaram,
Vishakapatnam, East Godavari, West Godavari, Krishna, Guntur,
Prakasham , Nellore, Chitoor, Mahaboobnagar, Medak, Nalgonda,
RangaReddy, Khammam, Nizambad and Karimnagar
 Kala azar is endemic in --- AP state is declared as Kala azar endemic state
Budget Expenditure Details for 2010-11 (In Lakhs)

Disease Balance Committed Cash Cash assistance State Proposal for
from expenditure assistance from NRHM flexi resources as 2011-12
previous 2009-10 from fund 2010-11 as per
years as on NVBDCP per PIP BE 2010-11
31.03.2010 2010-11 as
per PIP
NVBDCP
a. Domestic
0 0.14 121.9 22 567.8 286.6
Budget Support
b. World Bank
fund for project
states (HR, 28.42 1.35 126.1 0 0 197.204
Mobility, Training
and M&E)
178
Dengue /
0 1 45 0 0 80.04
Chikungunya
JE 0 0 5 0 0 41.55
Filaria 0 0 282 0 1.77 468.3
Decentralized
3.49 0 83 0 0 624. 376
Procurement
c. GFATM fund
0 0 0 0 0 0
for project states
Kala-azar 0 0 0 0 0 0
Kala-azar World
Bank Project 0 0 0 0 0 0
assistance
Total 31.91 2.49 663.00 22.00 569.57 1698. 104
Malaria
a. Goal:
To reduce the Annual Parasitic Incidence 0.327 of 2009 (2010 value of API is
0.35) to 0.31 by 2011-12.
b. Demographic Profile and Infrastructure of the state:
Population of the State: 84161186

Infrastructure Number
Districts 23
World Bank Districts 5
Tribal Districts 10
Entomological Zones 6
CHCs 309
PHCs 1624 (1709*)
HSCs 12092 (12167*)
Villages 48276 (48512*)
FTDs 1655
* Figure includes Urban Units and Sections of Hyderabad
c. State and Zone-wise status of Manpower (sanctioned & vacant)
Regular Posts Sanctioned In Vacant

Position
District Malaria Officer 22 14 8
Assistant Malaria Officer 41 11 30
Medical Officer 3760 3003 757
Lab. Tech. 1980 1420 560
Zonal Office
Zonal Officer (Malaria) 6 5 1
Assistant Director (Ent.) 6 4 2
Others
Sr. Entomologist/Biologist 28 7 21
SUO 258 237 21
d. District Wise Human Resources Details
179
Sl No District DMO (Full Time)
Sanctioned In Place Vacant
1 Srikakulam 1 1 0
2 Vizianagaram 1 0 1
3 Visakhapatnam 1 0 1
4 East Godavari 1 1 0
5 West Godavari 1 0 1
6 Krishna 1 1 0
7 Guntur 1 1 0
8 Prakasham 1 0 1
9 Nellore 1 0 1
10 Chittoor 1 0 1
11 Cuddapah 1 1 0
12 Ananathapur 1 0 1
13 Kurnool 1 0 1
14 Mahboobnagar 1 1 0
15 Medak 1 1 0
16 Nalgonda 1 1 0
17 Hyderabad 0 0 0
18 Rangareddy 1 1 0
19 Nizamabad 1 1 0
20 Adilabad 1 1 0
21 Karimnagar 1 1 0
22 Warangal 1 1 0
23 Khammam 1 1 0
Grand Total 22 14 8
Sl No District Assistant Malaria Officer

1 Srikakulam 1 0 1
6 Krishna 2 1 1
7 Guntur 3 1 2
8 Prakasham 2 0 2
9 Nellore 1 0 1
10 Chittoor 2 0 2
11 Cuddapah 2 0 2
13 Kurnool 2 1 1
15 Medak 1 0 1
16 Nalgonda 1 0 1
17 Hyderabad 0 0 0
18 Rangareddy 2 0 2
19 Nizamabad 1 0 1
20 Adilabad 2 0 2
21 Karimnagar 1 0 1
180
22 Warangal 1 0 1
23 Khammam 2 0 2
Grand Total 41 11 30
Sl. No District Medical Officer

1 Srikakulam 178 118 60
6 Krishna 167 120 47
7 Guntur 161 152 9
8 Prakasham 257 180 77
9 Nellore 188 146 42
10 Chittoor 173 155 18
11 Cuddapah 162 124 38
13 Kurnool 207 156 51
15 Medak 117 113 4
16 Nalgonda 136 129 7
17 Hyderabad 49 49 0
18 Rangareddy 86 77 9
19 Nizamabad 90 77 13
20 Adilabad 166 94 72
21 Karimnagar 166 163 3
22 Warangal 177 170 7
23 Khammam 169 162 7
Sl No District Lab Technician

Sanctioned In Vacant
Place
1 Srikakulam 81 71 10
6 Krishna 69 57 12
7 Guntur 120 65 55
8 Prakasham 75 70 5
9 Nellore 88 26 62
10 Chittoor 109 72 37
11 Cuddapah 75 53 22
13 Kurnool 75 70 5
15 Medak 94 83 11
16 Nalgonda 108 72 36
181
17 Hyderabad 17 1 16
18 Rangareddy 57 42 15
19 Nizamabad 37 10 27
20 Adilabad 77 57 20
22 Warangal 111 60 51
23 Khammam 84 70 14
182
Zonal Officer
Name of the Zonal Sanctioned / In
Vacant
Zone Office(Malaria) Required Place
I Visakhapatnam 1 0 1
II Rajahmundry (E.G.Dist) 1 1 0
III Guntur 1 1 0
IV Kadapa 1 0 1
V Warangal 1 1 0
VI Hyderabad 1 1 0
Total 6 4 2
Asst.Dir (Ent)
Name of the Zonal Sanctioned / In
Vacant
Zone Office(Malaria) Required Place
I Visakhapatnam 1 1 0
II Rajahmundry(E.G.Dist) 1 0 1
III Guntur 1 0 1
IV Kadapa 1 1 0
V Warangal 1 1 0
VI Hyderabad 2 2 0
Total 7 5 2
Sl No District Sr. Entomologist

1 Srikakulam 1 0 1
6 Krishna 1 0 1
7 Guntur 4 1 3
8 Prakasham 0 0 0
9 Nellore 1 0 1
10 Chittoor 1 0 1
11 Cuddapah 0 0 0
13 Kurnool 3 3 0
15 Medak 1 0 1
16 Nalgonda 5 3 2
17 Hyderabad 0 0 0
18 Rangareddy 1 0 1
19 Nizamabad 0 0 0
20 Adilabad 1 0 1
21 Karimnagar 0 0 0
22 Warangal 3 1 2
23 Khammam 1 0 1
183
Sl No District Sub Unit Officer (SUO)
1 Srikakulam 10 9 1
6 Krishna 14 14 0
7 Guntur 16 16 0
8 Prakasham 12 10 2
9 Nellore 11 10 1
10 Chittoor 11 11 0
11 Cuddapah 10 10 0
13 Kurnool 13 13 0
15 Medak 9 9 0
16 Nalgonda 6 6 0
17 Hyderabad 6 6 0
18 Rangareddy 4 4 0
19 Nizamabad 5 4 1
20 Adilabad 14 12 2
22 Warangal 13 11 2
23 Khammam 12 11 1
e. Contractual Staff
Post Number Remarks (Supported by)

Sanctioned/In Position
State Level
Consultants 6/4 World Bank
GIS Operator 1/1 World Bank
Accountant 1/1 World Bank
Secretarial Assistant 1/1 World Bank
Insect Collector 2/1 World Bank
District level
DVBD consultant 5/5 NVBDCP
District level support staff
Data Entry Operator 5/5 World Bank
Financial and logistic assistant 5/5 World Bank
MPW 1053 Financed by State or
NRHM
MPW 55/47 NVBDCP
Lab.Tech. 15/13 World Bank
Malaria Technical Supervisors 30/30 World Bank
Project monitoring unit staff both at
state and district level ( indicate
positions ) Nil
184
f. District Wise WB Supported Contractual Staff Details
DVBD
Consultant DEO FLA MTS MPW LTs
District S P S P S P S P S P S P
Srikakulam 1 1 1 1 1 1 5 5 2 2
Vizianagaram 1 1 1 1 1 1 5 4 28 28 2 2
Visakapatnam 1 1 1 1 1 1 8 8 4 4
East
Godavari 1 1 1 1 1 1 6 6 27 18 4 0
Khammam 1 1 1 1 1 1 6 4 3 2
Total 5 5 5 5 5 5 30 27 55 46 15 10
185
g.Epidemiological Data for Malaria upto December 2010
Persons Examined Tot Positive Pf No. of ABER API Pf% SPR SFR
BSE+RDT deaths
Sl BSE RDT Positive
No District Population positive
1 Srikakulam 2417598 385455 533 385988 1283 1176 3 15.97 0.53 91.66 0.33 0.31
2 Vizianagaram 2192267 355030 250 355280 2351 2131 2 16.21 1.07 90.64 0.66 0.60
3 Visakhapatnam 4489923 812132 4018 816150 12815 9861 11 18.18 2.85 76.95 1.58 1.21
4 East Godavari 4895579 571485 292 571777 2258 2053 0 11.68 0.46 90.92 0.40 0.36
5 West Godavari 4425242 528834 8 528842 402 308 0 11.95 0.09 76.62 0.08 0.06
6 Krishna 4458675 523019 265 523284 2751 176 0 11.74 0.62 6.40 0.53 0.03
7 Guntur 4851712 612572 45 612617 429 24 0 12.63 0.09 5.59 0.07 0.00
8 Prakasham 3282247 433377 1189 434566 1639 700 1 13.24 0.50 42.71 0.38 0.16
9 Nellore 2675895 231411 229 231640 118 61 0 8.66 0.04 51.69 0.05 0.03
10 Chittoor 4258424 399460 8 399468 241 78 0 9.38 0.06 32.37 0.06 0.02
11 Cuddapah 2800395 404559 28 404587 1607 222 0 14.45 0.57 13.81 0.40 0.05
12 Ananathapur 4113814 477369 49 477418 368 161 0 11.61 0.09 43.75 0.08 0.03
13 Kurnool 3990534 448730 0 448730 279 89 0 11.24 0.07 31.90 0.06 0.02
14 Mahboobnagar 3936246 421524 93 421617 239 122 0 10.71 0.06 51.05 0.06 0.03
15 Medak 3029938 217187 43 217230 154 90 0 7.17 0.05 58.44 0.07 0.04
16 Nalgonda 3895019 266593 0 266593 40 5 0 6.84 0.01 12.50 0.02 0.00
17 Hyderabad 4707007 264377 0 264377 274 37 0 5.62 0.06 13.50 0.10 0.01
18 Rangareddy 4266541 185408 9 185417 195 63 0 4.35 0.05 32.31 0.11 0.03
19 Nizamabad 2708997 224357 1 224358 30 13 0 8.28 0.01 43.33 0.01 0.01
20 Adilabad 2955352 224267 185 224452 612 412 0 7.59 0.21 67.32 0.27 0.18
21 Karimnagar 3784302 230480 127 230607 166 87 0 6.09 0.04 52.41 0.07 0.04
22 Warangal 3446552 239617 78 239695 156 114 0 6.95 0.05 73.08 0.07 0.05
23 Khammam 2578927 440966 2951 443917 4811 4731 3 17.21 1.87 98.34 1.09 1.07
AP Total 84161186 8898209 10401 8908610 33218 22714 20 10.59 0.39 68.38 0.37 0.26
186
h.Map showing Prioritized districts for Malaria based on epidemiological situation in 2010
187
I. API wise list of prioritized PHCs, Sub Centres and Villages
Sub Population %
PHCs Villages
S. No. API centre @ Village Population
(No.) (No.)
(No.) (No.) @ villages
1 <1 1158 10689 39739 79057665 93.94
2 1–2 180 567 2255 2240663 2.66
3 2–5 82 342 1719 1067275 1.27
4 5 – 10 68 274 2161 1102427 1.31
5 > 10 55 220 2402 693156 0.82
Total 1543 12092 48276 84161186 100
j.Strategy proposed for 2011-12:
 Strengthening of surveillance further by increasing the ABER by 1% of 2010(11.2 projected value) and sustaining the ABER above
10% across all the high endemic units.
 The Objectives can possibly achieved if the logistics like budget, materials (insecticides, Larvicides, RDT, ACT etc.) are
provided by the 1st week of April 2011. Additional MSWs from local tribal youth to strengthen surveillance with
performance based incentives from April to Nov.
 Asha of the 5 WB districts to be provided with performance incentives for Blood slide collection, Performing RDT and
providing complete treatment for malaria Positives.
 Increase in the capacity building activity related to EDCT by providing training to ASHAs (6000 in 2011-12 as against 4100 could
be trained in 2010) and Medical officers (375, as against 300 in 2010) in 2011-12 especially in 6 high endemic districts.
 The Objectives can possibly achieve if the logistics like budget, are positively approved in PIP of 2011-12 on time.
 Sentinel hospitals of the high risk areas will be made fully functional.
188
k. Planning for Deployment of Drugs, testing kits for epidemic Preparedness for the year 2011-12 (All are in Numbers)
ACT
(Artesu Lancets
Chloroqui Primaqui Primaquine Quinine Quinine Arteether
District nate+S RDK for BS Micro Slides
ne ne 2.5 7.5 Injection Sulphate Inj
P) collection
Blister
Srikakulam 952811.75 3494.4 10203 1680 486 1458 218.7 285335 382038 393308
Vizianagaram 1349833.8 7224 21954 3180 1060 3180 403.875 140991 378824 204100
Visakhapatnam 66,00,000 90081.6 92380.8 14370 5100 15300 715.95 336077 982499 400000
East Godavari 1824799.5 0 638000 5752.5 1917.5 5752.5 862.875 347152 688506 300000
West Godavari 1892100 913.5 5965.75 943.5 304.5 913.5 137.025 19980 528740 119500
Krishna 1662840 0 42880.25 207 35.5 106.5 15.975 250 444431 166000
Guntur 2441542.5 13.5 8426.25 27 4.5 13.5 2.025 1250 668538 654300
Prakasham 0 0 16058 213 71 213 31.95 30218 459119 30217.5
Nellore 457628.75 2016 0 0 8.5 25.5 3.825 0 191119 0
Chittoor 1887603.8 5510.4 4476 80 27 80 9.9 76481 531120 276848.55
Cuddapah 1746746.3 0 48453.6 1119.3 0 309 46.35 2000 486524 200000
Ananathapur 1758786.5 0 12904.8 267 89 267 40.05 36000 474451 208468
Kurnool 1820238.8 11121.6 0 27 0 126 18.9 0 504936 266968.35
Mahboobnagar 1689033.8 0 4375 785 245 736 12.825 0 470169 247724.95
Medak 479697.25 2116.8 102.4 126 33 99 14.85 816 263506 127549.95
Nalgonda 1072071 1612.8 0 43.5 3.5 10.5 1.575 0 302505 0
Hyderabad 1007471.3 57 0 33 19 57 8.55 0 281699 347000
Rangareddy 604027.5 0 0 132 43 129 19.35 0 167686 74300
Nizamabad 894337.5 0 0 0 0.5 1.5 0.225 0 244396 241500
Adilabad 0 11558.4 23465.4 2844 194.5 583.5 87.525 0 198524 105170
Karimnagar 127151.5 0 1896.6 159 0 88.5 13.275 0 252336 35952
Warangal 0 806.4 0 365 0 261 39.15 17427 515846 152670.65
Khammam 1562737.3 0 24607.2 5070 1411 4233 634.95 477352 431859 229057.95
State (25% Buffer) 0 0 0 9549 0 0 0 442832 0 0
25231459 136526.4 956149.05 46972.8 11053 33943.5 3339.675 2214160 9849370 4780635.9
189
l.Planning for Bednet (LLIN) Distribution for the Year 2011-12
Sl. No. District Name Eligible Eligible Eligible Tribal Total Bednet Number of bed nets Required in Total Planned to be
Sub centre villages Population population Required available in the Current distributed in the year
community based on Year as per allocation
household survey
ITNs LLINs
A B C D = A-(B+C) ITNs LLINs
E F
1 Srikakulam 102 544 252549 135467 84466 0 0 84466 0 84466
2 Vizianagaram 145 1455 480450 480450 95350 0 0 95350 0 95350
3 Visahakapatnam 195 3490 600740 600740 230776 0 0 230776 0 230776
4 East Godavari 74 551 329603 329603 142630 80000 0 62630 0 62630
5 West Godavari 66 206 64646 68406 30914 611 0 30303 0 30303
6 Krishna 15 46 164000 0 5000 49500 0 0 0 0
7 Guntur 0 0 0 0 6188 0 0 6188 0 6188
8 Prakasham 29 101 52596 19436 34554 11708 0 22846 0 22846
9 Nellore 18 24 21861 0 8352 0 0 8352 0 8352
10 Chittoor 85 850 450000 0 32000 0 0 32000 0 32000
11 Cuddapah 16 67 30904 0 65643 0 0 65643 0 65643
12 Ananathapur 41 71 48660 0 26864 0 0 26864 0 26864
13 Karimnagar 8 16 32673 0 30000 0 0 30000 0 30000
14 Kurnool 7 18 13304 5203 13304 0 0 13304 0 13304
15 Medak 16 32 0 0 19456 0 0 19456 0 19456
16 Nalgonda 18 46 75800 0 0 0 0 0 0 0
17 MBNR 15 20 52350 10200 20940 0 0 20940 0 20940
18 Hyderabad 0 0 0 0 0 0 0 0 0 0
19 RangaReddy 0 0 0 0 0 0 0 0 0 0
20 Adilabad 111 656 186929 120347 111095 0 0 111095 0 111095
21 Nizambad 0 0 0 0 0 0 0 0 0 0
22 Warangal 27 84 61807 61807 31416 0 0 31416 0 31416
23 Khammam 122 510 230518 161417 169341 0 0 169341 0 169341
Total 1110 8787 3149390 1993076 1158289 141819 0 1060970 0 1060970
Grand Total (with 25% Extra for Buffer at State Level) 1326212.5 1326213
190
m. District-wise Planning for utilization of Insecticides for the year 2011-12
DDT Malathion
Sl no Districts SP 10%(MTS) Technical BTI Pyrethrum
50%(MTS)
(MTS) Temephose (Liters) (MTS) Extract (Liters)
1 Sirkakulam 5.46 0 0.5 0 0.8 200
2 Vizayanagaram 0 0 0.5 0 0.8 200
3 Visakhapatnam 13.56 0 1 1500 2.5 400
4 East godavari 4.78 0 0.5 0 0.8 100
5 West godavari 0 0 0 0 0.5 200
6 Krishna 0 0 0.5 4000 2.5 500
7 Guntur 0 0 0.5 1408 2.5 400
8 Prakasham 0 27.89 0 0 0.5 200
9 Nellore 0 0 0 0 0.5 200
10 Chittore 0 0 0 0 0.5 200
11 Kadapa 0 0.607 0 0 0.5 200
12 Anantapur 0 0 0 0 0.5 200
13 Karnool 0 7.095 0.5 434 1.5 200
14 Adilabad 8.83 0 0 0 1 200
15 Karimnagar 0.33 0 0 0 1 200
16 Warangal 0.27 0 0.5 179 1.5 200
17 Khammam 13.22 0 0.5 329 1 100
18 Mehboobnagar 0 1.64 0 0 0.5 150
19 Medak 0 0.075 0 0 0.5 100
20 Nalgonda 0 0 0 150 1 150
21 Hyderabad 0 13.15 1 5000 2.5 400
22 Rangareddy 0 0 0 0 0.5 150
23 Nizamabad 0 1.15 0 0 0.5 150
State 0 0 0 0 5.6 0
Total 46.45 51.607 6 13000 30 5000
191
n. Planning for Performance Incentives for Ashas for the Year 2011-12
Cost of Preparation of
Cost for Treating RDT Cost for Treating Slide +ve Total
Slide
Districts
Srikakulam 357300 100044 107190 564534
Vijayanagaram 310050 86814 93015 489879
Vishakapatnam 568050 159054 170415 897519
E.Godavari 592650 165942 177795 936387
Kammam 349350 97818 104805 551973
Total: 2177400 609672 653220 3440292
192
2. Dengue and Chikungunya
a. Goal:
Dengue:
Compared to 2006 dengue related mortality, we could already achieve the target of less than 50% in
2009& 2010, and we would like to sustain and continue the reduction of mortality further.
Chikungunya:
50% Reduction of morbidity caused due to Chikungunya
b. Disease Situation:
The District disease situation for Year 2010 may be given district-wise as per following table
Sl. Name of district/ Dengue 2010 Chikungunya 2010

