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RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI

RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI 3 rd AUGUST, 2010. STRUCTURE OF THE PRESENTATION. 1. Good / innovative practices adopted by the state in the focus areas Assured Service Delivery

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RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI

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  1. RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI 3rd AUGUST, 2010

  2. STRUCTURE OF THE PRESENTATION 1. Good / innovative practices adopted by the state in the focus areas Assured Service Delivery 2. Current status (Facility operationalisation and VHNDs) 3. Key issues 4. Way forward Programme Management 5. Current status (supportive supervision system) 6. Key issues and way forward Monitoring and Evaluation 7. Current status (maternal death review and name based tracking) 8. Key issues and way forward 10.Gender and Social Equity

  3. PRESENTATION ON FACILITY OPERATIONALISATION AND VHNDs : CURRENT STATUS , KEY ISSUES AND WAY FORWARD

  4. HEALTH INDICATORS 4

  5. HEALTH INDICATORS: ANTE NATAL CHECK UP

  6. HEALTH INDICATORS : CHILD HEALTH

  7. TARGETS FOR PUNJAB UNDER NRHM 7

  8. FINANCIAL REPORT FOR THE YEAR 2005-10 ` in lakhs 8

  9. FINANCIAL REPORT FOR THE YEAR 2005-10

  10. FINANCIAL REPORT FOR THE YEAR 2010-11 upto JUNE

  11. 1. GOOD/ INNOVATIVE PRACTICES • Reproductive and Child Health Programme focus on reducing MMR and IMR. • Strategies: • Infrastructure and Manpower Strengthening • Ensure Complete ANC Coverage • Promoting Institutional Deliveries

  12. Institutional Deliveries - Free: Data of DLHS-III shows that 36.1% pregnant women are not going to health institutions for delivery because of cost factors. To promote institutional deliveries, the State Govt. has initiated the following steps: Deliveries and delivery related services have been made free at all Govt. Hospitals from December 2008 by the State Govt. Provision of referral transport, ` 200/- to PW for referral transport Surakshit Janepa Yojna – PPP initiative The average fixed rate for delivery to be reimbursed to the API (Accredited Private Institution) has been revised to ` 2500/- from earlier rate of ` 1700. Approx. 600 deliveries conducted Incentive to ASHA for institutional deliveries Family Health camp in all blocks- 200 camps 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  13. Maternity Wards- maternity Wards in all the districts hospitals to be renovated/ constructed. The work has already started at most of the places. 24 Mobile Medical Units functional in the State 8 Mobile Units by Ranbaxy to serve in un-served areas. Emergency Response System in place by March 2011 Availability of drugs and other consumable in sufficient quantity at all levels. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  14. SPECIAL PROJECT FOR UPGRADATION OF HEALTH INFRASTRUCTURE Hon’ble Chief Minister, Punjab have approved a special project for upgradation of Health Infrastructure A major upgradation project worth ` 346 crores has been prepared for the upgradation of Health Infrastructure.. Under this project new blocks are to be added to the existing hospitals, new districts and Sub Divisional Hospitals and Community Health Centres will also be constructed. The details of spending are- cost of the construction ` 280 crores Equipments ` 66 crores The works for these projects would be allotted by 30.09.2010 and are likely to be completed by 31.08.2011. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  15. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Upgradation of District Hospitals: • Upgradation of 2 District hospitals- District hospital Muktsar & Tarn Taran will be upgraded to 100 bed hospital (` 14.40 Crore)and equipment worth ` 1.35 Crore. • New District Hospital-- District hospital Nawanshahar (` 16 Crore) and equipment worth ` 1.50 Crore. • Upgradation of SDHs: • Upgradation of 2 existing CHCs to SDH – 20 bed each will be added in SDH Dera Bassi (Mohali) and SDH Budhlada (Mansa)at the cost of ` 6.40 Crore. • Construction of 5 new 50 bedded SDH- Khadoor Sahib(Tarntaran), Bholath (Kapurthala), Moonak (Sangrur), Tapa (Barnala) and Ghudda (Bathinda) at the cost of ` 40 Crore. Equipment worth ` 3.75 Crore. will be provided. • Major repair and renovation of 22 existing SDH will be undertaken.