No Corporation Suspected Blood Positive Deaths Suspected Blood Posit Deaths
. cases samples cases cases samples ive
tested tested cases
1 SRIKAKULAM 36 36 0 0 0 0 0 0
2 VIZIANAGARAM 0 0 0 0 0 0 0 0
3 VISAKHAPATNAM 1 1 1 0 0 0 0 0
4 EAST GODAVARI 1 1 3 0 0 0 0 0
5 WEST GODAVARI 26 26 5 0 25 25 1 0
6 KRISHNA 584 584 201 3 0 0 0 0
7 GUNTUR 387 387 133 0 0 0 0 0
8 PRAKASHAM 289 289 100 0 0 0 0 0
9 NELLORE 74 74 41 0 0 0 0 0
10 CHITTOOR 4 4 4 0 0 0 0 0
11 KADAPA 19 19 0 0 0 0 0 0
12 ANANTHAPUR 5 5 5 0 0 0 0 0
13 KURNOOL 1 1 4 0 0 0 0 0
14 ADILABAD 1 1 1 0 10 10 5 0
15 KARIMNAGAR 46 46 15 0 0 0 0 0
16 WARANGAL 270 270 195 0 0 0 0 0
17 KHAMMAM 46 46 12 0 16 16 5 0
18 MB'NAGAR 34 34 5 0 27 27 18 0
19 MEDAK 25 25 6 0 9 9 3 0
20 NALGONDA 14 14 6 0 8 8 2 0
21 HYDERABAD 38 38 19 0 4 0 0 0
22 RANGAREDDY 46 46 16 0 2 2 1 0
23 NIZAMABAD 17 17 4 0 10 10 6 0
Total 1964 1964 776 3 107 107 41 0
193
c. Map showing Prioritized districts for Dengue and Chikungunya based on
Epidemiological situation in 2010
d. Strategy proposed for 2011-12:
 Strengthening of the reporting system from all the sentinel site hospital for taking
up prompt and effective containment measures to interrupt the transmission.
 More sentinel diagnostic centres need to be approved by NVBDCP , in
addition to 10 existing centres to cover 7 uncovered larger districts.
 Strengthening the active surveillance for early detection and referral to functional
sentinel hospital.
 Support for strengthening the sentinel sites from GOI (Training the
sentinel sites MOs and LTs)
 Capacity building of the Human resource of the SS hospital for strengthening the
case management to avert mortality.
3. Acute Encephalitis Syndrome including Japanese Encephalitis
a. Goal:
Compared to 2006 JE related mortality, we could already achieve the target of less than
50% in 2009&2010, and we would like to sustain and continue the reduction of mortality
further.
194
b. Disease Situation:
The number of cases and deaths of the preceding year may be given in the following
table .
Sl. No Name of the No. of AES No. of No. of No. Confirmed

District cases Deaths Sera/CSF for JE
Sample tested
1 Srikakulam 0 0 0 0
2 Vizianagaram 0 0 0 0
3 Visakhapatnam 0 0 0 0
4 East Godavari 1 0 1 0
5 West Godavari 0 0 0 0
6 Krishna 0 0 0 0
7 Guntur 2 0 2 0
8 Prakasam 0 0 0 0
9 Nellore 0 0 0 0
10 Chittoor 0 0 0 0
11 Kadapa 0 0 0 0
12 Ananthapur 1 0 1 0
13 Kurnool 3 0 3 0
14 Mahaboobnagar 15 0 12 0
15 Medak 17 0 15 0
16 Nalgonda 20 0 21 2
17 Hyderabad 28 0 25 0
18 Rangareddy 16 0 12 2
19 Nizamabad 11 4 11 2
20 Adilabad 2 0 2 0
21 Karimnagar 7 1 6 0
22 Warangal 8 0 7 0
23 Khammam 2 0 2 1
24 Out of State's 10 0 10 0
Total: 143 5 130 7
195
c. Map showing Prioritized districts for AES/JE based on epidemiological situation
in 2010
d. Strategy Proposed for 2011-12
 Providing all support to the Sentinel hospitals for effective case management.
 Making JE vaccination as a part of routine immunization.
 Strengthening the surveillance activity for early case detection and prompt
treatment.
 Enhancing the social mobilization activity through the appropriate IEC/BCC.
196
e. Monitoring of functioning of Sentinel surveillance Hospital separately for
Japanese Encephalitis.
Sl. No Name of the Total No. of No. of Reasons for non Suggested solutions
District Sentinel Sites functional functional status
identified
1 Hyderabad 1 1 Not Applicable Not Applicable
2 Warangal 1 1 Not Applicable Not Applicable
3 Kurnool 1 1 Not Applicable Not Applicable
4 Ananthapur 1 1 Not Applicable Not Applicable
5 Guntur 1 1 Not Applicable Not Applicable
Total 5 5
4. Lymphatic Filariasis
a. Goal:
With MDA we are able to achieve < 1% of Mf rate for last 4 years, the
reduction of Mf rate will be maintained further.
b. The status of LF in endemic districts of AP for 2009
SI. Name of Districts Population at Coverage of Microfilaria No. of line No. of line No. of
No. risk eligible rate listed total listed total Hydroce
population Lymphoedema Hydrocele le
under MDA cases cases operatio
ns
1 SRIKAKULAM 2660921 2413664 0.21 3160 483 0
2 VIZIANAGARAM 2398387 2206516 1.39 405 15 0
VISAKHAPATNA
3
M 4373277 4026542 0.06 2451 69 25
4 EAST GODAVARI 5510458 4915329 0.45 15480 128 26
WEST
5 3953014 3513911
GODAVARI 0.21 4796 126 0
6 KRISHNA 4299487 3869538 0.17 0 0 0
7 GUNTUR 4786584 4307928 0.81 3856 37 22
8 PRAKASHAM 3276233 2948614 0 440 13 0
9 NELLORE 2746411 2452153 1.73 3472 1300 45
10 CHITTOOR 4251583 3996488 0.15 2232 249 0
11 MB'NAGAR 3805058 3390625 0.06 649 25 0
12 MEDAK 2692487 2481969 0.29 8445 0 0
13 NALGONDA 3856454 3505867 0.68 140 350 105
14 RANGAREDDY 4113545 3677522 0.02 1208 0 0
15 NIZAMABAD 2579174 2417610 0 1538 0 0
16 KARIMNAGAR 3810463 3390944 0.08 9431 0 0
Total 55303073 50124276 0.45 57703 2795 223
* Note The Activity of Line Listing of LF & Hydrocele Cases and MDA Evaluation for 2010 still continues at the
field level.
197
c. Map showing Prioritized districts for Filaria based on epidemiological situation in
2010
Adilabad
Karimnagar Srikakulam
Nizamabad V’Nagaram
Medak Warangal Visakhapatnam

Khammam
Rangareddy HYD E.Godavari
Nalgonda
W.Godavari
Mahaboobnaga Krishna
r Guntur
Kurnool Prakasam
Filaria Endemic districts

Anantapur Nellore
Kadapa
Chittoor
d. Strategy Proposed for 2011-12

 Accurate Line listing of LF for home based morbidity management and surgical
treatment of Hydrocele cases is planned for 2011-12.
 In East Godavari, Nellore, Chittore 200 Hydrocele cases are planned for surgery
in 2011-12
 Home based morbidity management will be taken up.
e. The requirement of drugs for the districts to be covered under MDA

2011 should be given as per the format indicated below:
Sl Name of District Total Eligible DEC 100 mg. Albendazole 400

No Population Population mg tabs.
(population x (Population
2.5) x 1)
1 SRIKAKULAM 2660921 2352842 5882105 2352842
2 VIZIANAGARAM 2398387 2206516 5516290 2206516
3 VISAKHAPATNAM 4489923 4130725 10326812 4130725
4 EAST GODAVARI 5542482 4943894 12359735 4943894
5 WEST GODAVARI 4425242 3982778 9956945 3982778
198
6 KRISHNA 4452874 4007586 10018965 4007586
7 GUNTUR 4851712 4366544 10916360 4366544
8 PRAKASHAM 3282247 3118135 8205618 3118135
9 NELLORE 2783720 2449675 6124187 2449675
10 CHITTOOR 4186275 3996488 9991220 3996488
11 MB'NAGAR 392068 3448462 8621155 3448462
12 MEDAK 4266541 3839886 9599715 3839886
13 NALGONDA 3029935 2726944 6870360 2726944
14 RANGAREDDY 3895019 3505586 8763965 3505586
15 NIZAMABAD 2708997 2458799 6772493 2458799
16 KARIMNAGAR 3810462 3390944 8477360 3390944
Total 57176805 54925804 138403285 54925804
5. SWOT Analysis of NVBDCP in Andhra Pradesh
SWOT Status Actions to be Taken to match the

requirements
Strengths 1. Known problem. 1. Further studies are required to know
2. Availability of Officers with the Vector dynamics and parasite
adequate Knowledge to face the behaviour.
problem. 2. The present regular officers in
3. Problem is seasonal. different caders may be trained at
national level in transmission dynamics
and control of VBDs for a period of 10
days.
2. Qualified officers are to be recruited
through service commission
3. During the season the ITDAs may
have to be requested to appoint persons
on incentive payment basis for weekly
surveillance, diagnosis and Treatment
Weakness 1. Illiteratacy among the Ashas 1. Refresher training to Ashas at regular
2. Vacancies in basic health intervals of 6 months
functionaries. 2. Sanction of additional man power to
3.Constrains in Finance & meet the vacancy problem of basic
Logistics health functionaries in high risk areas to
4.Vast area of TSP with difficult be met by the project. Similar to Asha
terrain scheme male tribal surveillance teams
5. Congenial ecosystem for for vector borne diseases may be
perennial transmission of Malaria. provided during the transmission
6.Lack of awareness of Vector season.
borne diseases in the community 3. The important components like lab
7. Untimely supply of logistics equipments, reagents, and spray wages
is to be borne by the Project at least
during the project period which will
have impact on the incidence
4.Release of funds for social
mobilization for creating awareness
among the community pertaining to
diseases to be affected in difficult
terrains and congenial ecosystem and
their prevention and control.
199
Opportunities 1. Utilization ASHA‟s for 1.Trainings to all Ashas in the district
surveillance, diagnosis & irrespective of criteria of high risk or
treatment. low risk
2.Funds allotment may be increased for
2. Availability of NRHM funds control of outbreaks and epidemics
for prevention and control of 3.Funds from the project may have to
VBDs3.NGO Partnership large be considered for release for PPP
scale introduction of RDT ACT 4. The Project may consider supply of
LLIN in endemic RDTs to detect both PV. And PF in the
districts4.Possibility of field at least in inaccessible areas
introduction of specific RDT‟s for 5. Involvement of District Collectors,
PV & PF5.Weekly monitoring of P.O., and I.T.D.A.for close monitoring
Epidemiological Situation through and financial support directly from
Special Officers / Programme tribal funds.
Officers.
Threats 1.Unexpected change in climate 1. Sensitization of state level
by administrators and political heads by
global warming the NVBDCP at New Delhi or State
Head quarters
2.Resistance of mosquitoes to
insecticides and parasites to the 2. Imparting training to the dist. Level
drugs and state level officers of the
Programme in forecasting and facing
the climatologically changes, impact
VBDs effectively.
3.Regular Field level studies to detect

the resistance is the present day need for
which arrangements are to be made by
the national body .Vector sensitivity
and parasite sensitivity study may be
carried out by establishing field stations.
10.Out Come Analysis of PIP of 2010-11
Financial (Rs in Lakhs) Physical

2010-11 (As on
2009-10 31.12.2010) 2009-10 2010-11
Amt. Expected Expected
Activity approved Expd. Amt. approved Expd. Output Achievements Output Achievements
Malaria 293.76 252.32 248 148.55 88,79,304 9189256 8945542 8945542

Filaria 293 293 282 277.29 196208 255485 215870 220387
1190 /
*Dengue/Chikungunya 55.5 70.88 45 0 313 / 5 1190 / 117 117 776 / 41
J.E 10 6.63 5 2.99 16 34 34 6
Cash assistance for
decentralized
commodities 470.3 466.8 83 0 - - - -
*Commodity support by
GOI 1165.81 1165.81 689.32 817.79 - - - -
11.Policy and Systemic Reforms In Strategic Areas
Sl. No Strategic Areas Issues that need to be addressed

1 Human Resources All the Key posts in the Department are being filled
200
Wherever the filling is not possible the staff are redeployed
from silent areas to the high risk areas at the time of need
Most of the posts sanctioned under project on outsourcing /

contract basis are filled up, trained and positioned on work.
For remaining filling up is under process.
2 Accountability and From time to time the performance of Individuals at different
performance appraisal levels is being evaluated by conducting weekly, monthly
reviews starting from PHC level to the state level.
Basing on the performance gap need of training is identified

and the persons are trained in the identified fileld to improve
there performance.
Particularly in the Village level ASHAs are being paid

performance based incentives. MPWs are given commendation
certificates for best performance
Punitive measures are also implemented to punish the chronic

defaulters
3 Policies on drugs, Required insecticides, Larvicides and Drugs if any are being
procurement system and procured through a state level Government procurement
Logistics managements agency i.e., APHHMIDC.
The items are supplied in time to the fieid for utilization to the
patients.
4. Equipments Regular assessments of essential funcitional equipments needs
are being done before commencement of transmission season
wel in advance.
Timely indent is placed to the GOI, APHHMIDC for supply of

the required equipments. Due attention is given for repairs of
the available equipment
5. Diagnostics Sentinel Hospital are identified for diagnosis of Dengune /
Chikgunyana and JE in entire state. A list has been forwarded
to the Director NVBDCP for supply of Test kits as per
requirement.
6 Private Public Efforts are being made to involve the NGOs and other service
Partnership organization in to the programme. A state consultant has been
appointed for this specific purpose. Proposal for release of
Budget under PPP during 2011-12 is also putup.
7 Capacity building Trainings are planned and being implemented for all categories
like ASHAs, Lab Technicians , MPWs, MPHS, SUOs and
others involved in the programme
12. Conditionalities
Mandatory
1. As per the Mandate regular and detected district programme officers posted in all the
districts
2. All the contractual positions under NVBDCP are being filled 100%
201
3. The grant in Aid under NVBDCP from State Health Society to the district society will
be released with in 30 days after receipt of Grant – Aid from GOI.
Desirable:
1. The Annual Blood Examination will be maintained more than 10% of the Population
under Surveillance. Both state and district.
2. Minimum of the 30% of the Pf cases will be detected through Raid Diagnostic Test in
endemic areas.
3. The coverage under Indoor Residual Spray will be achieved more than 80% of the
targeted population projected in PIP.
4. More than 80% of the allotted SSH for Dengue, Chikungunya and JE will made
functional.
NVBDCP Andhra Pradesh

Abstract of Budget Requirement in PIP 2011-12 for VBDs
DBS / External NRHM

NRHM Assistance Additionality State G.Total
1801.04 197.20 1130.35 1179.74 4308.33
202
Districtwise Budget Requirement and Allocation for 2011-12 (In lakhs) Under NRHM Additionality
Malaria Other VBDs Others
Sl no Name of the district (To meet asha Procurement of Bed
RDT for Non
Dengue and AMC of Computer and Total
NGO/PPP Incentives in Non Net / LLIN for Non chikungunya Cost of Internet + GIS
Project Area
Project areas Project Area (Operational Cost) Software
1 2 3 4 5 6 7 8 9
1 Sirkakulam 4 0.06 0 0.00 0 1 5.06
2 Vizayanagaram 4 0.11 0 0.00 0 1 5.11
3 Visakhapatnam 7.58 0.62 0 0.00 0 1 9.20
4 East godavari 4 0.11 0 0.00 0 1 5.11
5 West godavari 0 0.02 45.0 2.39 0 1 48.41
6 Krishna 3 0.13 0.0 0.03 1.5 1 5.66
7 Guntur 3 0.02 9.6 0.15 1.5 1 15.27
8 Prakasham 3 0.08 50.0 3.60 1.5 1 59.18
9 Nellore 0 0.01 15.1 0.00 0 1 16.11
10 Chittore 0 0.01 78.1 9.17 0 1 88.28
11 Kadapa 0 0.08 100.9 0.24 0 1 102.22
12 Anantapur 0 0.02 65.1 4.32 0 1 70.44
13 Karnool 0 0.01 20.9 0.00 0 1 21.91
14 Adilabad 5 0.01 33.3 0.00 0 1 39.33
15 Karimnagar 0 0.01 45.0 0.00 1 1 47.01
16 Warangal 0 0.00 80.0 2.04 1.5 1 84.54
17 Khammam 6 0.01 0.0 0.00 0 1 7.01
18 Mehboobnagar 0 0.01 50.8 0.00 0.5 1 52.31
19 Medak 0 0.00 39.2 0.10 0 1 40.28
20 Nalgonda 0 0.03 0.0 0.00 0 1 1.03
21 Hyderabad 0 0.01 0.0 0.00 0 1 1.01
22 Rangareddy 0 0.01 0.0 0.00 0 1 1.01
23 Nizamabad 0 0.23 0.0 0.00 0 1 1.23
ZMO units(6) 0 0 0.0 0.00 0 0 0.00
State 0 0 345.0 51.64 0 7 403.64
Total 39.58 1.59 978.00 73.68 7.50 30.00 1130.35
203
Malaria Other VBDs World bank
Incentive
for Total Alloca
ASHAs Total Budget from
for Epidemic domestic Total from NRH
Sl Name of the Contractual identified Preparedness Dengue and Kala- Decentralized support Human mobility (WB+GFATM) NVBDCP Flex
no district MPWs districts IEC Training and M&E chikungunya AES/JE ELF azar commodities (3-12) Resources(*) Trainnig support (14-20) (13+21) Fun
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 21 22 23
1 Sirkakulam 7.2 5.65 5 0 3 1.5 0.75 24.79 0 30.2241 78.11 13.94 10.8 4 28.74 106.848 5.1
2 Vizayanagaram 7.2 4.90 3.75 0 3 1.5 0.75 27.54 0 31.2659 79.90 13.94 7.8 4 25.74 105.644 5.1
3 Visakhapatnam 20.16 8.98 6.5 0 3 1.5 1.6 31.09 0 96.8928 169.72 17.9 11.8 4 33.7 203.417 9.2
4 East godavari 19.44 9.36 1 0 3 1.5 0.75 35.79 0 51.9462 122.79 15.26 8.06 4 27.32 150.109 5.1
5 West godavari 0 0.00 1 4.55 0 2.5 0 31.49 0 40.7546 80.29 0 0 0 0 80.2946 48.
6 Krishna 0 0.00 0.96 4.34 2 6.54 0.75 28.99 0 92.5104 136.09 0 0 0 0 136.09 5.7
7 Guntur 0 0.00 0.5 5.5 2 6 1.65 29.89 0 73.8972 119.44 0 0 0 0 119.437 15.
8 Prakasham 0 0.00 1 6 0 4.25 0 26.09 0 27.3521 64.69 0 0 0 0 64.6921 59.
9 Nellore 0 0.00 0.5 4.29 0 2.5 0 26.29 0 25.5418 59.12 0 0 0 0 59.1218 16.
10 Chittore 0 0.00 0.5 4.75 0 2 0 30.99 0 30.9044 69.14 0 0 0 0 69.1444 88.
11 Kadapa 0 0.00 1.5 4.1 2 2 0 0 0 15.5592 25.16 0 0 0 0 25.1592 102
12 Anantapur 0 0.00 1.5 5 0 2 0.45 0 0 15.4511 24.40 0 0 0 0 24.4011 70.
13 Karnool 0 0.00 0.5 5.3 0 2 2.4 0 0 29.4246 39.62 0 0 0 0 39.6246 21.
14 Adilabad 0 0.00 3.5 7.9 2 3.25 1.75 0 0 13.4525 31.85 0 0 0 0 31.8525 39.
15 Karimnagar 0 0.00 0.5 2.7 0 3.75 2.25 24.59 0 28.5067 62.30 0 0 0 0 62.2967 47.
16 Warangal 0 0.00 1.5 4.75 0 6.25 2.9 0 0 19.9102 35.31 0 0 0 0 35.3102 84.
17 Khammam 7.2 5.52 5 0 3 1.75 2.25 0 0 25.7735 50.49 15.26 9.74 4 29 79.4924 7.0
18 Mehboobnagar 0 0 0.5 4.5 0 3.25 2 23.59 0 31.1844 65.02 0 0 0 0 65.0244 52.
19 Medak 0 0 0.5 2.89 0 2.25 1.75 24.89 0 26.6361 58.92 0 0 0 0 58.9161 40.
20 Nalgonda 0 0 0.5 2.5 0 2.25 1.75 30.09 0 32.9032 69.99 0 0 0 0 69.9932 1.0
21 Hyderabad 0 0 1 4.97 0 5 4 0 0 66.6851 81.66 0 0 0 0 81.6551 1.0
22 Rangareddy 0 0 0.5 5.37 0 2.25 2.75 29.44 0 28.3689 68.68 0 0 0 0 68.6789 1.0
23 Nizamabad 0 0 0.5 5.4 0 2.75 3.5 26.79 0 24.7381 63.68 0 0 0 0 63.6781 1.2
ZMO units(6) 0 0 0 0 0 0 0 0 0.00 0 0 14.4 14.4 14.4 0.0
State 0 0 25 20 0 11.5 10.55 16 0 61.6 144.65 33.31 0 5 38.31 182.959 403
Total 61.200 34.403 63.210 104.810 23.000 80.040 44.550 468.340 0.00 921.483 1801.04 109.60 48.20 39.40 197.20 1998.24 1130
1. In Human Resource under WB, 10% increase per year for contractual staff has been taken into consideration for calculation 2. The Colum number 17 to 20 which are not
applicable are placed in hide
204
Annexure-I
13. Financial Proposal for Vector Borne Diseases
Component (Sub- Component) Financial To be placed in