  16. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Upgradation of CHCs: • New building of 3 CHCs Ballianwali (Bathinda), Naushera Majjha Singh (Gurdaspur) and Dudhan Sadan (Patiala) at the cost of ` 14.40 Crore. • New CHCs- 29 PHCs will be upgraded to CHCs and new construction of these CHCs will be undertaken at the cost of ` 139.20 Crore. Equipment worth ` 13.05 Crore will be provided. • Upgradation of 204 PHCs: • ` 44.86 Crore have been earmarked out of which ` 34.68 Crore for civil work and ` 10.18 Crore for equipments. 204 PHCs which are yet not covered by NRHM will be taken.

  17. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • IEC & reference material for service guarantee designed and displayed for the service provider and community. • Unique Signages for the FRUs and 24x7 PHCs. • Protocol for EmOCby UNICEF displayed at labour room for reference. • IEC material on available services for community. TOP

  18. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • Pamphlets for community on information regarding service availability at sub-centres regarding availability of services, equipments, medicines etc.

  19. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • Charter at Sub-Centre: facilities available at Sub-Centre

  20. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • Duties of ANM displayed at Sub-Centre

  21. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • Display of IEC material for community on Care during pregnancy, JSY and Care of Neonates.

  22. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY • Service Guarantee • Protocols developed by UNICEF displayed as reference in labour rooms and Gynecologists OPD.

  23. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  24. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  25. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  26. 1. GOOD/ INNOVATIVE PRACTICES:ASSURED SERVICE DELIVERY

  27. 1. GOOD/ INNOVATIVE PRACTICES:PROGRAMME MANAGEMENT • State Health Systems Resource Centre (SHSRC) established: Consultants of different fields (Public Health Planning, Health – HRD, BCC/IEC, Quality Assurance, Community Participation) placed. • State Programme Management Unit, District Programme Management Units , Block Programme Management Units fully functional. • Hospital Administrator for five major District Hospitals. • Supervisory structure of LHVs strengthened.

  28. 1. GOOD/ INNOVATIVE PRACTICES:MONITORING & EVALUATION • Biometric based online attendance system for health institutions. • Daily online OPD monitoring mechanism. • Utilization of equipments monitored online. • Mobiles to all 4000 ANMs planned for systematic monitoring of their performance in respect of important parameters. • Registration of all 5 lakh pregnant women in the state is planned. Tracking of all new born children for full immunization is also planned with Government of India assistance under NRHM. • Maternal Death Review initiated, guidelines issued. • Community hotline. • Mobile Medical Units are monitored through GPS. • GIS is being developed

  29. 1. GOOD/ INNOVATIVE PRACTICES:GENDER & SOCIAL EQUITY • More focus on NSVs, special camps are being organized successfully • Strict enforcement of PC-PNDT Act. • Prizes announced for decoy customers, informers and for sting operations in regard to violation of PNDT Act. • Award to Panchayats. 83 Panchayats with sex ratio 1000 and above have been honored with Rs1.50 Lac each. • Community hotline to curb female foeticide. • Free deliveries, free referral, free treatment to children suffering from CHD/ RHD. • Jan Aushadhi Stores in all the 20 District Hospitals and 3 SDH to provide cheap generic medicines to the people have been started and more in process. • Free treatment for BPL families • Special outreach programme for minorities

  30. 2. CURRENT STATUS: FRUs * Desirable services

  31. 2. CURRENT STATUS: 24x7 PHCs 24 x 7 PHCs : Current Status (CONTD ..) * Desirable services

  32. 2. CURRENT STATUS: NEWBORN CARE FACILITIES 24 x 7 PHCs : Current Status (CONTD ..)