requirement functional head as
(in lakhs.) per NRHM
Malaria
Domestic Budget Support (DBS)
MPW 61.20 Human Resource
ASHA Honorarium 34.40 Honorarium and
Incentive
Monitoring , Evaluation & Supervision & Epidemic 23.00 Operating Cost
Preparedness including mobility
IEC/BCC 63.21 IEC & BCC
Training / Capacity Building 104.81 Training
Subtotal Malaria DBS 286.62
Additional support under World Bank States
Human Resource 109.60 Human Resource
Training /Capacity building 48.20 Training
Mobility support for Monitoring Supervision & Evaluation & 39.40 Operating Cost
review meetings, Reporting format( for printing formats)
Subtotal Malaria WB Project 197.20
Total for malaria (DBS+EAC) 483.82
Total financial requirement as per NRHM functional heads
Human Resource 170.80
Honorarium and Incentive 34.40
Operating cost 62.40
IEC/BCC 63.21
PPP/NGO 0
Training 153.01
Procurement
Infrastructure
Total Malaria (DBS + EAC) 483.82
Activities for Dengue & Chikungunya
Strengthening surveillance (As per GOI approval) Financial aid/grant
Apex Referral Labs recurrent @ Rs.1.00 lakh per lab. 1.00 to institutions
Sentinel surveillance Hospital recurrent @ Rs. 0.50 lakhs 11.50
per lab.
Test kits (Nos.) to be supplied by GoI (kindly indicate numbers 0 GOI Supply
of ELISA based NS1 kit and Mac ELISA Kits required
separately)
Monitoring/Supervision and Rapid Response 2.00 Operating cost
Epidemic Preparedness 8.50 Operating cost
IEC/BCC/Social Mobilization 51.54 IEC
Training/Workshop 5.50 Training
Total (Dengue and Chikungunya) 80.04
Human Resource 0
Honorarium and Incentive 0
IEC/BCC 51.54
205
PPP/NGO 0
Training 5.50
Procurement 0
Infrastructure
Financial aid/grant to institutions 12.50
Total Dengue/Chikungunya (Headwise) 80.04
Activities for AES/JE
Sentinel Sites which will include diagnostics and management as 4.00 Procurement
well as supply of Elisa kits
IEC/BCC specific to J.E. in endemic areas 27.00 IEC
Training specific for J.E. prevention and management 7.55 Training
Monitoring 3.00 Operating cost
Procurement of insecticides (Technical Malathion) 3.00 Procurement
Total AES/JE 44.55
Procurement 7.00
IEC 27.00
Training 7.55
Operating cost 3.00
Total AES/JE (Headwise) 44.55
Activities for ELF
State level meeting viz. State Task Force meeting, State 1.00 Operating Cost
Technical Advisory Committee (TAC) meeting
Training/sensitization of district level officers on ELF 16.00 Training
IEC/BCC for ELF at state level 15.00 IEC
Printing of forms for line listing, MDA reports & registers for 16.00 Operating Cost
drug distributors etc.
Mobility support for M&E 8.00 Operating Cost
Dist. Coordination committee meeting in each district 4.00 Operating Cost
Sensitization of Media and other voluntary organizations 4.00 Operating Cost
IEC/BCC for ELF at district level, CHC, PHC, Sub-centre, 27.75 IEC
Village including VHSC/GKS for community mobilization
efforts to realize the desired drug compliance of 85% during
MDA
Capacity building of peripheral health workers and drug 139.00 Training
distributors for MDA
Demonstration of home based morbidity management for 18.00 Operating Cost
lymphoedema cases
Hydrocelectomy for lymphoedema cases 6.10 Operating Cost
Microfilaria survey in the night in identified sentinel and random 8.00 Operating Cost
villages and wards in urban areas before MDA in each filaria
endemic districts
Honorarium to drug distributors including ASHA involved in 177.00 Honorarium &
MDA Incentives
Honorarium to supervisor to Drug distributors 18.05 Honorarium &
incentives
Monitoring and supervision by district, block, PHC and health 9.00 Operating Cost
supervisors including mobility support and support for rapid
response team
Post MDA assessment by medical colleges (Govt. & private)/ 1.44 Operating Cost
ICMR institutions.
206
Total filaria elimination (Headwise) 468.34
Sub Total Filaria elimination 468.34
Operating Cost 75.54
Training 155.00
IEC 42.75
Honorarium & Incentives 195.05
Total filaria elimination (Headwise) 468.34
Commodities (Cash Grant form GOI )

Drugs
Chloroquine phosphate tablets 124.143 Procurement
Primaquine tablets 5.081 Procurement
Quinine sulphate tablets 0.509 Procurement
Quinine Injections 2.900 Procurement
DEC 100 mg (1200 lakhs) 300.000 Procurement
Insecticides
DDT 50% wdp (51.6 MTs ) 0.000 Supplied by GOI
Synthetic Pyrethroid 10% WP - for WB Dist (46.43 MTs ) 0.000 Supplied by GOI
Malathion 25% wdp (600 MTs) 0.000 State Resources
UMS – Larvicides
Temephos (13000 liters) 83.850 Procurement
Bti (WP/AS) (15 MTs Bti WP , 1500 liters Bti AS ) 330.000 Procurement
Pyrethrum extract 2% (5000 liters) 75.000 Procurement
Subtotal for Decentralised commodities 921.483
Cash assistance from GOI for Malaria , Dengue chikungunya, 1076.75

AES/JE and filaria
Cash assistance from GOI for Decentralized commodities 921.483
Grand Total Cash assistance 1998.233
Total financial requirement under DBS as per NRHM

functional heads
Honorarium and Incentive 229.450
IEC/BCC 184.500
PPP/NGO 0.000
Training 272.860
Procurement 928.483
Total (DBS ) 1801.033
Total financial requirement under EAC as per NRHM

functional heads
Training 48.20
Total ( EAC) 197.20
Grand total (DBS+EAS) 1998.23
207
NRHM Flexibility
Asha Incentives 1.59 Incentives for non
project areas
AMC, Computer, GIS 30 operational cost
(NRHM)
Dengue chikungunya (spray, transportation and OIL for spray) 7.5 operational cost
(NRHM)
PPP / NGO activities 39.58 PPP/NGO
Procurement of Bednet / LLIN (LLIN: Total requirment for 978 Procurement
18 districts is 13 lakh nets . 10 lakhs nets expected from GOI
for project districts . Hence 3.26 lakhs nets proposed)
RDT Malaria (For Non Project Areas)- Out of total 73.68 Procurement
requirment of 22.14 lakhs RDTs, 15.86 lakhs is expected from
GOI , Hence 6.27 lakhs @ 12.Rs per test is projected )
NRHM Flexibility 1130.35
Total (WB+DBS+Decentralised commodity + NRHM Flexi) 3128.58
Total Functional head-wise breakup (NVBDCP)

Training 321.06
Infrastructure 0
Procurement 928.48
IEC 184.50
Untied funds 1130.35
Honorarium & incentives 229.45
RKS 0
Other Mission 0
PPP/NGO (asked NRHM untied fund ) 0
Operating Cost 151.44
Grand Total 3128.58
State Fund
Component (Sub- Component) Financial To be placed in
requirement functional head as per
(in lakhs.) NRHM
Wages for IRS 314.606 operational cost
Maintainance of hatcharies (@ Rs 50,00 per district, and one 12 operational cost
at the state level)
Malathion 25% WDP( 594 MT @70000 per MT) 416.198 Procurement
Knap sack sprayer (130 sprayer @2000Rs per sprayer ) 2.78 Procurement
Hand fogging (80 machines @50000Rs per machine) 40 Procurement
Vehicle mounted (3 machines @ 10 lakh per machine) 30 Procurement
Medium fogging (8 machines @5.5 lakh per machine) 44 Procurement
Power Spray (15 machines @6930 Rs per spray) 1.04 Procurement
Stir Pump (1120 @2470 Rs per pump) 42.98 Procurement
Slide box (10 capacity slide box per ASHA costing 15 Rs each, 16.22 Procurement
25 capacity slide box per MPW cost 22 Rs each ,total MPWs
25993 and Ashas 70252))
Lab Reagent ( 1860 labs , @10000 per lab) 186 Procurement
208
Slides (4780636 slides @0.52 Rs per slide) 24.77 Procurement
Lancets (9849370 lancets @ 0.5 Rs per lancet) 49.15 Procurement
Subtotal (State fund) 1179.744
Total financial requirement from state fund as per functional

head
Human Resource 0
Honorarium and Incentive 0
IEC/BCC 0
PPP/NGO 0
NRHM additionalities 0
Training 0
Procurement 853.138
Infrastructure 0
Total VBD budger for state fund 1179.744
GRANDTOTAL BUDGET FOR VBD FOR ANDHRA 4308.33

PRADESH (Including DBS, ECS , NRHM and State fund)
In-kind Contribution
Items Quantity
ACT (For5 Project districts) Adequate
Quanatity of
Act available
for the year
2011-12
RDT (For5 Project districts) 15.86 lakh
tests
LLIN (For5 Project districts) 10 lakh nets
DDT 50% wdp Adequate
Quantity
available
Synthetic Pyrethroid - for WB Dist 46.27 MTs
Arteether 3340
injections
Albendazole (Tablets) 54925804
Proposal for Epidemic Preparedness:
Andhra Pradesh State though is able to keep the API of Malaria lower than 1 %
for last few years there are sporadic outbreaks observed through out the year in different
parts of the states specifically tribal areas located in Eastern Ghats. To deal with such
incidence, specific budget (Epidemic preparedness) has been allocated for high endemic
districts. However it is essential that in the situation of emergency, provision should be
made under the NRHM flexi fund to provide immediate budgetary allocation to specific
districts in case any vector borne disease related outbreaks or epidemic occurs.
209
D.2 REVISED NATIONAL TB CONTROL PROGRAM
282. The Revised National TB Control Programme (RNTCP), based on the

internationally recommended Directly Observed Treatment Short-course (DOTS)
strategy, was launched in India in the year 1997 expanded across the country in a phased
manner with support from the World Bank and other development partners. The entire
state of Andhra Pradesh is covered under RNTCP since February, 2004. Presently the
state has 178 TB Units (One each for five lakh population) and 919 Designated
Microscopy Centers (one each for one lakh population). The state under RNTCP is
providing the following services,
 Diagnostic and treatment services for the control of TB ,which is not drug
resistant.
 Multi TB drug resistant (MDR TB ) diagnostic and treatment services in eight
districts, and the entire state to be covered by the end of 2011.
 Co-trimoxozole preventive therapy and linking up of TB/HIV co-infected
patients to the ART center.
 Operational research activities support for the medical colleges on priority areas.
Key Objectives:
The objectives of the programme are to:

 Detection of at least 90% of all incident TB cases
 Successfully treat at least 90% of New Smear Positive cases
Situational Analysis, Critical gaps Identification:
SN Priority areas Activity planned under each priority area

1 To Improve Case Detection 1 Strengthen the involvement of other public sector
among all types of TB hospitals like military hospitals, coal hospitals etc.
patients 2 Involvement of PPs through IMA
3 Strengthen the TB HIV coordination and implement
“Intensive case finding” across the state
2 To Improve Quality of 1 Vacant posts be filled at all levels including contractual
DOTS posts and ensure supervision and monitoring
2 To involve General Health staffs effectively in
implementing RNTCP
3 Involvement of Community volunteers
4 Involve all ASHAs across the state in DOT Provision
3 To Improve Supervision and 1 Implement Supervision & Monitoring Strategy To
monitoring at all levels implement supervisory registers in all PHIs
2 Regular monthly review of key staff at District level
3 Regular Internal Evaluation from State Level.
4 Bi annual DM&HO review meeting to enhance the
involvement
4 Regular Training/Re- 1 Training of all untrained staffs
training/Sensitization 2 Retraining of low performing key staffs at the state level
3 Regular sensitization of General health staffs and Private
practitioners
210
5 EQA implementation in all1 Regular Monitoring by STDC and prompt feedback
the districts 2 On site evaluation of all the districts of AP by IRL
3 Analysis of Annexures submitted by the DMCs, identify
constraints on the priority areas and seek implementation of
the recommendations on a quarterly basis.
6 Implementation DOTS Plus 1 Accreditation of laboratory at Kurnool medical college
in all districts and 2nd lab at IRL
2 Training of all staff under DOTS Plus and
implementation of DOTS Plus
3 Prompt air borne infection Control in DOTS Plus site
7 TB-HIV Collaborative 1 Strengthen intensified case finding at ICTCs, Care &
activities Support centres and ART centres.
2 Expand Co-trimoxazole, Prophylaxis therapy for HIV-TB
patients in all the districts
3 Strengthen the linkage between TBHIV patients with CPT
and ART linkage
Key Strategies of the Program:
PURSUE HIGH-QUALITY DOTS EXPANSION AND ENHANCEMENT

 Secure political commitment, with adequate and sustained financing
 Ensure early case detection, and diagnosis through quality-assured
bacteriology
 Provide standardized treatment with supervision, and patient support
 Ensure effective drug supply and management
 Monitor and evaluate performance and impact
ADDRESS TB/HIV, MDR-TB, AND THE NEEDS OF POOR AND
VULNERABLE POPULATIONS
 Scale–up collaborative TB/HIV activities
 Scale-up prevention and management of multidrug-resistant TB (MDR-TB)
 Address the needs of TB contacts, and poor and vulnerable populations
CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING BASED ON
PRIMARY HEALTH CARE
 Help improve health policies, human resources development, financing,
supplies, service delivery and information
 Strengthen infection control in health services, other congregate settings and
households
 Upgrade laboratory networks, and implement the Practical Approach to Lung
Health (PAL)
 Adapt successful approaches from other fields and sectors, and foster action
on the social determinants of health
ENGAGE ALL CARE PROVIDERS
 Involve all public, voluntary, corporate and private providers through Public-
Private Mix (PPM) approaches
 Promote use of the International Standards for Tuberculosis Care (ISTC)
EMPOWER PEOPLE WITH TB, AND COMMUNITIES THROUGH
PARTNERSHIP
 Pursue advocacy, communication and social mobilization
 Foster community participation in TB care, prevention and health promotion
 Promote use of the Patients' Charter for Tuberculosis Care
211
ENABLE AND PROMOTE RESEARCH
 Conduct programme-based operational research
 Advocate for and participate in research to develop new diagnostics, drugs
and vaccines
Programme Components:
283. Political and Administrative Commitment: The Government of India has given
TB control programme top priority. The government‟s continuous financial
commitment, human resources and administrative support speak of its commitment to
control and eliminate TB and the success of the programme, to date, bears testimony to
this commitment.
284. Good Quality Diagnosis through sputum Microscopy: Sputum microscopy

continues to be the primary tool for detection of infectious cases. Apart from sputum
microscopy, RNTCP also uses standardised diagnostic algorithms to diagnose and treat
all forms of TB wherein X-ray plays a supporting role. However in line with the stop TB
strategy the programme is exploring all possible avenues with newer and innovative
technologies for early detection of TB including use of LED fluorescent microscopes,
liquid culture and line probe assay for diagnosis drug resistant TB etc.
285. Uninterrupted supply of Good Quality Drugs: RNTCP uses intermittent short-
course chemotherapy (SCC) regimens to facilitate the direct observation of treatment.
RNTCP ensures that there is no interruption in treatment due to shortage of drugs, once
a person is diagnosed with TB. Suffi cient anti-TB drugs in patient wise boxes are made
available at all the appropriate levels (Peripheral Health Institution/TB
unit/District/State/National). The uninterrupted supply of drugs to each patient is made
possible through the “patientwise box.”
286. Directly observed treatment: Directly observed treatment (DOT) is one of the key
elements of the DOTS strategy. In DOT, an observer (health worker or trained
community volunteer who is not a family member) watches and supports the patient in
taking drugs. The DOT provider ensures that the patient takes the right drugs, in the
right doses, at the right intervals, for the right duration.
287. Systematic Monitoring and Accountability: :RNTCP has a systematic monitoring

mechanism which accounts for/tracks the outcome of every patient put on treatment.
There is a standardised recording and reporting structure in place. The cure rate and
other key indicators are monitored regularly at every level of the health system and
regular supervision ensures quality of the programme. RNTCP shifts the responsibility
for cure from the patient to the health system.
Implementation Methodology:
288. Structure Of The Revised National Tuberculosis Control Programme: The

RNTCP has a central division, state, district and sub-district levels and health units. As
noted above, a major organizational change is the creation of a sub-district level.
Creation of a sub-district level allows for the systematic monitoring of the outcome of
every patient. An additional structure of the RNTCP is the District Tuberculosis Control
Society. This society functions with the District Collector as the Chairman, the District
212
Tuberculosis Officer (DTO) as Member Secretary, and has governmental and non-
governmental representatives. It is responsible for monitoring the programme
implementation, arranging necessary logistics such as transport and procuring materials
such as laboratory consumables.
289. State level : At this level, a State Tuberculosis Officer (STO) is responsible for
planning, training, supervising and monitoring the programme in the state. He is
responsible administratively to the State Director of Health Services and technically
follows instructions of the Central TB Division. There should be a full-time STO trained
in the RNTCP for each state.
Main responsibilities at the state level are to:

 work closely with the Central TB Division for performing the duties mentioned
above;
 plan, supervise, monitor and evaluate anti-tuberculosis activities throughout the
state;
 ensure adequate supply of drugs, laboratory equipment and documents needed in
the state;
 organize training programmes in the state in collaboration with the Central TB
Division, the State TB Training and Demonstration Centre (STDC) and the
District Chief Medical Officers, and to give on-the-job training to the district and
peripheral workers;
213
 ensure that the required reports on case-finding, results of treatment and
programme management are completed in each district and sent to the Central
TB Division in time;
 review the reports on case-finding, results of treatment and programme
management from the districts and take necessary action for their improvement;
and ensure close cooperation between the staff in case-finding and treatment of
tuberculosis and the microscopy services.
290. District level: The district is the key level for the management of primary health
care. The district level (or municipal corporation level in large metropolitan areas)
performs functions similar to those of the state level in its area. The District Medical
Health Officer or his equivalent is the principal health functionary in the district and is
responsible for all medical and public health activities including control of TB. The
District Tuberculosis Centre (DTC) is the nodal point for TB control activities in the
district and also functions as a specialized referral centre. The DTO at the DTC has the
overall responsibility of the Programme at the district level and is assisted by an MO,
Statistical Assistant and other paramedical staff. For each district, there should be a full-
time DTO who is trained in the RNTCP.
Main responsibilities at the district level are to:

 implement the RNTCP through the district health staff;
 maintain a map of the area detailing all health facilities, government
organizations and NGOs which specifically carry out TB activities, including the
staff responsible for these activities (name, position and location);
 train and re-train the medical and paramedical staff;
 maintain a regular supply of drugs, treatment-related materials, sputum
containers and slides, laboratory-related materials, forms and registers for the
district;
 supervise and ensure proper treatment of tuberculosis throughout the district, and
particularly ensure that:
o the correct treatment is prescribed in all health facilities
o patients are receiving the appropriate drugs under direct observation of
health workers during the intensive phase of treatment and at least one
dose per week in the continuation phase is directly observed
o regimens are given for the required period, and cured patients are
discharged from treatment
o sputum is examined for acid-fast bacilli (AFB) at the stipulated time
intervals
o patients are individually advised about their disease
o patients are referred or transferred as appropriate
o treatment outcomes of patients are determined and recorded in the
Tuberculosis Register;
 organize health education and establish liaison with private practitioners and
NGOs who provide TB services to promote compliance with national norms and
facilitate referral;
 assist staff in the diagnosis of TB in all health facilities in the district;
 ensure that the sub-district staff visit all microscopy centres for supervision at least
once a month;
214
 make sure, by reviewing quarterly reports and randomly spot-checking, that MOs
and health workers properly identify symptomatic patients, collect and transport
sputum specimens and refer patients for diagnosis;
 visit all sub-district Tuberculosis Units, hospitals, Community Health Centres
(CHCs) and Block Primary Health Centres (Block PHCs) at least once a quarter;
and complete quarterly reports on notified New and retreatment cases of
tuberculosis, sputum conversion and on the results of treatment.
291. Sub-district level: A team comprising a specifically designated MO-TC, STLS and
STS is based in a CHC or Taluk Hospital (TH) or Block PHC. The team constitutes the
TU, and the STS and STLS are under the administrative supervision of the DTO. The
staff from the DTC (laboratory technician and treatment organizer) will carry out the
functions of the sub-district supervisory team in its respective sub-district in addition to
their functions as a microscopy and treatment centre. The sub-district covers a
population of approximately 5,00,000. The sub-district is reponsible for accurate
maintenance of the Tuberculosis Register and timely submission of quarterly reports.
Functions of the TU are to:

 maintain a map of the area detailing all health facilities, and government
organizations and NGOs which specifically carry out TB activities, including the
staff responsible for these activities (name, position and location);
 maintain a regular supply of drugs and other logistics and ensure their
uninterrupted availability in all designated centres in the sub-district. Retrieve
unfinished medicine boxes of patients who have defaulted (i.e. stopped treatment
for two months or more continuously);
 establish liaison with private practitioners and NGOs providing TB services to
promote compliance with national norms, facilitate referral and ensure
registration and notification;
 organize sputum smear examination at the microscopy centres of the
 sub-district;
 carry out categorization of treatment services and DOT;
 organize regular training and continuing education;
 supervise the microscopy centres and PHCs at least once a month, and
 perform quality control of slides as per the Laboratory Manual;
 prepare and distribute reagents, and ensure regular and sufficient
 supply of reagents and sputum containers in each health facility;
 keep the Tuberculosis Register up-to-date and accurate;
 prepare quarterly reports on case detection, sputum conversion, treatment
outcome and programme management;
 make sure MOs and health workers correctly identify symptomatic patients and
refer patients for diagnosis;
 diagnose smear-negative patients who require X-ray examination (if facilities
exist);
 act as a referral point, for example, for patients who:
o present diagnostic problems
o have drug reactions
o refuse to take drugs
o are failure cases requiring further investigation
215
o do not convert to smear-negative status at the end of the intensive phase
and identify the reasons for the same
o require evaluation of treatment outcome, i.e. cured, treatment completed,
defaulted, died, transferred out, failure; and
 Monitor the maintenance of the Laboratory Register and the documentation
related to microscopy examinations.
Health units: At this level are the rural and other hospitals, health centres, dispensaries
and health facilities within a district.
Main responsibilities at the health units are to:

 send tuberculosis suspects or their sputum specimens to designated microscopy
centres for examination;
 carry out categorization of treatment services and DOT;
 trace patients who do not collect their drugs and bring them back under
treatment;
 keep Tuberculosis Treatment Cards and records and make them available for the
STLS, STS, MO-TC, DTO and other supervisory staff when they visit the health
unit;
 facilitate follow-up sputum smear examinations;
 trace and investigate contacts; and
 discharge patients who have come to the end of their treatment regimen in
coordination with the designated MO-TC of the sub-district
Monitoring & Reporting System:
216
Risk Analysis
o TB primarily affects people in their most productive years of life with important
socio-economic consequences for the household and the disease is even more
common among the poorest and marginalized sections of the community.
o 70% of TB patients are aged between the ages of 15 and 54 years of age. While
two thirds of the cases are male, TB takes a disproportionately larger toll among
young females, with more than 50% of female cases occurring before 34 years of
age.
o The direct and indirect cost of TB to India amounts to an estimated $23.7 billion
annually. Studies suggest that on an average 3 to 4 months of work time is lost as
result of TB, resulting in an average lost potential earning of 20-30% of the annual
household income.
o Tuberculosis is one of the earliest opportunistic diseases to develop amongst

persons infected with HIV. HIV infection is the most powerful risk factor for the
progression of TB infection to TB disease. An HIV positive person has many
times higher risk of developing TB disease in those infected with TB bacilli, as
compared to an HIV negative person.
Expected Outcomes:
S.No Priority areas Expected Outcome
.
1 To Improve Case  Total CDR from 136/lac to 150/lac
Detection among all types  NSP CDR Increase from 50107 (80%) to
of TB patients 56370(90%)
 NSN CDR Increase from 28529 cases to 50107
cases
2 To Improve Quality of  Reduce initial defaulters from 762 cases (4.2%)

DOTS to less then 150 cases (1%)
 Percentage of patients started DOTS within
seven days of diagnosis increase from 90 to
100%
3 To Improve Supervision  Improvement in program indicators
and monitoring at all  Submission of ATPs and Tour Diaries of MOs
levels and other key staff
 Regular review meetings both at state, district
and sub district level
4 Regular Training/Re-  Training of all untrained staffs
training/Sensitization  Retraining of low performing key staffs at the
state level
 Regular sensitization of General health staffs
and Private practitioners
217
5 EQA implementation in  Regular Monitoring by STDC and prompt
all the districts feedback
 On site evaluation of all the districts of AP by
IRL
 Analysis of Annexures submitted by the
DMCs, identify constraints on the priority areas
and seek implementation of the
recommendations on a quarterly basis.
6 Implementation DOTS  Accreditation of laboratory at DFIT, Nellore
Plus in all districts and 2nd lab at IRL
 Training of all staff under DOTS Plus and
implementation of DOTS Plus
 Prompt air borne infection Control in DOTS
Plus site
7 TB-HIV Collaborative  The proportion of TB patients knowing their
activities HIV status improvement from 76% to 100%
 The proportion of co-infected cases to be
started on CPT to be 100%
292. Andhra Pradesh in one of the very few states in the country implanting all the
components of RNTCP, DOTS, DOTS Plus, Intensified TB HIV Package, Airborne
Infection Control, PPM Initiatives
1. Culture & DST Lab scale up plan

2. Culture & DST Lab at DFIT Nellore
3. Culture & DST Lab at SVIMS, Tirupati
4. Culture & DST Lab (II Lab) at IRL, STDC, Hyderabad, all labs to have liquid
Culture and DST and LPA diagnostics for MDR TB diagnosis.
293. LPA drastically reduces the diagnostic time from three to four months to three
days. This helps an early detection and initiation of treatment thus cutting the threat of
infection.
o Extension of DOTS Plus services
218
New DOTS Plus sites at Chest Hospital, Vizag, Chest Hospital, Warangal & DFIT
Nellore.
 The state in collaboration with TBAlert has launched Axshya Project in seven
districts of Andhra Pradesh. The goal of the Axshya project is to decrease
morbidity and mortality due to TB in India and improve access to quality TB care
and control services through enhanced civil society participation.
 Piloted referral mechanism of TB symptomatic from medical outlets in Ongole
TU, Prakasam district.
 Airborne Infection Control – Guidelines were piloted in 13 selected health
facilities.
 The state is now moving towards the Universal Access concept of providing early
and better diagnosis and treatment i.e., affordable and convenient in time, place
and person.
Budget Analysis:
Statement of Budget release vs Expenditure for FY 2009-10
S.N Heads Budget Budget Expenditure Difference

approved for released for the
the f.y.2009- during 2009- f.y.2009-10 (
10 10 Rs.in lakhs)
1 2 3 4 5 6(4-5)
1 Civil Works 12.66 10.42 1.52 8.90
2 Laboratory Materials 135.60 240.56 235.00 5.56
3 Honorarium 92.54 50.00 33.00 17.00
4 Publicity 77.80 81.99 64.75 17.24
5 Equipment 26.14 57.54 48.07 9.47
Maintenance
6 Training 52.22 34.58 24.45 10.13
7 Vehicle Maintenance 46.25 60.08 46.79 13.29
8 Vehicle Hiring 154.48 146.56 113.35 33.21
Charges
9 NGO Support 236.10 47.68 32.83 14.85
219
10 Medical Colleges 77.44 20.89 15.19 5.70
11 Miscellaneous 275.27 132.51 105.24 27.27
12 Contractual Service. 708.64 891.98 777.96 114.02
13 Printing 127.00 25.36 24.13 1.23
14 Research and Studies 100.00 2.20 2.20 0.00
15 Salary for Regular 0.00 0.00 0.00 0.00
Staff
16 Procurement of Drugs 0.00 0.26 0.00 0.26
17 Procurement of 33.00 49.66 29.62 20.04
Vehicles
18 Procurement of 0.00 3.01 1.64 1.37
Equipment
19 Additionalties 300.00 0.00 0.00
TOTAL 2455.14 1855.28 1555.74 299.54
Statement of budget proposals in the f.y.2010-11 & 2011-12.
Sr.No Expenditure Annual Budget Annual Budget Diff

proposal for the proposal for the
f.y.2010-11 f.y.2011-12
a b c=b-a
1 Civil Works 62.04 72.04 10.00
2 Laboratory Materials 136.95 149.46 12.51
3 Honorarium 75.00 115.00 40.00
4 Publicity 77.00 79.50 2.50
5 Equipment Maintenance 30.00 60.13 30.13
6 Training 52.00 100.03 48.03
7 Vehicle Maintenance 50.00 47.75 -2.25
8 Vehicle Hiring Charges 154.35 166.14 11.79
9 NGO Support 150.00 200.08 50.08
10 Medical Colleges 50.00 130.31 80.31
11 Miscellaneous 131.50 136.95 5.45
12 Contractual Service. 1443.70 1056.04 -387.66
13 Printing 125.00 125.00 0.00
14 Research and Studies 70.00 70.00 0.00
15 Salary for Regular Staff 0.00 0.00 0.00
16 Procurement of Drugs 0.00 0.00 0.00
17 Procurement of Vehicles 45.00 0.00 -45.00
Procurement of
18 Equipment 18.00 24.60 6.60
Sub-total 2670.54 2523.03 -147.51
19 Additionalties 193.00 97.80 -95.20
TOTAL 2863.54 2688.03 -175.51
ANNEXURE 1
Civil Works
(Rs.in Lakhs)
Activity No. No. No. Pl provide Estimated Quarter in
required already planned justification if an Expenditure which the
as per upgraded/ to be increase is on the planned
the present in upgraded planned in excess activity activity
norms in the state during of norms (use expected to
the state next separate sheet if be completed
220
financial required)
year
(a) (b) (c) (d) (e) (f)
STDC/ IRL 1 Upgraded
SDS 1 Upgraded 1.50
DOTS Plus Upgradation of
Site DOTS Plus site at
5 5 Hyd, Guntur, 50.00
Vizag , Warangal
and Thirupati
DTCs Up gradation of
24 Upgraded 7.20
DTC drug stores.
TUs 178 Upgraded
DMCs 920 Upgraded
Civil works – 13.34
maintenance
TOTAL 72.04
ANNEXURE 2
Laboratory Materials
Activity Amount Amount Procurement Estimated Justification/
permissible actually planned Expenditure Remarks for
as per the spent in during the for the next (d)
norms in the the last 4 current financial year
state quarters financial year for which
(in Rupees) plan is being
submitted
(Rs.)
(a) (b) (c) (d) (e)
Purchase of Lab
Materials by Districts 124.80 111.99 124.50
Lab mate rials for EQA
activity at STDC (eg.
Lab consumables for 12.48 12.48 12.48
trainings, preparation of
Panel slides etc)
Lab materials & 172.96
consumables for
Culture/DST activity at
IRL and other 12.48
12.48 12.48
Accredited Culture &
DST labs in Govt. sector
including Medical
Colleges
Total 136.95 149.46
ANNEXURE 3
Honorarium
Activity Amount Amount Expenditure Estimated Justification/

permissible actually (in Rs) Expenditure for Remarks for
as per the spent in planned for the next financial (d)
norms in the the last 4 current year for which
state quarters financial plan is being
221
year submitted
(Rs.)
(a) (b) (c) (d) (e)
Honorarium for DOT
providers (both tribal
120.00 31.44 68.40 90.00
and non tribal
districts)
Honorarium for DOT
providers of Cat IV 6.60 6.60 25.00
patients
Total 126.60 31.44 75.00 115.00
No. presently Additional enrolment * These community volunteers are other

involved in proposed for the next than salaried employees of Central/State
RNTCP fin. Year government and are involved in provision
of DOT e.g. Anganwadi workers, trained
Community
dais, village health guides, ASHA, other
volunteers in all the 48000 10000
volunteers, etc.
districts*
ANNEXURE 4
Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP
1) Information on previous year‟s Annual Action Plan
a) Budget proposed in last Annual Action Plan : Rs. 77 lakhs
b) Amount released by the state : Rs.19.88 lakhs
c) Amount Spent by the district- : Rs.3.46 lakhs (12 months)
2) Permissible budget as per norm : 78,50,000/-
3) Budget for next financial year for the district as per action plan detailed below
: 79,50,000 Lakhs
Program WHY For WHAT When

Challenges to WHOM By Monitoring Budget
be tackled by ACSM ACSM Activities Time Frame WHOM and
ACSM during Objective Target Evaluation
the Year Audience
20010-11
Based on Desired Activities Media Q Q Q Q Key Outp Outc Total
existing TB behavior or / 1 2 3 4 implem uts; omes expenditure
indicators and action Mater enter : for the
analysis of (make ial and Evide activity
communicatio SMART: Requi RNTCP nce Evide during the
n challenges specific, red officer that nce financial
(Maximum 3 measurable, 20000re the that year
Challenges ) achievable, sponsibl activit it has
realistic & e for ies been
time bound supervis have effect
objectives) ion been ive
done
Challenge 1. Maintain & Sustain Case Detection
Advocacy Activities
Maintain & To gain Opinion World TB Rallie Y Photo Medi 1000000
Sustain Case administrati leaders Day s/Mee STO/D s, a
Detection in ve support, Community tings/ TO Paper Repo
the state and increase School & Sensiti clippi rts
increase Case referrals, colleges zation ngs,
Detection in involve students / Repor
ADB,APR,C community Govt. & Quiz t,
HT,KRN,KM and other Prvt. Letter
R,MBR,MDK partners like Employees
222
,NGD, NZD NGOs,SHG
districts s etc
To gain Annual STO

administrative Key Book STO/ Y Relea
support and Annual decision DTO Annu se on 250000
involve Performance makers/ al Worl
partners Report & to Officials Repor d TB
gain t Day/
administrati Usag
ve support e
durin
g
revie
ws
Communication Activities
Posters Y Displ 500000 1.
Display of ay of
IEC material Maintain Opinion Pamphlets Y Increa mater 450000
at all the and sustain leaders se in ial at
health NSP CDR Community Case healt
facilities, govt. >70% School & Detec h
& non-govt. colleges tion facilit
organisations students Tin plates Y ies, 1200000
Govt. & Radio Y Y DOT 600000
Prvt. Cent
Employees Flip Y ers,G 300000
Books ovt.
Y Y & 200000
Miking non
Y Govt. 200000
Cinema Offic
Slides Y es 600000
Annual
Diary
Social Mobilization activities

NSP CDR Opinion Communi Flip Y Y Y Y Docum DTO 1200000
Increase of >70% in leaders/SH ty Books entaion/
involveme 6 districts G Meetings /Pam Photog
nt of (NZB,CHT, Members/ phlets raphs
communit RGY,KRN, Teachers/
y, local KRM,CDP) School &
opinion college
leaders students
Y Y Y Y Docum
Increase School/C entaion/ 250000
involveme ollege Photogra
nt of Activity phs
school &
college
students
Challenge 2: Low Pediatric Case Registration
Advocacy Activities
Low To motivate 2. STO
involveme members to /DT
nt of IMA refer O
& pediatric
223
Pediatrics cases
Asso.
Communication Activities
Increased MOs/Pedia
referrals tricians
from MOs,
Pediatrician
s
Pvt. Prac.
MOs/Pedia Kits 900000
Increased tricians Table Top
referrals Kit with
from MOs, Pen stand,
Pediatrician Table
s Tops
Social Mobilization
Challenge 3:- Defaults and low adherence
Advocacy activities
Communication activities
Increase Motivate Patients/D Pat. Flip Docu Redu 300000
Interactive patients & OT Provider materi menta ction
meetings/ DOT Providers/I meetings al/Ch tion in
Counselin Providers mmediate arts of defau
g of family For family event lts
members/ completion members of /Phot
Sharing of of treatment patients os/
experience
s by cured
patients
DOT Sensitizati DOT

Providers on Provid
Sensitizati Meetings ers DTO
on/TB trainin
Care g
Clubs/IP materi
C al
Social Mobilization Activities
TOTAL BUDGET 7950000
ANNEXURE 5
Equipment Maintenance
Item No. Amount Amount Estimated Justification/
actually actually Proposed for Expenditure for Remarks for (d)
present in spent in Maintenance the next financial
the state the last 4 during current year for which
quarters financial yr. plan is being
submitted
(Rs.)
(a) (b) (c) (d) (e)
Computer
(Maintenance includes AMC,
software and hardware upgrades, 26 44.00 8.10 8.10
Printer Cartridges and Internet
expenses)
Binocular Microscopes
1069 8.00 16.03
(RNTCP)
STDC/ IRL Equipment 15% of the
7.90 30.00 equipment cost
AMC to be given
224
for IRL
equipment.
Any Other (pl. specify) Maintenance of
Generator at STDC generator at
1 6.00 6.00
STDC,
Hyderabad.
TOTAL 30.00 60.13
ANNEXURE 6
Training
Activity No. No. No. planned to be trained Expenditure Estimated Justification/

in the already in RNTCP during each (in Rs) Expenditure remarks
state trained quarter of next FY (c) planned for for the next
in current financial
RNTCP financial year
year (Rs.)
Q1 Q2 Q3 Q4
(a) (b) (d) (e) (f)
Training of 24 10
DTOs (at
National
level)
National 40 120 80 40 40 40 30.00
DOTS Plus
trainings
Training of 178 161 17 4.00 4.00
MO-TCs
Training of 4107 2762 400 400 300 245 7.00 5.58
MOs (Govt
+ Non-
Govt)
Training of 918 849 40 28 4.00 0.38
LTs of
DMCs-
Govt + Non
Govt
Training of
MPWs
Training of 24 + 489 2000 2000 1500 4.00 10.12
MPHS, 581
pharmacists,
nursing
staff, BEO
etc
Training of 60658 51744 15000 15000 15000 3.00 10.00
Comm
Volunteers
Training of 200 200 200 200 6.00 17.40
Pvt
Practitioners
Other
trainings
Re- training 25 25 25 40 2.00 0.19
of MOs
Re- Training of 30 20 15 15 2.00 0.20

LTs of DMCs
225
Re- Training of 120 130 120 130 2.00 0.07
MPWs
Re- Training of 10 20 30 10 2.00 0.10
MPHS,
pharmacists,
nursing staff,
BEO
Re- Training of 500 500 500 500 10.00 3.10
CVs
Re-training of 10 20 10 15 5.00 0.08
Pvt Practitioners
TB/HIV 4285 1125 1000 1000 500 500 3.00 4.65
Training of MO-
TCs and MOs
TB/HIV 1200 1200 1200 1200 2.00 12.84
Training of
STLS, LTs ,
MPWs, MPHS,
Nursing Staff,
Community
Volunteers etc
TB/HIV 60 60 60 3.00 0.78
Training of STS
Training of MOs 500 500 500 500 3.00 0.54
and Para
medicals in
DOTS Plus for
management of
MDR TB
Provision for 1.00
Update Training
at Various
Levels #
Review
Meetings at State
Level
Any other
activity
Total 52.00 100.03
ANNEXURE 7
Vehicle Maintenance
Type of Vehicle Number Number Amount Expenditure Estimated Justification/

permissible actually spent on (in Rs) Expenditure for the remarks
as per the present POL and planned for next financial year
norms in Maintenance current for which plan is
the state in the financial being submitted
previous 4 year (Rs.)
quarters
(a) (b) (c) (d) (e) (f)
Four Wheelers 3 3 2.00 3.25
Two Wheelers 178 178 40.14 48.00 44.50
TOTAL 50.00 47.75
ANNEXURE 8
226
Vehicle Hiring*
Hiring of Number Number Amount Expenditure Estimated Justification/

Four permissible actually spent in (in Rs) Expenditure for the remarks
Wheeler as per the requiring the prev. planned for next financial year
norms in the hired 4 qtrs current for which plan is
state vehicles financial year being submitted (Rs.)
(a) (b) (c) (d) (e) (f)
For STC/ Nil Nil
STDC
For DTO 24 24 97.85 41.25 54.00
For MO-TC 178 178 113.10 112.14
TOTAL 154.35 166.14
* Vehicle Hiring permissible only where RNTCP vehicles have not been provided
ANNEXURE 9
NGO/ PP Support: NGO/ PP Support: (New schemes w.e.f. 01-10-2008)
Activity No. of Additional Amount Expenditure Estimated

currently enrolment spent in (in Rs) Expenditure
involved planned the planned for for the next
in for this previous current financial
RNTCP year 4 financial year for
quarters year which plan
is being
submitted
(Rs.)
(a) (b) (c) (d) (e)
ACSM Scheme: TB advocacy,
communication, and social 15 28 37.06 5.00 22.50
mobilization
SC Scheme: Sputum Collection
8 41 9.41 5.60
Centre/s
Transport Scheme: Sputum Pick-
8 34 9.80 9.80
Up and Transport Service
DMC Scheme: Designated
Microscopy cum Treatment 20 13 31.90 30.00
Centre (A & B)
LT Scheme: Strengthening
4 18 15.89 4.28
RNTCP diagnostic services
Culture and DST Scheme:
Providing Quality Assured
1 0 28.80 28.80
Culture and Drug Susceptibility
Testing Services
Adherence scheme: Promoting
12 508 10.00 24.00
treatment adherence
Slum Scheme: Improving TB
3 17 7.10 7.50
control in Urban Slums
Tuberculosis Unit Model 8 1 20.00 42.40
TB-HIV Scheme: Delivering TB-
HIV interventions to high HIV 7 5 12.10 25.20
Risk groups (HRGs)
TOTAL 150.00 200.08
227
ANNEXURE 10
Miscellaneous
Activity* Amount Amount Expenditur Estimated Justification

e.g. TA/DA, Stationary, permissible spent in the e (in Rs) Expenditure / remarks
etc as per the previous 4 planned for for the next
norms in quarters current financial year
the state financial (Rs.)
year
(a) (b) (c) (d) (e)
Miscellaneous (ta/da) 131.95 98.00 126.50 131.95
Miscellaneous
(Stationery)
Miscellaneous
(furniture)
Miscellaneous
(transport)
Miscellaneous
(insurance)
Miscellaneous
(telephone charges)
Miscellaneous
(electricity)
Miscellaneous (water
charges)
Miscellaneous (cell
phone charges)
Miscellaneous
(conveyance)
Miscellaneous (Dots
plus)
Miscellaneous - CFs 5.00 5.00 5.00
(TA/DA)
TOTAL 136.95
Please mention the main activities proposed to be met out through this head
Note: Dots plus implementing districts Hyderabad, Rangareddy, Medak, Nalgonda, Guntur, East
Godavari, West Godavari, Krishna, Vizianagaram, Srikakulam and Visakhapatnam.
228
ANNEXURE 11
Contractual Services
Category of Staff No. No. No. Amount Expendi Estimated Justificati

permissible actuall planned to spent in ture (in Expenditu on/
as per the y be the Rs) re for the remarks
norms in presen additional previou planned next
the state t in the ly hired s4 for financial
state during quarters current year (Rs.)
this year fin. Yr
(a) (b) © (d) (e)
Asst. Program Officer / 1 1 5.04 4.8
Epidemiologist
Medical Officer(STC) 1 1 3.78 3.6
TB/HIV Coord. 1 4.41
Urban TB Coord. 1 2.52
DOTS plus site Sr. 1 5 3.78 18.00
Medical Officer
DOTS plus site Statistical 1 5 1.89 9.00
Assistant
Microbiologist (IRL) 1 1 6.72 4.41
Sr.LT (IRL) 1 1 746.76 1.89 2.87
IEC Officer 1 1 2.84 2.27
Accounts officer/State 1 1 2.84 2.27
Accountant
Addl. Accountant 1 1 1.62 1.51
Secretarial Asst 1 1 1.35 1.07
Pharmacist / Storekeeper 1 1 1 2.08 1.5
Store Assistant (SDS) 1 1 1.01 0.96
DEO- (State TB Cell) 1 1 1.74 1.26
DEO- (IRL) 1 1 1.74 1.26
Driver- State 2 2 2.53 1.76
Medical Officer (District) 4 2 4 15.46 20.49
Sr.DOT Plus & TB –HIV 20 24 DEO 24 41.40 43.20
Supervisor +,ZTF
STS 178 81 Chairm 215.39 122.47
STLS 178 141 an 313.06 213.19
DEO=
Contractual LT 144 333 472.10 356.64
total 25
TBHV 223 204 288.27 205.63
DEO 25 24 36.53 25.70
Accountant – part time 24 14 8.72 5.29
Driver 26 1 0.00 0.88
CFs 5 5 5.00 6.00
Any other contractual
TOTAL 812 1443.71 1056.04
229
ANNEXURE 12
Printing
Activity Amount Amount Expenditure Estimated Expenditure Justificati

permissible as spent in (in Rs) for the next financial on/
per the norms the planned for year for which plan is remarks
in the state previous 4 current being submitted (Rs.)
quarters financial year
(a) (b) © (d) (e)
Printing-State
level:*
Printing- Distt. 125.00 15.78 125.00 125.00