  33. R: Required as per GoI guidelines/ norms of respective facility irrespective of number of positions sanctioned; A: Available, both regular and contractual EmOC refers to the Comprehensive EmOC training (including C-section); BEmOC refers to Management of common obstetric complications; LSAS refers to training in Life Saving Anaesthesia Skills 2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos)

  34. 2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos) A: Available, both regular and contractual

  35. 2. CURRENT STATUS: NSSK TRAININGs

  36. INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2009-10 Institutional Deliveries in Govt. Institutions: 2009-10 Institutional Deliveries increased to 49.56% in 08-09 over 07-08 and further 32.20% in 09-10 over 08-09

  37. INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2010-11

  38. C-SECTION IN GOVT. INSTITUTIONS: 2010-11

  39. TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTES (2007-08, 2008-09, 2009-10 & 2010-11)

  40. DELIVERIES IN CHCs AS FRUs (2007-08, 2008-09, 2009-10 & 2010-11)

  41. DELIVERIES IN 24x7 PHCs (2007-08, 2008-09, 2009-10 & 2010-11)

  42. JANANI SURAKSHA YOJANA Estimated Number of Cases : Estimated number of deliveries in a year in the State of Punjab = 5,00,000 Estimated number of deliveries of BPL/SC/ST @ 35% = 1,75,000 Estimated number of Beneficiaries upto 2 living Children @ 50% = 87,500 Financial Assistance : Home Delivery - ` 500 Institutional Delivery - ` 600/ 700 for Urban and Rural women TOP

  43. JANANI SURAKSHA YOJANA Yearly Progress JSY :

  44. JSY BENEFICIARIES OVER THE YEARS

  45. JANANI SURAKSHA YOJANA

  46. FAMILY PLANNING

  47. All 20 DH, 35 SDH & 114 CHCs providing sterilization services • Quality Assurance Committees constituted at all levels and are functional. • Fixed day Tuesday for NSV and Thursday for Vasectomy throughout State • Most of the District Quality Assurance Committees are Meeting regularly. • Regular meeting of QAC at State Level. • Consultant Quality Assurance, SHSRC has been appointed and will ensure the regular monitoring. FAMILY PLANNING

  48. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) (1) SHORTAGE OF MANPOWER Gynaecologists: • All the 20 District and 36 Sub-Divisional hospitals have Gynecologists. • Out of 117 CHCs, 34 CHCs are without Gynecologists. Paediatricians: • There is shortage of 63 Paediatricians. 6 in DHs, 13 in SDHs, 44 in CHCs Medical Officers (Female): • Out of 236 up-graded PHCs, there are Female Medical Officers in 189 PHCs and 47 PHCs are without Female Medical Officers.

  49. (2) BLOOD STORAGE UNITS OF PUNJAB All the DH and SDH Hospitals have blood storage facilities. 25 CHCs out of 107 CHCs have been provided staff and equipment for blood storage facilities. It would be made functional very soon. The remaining 89 CHCs would be provided with Blood Storage facility in the current year. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs)

  50. 3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs) (3) EASY AND SUBSIDIZED ACCESS TO HEALTH SERVICES • Free deliveries in all Government Hospitals since December 2008. • Free treatment of school children in Government Hospitals since June 2009. • Free treatment of school children for congenital heart disease and cancer in PGI at a cost ranging from 1 to 1.5 lakh per student. • Jan Aushdi Stores for supply of generic medicines manufactured by Government PSUs setup in all District Hospitals in 2009. Punjab is the only State to cover all districts and out of 39 such stores in India 20 are functional in Punjab alone. • Effective implementation of Punjab Nirogi Scheme for BPL families for assistance upto Rs. 1.5 lakh. • Free treatment of BPL families without charging any user charges in all Government Hospitals. • Regular Supply of medicines in all Government Health Institutions.

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