Level:*
Total 125.00 125.00
ANNEXURE 13
Research and Studies (excluding OR in Medical Colleges)
Any Operational Research projects planned (Yes/No) __Yes

Estimated Total Budget:
Sr. No. Details of protocol Amount in lakhs

01 Study prevalence of TB among indigenous 50.00
community across AP
02 Multi centric study to study the outcome of 20.00
referred and transferred out patients in AP
Total 70.00
ANNEXURE 14
Medical Colleges
Activity Amount Estimated Justification/

permissible Expenditure for the remarks
as per norms next financial
year(Rs.)
Contractual Staff:
 MO-Medical College (Total approved in state:
11)
 STLS in Medical Colleges (Total no in state :
0)
 LT for Medical College (Total no in state: 35)
111.56
 TBHV for Medical College (Total no in state: 111.56
35)
Research and Studies:

 Thesis of PG Students
8.75 8.75
 Operations Research*
Travel Expenses for attending STF/ZTF/NTF
8.00 8.00
meetings
IEC: Meetings and CME planned 2.00 2.00
Equipment Maintenance at Nodal Centres
Total 130.31
230
ANNEXURE 15
Procurement of Vehicles
Equipment No. No. planned for Estimated Expenditure for Justification/

actually procurement this year the next financial year for remarks
present in (only if permissible as which plan is being
the state per norms) submitted (Rs.)
(a) (b) © (d)
4-wheeler ** 3
2-wheeler 178 45.00 0.00
Total
** Only if authorized in writing by the Central TB Division
ANNEXURE 16
Procurement of Equipment
Equipment No. actually No. planned for Estimated Expenditure Justification/

present in the this year (only for the next financial remarks
state as per norms) year for which plan is
being submitted (Rs.)
(a) (b) © (d)
Office Equipment Replacement of
(Computer, modem, scanner, 26 9.00 15.60 computer systems at
printer, UPS etc.) state & districts.
Any Other – Xerox machines 26 10 9.00 Replacement - most
of the Xerox
machines in the
state are beyond
repairs.
Total 24.60
ANNEXURE 17
Additionality funds from NRHM
S.no Proposed plan / activity Number Amount (Rs Justification

planned in lakh)
for the
financial
year
1 Up gradation and extension 1 45.00 The existing hotel building is not
of STDC Hostel Building sufficient to accommodate the
trainees. Hence we proposed to
extent the Hostel building.
2 Transport Charges 18 .00 Sputum transportation charges for
DOTs Plus Culture & DST Lab
for one year.
3 LCD Projectors 24 4.80 To install at DTCOs offices.
4 Extension of State Drug 1 20.00 To Accommodate CAT-IV
Stores Drugs, racks, fittings and ACs.
5 Walk in cold room 01 5.00 Purchase of walk in cold room
6 Walk in Incubator for C & 01 5.00 Purchase of walk in incubator.
DST Lab at Visakhapatnam
Total 97.80
231
ANNEXURE 18
Consolidated Budget Summary of proposed under RNTCP
SN Category of Expenditure Budget estimate

for the coming FY
2011 – 2012(To be
based on the
planned activities
and expenditure in
Section C)
1 Civil works 72.04
2 Laboratory materials 149.46
3 Honorarium 115.00
4 IEC / Publicity 79.50
5 Equipment maintenance 60.13
6 Training 100.03
7 Vehicle maintenance 47.75
8 Vehicle hiring charges 166.14
9 NGO/PP support 200.08
10 Miscellaneous 136.95
11 Contractual services 1056.04
12 Printing 125.00
13 Research and studies 70.00
14 Medical Colleges 130.31
15 Procurement –vehicles 0.00
16 Procurement – equipment 24.60
Total 2533.03
17 Additonalities funds from NRHM 97.80
Grand Total 2630.83
232
D.3 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
294. Blindness is a major socio economic problem in developing countries realizing

this problem the Government of India has established National Programme for control
of Blindness in the year 1976 as a 100% centrally sponsored scheme with the goal of
reducing the prevalence of blindness from1.4% to 0.3% by 2020 with participation of
NGO‟s and PMP‟s.
295. Pertaining to Andhra Pradesh State, the programme is implemented by

reaching goals every year by achieving 100% targets. At present the Cataract Surgery
Rate for the year 2009-10 is 662 per lakh population against Government of India
allotted 644 per lakh population . Present prevalence of avoidable blindness is 1% as
per National Survey 2007.
Key Objectives
 To provide high quality eye care to the effected population by reducing the
prevalence of the avoidable blindness from 1% to 0.9% such as Cataract,
Refractive Errors , Glaucoma, Diabetic Retinopathy and Corneal Blindness
 To expand coverage of eye care services to the under served areas i.e, in Tribal
PHCs 100 posts of PMOAs may be accommodated to achieve more
performance in under served areas.
 To reduce the backlog of blindness i.e., Eye Ball Collection from 65% to 100%
by strengthening and Establishment of Eye Donation Centers and Eye Banks.
Screening and Treatment of Diabetic Retinopathy, Glaucoma.
 To develop institutional capacity for Eye care services by establishing Fixed
Service Centers in (40)-Area Hospitals.
Situational analysis , Critical Gap Identification
 Specialty Eye Care Activities are available in Medical Colleges, 4- Regional eye
Hospitals , District Head Quarters Hospitals.
 Screening of Eye Ailments available at old PHCs level .
 All the Areas Hospitals to be provided with Ophthalmic Equipment and trained
Ophthalmic Personnel
 Annual Maintenance Contract for Equipment is required
 Timely release of budget in phased manner
Key Strategies of the Programme
 Reduction in the backlog of blind persons by active screening of population above

50 years, organizing screening eye camps and transporting operable cases to eye
care facilities;
 Involvement of voluntary organization in various eye care activities;
 Participation of community and Panchayats, ANMs, Asha and Aganwadi in
organizing services in rural areas
233
 Development of eye care services and improvement in quality of eye care by
training of personnel, supply of high-tech ophthalmic equipments, strengthening
follow up services and regular monitoring of services
 Screening of school age group children for identification and treatment of
Refractive Errors, with special attention in under-served areas
 Public awareness about prevention and timely treatment of eye ailments
 Special focus on illiterate women in rural areas. For this purpose, there should be
convergence with various ongoing schemes for development of women and
children
 To make eye care comprehensive, besides cataract surgery, provision of assistance
for other eye diseases like Diabetic Retinopathy, Glaucoma Management, Laser
Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of
Childhood Blindness etc.;
 ·Construction of dedicated Eye Wards and Eye OTs in all Area Hospitals as per
need
 Development of Mobile Ophthalmic Units and linked with Tele-Ophthalmic
Network and few fixed models
 Involvement of Private Practitioners in sub-district, blocks and village levels.
 The prevention and treatment of blindness may be categorized under the public
health sector (i.e., prevention) and the ophthalmologic sector (i.e., treatment
solutions)
Programme Components
 Cataract Surgeries
 Refractive Errors
 School Children eye Screening
 Eye Ball Collection
 Diabetic Retinopathy
 Glaucoma
 Squint
 Trachoma
 Training
 IEC
 As it is possible as well as efficient to manage most eye diseases in the

communities where they arise, emphasis should be places on the development of
primary eye care and a good referral system.
 Conducting Screening Camps in under served areas i.e., Rural, Tribal and
urban areas which aids in motivating and referring cases to secondary level
for intervention.
 The State Red Cross Society has been requested to associate with NPCB
activities for which they have agreed.
 As State Government introduced JAWAHAR BALA AROGYA RAKSHA
SCHEME for School going children , All schools are to be covered under
NPCB and Spectacles are to be issued to needy children.
234
 A Proposal was submitted to the Government of India for establishing (3)-eye
Banks at (3)-Regional Eye Hospitals i.e, Viskhapatnam, Kurnool, Warangal for
improvement of Eye Ball Collection and Utilization
 A Proposal was submitted to the Government of A.P for permission to obtain eye
balls from bodies which are sent for postmortem to the hospitals. If the Govt.
issue permission the eye ball collection will be improved.
 At tertiary level treatment is provided for Diabetic Retinopathy ,Glaucoma and
Squint .
Monitoring and Reporting Systems :
 The DPM is Monitoring the eye Care activities in the District and submitting
Monthly and Quarterly (including Physical and financial) reports to State
Programme Officer.
 The District collector and Chairmen of DBCS will review the performance
quarterly and provide suggestions for improvement of performance .
 The State Programme Officer(NPCB) under the control of Director of Public
Health will monitor and review the progress of the activities monthly and
inturn the reports submitted to Mission Director (NRHM) and Director
General of Health Services, New Delhi.
 Quarterly review meeting will be convened under the chairman ship of the Prl.
Secretary to Government ,HM&FW Department ,Hyderabad for strict
implementation of the NPCB activities.
Risk Analysis
 All Service Centers are not provided with required infrastructure and
Manpower.
 All Areas hospitals to be provided with staff trained in Ophthalmic services
 Since the vehicles provided 15years back at present they are not road worthy
due to which performance is effected .
Expected Out Comes
 Cataract surgeries 6.00 Lakhs

 School children Eye Screening 20.00 Lakhs
 Refractive errors 1.00 Lakhs
 Free Spectacles Distribution 0.40 Lakhs
 Eye Ball collection 0.06 Lakhs
 Other eye Diseases 0.05 Lakhs
Special Features for 2011-12

 Establishment of 100-Vision centers in Tribal Areas and underserved areas.
 Fixed Service centers(40) to be provided with Infrastructure and Manpower.
 Strengthening and Establishment of (3)-eye Banks at (3)-Regional Eye
Hospitals i.e, Viskhapatnam, Kurnool, Warangal for improvement of Eye Ball
Collection and Utilization
 To Provide Argon laser for Diabetic Retinopathy Treatment in seven Teaching
hospitals.
235
 Training of Ophthalmic surgeons and Other Staff
 To develop a software by NIC for on line submission of reports to avoid delay
reporting and take immediate decisions.
Budget Analysis
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
FUNCTIONAL HEAD WISE CLASSIFICATION OF THE BUDGET
Physical Required fund

Sl.No. Activity Unit cost
Target under NRHM
Human Resource
F National Programme for Control of Blindness
15Surgeons X
a Ophthalmic Surgeon 25000 45.00
12 Months
50 PMOOs
b Ophthalmic Assistant 8000 48.00
X12months
12EDCs
c Eye Donation Counselor 10,000 14.40
X12months
5 Training
Training /Capacity
5.1 building for health - - -
personnel‟s
Training of Teachers and
- 11000 -
others
F Procurements-Drugs and Supplies
Per case:
Drugs&
consumbles-
Procurement of Drugs 1lakhGovt.Sect
a 200 575.00
and Supplies and or cases
Sutures-50
IOLs-200
Spects-125
F. Procurements-Equipment
Procurement of
Equipment- ARGON 07 Nos for 7- 140.00
20,00,000
Green Laser equipment Medical Colleges
for DBR
25 Nos
Each Rs.2.50 Dist.Hospitals-
New Ophth. Microscopes Rs.62.50
Lakhs 16,A.H- 7 & CHC-
2
for 50 Nos for
Rs.25000 for
Other Ophthalmic establishment of
each Rs.12.50
Surgical Equipment for New Ophthalmic
Ophthalmic
Operation Theatres Centers& O.T.s in
Unit
AH
for 10 Nos in 4-
Each Rs.3 District Hospitals
A-Scan Rs.30.00
Lakhs and 3- Area
Hospitals and 3- in
236
CHCs.
Each for 10 –District
Keratometer Rs.4.00
Rs.40,000 Hospitals .
for 3 Nos Medial
eachRs.35
Phaco Machines Colleges and 3- Rs.105.00
lakhs
Dist. Hospitals
Each Rs.15 for 4 District
Yag leasers Rs.60.00
Lakhs Hospitals
for 20 District
Each Rs.3
Electro Vitrectromy Hospitals & 3 Area Rs.70.00
Lakhs
Hospitals
for 20 Nos 10- in
Dist. Hosp, AHs-
Each
Slit Lamps 03,CHCs-02 and 5- Rs.8.00
Rs.40,000/-
for Medl. colleges.
F. ICC/BCC Works
IEC-BCC Activities
1lakhGovt.Sect
a Cataract Operations 75/case 75.00
or cases
b Eye Donation
c Other Activities
World Sight Day 10,00,000 1 10.00
Eye Donation Fortnight 10,00,000 1 10.00
F ASHA’s
a ASHA Incentives (covered under package)
Referral Transport
Transport/
1lakhGovt.Sect
1.6 Referral Transport POL- 100.00
or cases
100/case
Other Mission Flexible Pool Activities
Other M&W
Development of Soft ware
B
for online reporting 20,00,000 1 20.00
15.3.3
system from Districts
B 23.1 Support Strengthening of NPCB

School Children Eye
5,00,000 23 Districts 115.00
Screening
Eye Ball Collection 1,000 2000 20.00
DBR & Glaucoma etc., 1,000 5000 50.00
INNOVATIONS/PPP/NGO
E Cataract Performance
Ngo Sector 750/- 2,80,000 2100.00
Private Sector (PMPs)
1,85,000 -
(not Claiming)
G OPERATIONAL COST
a Mobility Support
c Review meetings
d Field visits / T.A 14,00,000 SBCS 14.00
Office expenditure
e
Formats &Reports
b Lab consumables and 50,000 23 districts 11.50
237
salaries at DBCS
Financial Aid/Grant to institutions
a Medical Colleges 40,00,000 1 40.00
b Vision Centers 50,000 50 25.00
c Eye Donation Centers 1,00,000 2 2.00
d Eye Banks 15,00,000 3 45.00
e NGOs 30,00,000 2 60.00
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

PROGRAMME IMPLEMENTATION PLAN (PIP) BUDGET 2011-2012
SN Activity 2010-11 2011-12 Remarks/ Justification

Approved (Proposed)
as per PIP (Rs/lakhs)
(Rs/Lakhs)
Recurring Grant -in- Aid
Rs.750 per case X3,80,000 Cataract
1 Cataract Operations 1674.00 2850.00
Operations
IEC: for other than Cataract World Sight Day &Eye Donation
2 20.00
operations fortnight each @Rs.10lakhs
3 SES Programme 46.00 115.00 @5.00 Lakh each DBCS
4 Grant-in-Aid for Eye Ball Collection 15.00 20.00 @Rs.1000eachpair for 2000
Salaries,T.A&D.A,POL and
Maintenance of State Blindness Control
5 14.00 purchage of consumbles etc., as per
Society 10.00
guidelines of NPCB
Maintenance of Ophthalmic
6 Equipment in 23 DBCSs and DBCS 5.00 11.50 For 23-Districts @ Rs.50000/- each
Salaries
New initiative Diabetic Retinopathy For laser treatment eachRs.1000/-
7 50.00 50.00
and Glaucoma management etc., for 5000cases
Manpower
Ophthalmic Surgeons in District
1 45.00 45.00 @25000/-PM for 15 X12months
Hospitals in 42- FSCs
Ophthalmic Assistants in District
2 48.00 48.00 @8000/-PM for 50 X12 months
Hospitals, PHC and Vision centers
Eye Donation Counselors in Eye @Rs.10,000/-PMfor 12 X12
3 14.40 14.40
Banks Months
Non- recurring Grant -in- Aid
1 Medical Colleges 40.00 40.00 For procurement of equipment
2 GIA for Vision Centre 25.00 25.00 For 50-VCs @ Rs.50,000/- each
2-Units for up-gradation/
3 Eye Donation Centre 1.00 02.00
Strengthening
4 Eye Banks 0.00 75.00 For 3-Unit establishment (3-REHS)
Non- Recurring GIA for NGOs
For 2-Unit for Strengthening/Up
5 30.00 60.00
gradation
Each Rs.2.50 Lakhs X25 Nos
6 New Ophth. Microscopes Rs.62.50
Dist.Hospitals-16,A.H- 7 & CHC-2
Rs.25000 for each Ophthalmic
Other Ophthalmic Surgical Equipment Unit for 50 Nos for establishment
7 Rs.12.50
for Operation Theatres of New Ophthalmic Centers&
O.T.s in AH
238
Each Rs.3 Lakhs for 10 Nos in 4-
8 A-Scan Rs.30.00 District Hospitals and 3- Area
Hospitals and 3- in CHCs.
Each Rs.40,000/- for 10 –District
9 Keratometer Rs.4.00
Hospitals .
eachRs.35 lakhs for 3 Nos Medial
10 Phaco Machines Rs.105.00
Colleges and 3- Dist. Hospitals
Each Rs.15 Lakhs for 4 District
11. Yagleasers Rs.60.00
Hospitals
Each Rs.3 Lakhs for 20 District
12. Electro Vitrectromy Rs.70.00
Hospitals & 3 Area Hospitals
Each Rs.40,000/- for 20 Nos 10- in
13. Slit Lamps Rs.8.00 Dist. Hosp, AHs-03,CHCs-02 and
5-for Medl. colleges.
Total 3741.90
Particulars 2009-10 2010-11(up to Dec,2010)

Annual Target 550000 550000 (412500 P.T)
Achievement:
Govt. Sector 86248 54403
NGO Sector 274621 191740
PMP Sector 213313 178876
Total 574182 425019
Percentage 104.4% 103.03%
Performance :
1.The Cataract Operations performed 2009-10 and 2010-11(up to December 2010)

as follows:
2. Year wise Cataract Operations performance
Year Annual Target IOL Total % on A.T.

2008-09 5,50,000 576601 582318 105.9
2009-10 5,50,000 568288 574182 104.4%
2010-11
up to 5,50,000 420502 425019 103.03%
Dec,2010
3. School Children Eye Screening :
2010-11
2008-09 2009-10
(up to December,)
Activity
Annual Annual Annual
Achievement Achievement Achievement
Target Target Target
No. of
Teachers 11000 10828 11000 10290 11000 9928
Training
239
No. of School
Children 952381 1392412 1500000 1623223 1500000 1472607
Screened
No. of School
Children
66667 69111 90000 73034 90000 69680
detected with
Reff. Errors
Distribution
20000 33118 27000 42619 30000 25394
Free Glass
Eye Ball
5000 3570 5500 3005 6000 2943
Collection
4. Year wise Eye Ball Collection
Year Collection
2008 3570
2009 3005
2010 (up to Dec,2010) 2943
240
D.4 NATIONAL IODINE DEFICIENCY DISORDERS CONTROL
PROGRAMME
296. Every year nearly 2/3rd of the population is not protected from Iodine
Deficiency, which implies that every year nearly 1 million newborns may be at risk of
suffering from preventable brain damage that can result from Iodine Deficiency in
mothers. Iodine is an essential micro nutrient required for human body with a view to
cover wide spectrum of iodine deficiency disorders such as mental and physical
retardation, brain development, deaf mutism, still birth, abortions etc., The Govt. of
India launched 100% centrally assisted National Goiter Control Program (NGCP) in
August 1992, which was subsequently renamed as the National Iodine Deficiency
Disorder Control Program (NIDDCP).
297. In the State of Andhra Pradesh efforts were directed to overcome iodine
deficiency by setting up a IDD cell, established at the Directorate of Health Services in
2009 in Andhra Pradesh. Despite the fact that there is a national ban on sale of non
iodized salt for edible purposes and efforts have been made to ensure universal
consumption of iodized salt, the state of Andhra Pradesh is reported to have the lowest
consumption of adequately iodized salt in the country. Annual report for the year 2009-
2010 indicates that in AP only 46.39% salt is adequately iodized (>15ppm iodine), which
implies that every year nearly 2/3rd of the population is not protected from iodine
deficiency, which implies that every year nearly 1 million newborns may be at risk of
suffering from preventable brain damage that can result from iodine deficiency in
mothers.
KEY OBJECTIVES
 Surveys to assess the magnitude of the Iodine Deficiency Disorders.
 Supply of iodated salt in place of common salt.
 Resurvey after every 5 years to asses the extent of Iodine Deficiency Disorders
and the Impact of iodated salt.
 Laboratory monitoring of iodated salt and urinary Iodine excretion.
 Health education. & Publicity
SITUATION ANALYSIS
298. The Physical performance for the year 2009-2010 indicates that 46.39% of the salt
samples were Adequately Iodized and in the year 2010-to till October it is 46% of the salt
samples were Adequately Iodized.
Physical Performance for the year 2009-10 and Apr 2010- Sep 2010
SN Year Total No. Total No. of Total No. of % of the

samples tested samples with Samples with samples with
Nil Iodine 15 PPM or 15 PPM or
more Iodine More Iodine.
1 2009-10 774351 158301 359225 46.39
2 Apr to Sep 2010 411661 73755 191112 46
241
KEY STRATEGIES
 Checking iodine levels of iodated salt with wholesalers and retailers within the
State and coordinating with the Food and civil Supplies Department.
 The Distribution of iodated salt within the State through open market and
public distribution system.
 Creating demand for iodated salt.
 Monitoring consumption of iodated salt.
 Conducting IDD surveys to identify the magnitude of IDD in various districts.
 Conducting training.
 Dissemination of information, education and communication.
 To increase the awareness about the usage of Iodized salt.
PROGRAMME COMPONENTS
 IDD Cell
 IDD Monitoring Lab
 Health Education And Publicity
 IDD Surveys
 Running School Health and awareness Programmers.
 Creating effective collaboration with the Inter Ministerial Stake holders.
 Conducting workshops.
IMPLEMENTATION METHODOLOGY
 Conducting surveys in the District assess the magnitude of IDD.

 Conducting awareness campaign in the District to create awareness about IDD
and using of Iodized salt.
 Training of ASHA, ANMS and AWW for community awareness and
monitoring.
 Training of Health Inspectors and Food –Drug Inspectors, State, District,
Community, Salt
 Production and Monitoring under the Programme.
o Coordinating with the civil suppliers department to ensure apply of
Iodized salt through PDS.
o To Organize a State level Stake holders meeting.
o IEC and campaigns.
o School awareness programmers and to include in school curriculum at
level of primary and higher education. For this purpose CBSC, NCERT,
State Boards and UGC may be requested to be include Iodine efficiency
Disorders and Iodated salt in their Syllabi for various levels of education
including Medical Education.
 Implementation of the transport of Iodized salt through railway mode, So that
this will help in the proper movement.
 Radio/TV spots have been prepared and their broadcast/telecast is being carried
out.
 A 10 minutes video film on IDD has been prepared and is being distributed to the
States.
242
 Pamphlets have been developed for distribution to States & UTs. Poster
depicting the various facets of IDD manifestation have also prepared.
 Salt Testing Kits for the qualitative testing of iodated salt to show presence of
iodine are being used for creating awareness among people, including those living
in remote, rural areas and urban slums.
 IEC activities have also been intensified in coordination with the Song & Drama
Division,
 Directorate of Field Publicity DAVP Doordarshan & AI with a view to promote
the consumption of iodated salt among the masses.
MONITORING & REPORTING SYSTEMS

 Currently Ministry Health and Family Welfare has appointed State IDD Cell
Team.
 Its very important that state DPH&FW has to take responsibility to sustain the
monitoring system and create a strong reporting system with in the state and
MOHFW in future.
 The State IDD Monitoring cell and Laboratory is responsible to assess the
estimation of Iodine in salt and Urine.
 The State IDD cell team is conducted survey in these Districts.
o Nizamabad
o Nalgonda,
o Warangal,
o Khammam Districts
o Consolidation of Monthly reports received from all the Districts.
RISK ANALYSIS
Fetus Abortions Stillbirths

Congenital anomalies
Increased perinatal mortality
Endemic cretinism
Neonate Neonatal goiter Neonatal hypothyroidism
Endemic mental retardation
Increased susceptibility of the thyroid gland
to nuclear radiation
Child and Goiter adolescent (Subclinical) hypothyroidism
Impaired mental function
Retarded physical development
Adult Goiter with its complications Hypothyroidism
Impaired mental function
Spontaneous hyperthyroidism in the elderly
Iodine-induced hyperthyroidism
243
Importance of the problem
EXPECTED OUTCOMES
 Conducting surveys in the District assess the magnitude of IDD.
 Conducting awareness campaign in the District to create awareness about
IDD and using of Iodized salt.
 Training of ASHA, ANMS and AWW for community awareness and
monitoring.
 Training of Health Inspectors and Food –Drug Inspectors.
 Coordinating with the civil suppliers department to ensure apply of Iodized
salt through PDS.
 To Organize a State level Stake holders meeting.
SPECIAL FEATURES
299. For proper implementation of Programme in some Districts concerned

responsible persons should be appointed, so that the programme will run smoothly.
300. For proper analyzing of spot test method kits should supply to all the sub centers
and even to ASHA, ANM, Aganwadi works.
244
Budget for NIDDCP activities for 2011-12
SN Proposed Activity Amount

Required
Rs.In Lakhs
1 Posters on ill effects on using the non iodized salt 20.00
2 Book lets for Para medical staff & Anganwadi workers 20.00
3 State level workshop for Stake holders 5.00
4 Work shops at District level 5.75
5 Celebration of Global Iodine Deficiency Day at State and 3.75
District level
6 Salaries to the IDD Monitoring Lab Staff 12.00
7 Surveys in the Districts (field visits) 12.00
8 Lab Consumables 5.00
9 Mobility Support and Monitoring 5.00
10 Formats and reports 1.00
TOTAL 90.00
245
D.5 NATIONAL LEPROSY ERADICATION PROGRAMM
301. National Leprosy Eradication Programm in the state of Andhra Pradesh has been
started as National Leprosy Control Programme (NLCP) in 1954- 55, and adopted
Survey, Education and Treatment (SET) Strategy. Dapsone has been the main stay of
treatment. In 1976 Dapsone resistance was reported from India. Further WHO has
advocated a new therapy called Multi Drug Therapy (MDT) for treatment of Leprosy in
1981. Since 1983 MDT has been used for treatment of Leprosy in National Programme,
which has been renamed as National Leprosy Eradication Programme and the same has
been included in the Prime Minister‟s 20 Point‟ Economic Programme.
Before MDT
Before MDT total cases - 4.9 lakhs

Prevalence Rate - 124/10,000
Total cases on hand as on Jan 2011 - 4843
Prevalence rate - 0.57
Gr-II Deformity rate - 4.7
Child rate - 11.5
 Brining the ANCDR to below 10/ one lakh population in all mandals of A.P so
as to reduce the burden of leprosy and disease deformity rate.
 AS on 2010 March ANCDR is 10.74 / lakh population, Deformity rate among
new cases are 4.5% .
 Sensitization capacity building, orientation, training to NLEP staff Medical
Officers and DM&HO.
 Effective IEC activities. Supervision and monitoring.
 All the mandals with ANCDR more than 10/ one lakh house to house survey
should be conducted with the help of General Health Staff and ASHA‟s.
 Delay in diagnosis may result in increasing transmission of diseases and
Deformity rate.
Key Objectives:
 Bringing the ANCDR to below 10 per 1 Lakh Population in all the Mandals of
 Andhra Pradesh. So as to reduce the burden of leprosy both in Rural and Urban.
 Sustaining of quality Leprosy services.
 Reducing stigma and discrimination.
 Involvement of General Health Care staff in early diagnosis, treatment and
disability limitation.
 Improving referral system in the integrated setup.
Situational Analysis:
 Before the start of Multidrug Therapy (1983) the PR is 124/10,000 Population.

 Total Cases at 1983 (Start of MDT) : 4.91 Lakhs
 The state has achieved the Goal of Elimination ie. Less than „1‟ case per 10,000 at
the State Level by March,2005.
246
 Total registered cases as on March 2005 : 6323
 PR as on March 2005 : 0.79/10,000 Population
 Total Registered cases as on December,2010 : 6032
 PR as on December,2010 : 0.57/10,000 Population
Key Strategies of the Programme:

 Sensitization, capacity building, orientation and reorientation trainings in NLEP
to General Health staff from ASHA, ANM to Medical Officers and DM&HOs.
 Special 2 days sensitization and orientation to all the District Collectors and
DM&HOs.
 Effective supervision in monitoring at Sub-Center and PHC level.
 Reducing the reservoir of infection by early Case Detection, prompt and complete
treatment.
 Increased IEC campaign especially through TV and radio so that hidden cases
may come out due to self reporting.
 Predinsolene tablets and Clofazamine tablets should be available in all the
Primary Health Centers.
 All Lab Technicians in the designated Microscopic centers for the tuberculosis
should given training for taking slit skin smear test and punch biopsy.
 Lab Reagents should made available at all the designated microscopic centers.
All the APMOs, DPMOs and District Nucleus Medical Team should be given
reorientation training in Leprosy
Programme Components:
 Early case detection and prompt complete treatment.

 Disability limitation by DPMR activities.
 Training to all General Health Care Staff
 IEC campaign
 Involvement of ASHA workers.
Implementation Methodology :-
 Effective IEC activities at Sub centers, PHC and District Levels.

 For every New MB case detected focal survey should be conducted in
surrounding 50
 houses.
 All mandals with ANCDR more than 10 house to house survey should be
conducted
 involving the General Health Care staff and incentive IEC campaign should be
 undertaken.
 School Health IEC activities and Healthy contact survey.
 Utilisation of services of ASHA and Aganwadi.
 All the deformed cases should be educated about self care and physiotherapy
should be
 given and Reconstructive Surgeries should be undertaken for all the fit deformed
cases.
247
Monitoring & Reporting Systems:
 Effective monitoring by the PHC Medical Officers at every weekly meeting and
the
 Medical Officer should see every Leprosy case once in two months.
 The District Nucleus Medical Team should visit 1/4 of the PHCs in the district
every
 month and review the programme in detail.
 The ADM&HO (Lep & Aids) should visit 1/4 of the PHC in the district every
month
 and review the programme in detail.
 The DM&HO should compulsory review the NLEP programme. During the
monthly
 Medical Officers review meeting.
 Proper reporting duly following the simplified information system (LF1,
LF2,LF3&
 LF4) as per the NLEP guidelines.
8. Risk Analysis:
 Delay in diagnosis may result in deformity.

 In proper management of reactions may result in deformity.
 Unable to control the reservoir infection will result in more number cases
especially children.
 Lack of self care may result in more complication like secondary infection,
absorption of fingers.
 Deformed cases will be burden to the individual, family, community and hospital
services.
Delay in early diagnosis More MB cases Transmission of the disease in

the community – in proper treatment Type – I and Type- II reactions, disability
& deformities Burden to the individual – community –Nation.
Expected Outcomes:
 Reduce the transmission of the disease in the community.

 Reduction in the case load both in Rural and Urban by early case detection and
prompt treatment.
 Reduction in deformity rate.
 Reduction in the child prevalence.
248
 Budget allocation should be more from the previous year for better mobility of the
District Nucleus Team, ADM&HOs (Lep & Aids) and the Sample survey cum
Assessment Units.
 IEC campaign through TV and radio (FM radio) so that self reporting of the cases
will be more.
 Providing Medical and Social Rehabilitation to the deformed and disabled
patients.
 More involvement of the General Health Care staff.
 Community participation in diagnosis and rehabilitation.
Budget for NLEP activities for 2011-12
Activity Amount
Proposed Rs.
In Lakhs
A. Contractual Staff (State & District)
1) BFO 1.80
2) Administrative Assistant 0.84
3) Surveillance Medical Officer at SLO 2.40
4) Drivers 4.86
5) D.E.O. 0.96
Total 10.86
B. Incentives for ASHA workers
1) Intensive payment for Expected new case to detected by ASHA 3.50
workers
2) Intensive payment for expected MB patients satisfactory 5.00
completing treatment :
3. Intensive payment for expected PB patients satisfactory 3.00
completing treatment :
Total 11.50
C. Drugs and Materials Supplies
1. Supportive drugs for leprosy patients @ 24000/ Dist including 5.50
patients in Leprosy colonies
2. Lab reagents and equipments for dist. 2.50
3. Printing of formats etc 4.00
Total 12.00
4. Vehicle Operation and Hiring
1. State Health & Family Welfare Society (NLEP) 1.70
2. District Health Society (NLEP) 17.25
Total 18.95
D. IEC Plan
1) Wall paintings 6.90
2) Quiz 0.70
3) Posters 4.50
4) Banners 3.45
5)Rallies 0.60
249
6)Sensitization meetings with ZPs and Mahalial Mandals NGOs etc 1.15
5 Nos.per Dist.
7)School IEC activities 2.30
8)Hoardings 9.20
9)Special Campaigns In priority mandals with PR above 1 by taking 6.20
up suitable IEC activities
Total 35.00
E. Training & Capacity Building
1) 4 days training to newly appointed MO's 3.00
ii. 3 days training to newly appointed HS (M & F) 2.00
iii. 3 days training to newly appointed HW (M & F) 4.22
iv. Two days Reorientation Training. 5.01
v. 5 days training to Lab Technicians District Hospital / CHC 0.48
Vi. ASHA Training 7.95
Total 22.66
F. DPMR Plan
1. MCR footwear 120 Nos. 7.00
2. Aids & Appliances 3.00
3. Honorarium to Government Medical Colleges for under 3.00
taking Reconstructive Surgeries
4. Honorarium to 400 patients of below BPL who have undertaken 20.00
Reconstructive Surgeries
Total 33.00
G. Urban Leprosy Control :
46 Identified Urban areas 20.15
Mega City Medium City Township
Total 20.15
H. NGOS Services – SET Scheme
1. GMLF, chilakalapally, Viziangaram Dist. 18.00
2. GRETNALTES, Morampudi, Guntur Dist.
3. SRDS, Vijayawada, Krishna District.
4. The Libra Society, Ramachandrapuram, E.G. Dist
Total 18.00
I. NLEP Supervision, Monitoring and Review
1. TA / DA of Contractual staff . 0.60
2. State level Review Meetings 1.00
Total 1.60
J. Office Operations and Maintenance
1. Rent, Telephone, Electricity, P & T Charges, Miscellaneous (State 4.52
and Districts)
2. Office equipments maintenance cost at state level 0.48
3. Consumables – Stationary Items (State and Districts) 3.50
Total 8.50
H. Cash Assistance 25.00
Grand Total 215.22
250
ABSTRACT
Estimated
Sl. Budget
Name of the Activity
No Rs. In
Lakhs
1 State Leprosy Cell-Contractual Staff 10.86
2 Incentive for ASHA 11.50
3 Drugs Materials and Supplies 12.00
4 Vehicle Operation and Hiring 18.95
5 IEC Plan 35.00
6 Training & Capacity Building 20.44
7 DPMR Plan 33.00
8 Urban Leprosy Control 20.15
9 NGOS Services – SET Scheme 18.00
10 NLEP Supervision, Monitoring and Review 1.60
11 Office Operations and Maintenance 8.50
12. Cash Assistance 25.00
Total : 215.00
251
D.6 INTEGRATED DISEASES SURVEILLANCE PROGRAMME
Strengthening IDSP Reporting Infections Diseases Effectively (RIDE)
Executive Summary:
 Strengthening the DSU and SSU and medical colleges units.
 Timely reporting by sub-district level functionaries.
 Real time monitoring and alerting using SMS,IVRS,GIS, systems with the NICs
(Govt. of India) technical support.
 Water quality Sampling and testing at sub-district level.
 Estimated Expenditure Rs.1098.77 Lakhs.
 No additional posts are erected
 Involvement of all stake holders without creating field level infrastructure
 Public private partnership with private medical colleges, Hospitals, and NGOs.
 Setting up of 21 districts Laboratories with Rs.728 lakhs as directed by the
Officers IDSP, Delhi to includes in PIP.
 Strengthening of information system by way of Broad band audio/video
conference that existed in the districts.
Project Identification:
1. Name of the Scheme: reporting Infectious Diseases Effectively (RIDE).
2. Location of Scheme: Health Sector Instructions in entire Andhra Pradesh.
3. Broad description of Scheme: to Monitor and control the diseases especially the
communicable diseases effectively and efficiently.
4. Forecasting the Disease occurrence and to render feedback for preventive
measures.
Objectives:
 Creation of minimum infrastructure to maximize the benefits of other available
infrastructure
 To strengthen State and District Surveillance Units and operationalise the
monitoring on 24X7 basis using state – of – the – art technology solutions
efficiently and effectively, to enable them to function as even epidemic control
cells.
 Map risk zones and facilitate differentiation of risk zones.
 Forecasting epidemics.
 Coordinating diseases and interventions over time.
 Monitoring the activities of health infrastructure and personnel in field.
 To develop state - of - the - art online early warning and alerting system.
 To build a State – of – the – art technology based mobile computing solution to
ensure instantaneous flow of information even from locations which are devoid of
any computer and electricity, example Tribal Thandas and Sub – PHCs in
remote, inaccessible areas.
 To build a GIS based state wide spatial analysis system for monitoring the spread
of diseases.
 To facilitate sampling and preliminary testing of water in-situ.
252
 To establish 21 district laboratories and to strengthen 2 districts priority
laboratory which are already existed.
Inter-linkage with other existing programmes providing similar benefits: the
proposal facilities maximize the benefits of the infrastructure and being created
under the IDSP Project. The private health institutions partnership will also be
taken for effective surveillance.
Demand Analysis:
Need / Justification, Basis of Estimation of Quantifiable:
302. Under the IDSP Project, Infrastructure is created at district level only. However,
districts is not the source of information. The field level units and health workers are the
sources of information. So there is an urgent need to equip the field level workers with
effective training and especially the newly recruited Medical Officers, 2 nd ANMs and
other field functionaries. This facilities timely reporting of the Disease incidence
information. This needs also the mobility (Transport) in a big way so as the RRT staff
and other staff to reach the spots without loss of time and the immediate investigation of
the epidemic can be done. Hence the train‟s component is included in the PIP for better
desirable levels of benefits in IDSP. Hence the training component is included in the PIP
for better desirable levels of benefits in IDSP.
At Present there are:

 13,711 Female Health workers
 1839 Pharmacists
 CHCs – 50
 PHCs 1791
 Lab Assistants: 1713
 APVVP Hospital and Teaching / General Hospitals approximately 200
303. All of them besides the private diagnostics centers, Hospitals, Nursing Homes,
Private Practitioners etc., are also going t involved in this reporting system.
Examinations of Alternatives
Alternatives considered indicating their physical and financial parameters:
The timely reporting is crucial.

 Present System: At present through phone, fax, email and post, the information is
being sent; it is taking a lot of time. S-form, P-form & L Form.
 Alternative: If Computers can be installed at all the locations and internet facility
can be provided and online internet based reporting is possible.
 Second Alternative (RIDE): Mobile computing technology to be used to get the
information online without creating any additional infrastructure in the field.
Rapid Response Teams mobility is ensured for the quick epidemic investigation
and preventive and control measures.
304. Basis of alternatives selected whether it is least cost option (to achieve a given
object or based on maximization of end results.
253
305. The second alternative is preferable is preferable as the cost involvement is least.
The field level workers who are mostly computer illiterates can also easily report the data
using mobile or POTs.
Physical parameters of the proposed programme/project/scheme
 Duration : One year

 Salient Features of the proposal.
306. To identify the potential areas infectious diseases occurrence and paths of their
spread Geographical in formations System can be used very effectively. The diseases
surveillance activities, The public health infrastructure and resources the Disease
demographic information can be mapped together to monitor and manage the infectious
disease, so that timely control measures can be taken before reaching the epidemic
proportions. Thus the benefits of such spatial analysis include –
 Physical Targets together with the basis/norms for fixing the targets – year wise
physical targets along with the build up and output expected.
o Empowering other stake holders
o Provision of preliminary water quality testing kits to the PHCs (H2S
Kits) and Cl estimation kits to Sub – Centers and ANMs.
o Establishing / Strengthening district laboratorie
 Physical inputs and activities proposed – land, buildings, utilities, equipment,

supplies etc. – Land provided free of cost or at a sub sized rate (i.e. capital cost)
 Manpower requirements (category/post-wise-existing/proposed), their training
requirements and arrangements.
 Transport of samples from the field to the laboratory for testing.
 Purchasing the diagnostic kits etc.
 For greater mobility and control measures
Impact /target Groups / Beneficiaries

 Likely Impact of the Scheme:
 Locating the geographical distribution and variation of diseases
 Map risk zones and facilitate differentiation risk zones.
 Forecasting epidemics, and feed back to the field functioning
 Controlling epidemics and better training
 Coordinating diseases and interventions over time and sustain the preventive
aspects
 Manage patient care environments, materials, supplies and human resources
 Monitoring the activities of health infrastructure and personnel in field.
 Route health workers, equipment and supplies to needy locations
 Identification of direct beneficiaries / specific target groups – criteria of the
selection of beneficiaries and mechanism built in the proposal for ensuring proper
selection of beneficiaries
 Beneficiary‟s involvement in the formulation of the scheme and consideration of
their needs.
 Private institutions involvement
254
Budget for IDSP activities for 2011-12
SN Activity Unit Rate No.of Annual Proposed

(Rs/Unit) posts / total budget
units / (Rs/lakhs) (Rs/lakhs)
quantity
1 2 3 4 5 6 7
I Surveillance & Preparedness
a) Total cost for Training
i. DM&HO(23) 2 1000 23 0.46
ii. DSO(23) 2 750 23 0.35
iii. DM/DEO 2 500 23 0.23
iv. Training toNewly posted doctors 1 1000 800 8.00
v. supervisor (Dist) 1 200 2500 5.00
vi. MPHA(F) (2nd ANM) 1 200 10000 20.00
vii. Newly Posted MPHA(F) 1 200 1700 3.40
viii. Pharmacist & Laboratries 1 200 3220 6.44
ix. Supervisor staff at Districts 1 250 250 0.63
x. ANM, CHC 1 200 350 0.70
xi. CHNC staff 1 200 1800 3.60
Private Nursing Home Doctors (1
1 300 1000
xii. each) 3.00
xiii. Ashas Training at PHC 1 100 34500 34.50
Total 86.30 86.30
b) Staff Remuneration
i. Remuneration of Epidemiologist 12 30000 24 86.40
ii. Remuneration of Microbiologist 12 30000 3 10.80
iii. Remuneration of Entomologist 12 15000 1 1.80
iv. Cosultant -Finanace 12 14000 1 1.68
v. Cosultant - Training 12 28000 1 3.36
vi. Data Manager
vii. Head Quarter 12 14000 1 1.68
viii. Data Managers 12 13500 23 37.26
ix. Data Entry Operators
a. Ssu 12 8500 1 1.02
b. DSU 12 8500 23 23.46
x. Medical colleges . Other Instt 12 8500 13 13.26
Total 180.72 180.72
c) Transport (Mobility Support)
i. At District
a. DSO/DM/DEO/ DE 20 300 3 0.18
b. Meetings at State Head Quarter 4 300 23 0.28
c. Hire of Vechile Mobolity 10 750 23 1.73
d. State Head Quarters 4.50
Total 6.68 6.68
II Office Expenses
a. SSU
b. Statinery 12 2000 1 0.24
c. Computer peripherals etc 13 2000 1 0.26
d. Computer Repairs other Misc 1.00
Statinery,Computer peripherals etc,
12 1500 23
e. Computer Repairs other Misc 4.14
255
SN Activity Unit Rate No.of Annual Proposed
(Rs/Unit) posts / total budget
units / (Rs/lakhs) (Rs/lakhs)
quantity
1 2 3 4 5 6 7
Total 5.64 5.64
III. Telephone & Broadband
a. Tephone & BB 12 4000 1 0.48
b. Data cards & and others 12 2500 1 0.30
c. Telephone & BB 12 1700 23 4.69
d. Medical colleges 12 1700 13 2.65
Total 8.12 8.12
IV. For strenghthning of district Labs
a) Basic Equipment 1 1790000 21 375.90
i. Staff salary 1 1188000 21 249.48
ii. Consumables and general Lab ware 1 100000 21 21.00
iii. Cost of kits, media, reagents 1 347500 21 72.98
iv. Contingency amoutn Annum 1 45000 21 9.45
Total 728.81 728.81
Collection and Transportation of
650000 6.50
V. samples 6.50
VI. Other Misc Expenses
a. Computer Rentals for trainings 100000 1.00
Software development charges for
300000
b. NIC 3.00
Procurement of new computers,
updation of RAMS, Updations HDD,
2000000
Procurement of Mass storage devices
c. for backup, 20.00
Printing of Formats and Reports ( S,
3000000
e. P, L, W Forms and their registers) 30.00
Innovations / PPP / NGO
750000
f. coordinations with IDSP 7.50
IEC and BCC activities towards
1050000
g. Outbreak Response and prevention 10.50
Total 72.00 72.00
VII. Outbreak Investigation and Response
Consumables for and kits for
1 200000 2 4.00
a. Identified distrit prioroty labs 4.00
Grand Total 1098.77 1098.77
256
Abstract of National Disease Control Programme
SN Activity Proposed Proposed

during Sub- after Sub-
group group
1 2 3 4
1 National Vector Borne Diseases Control Programme 1801.04 1801.04
2 Revised National T.B. Control Programme 2533.03 1978.24
3 National Programme for Control of Blindness 3741.90 2500.00
4 National Iodine Deficiency Disorders Control Programme 90.00 26.00
5 National Leprosy Eradication Programme 215.00 215.00
6 Integrated Disease Surveillance Programme 1098.87 272.92
NDCP Total 9479.84 6793.20
257
CHAPTER-5
MONITORING AND EVALUATION
307. Public health systems are essential systems and always remained the priority
subjects of the state and central government. Policies are made by the GoAP to ensure
equitable, easily accessible, good quality services to all the citizens, focusing on un-
reached and the tribal areas.
308. The planning and the service delivery & utilization of resources mainly depend on
the availability of timely and accurate data, its analysis & feed back. The real time MIS
data is an „essential decision support tool‟.
Executive summary:
309. The state has undertaken many reforms to strengthen the health care delivery
system in Andhra Pradesh. One amongst them is strengthening of monitoring and
evaluation system. A post of joint director (Monitoring and evaluation) is created for the
management of collection and compilation of data from all the primary secondary &
tertiary health care systems and private hospitals. Government has strengthening District
Project Monitoring Units in the districts, SPMU in the state.
310. To build effective MIS and system for real time data collection & analysis and
feed back, Nodal MIS personnel at all levels from PHC to state were identified and
instructions were issued.
311. As a part of organization strengthening reforms “Community Health Nutrition

Clusters” were created by the GoAP to extend supportive supervision, and to monitor 5
to6 PHCs by a senior Public Health Officer with senior experienced team members to
support him. To ensure consistency and quick response from peripheral grass root
institution and the analysis of such data , it is decided by the GoAP to design develop
and adopt suitable IT systems. It is also envisioned that all the levels of administrators
and nodal persons to be trained in utilizing these systems. The IT infrastructure is to be
provided for this purpose.
312. GOI has introduced HMIS web portal to effectively monitor NRHM activities
(physical and financial) and strengthen the program implementation. The HMIS enables
data collection from the level of sub centers, PHCs, CHCs, Area hospital, District
hospital and reports are collected from PHCs, and districts and up loaded from state to
the GOI.
Key objectives:
 Collection of accurate and quality data from sub centers and to upload from
PHC.
 Collection of data from private sector through existing PHCs, CHNCs, and other
assigned government health institution.
258
 For Compilation and evaluation of data and communication of feedback
information at all levels to take corrective actions immediately to achieve the
objectives set by the GoAP.
 To have regular monitoring system at all levels.
Situation Analysis:
 At present data is collected from sub centers and compiled at PHC and is being
handed over to district manually. No IT enabled systems exist at this level. This
often results in delay, default, and submission of in accurate data, no accounting
software packages are used for the purpose.
 Districts compile the data that is available as on the date of reporting upload it in
to HMIS portal. The cadres involved in data collection and compilation are not
trained. Hence there are many gaps inaccuracies in the reports generated.
 There is no on line data feeding facility at PHCs.
 Critical analysis of data is not being done in all levels especially at the PHCs and
feed back is not generated and used.
 Mid term analysis of on going programs are not done.
 Intra departmental coordination in collection and compilation of data is a matter
of concern.
 There is no policy for training the personnel who are posted /assigned the
responsibility of handling the data as a result of transfers, new recruitments,
promotions etc. There is a need for periodic trainings in this regard to all the
cadres involved.
 There is no regular supervision for ensuring the quality reliability at all levels.
 Registers and report formats are not supplied regularly to the field staff to collect
the data that is useful for the field staff in their day to day health program
implementation activities. Registers and formats are not user friendly.
 The PHC , CHC , and all the other staff are not trained to enable them for
understanding their rolls clearly.
 There are no regular fixed day reviews and support for improvisation of staff
performance.
 Mobility (vehicles) for the monitoring officers is not provided.
Key strategies:
 Online data collection; Provision of on line facility to all PHCs, CHNCs and
districts so as to enable them to have the information, and to disseminate the
information and implementation of the web based computerized Accounting
System („Tally Accounting System - software package‟).
 Nodal MIS person is kept responsible at all levels and data will be shared with all
program officers for effective utilization of data and to take corrective measures.
 Effective supervision; Supervision by SPHOs along with his/her team in their
jurisdiction. Utilization of Services of all Nodal officers who were kept in charge
for each district to support SPHO and supervisors at district and at PHC as
district task force teams. All these teams will give supportive supervision to the
field level functionaries.
259
 Registers and report formats are to be supplied regularly to the field staff to collect
the data that is useful for the field staff in their day to day health program
implementation activities. Registers and formats are to be user friendly and
relevant to their function and easy to understand. Printed preferably in telugu
language.
 To have regular fixed day reviews and support for improvisation of staff
performance.
Program Components:
 To have Regular review at all levels to monitor the program

 Training / sensitization on HMIS data up loading.
 Training / sensitization on filling up of all user friendly registers and reporting.
 Provision of registers and reporting formats.
 Mobility to monitoring officer.
 IT enabling of the PHCs CHNCs and other health institutions.

o Procurement of computers, printers, internet facility through APHMHIDC/
APTS or any authorized government agency as decided by the GoAP.
 Printing of registers and formats as per established government procedures for
production and supply of printed material for the department.
 To recruit data entry operators through Rogi Kalyan Samithis or Hospital
development societies as 3rd party for a period of one year by the end of the year
institution must develop competence.
 Trainings and capacity building:
o Training of trainers – to be done by the joint director – trainings.
o State level workshop for all HODs regarding HMIS – convened by JD M&E.
o Training of all Nodal persons of PHCs , CHNCs and DM&HOs, Statistical
officers – to be done by the District Training team.
o Funding by NRHM.
o Training the concerned staff in usage of „Tally Accounting System software
package‟
 Provision of laptops and data card for internet connectivity to all the joint
directors for real time data exchange collective decision making.
 Possibilty of creating state owned M&E portal to meet the needs of RTI is to be
explored.
 A vehicle is to be provided under NRHM to the monitoring officer.
 Provision of strengthening of Finance wing in the district and state level under
NRHM by providing Tally System.
Monitoring and reporting system for assessment the performance M&E wing :
 Number of institutions reporting in time.
 Number of program specific analysis reports generated moth wise, quarterly.
 Consolidated performance reposts for the state district wise – submitted to the
GoAP for decision support and state health planning.
260
 Periodic conference / evaluation meeting conducted for reporting officers of
different levels of administration
 Number of tours made by the state M&E team and the individual officers with
outcomes achieved month wise quarter wise.
Risk analysis :
313. The implementation of the proposed interventions enabling is essential as failure

to implement may result in ineffective performance.
To sustain the M&E system and improve the functionality following are essential.
 Ensuring trained staff availability.
 Ensuring the availability of computers and technical support to maintain them.
 Minimizing the administrative delay in release of funds.
 Timely supply of registers and formats.
Expected out comes:

 Real time reliable quality ensured institution wise district wise report generation.
 Well maintained periodicity of reporting to assist the decision support at state
level.
 Improvement in accuracy and reliability of the reports as result of real time
collection submission and consolidation of the reports,
 Timely analysis of the reports and rapid communication of analyzed reports and
suggested interventions to the concerned HODs and controlling/program officers
for necessary corrective action.
 Provision of accurate program management data and analysis reports for state
health planning.
 Inputs under RTI act implementation, to support in preparation of answers to
LAQs.
 Online Accounting will be available.
 Real-time automated financial report generation through „Tally Accounting
System software package‟
Special features in 2010 -11 proposals:

 Refinement and rationalization of reporting formats.
 IT enabling of M&E systems.
 Capacity building in identified target group in a mission mode.
 Mobility to monitoring officers.
Budget Analysis (summaries budget utilization since inception of NRHM, with

specific reference to 2010-11 and analyze the proposal for 2011-12)
 An amount of Rs.10.00 lakhs are released for M&E under NRHM on Health
Statistics and Demography & HMIS Portal.
 The Reorientation training are being conducted to the Deputy Director (Stat.),
Statistical Officers, Lecturer and Statistics & Demography, Deputy Statistical
Officers, Assistant Statistical Officers and LD Computers at State, District, and
PHC Level.
261
 The following surveys are being conducted and planned during 2010-11 with in 3
months.
o Evaluation Study on Role and Responsibilities of 2nd ANMs in Andhra
Pradesh.
 Study on Utilization of Rogi Kalyani Samithi Funds.
 Evaluation of 108 and 104 partner
 Public Health facility survey of PHCs and CHCs in the districts in tribal
area
 Sample Survey of Health practices for adolescent girls in tribal welfare
schools in Andhra Pradesh
Trainings to Statistical Personnel on Health Statistics, Demography & HMIS Portal
a) Rs.3,93,969/- was released to the Director, Indian Institute of Health and Family
Welfare, Vengalraonager, Hyderabad for conducting the HMIS Re-Orientation
Training Programme to the Deputy Directors (Stat.), Statistical Officers and
Lectures in Statistics & Demography. For 3 batches @Rs.1,31,323/- 1st batch is
planned from 19.01.2011 to 22.01.2011 (4days)
b) An amount of Rs.1,48,199/- was released to the Director, IIH&FW,
Vengalraonagar, Hyderabad for 2 batches @Rs.74,050/- for each batch for
conducting training on Health Statistics, Demography & HMIS Portal to LD
Computers, ASOs and Dy. SOs.
c) Rs.4,46,100/- was released to the Principals of RTC, Kurnool, Guntur and
Visakhapatnam for 6 batches @Rs.74350/- for each batch for conducting training
on Health Statistics, Demography & HMIS portal to LD Computers, ASOs and
Dy. SOs for 2 batches at each centre.
Sl Place of Training No.of Participants Date of No.of

No Batches Training participants
attended
1 RTC Kurnool 1 LD Computers, ASOs 09.11.2010 to 25 Members
and Dy. SOs 12.11.2010
2 RTC Kurnool 1 LD Computers, ASOs 07.12.2010 to 25 Members
and Dy. SOs 12.12.2010
3 RTC Guntur 1 LD Computers, ASOs 09.11.2010 to 23 Members
and Dy. SOs 12.11.2010
4 RTC 1 LD Computers, ASOs 27.12.2010 to 17 Members
Visakhapatnam and Dy. SOs 30.12.2010
5 IIH&FW, 1 LD Computers, ASOs 15.09.2010 to 28 Members
Hyderabad and Dy. SOs 18.09.2010
Total 5 118 Members
Proposed to be conducted in January 2011
SN Place of No.of Participants Date of No.of

Training Batches Training participants
attended
1 IIH&FW, 1 Dy. Directors, SOs and 19.01.2011 25 Members
Hyderabad Lec. In Stat. & Demo. to
22.01.2011
2 IIH&FW, Proposed 2 Dy. Directors, SOs and 50 Members
262
Hyderabad Batches Lec. In Stat. & Demo.
3 RTC Guntur 1 LD Computers, ASOs 03.01.2011 25 Members
and Dy. SOs to
06.01.2011
4 RTC 1 LD Computers, ASOs 03.01.2011 25 Members
Visakhapatnam and Dy. SOs to
06.01.2011
5 IIH&FW, Proposed 1 LD Computers, ASOs 25 Members
Hyderabad Batch and Dy. SOs
Total 6 150 Members
Abstract of Trainings Conducted so far on Health Statistics, Demography & HMIS Portal
Sl. Released to Training to No.of Amount
No. Batches released
1 Director, IIH&FW, Vengalraonagar, DD (Stat.), SOs 3 Rs.3,93,969/-
Hyderabad & Lecs. in Stat.
(for 3 batches @Rs.1,31,323/- for each & Demography
batch)
2 Director, IIH&FW, Vengalraonagar, LD Computers, 2 Rs.1,48,199/-
Hyderabad ASOs and Dy.
(for 2 batches @Rs.74,050/- for each SOs
batch)
3 Principals of RTC, Kurnool, Guntur and LD Computers, 6 Rs.4,46,100/-
Visakhapatnam ASOs and Dy.
(for 6 batches @Rs.74350/- for each SOs
batch)
Total 11 Rs.9,88,268/-
263
Budget for Monitoring and Evaluation activities for 2011-12

units / (Rs/lakhs)
quantity
1 2 3 4 5 6
1 Strengthening of
M&E/HMIS/MCH Tracking
a) Mobility Support
i) State level M&E Officer Mobility 20000 1 2.40
ii) State level District Nodal Officers for Mobility 2600 1320 411.84
fields visits
b) State level convention for all HODs Conventions 100000 2 2.00
c) Quarterly review meetings of Meeting 500 660 3.30
DMHOs
d) SPHOs monthly review meetings Meeting 300 360 12.96
Quarterly Review meetings to all Meeting 200 8800 17.60
Medical Officers at District level
c) Workshops / Training on M&E
i) State Level workshop to all HODs 1 5000 1 0.05
ii) District Level workshop to all District 1 3000 22 0.66
iii) Monthly Review meetings to 1 10000 12 1.20
Statistical Officers
d) M&E Studies
i) NRHM important interventions 1 5000000 1 50.00
survey
e) Others
i) Medical Officers review meetings to 1 200 464 0.93
all PP Units, UFWCs, UHCs an
UHPs
Sub Total 502.94
2 Operationalising HMIS at Sub-
District Level
a) Review of existing registers to make
them compatible with National HMIS
i) NRHM Reports consisting 8 pages 1 5 5600 3.36
per 2800 Institutions 2 sets per month
ii) FWP Performance formats 12 Sets per 1 55 5600 36.96
each Institute in duplicate for 12
months
b) Printing of New Registers/ Forms
c) Training of Staff 1 21750 42 9.14
Sub Total 49.46
3 Operationalising MCH Tracking
a) Towards Printing and Reproducing 1 30000000 1 300.00
Registers / Forms (Field Survey
Registers MPHA (M&F), Field
Supervisory Register (M&F), House
Hold Registers)
b) Capacity Building of Teams
i PHC 1 5000 1624 81.20
ii PP Unit & UFWCs 1 500 227 1.14
c) On going review of MCH tracking
activities
264
units / (Rs/lakhs)
quantity
1 2 3 4 5 6
i On going review of MCH tracking 1 5000 360 216.00
Cluster Level
ii On going review of MCH tracking 1 8000 22 21.12
District Level
iii On going review of MCH tracking 1 18000 12 2.16
State Level
d) Monitoring data collection and data
quality
i Monitoring data collection at district 1 50000 22 11.00
level
e) Administrative overheads to 22 1 50000 23 11.50
districts & Headquarters
Sub Total 644.12
M&E Total 1196.51
265
CHAPTER-6
FIANANCIAL MANAGEMENT
1. Budgeting for Various Activities:
314. The State of Andhra Pradesh has impressive Tertiary Health infrastructure,
especially in the private sector. In this back ground the Government of Andhra Pradesh
has demonstrated its commitment to achieve sustainable improvement in the health
status of its population with strong focus on improvement in the health outcomes for all
sections of people, especially women, children, vulnerable group of population such as
SC‟s and ST‟s etc.
315. The budgeting for various Programmes/activities under NRHM is proposed

strictly in accordance with Financial Monitoring Report (FMR) Format so as to facilitate
proper analysis of the progressive utilization of funds and taking remedial measures.
316. The Fiduciary Risk Assessment (FRA) which was carried out as a precursor to
the APHSRP pertains to enhancing financial accountability in societies key functions
need to be established within society‟s to ensure processes which improve accountability
including internal controls; periodic reports; submission of statutory requirements;
liaison with audit/public Accounts committee (PAC); and follow – up of external and
internal reports.
317. Financial Management is one of the Key Performances Indicators (KPI) allocate,
monitor and to appraise the degree of proper utilization of funds under different health
interventions by different plan Implementing Officers at both State and District level and
achieving the ultimate objective of ensuring financial propriety.
318. To implement and monitor the activities during the year, each implementing
agency in the state and district DCHS prepare a plan of action indicating inter-alia, the
physical targets and budgetary estimates in accordance with approved pattern of
assistance under the scheme, covering all aspects of the program activities for the period
from April to March each year, and send it to Department of Family Welfare for
approval well before the start of the financial year.
319. The monitoring by the GoI will be at the program level. However, to evaluate
performance, progress under each activity as proposed by the state in the Annual Work
Plan (AWP) and agreed by the GoI, will be monitored. Any changes in the approved
AWP will be discussed during the quarterly and annual reviews and implemented by
mutual consent. Activity wise performance evaluation will then be synchronized with
the revised work plan. In all such cases FMG, GoI will necessarily be informed of this
revision.
266
2. Financial Management Staff:
320. Chief Finance Officer (SPMU) was appointed at state level and recently two
Assistant Accounts Officers have also been appointed to assist the Chief Finance Officer
(SPMU) in the Financial Management
321. Accountants & Data Assistants are in position at State / District level. At State
level one Senior Assistant (Regular), one project Assistant, four Account Clerks and one
Junior Accountant one personal Assist, two Contract Junior Assistants are working. At
District level One DPO, AO (NRHM), MIS & DEO are working at District Level, and
remuneration of the PMU staff including NDCPs is under process.
322. The powers to accord financial approvals/sanctions are vest at the level where the
funds have been devolved.
 For the funds to be spent at the State Health Society level for any activity
included in the approved State PIP the office bearers of the SHS should have full
powers to sanction the expenditure in accordance with norms and no separate
approvals of any State Government Department should be necessary.
 For the funds to be spent at the District Health Society level for any approved
activity the office bearers of the District Society have full powers to sanction the
expenditure in accordance with norms and no approval of the SHS or State
Government is necessary.
 For the funds to be spent by BMOs, CHCs/PHCs, Sub – Centers, VHSCs, etc,
for approved activities, the functionaries concerned are fully empowered to incur
expenditure in accordance with the norms laid down in the approved plans. The
functionaries concerned refrain from seeking unnecessary administrative /
financial approvals of the higher authorities.
 The delegated powers for the office – bearers and authorities of the State Health
Society and District Health Society are same across all Programmes and the
framework of delegation of these powers also apply to the State‟s Share
contributed to the State Health Society under NRHM. However procurement
procedures (including Civil Works) for any programme should be in accordance
with specific agreements entered into with funding agencies or donors, as the case
my be.
Key Tasks:
323. The Chief Financial Officer‟s key tasks included but not be limited to the
following:
 Develop an operational manual of management of funds in state society,
district society and facility level societies (eg Rogi Kalyan Samiti); obtain
necessary approvals.
 Manage society funds including flexi pool funds by:
 Overseeing disbursement of funds to implementing agencies.
 Ensuring that the accounting procedures laid down in the
operational manual are followed.
 Preparation of statement of expenditure and collection of
utilization certificates.
 Ensuring conduct of financial counting / management audits and
compliance with findings.
267
 Ensure conduct of training needs assessment of state and district
accounting staff and conduct of training programmes for them (Such as
double entry book keeping, using accounting software, etc.)
 Budget analysis of the state, district and facility level societies and
developing proposlas for improving financial management systems at
these levels.
324. Accounting Policies: In order to ensure uniformity and consistency in the

method of accounting for program funds and financial reporting, the periodic financial
reporting and the annual financial statements are guided by the accounting policies and
principles. In some cases there are some deviations from the accounting standards
prescribed by the institute of Chartered Accountants of India, e.g. Depreciation policy.
Some key accounting policies are:

 Maintenance of Accounts:
The accounts of the society are maintained on double entry book keeping
principles, on cash basis of accounting. Standard books of accounts (cash book,
journal, ledger, etc.) are maintained in accordance with the accounting policies
being given bellow.
The financial statement has been prepared on the cash basis of accounting and the
applicable accounting standards issued by the Institute of Chartered Accountants
of India subject to certain exceptions which are listed below.
 Fixed Assets:
Fixed assets are stated at cost of acquisition and subsequent improvements
thereto including taxes, duties, freight and other incidental expenses relating to
acquisition. Capital fund, equivalent to cost of fixed assets purchased during the
year, is created.
For the purpose of fixed assets only those assets are counted which are directly
purchased for the use in the premises of the state and district society officers and
the vehicles purchased for the use of society.
 Investment:
Investment in FDRs or any other instruments are current investments and are
stated at cost.
 Depreciation:
Depreciation of fixed assets is not provided as assets are generated out of Grants-
in-Aid (GIA). However assets are disposed of / condemned as per the provisions
under General Financial Rules (GFR) of state/UT governments or GoI.
 Recognition of Income / Expenditure:
 The Grant-in-Aid (GIA) is accounted on cash basis.
 The Grant-in-Aid (GIA) is reflected in the Income & Expenditure
accounts as income to the extent of fund utilization against it.
 The Grant-in-Aid (GIA) to the extent it remains utilized at the end of the
financial year is shown as liability in the balance sheet.
 „Other Income‟ – interest income, income from investments are accounted
on cash basis.
 Commodity grants received from the Government of India relating to the
RCH program are not reflected in the financial statements of the society.
Maintenance of Accounts Records:
268
325. A record of all program transactions is maintained with appropriate supporting
documentation for the transactions. These supporting documents should be cross –
referenced so as to link them to each item of expenditure with budget heads, project
components, expenditure categories (summary and detailed) compatible with
classification of expenditure and sources of funds indicated in the project
implementation plan and project cost budget sheets. These books of accounts together
with supporting documents and project management reports are maintained for at least
three years after the completion of audit of the entire program expenditure, i.e., at least
three years after the completion of RCH Phase II program.
Heads of Accounts:
326. In order to keep proper financial information on the program activities, the
standard ledger heads for each component and sub-ledger heads for all the categories
under these components are maintained. All expenditure incurred by a society is booked
under the account heads maintained in respect of various items of expenditure relating to
these components.
Submission of Financial Reports:
327. All the districts send a monthly financial report to the state by the 10 th of the
following month in respect of expenditure incurred. In case the information is not
received from the districts by 10th, the state immediately contacts the district RCH
Society/CMO to get the information expeditiously.
Utilization Certificate:
328. In respect to the grants-in-Aid received from the Government of India, the
Society shall furnish a “Utilization Certificate” (UC) in Form No. GFR 19A duly signed
by the ED/ Project Director to Department of Family Welfare, GoI along with the
audited annual financial statements. The UC is required to be submitted by 31 st July
every year along with the audited statement of expenditure.
Basis for assessment of Performance:

 Timely disbursement of funds to the district societies and, collection of
SoEs and consolidation of financial data each district wise and for the state
as a whole.
 Budget analysis of the state, districts and facility level societies.
 Timely conduct of financial management / accounting audits.
 Number of suggestions for improved utilization of funds implemented and
quantum of financial impact.
3. Statutory Audit:
329. Statutory Audit for the year 2009-10 is completed and submitted to GOI by 27th
January 2011, some clarification regarding the expenditure split under RCH Flexible
Pool for this we are working out, soon we will forward the information desired by the
GOI-NRHM.
269
330. Selection of Statutory Audit for the year 2010-11 is under process by this month
we will inform the Status of the Statutory Auditor for the Year 2010-11.
331. The Government of Indian Ministry of Health and Family Welfare has
communicated the Guidelines for the appointment of Statutory Auditor through Open
Tender System to Conduct Audit of State and District Health Societies for the year 2010-
11. Therefore a tender notification for hiring the services of Charted Accountant firms
for Statutory Audit of State Health and Family Welfare Society and District Health and
Family Welfare Society for the Financial Year 2010-11 under the (NRHM) has been
issued vide Rc.No 018/NRHM/Fin./2011, dated 07.02.2011 in Times of India. Last
date for submission of tender proposals is 25.02.2011.
4. Concurrent Audit:
332. For the Financial year 2009-10 instructions are given to DHS to appoint
Concurrent Auditors to conduct Concurrent Audit, in some of the DHS they are failed to
appoint but in some DHS appointment of Concurrent Auditor was delayed so this was
the reasons, we couldn‟t submit the Executive summery Report, But for the Financial
Year 2010-11 we have taken necessary steps for appointment of Concurrent Auditors at
DHS by Open Tender System and appointing single Auditor for 6-7 DHS ,
333. The Financial Management unit of NRHM is considerably strengthened to

provide sustained oversight and capacity development of the financial management units
from the state to the PHC level.
334. Systems are being strengthened to ensure streamlined and transparent

management of NRHM finances. Concurrent audit was ordered in all the 23 districts by
4 audit parties. The names of the audit parties and districts where they conduct
Concurrent Audit are shown bellow.
Sl.
Name of the firm District allotted
No
1 Sayanarayana Raju & East Godavari, West Godavari, Guntur, Prakasam,
Co SPSR Nellore, Chittoor
2 A V Ratnam & Co Hyderabad, Medak, Nalgonda, Visakhapatnam,
Vizianagarm and Srikakulam and Head Quarters.
3 V Suneeth Krishna, Ananthapur, Nizamabad, Khammam,
Karimnagar and Kadapa
4 K Suseela & Co Mahabbonagar, Warangal, Adilabad, Rangareddy
and Kurnool.
5. Implementation of Tally:
335. Tally has been procured and installed in 23 district & Head Office, In 9 districts
and Head Office Tally version is updated as per the new TCP developed by the GOI
NRHM. In the remaining 14 districts updating of Tally version is under process,
Training will be imparted to all the staff concerned in districts as well as in Head Office.
270
6. Mode of Fund Transfer:
336. Fund Transfer from SHS to DHS by e-transfer and fund transfer from PHCs by e-
Transfer (There are no Blocks in this State).
7. Financial Reporting under NRHM:
337. FMR (excluding NDCPs) up to 28.02.2011 & Statement of Fund Position as on

28.02.2011 had sent to GOI/FMG in a prescribed time frame, integration of NDCPs is
under Process.
338. FMRs are sent timely (excluding NDCPs). Consolidated FMR up to 31.12.2010
has already been submitted to Government of India.
339. All the districts send a monthly financial report to the state by the 10 th of the
following month in respect of expenditure incurred. In case the information is not
received from the districts by 10th, the state immediately contacts the district RCH
Society/CMO to get the information expeditiously. In some cases concerned district
officials are asked to personally bring the information to ensure compliance. In case
districts neither furnish the information nor bring the information personally, the state
officials are deputed to look into the problems of the district in giving the information
and set it right for future.
340. A format of financial report is to be furnished quarterly within 30 days from the
close of each quarter by the state to the center. As stated in the above para, the state
ensure receipt of information from all the districts, compilation, and furnishing of the
same to the MoH&FW, GoI within the stipulated date without fail and no excuse is
acceptable on this count.
341. The state evaluates the performance of the contractual Finance and Accounts
staff by suitably devising a performance appraisal format/sheet which will inter-alia
include her/his performance vis-à-vis Financial Performance related indicators. A copy
of this performance appraisal sheet is forwarded to the Financial Management Group
(FMG) , GoI for getting concurrence for the yearly extension of tenure of the Finance
and Accounts personnel. Pending feedback from the central FMG, the state is
empowered to extend the tenure up to six months.
342. A similar procedure is followed by the state/UT to evaluate and monitor the
performance of accounts and finance staff of the district RCH societies.
9. MIS:
The timely submission of monthly MIS/FSP and quarterly MIS is in place, But
with head wise and age wise details of advances up to 31.12.2010 will be initiated
10. RCH – I Unspent Balance:

There were no Unspent Balances under RCH – I Project.
271
11. Key Areas for Priority during 2011-12:
The following six district have been identified as high focus districts / backward areas on
the basis of left wing affected, minority, tribal, SC/ST, Gender etc., grounds
1. Adilabad
2. Mahabubnagar
3. Warangal
4. Ananthapur
5. Khammam
6. Nellore
The para-medicos working in above districts are being paid special pay and allowances.
272
BUDGET ABSTRACT OF NRHM PIP – 2011-12
(Rupees in lakhs)
SN Activity Budget
proposed
2011-12
RCH Flexible Pool
I Maternal Health
1 Referral Hospital Strenthening 2147.87
2 24-hours MCH Centres 4767.84
3 Janani Suraksha Yojana 4282.94
4 Maternal Death Review(MDR) 159.00
5 Mother & Child Tracking 100.00
6 MTP Services (Trainings) 10.60
7 RTI/STI Services (Trainings proposed) 233.40
8 Midwifery Training for ANMs, Staff Nurse & MOs 100.00
10 Blood Bank & Blood Storage Centres 239.80
II Child Health
1 New Born Care Corners 2418.35
2 New Born Stabilization Units (NBSU) 1247.10
3 Sick New Born Care Units (SNCU) 281.00
4 Nutritional Rehabilitation Centers 515.73
III Family Planning Strategy
1 Family Planning Management 9.01
2 Terminal / Limiting Methods
a) Plan for facilities providing FEMALE sterilisation services on fixed days 65.64
at health facilities in districts
b) Compensation for sterilisation (Female) 2250.00
c) Compensation for sterilisation NSV (male) 600.00
d) Accreditation of NGOs / Voluntory Organizations for sterilization 250.00
services
3 SPACING METHOD (Providing of IUD services by districts)
a) IUD services at health facilities in districts 94.00
b) Compensation to ASHA for 100% retention of IUD by clients 200.00
4 Workshop on Population Stabilization 28.00
5 BCC/IEC activities/campaigns/melas for family planning 36.00
IV Adolescent Health
1 Establishment of Health Clubs 99.20
Fixed Day Health Clubs with Specialist Services & Consellers 18.72
Printing of Booklets & IEC activities 21.75
V School Health Programme
1 School Health Programme 1560.50
VI Urban Health Strategy
1 Urban Health centres 706.08
2 Other initiatives 147.44
273
SN Activity Budget
proposed
2011-12
VII Tribal Health Strategy
1 Tribal RCH 2244.71
VIII Vulnerable Groups
1 Special Package to the identified Institutions 1527.60
IX High Focused Districts
1 High Focused Districts 292.96
X Training Strategy
1 Skill Birth Attendance Training to Staff Nurses and ANMs 444.00
2 BEMONC 57.00
3 Training of MOs in Emergency Obstetric Care 60.00
4 Training of MOs in Life saving Skills in Anesthesia 30.00
5 NSSK Training 259.20
6 F-IMNCI Training 285.00
7 IMNCI Training 1435.49
8 Pre Services IMNCI 48.00
9 Capacity Development FBNC 97.08
10 Training in Management of SAM 29.99
11 IUCD Training 270.26
12 ARSH training 400.56
13 Menstrual Hygiene 25.60
14 Induction Training for PHC Medical Officers 144.00
15 Capacity enhancement on BCC 58.09
16 Orientation Training to Cluster / District / State level Management 50.00
Units
Training Strategy Total 3694.27
XI Programme Management Unit 2248.91
XII Behaviour Change Communication (BCC) 875.00
Total RCH Flexible Pool 33496.43
II) Mission Flexible Pool
1 Strengthening the Role of ASHA
a) ASHA Performance Based Incentives 2890.98
b) Best ASHA Awards 24.69
c) ASHA Conventions 848.40
d) Providing Saree to ASHAs (2 sarees) 282.80
e) Ashas Training TOT (6&7 Modules) 5.66
f) Training for ASHAs 482.09
f) Translation and Printing of ASHAs modules 20.00
2 Village Health Sanitation Committees 2227.60
3 Untied funds
4 Annual Maintenance Grants
274
SN Activity Budget
proposed
2011-12
5 Hospital Development Societies (HDS)
a) Primary Health Centres 1624.00
b) Community Health Officeer 309.00
c) Area Hospitals 54.00
d) District Headquarters Hospitals 85.00
6 Construction of Health Facility Buildings
c) Community Health Centres 1875.00
d) Developing the Project hospital at Srisailam ITDA in to a multi specialty 200.00
hospital for Primitive tribal Chenchu citizens.
e) Strengthening of existing SCNUs 190.00
f) New SCNUs ( 20 bedded) 190.00
g) New SCNUs ( 12 bedded) ( Tribal) 240.00
h) Refurbishment of New Born Stabilization Units 1320.00
7 Strengthening of Community Health and Nutrition Clusters 500.00
8 Salaries of Second ANM 12745.44
9 Salaries for MPHA (Male) 2485.36
10 Procurement of Equipment & Medicines 4022.25
11 Nutrition Support Intervention
a) Village Health & Nutrition Day 886.33
b) Establishment of Nutrition rehabilitation centers (SAM) 609.27
12 RNTCP 143.00
13 Quality Assurance Cell for monitoring MCH activities & Trainings 21.24
14 Mainstreaming of AYUSH 2959.53
15 CUG Mobile connection to Tribal areas ANMs 123.00
16 Salaries of NPs (Nurse Practioners) 617.76
17 Strengthening of RCH services through CHNC 760.00
18 PHC mobile for strengthening RCH services 686.40
19 PG Diploma Course in Public Health 75.00
Total NRHM Flexible Pool 51035.80
III) Strengthening of Routine Immunization
1 Mobility for supervision at District-level 23.81
2 Mobility for supervision at state-level 3.00
3 Review meetings for the DIOs 3.58
4 Alternative Vaccine Delivery 300.53
5 Vaccine Transport 59.04
6 Support for Computer Assistance to DIOs 27.60
7 Support for two Computer Assistance to JD(CH&I) 2.88
8 Cold chain repairs and maintenance of equipment 33.16
9 Printing of Mother & Child Protection Cards and Registers 150.00
10 Special plan for Underserved Areas 33.94
11 Social Mobilization by ASHA /Link workers 1272.60
12 Cold Chain electricity charges
a) Central Vaccine Stores 8.40
b) Regional Vaccine Stores 7.92
13 Hiring services of ANMs in vacant places of SCs (urban areas) 100.80
14 Repairs to vaccine delivery vans 15.60
275
SN Activity Budget
proposed
2011-12
15 Handling and Service charges (Airport charges, etc.) 5.00
16 Training to Health Workers on Immunization 364.83
17 Maintenance of Data Loggers to WICs/WIF at state headquarters 0.60
18 Adverse Events Following Immunization 3.13
19 Supportive supervision from state-level 23.00
20 Providing fuel to Generators at CVS, RVS and districts 8.50
21 Procurement of Spare Parts 34.50
22 Procurement of Vaccine Carriers 9.31
23 Procurement of Spare ice packs 1.25
SRI Total 2492.96
IV National Disease Control Programme
1 National Vector Borne Diseases Control Programme 1801.04
2 Revised National T.B. Control Programme 1978.24
3 National Programme for Control of Blindness 2500.00
4 National Iodine Deficiency Disorders Control Programme 26.00
5 National Leprosy Eradication Programme 215.00
6 Integrated Disease Surveillance Programme 272.92
NDCP Total 6793.20
V Monitoring & Evaluation
1 Strengthening of M&E/HMIS/MCH Tracking 502.94
2 Operationalising HMIS at Sub-District Level 49.46
3 Operationalising MCH Tracking 644.12
M&E Total 1196.51
VI Direction and Administration (Treasury route)
1 001 Direction & Administration - Headquarters Office 393.18
2 001 Direction & Administration - District Family Welfare Bureau 4111.60
3 003 Training - Regional FW Training Centres 481.40
4 003 Training - Training of ANM, Dayas & LHVs 868.45
5 003 Training - ANM Training Schools run by LBs & VOs 412.50
6 003 Training - Training and Employment of MPW(Male) 452.86
7 101 Rural Family Welfare Services - Sub-centres 25588.32
8 102 Urban Family Welfare Clinics - Urban Family Welfare Centres 1932.55
9 103 Mother & Child Health - Medical Termination of Pregnency 35.84
10 200 Other Services - Maintenance of Sterilisation Beds 383.98
11 200 Other Services - Micro Surgical Recanalisation 0.20
Treasury budget Total 34660.88
VII Pulse Polio 2200.00
GRAND TOTAL 131875.78
276

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NATIONAL RURAL HEALTH MISSION – ANDHR APRADESH

THE PROGRAMME IMPLEMENTATION PLAN (PIP) 2011-12

2. The Government of Andhra Pradesh has demonstrated its commitment to

3. Revitalisation of the Primary Health System: The Government‟s endeavour is to

 Strengthen preventive, promotive, curative and referral health services through

4. Institutional Strengthening: The government has ensured for effective integration

5. Human Resources: The Government have commitment to strengthening the

6. Programme revitalization: The institutional reengineering has shown impact both

7. The NRHM Project Implementation Plan (PIP) for 2011-12 is a salubrious

Sectoral Priorities – Budget Allocation

OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11

Socio-Demographic Profile of Andhra Pradesh

Rural Urban Total

Census Urban Percent of Urban Decadal growth

 Achieve a cure rate (TB - DOTS) of – 85% by 2012

Infant Mortality Rate Maternal Mortality Ratio

Source: Sample Registration System (SRS), RG, GOI

Total Fertility Rate Institutional Deliveries

Out come of surveys on Service Delivery

NRHM /RCH-II Outcomes

Service Delivery Summary

B. Delivery and Post Natal care

Surveys Home Public Private Total

a) The percentage of institutional deliveries increased to 94.6% as per HMIS data

Trends in Institutional Deliveries in Andhra Pradesh

d) Home based deliveries declined from 23% in 2007-08 (DLHS-3) to 5% (HMIS,

g) 34% of C-Sections are conducted in private institutions as compared to 8.5% in

2009-10 April – Sept. 10

Unreported Home SBA

Comparison of type of deliveries Comparison of institutional deliveries:

District-wise institutional deliveries to reported deliveries 99.7

Institutional Deliveries Institutional Deliveries

C-Section, complicated & normal del. District-wise C-Section deliveries to institutional

Treatment of complicated pregnancies and deliveries:

Home Institutional (Public) Institutional (Pvt.)

2009-10 Apr-Sep 2010 0

ANC services Pregnancy complications reported during ANC

C. Newborn care and Breast feeding

District-wise fully immunized (0-11 months)

HMIS (Apr-Sept 2010) HMIS (2009-10) CES, 2009 (UNICEF)

Hospital service delivery: HMIS (April to Sept.10)

Abortions April – September 2010

RTI cases reported in public & private institutions

RTI cases reported in public & private institutions:

Laboratory services in hospitals: HMIS (April to September 2010)

Vaccine preventable childhood disease:

Reported infant & child deaths: HMIS (April to September 2010)

Child deaths Infant deaths

Child deaths Infant deaths

Sepsis Asphyxia LBW

Sepsis Asphyxia LBW

POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS

SN Strategic areas Issues that need to be addressed

17 Medical Colleges (New  There are 13 Government & 23 Private Medical

a) Release of the first trench of funds:

2) A full- time Director/Joint Director/Deputy Director (Finance) (depending on

o The post of Chief Finance Officer in the cadre of Joint Director on

o Overall Health Budget for the last 5 years is as follows:

b) Release of second trench of funds:

1) HR POLICIES & SYSTEMS as mentioned at S.NO. 1 of the Management

o As far as Andhra Pradesh is concerned, the A.P. Health & Medical

3) The compliance status in respect of the 31 Conditionalities mentioned below is