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Project Implementation Plan National Rural Health Mission (NRHM) Orissa 2008-09

This project aims to improve healthcare infrastructure, increase access to services, enhance maternal and child health, and strengthen human resources in Orissa. Key initiatives include expanding medical education and courses, upgrading facilities, and implementing schemes like Janani Surakhya Yojana (JSY) and Janani Sahayata Yojana.

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Project Implementation Plan National Rural Health Mission (NRHM) Orissa 2008-09

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  1. Project Implementation Plan National Rural Health Mission (NRHM) Orissa2008-09

  2. ORISSA Demographic Profile • Total Population : 3.68 Crore • Scheduled Tribe : 22.13% • Scheduled Caste : 16.53% • Urban Population : 15% • No of Districts : 30 • Sex ratio : 972 • B.P.L : 47.15% • Life expectancy : 61.64

  3. Health Infrastructure • Dist. HQ Hosp. : 32 • SD Hospitals : 22 • Other Hospitals : 120 • CHC : 231 • PHC : 117 • PHC (New) : 1162 • Sub-centers : 6688 • PPC : 79 • MHU : 90

  4. Human Resource

  5. State Goals * Sources NFHS - 3

  6. Important State Initiatives

  7. Important State Initiatives • Increase in MBBS seats in VSS, Burla and Berhampur Medical colleges (43 each). • Doubling of seats in DMLT (Lab. Tech.) & DMRT(X-ray Tech.) courses in 3 medical colleges. • 33% increase in seats in all the16 ANM training centres. • Enhancement of remuneration for contractual doctors in KBK and 3 difficult districts • Doubling of rate of daily diet for indoor patients • Doubling of State drug budget

  8. Important State Initiatives Running of new courses • M.Sc Nursing course in Nursing College, Berhampur. • B.Sc Nursing course in SCB medical college from 2008-09.

  9. Additional incentive for regular doctors ( Boudh, Phulbani & Gajapati)

  10. Important State Initiatives • Up gradation of post at entry level for doctors from class II to class I • Restructuring of cadre for better promotional avenues • Increase in specialist allowances from Rs. 150/- to Rs. 3000/-per month • Enhancement of remuneration for Junior doctors • Enhancement of service condition of paramedicals

  11. State Budget Rs. in lakhs

  12. NRHM State PIP 2008-09

  13. RCH-II Maternal Health • Improve facilities in health institutions • Strengthening Referral transport • Improve access to services • Enhance institutional deliveries (JSY) • Capacity Building of MOs and Paramedics • Training of TBAs • Improving out reach services • Strengthening the fixed health day • Clinical and Social Audit of Maternal deaths • Advocacy & IEC • New schemes

  14. Operationalisation of FRUs • Micro Planning for FRUs & 24X7 - Workshops, Field visits, Review & modification • Basic 3 criteria of GOI guideline to operationalise FRU

  15. Operationalisation of Facilities

  16. Total JSY beneficiaries : 6.60lakhs RCH II- Janani Surakhya Yojana

  17. Impact of Janani Surakhya Yojana (JSY)

  18. Impact of Janani Surakhya Yojana (JSY)

  19. Janani Surakhya Yojana (JSY)

  20. JSY Proposal for 2008-09 • Total no of deliveries - 9.54 lakhs • Targetted Coverage under JSY - 85% • Institutional Coverage - 75% • Rural beneficiaries - 80% • Total amount proposed - Rs.11051.25lakhs • Strengthening District cell • Cheque payment for ASHA • Free of cost Referral transport Facility

  21. Operationalisation of FRUs Strategy - Anaesthesia (Short Term Course) -18x2 batches - 36 - Already trained - 18 - In service PG & others - 4 - Private Medical College - 6 - Total - 64

  22. Operationalisation of Facilities Multi Skilling of MBBS Doctors - Anesthesia - 23 - Emoc - 12 Blood Storage Training- 104 • Emoc Training - No. to be trained 8x2 batches(16 Doctors) ( To be placed to FRUs having higher delivery load) • RTI/STI Training - 488 • Blood Storage training for MO/LT- 20 • PNDT Training - 540

  23. Operationalisation of Facilities SBA Training • District Level TOT - 30 Districts • 15 days Training - 367/748 • 21 days Training - 78/487 • Trg of MOs, O&G, Paediatrician- 422 • Training of Paramedical - 264 • No of Venues operational - 57 • No of Districts Trg initiated - 21

  24. New Schemes Janani Sahayata Yojana - Accreditation of Private Hospitals for Institutional Delivery for BPL women - Rs. 2000/- to be reimbursed to the institutions - Rs. 500/- to the Beneficiary Incentive for Institutional Delivery - To Health Providers at Block and Sub Block level - Gradation of institutions as per specialist availability and delivery load - An amount of Rs.200 per delivery after the prescribed limit - Incentive amount to be provided - 50% to Medical officer - 25% to RKS - 25% to Staff

  25. Comments and Compliance • RCH- Goal for 2008-09 Already included • Maternal health Strategy Already included • JSY break up for institutional and Home delivery Already provided • Facility augmentation and planning Already provided • Emphasis on PNC Planned through Motivation by ASHA Strengthening of VHND • Training Other mismatch corrected

  26. BUDGET SUMMARY OF MATERNAL HEALTH FOR THE YEAR 2008- 09

  27. Child Health Progress so far • IMNCI training in 12 high IMR districts Basic Health Worker–1908 • Special New Born Care Unit (II) established in Mayurbhanj. • Prustikar Diwas for treating Malnourished children. • Treatment Protocol developed for Prustikar Diwas • 53% full immunization achieved

  28. RCH Child Health Proposal • IMNCI training in 10 Districts -2976 • FBNC training - 384 • Establishment of SNCU - I in FRUs • Establishment of SNCU - II in 5 Districts • Establishment of SNCU - III in 3 Medical colleges • School Health programme 6 to 11 year • 30% of the total child population of 232000 • Support to Prustikar Diwas • Investigation costs • Equipments • Referral transport cost

  29. Child Health Proposal • Nutrition Rehabilitation Centre (NRC) Establishment of NRC in Kalahandi & Mayurbhanj • Incentive Scheme for Full immunisation Rs 500/- incentive on completion of full immunisation to mother from supported OHSP funds NIPI Supported activities • Home Based New born care Training for ASHAs in one District • Strengthening of the Block and District Child Health Resource units

  30. Compliances • FBNC target for Medical Officers and staff nurse enhanced from 125 to 384 • IMNCI logistic like drugs and monitoring has been included under procurement and institutional strengthening in RCH-II • Details of SNCU-I implies new born care corner, which has been provided under detailed compliance write up • IYCF dissemination activities included under BCC/ IEC activities. • Detailed section on child health provided in the revised PIP

  31. BUDGET SUMMARY OF CHILD HEALTH FOR THE YEAR 2008- 09

  32. Immunisation Compliance • Status Report on training Provided. • Training of health worker presently ongoing. • RIMS upload status completed in 15 districts. • Unicef support for monitoring of training sessions.

  33. RCH-II Family Planning • Total No of sterilization (Dec’ 07) – 52106 • IUD insertion (Dec’07) – 15033 • New compensation package from Dec’07 • Contraceptive update training – 20 • SSD Training for 166 (MOs & Paramedics) • Regular District & State Quality Assurance Committee meetings. • 73 Accredited Family Planning institutions in the private sector

  34. RCH - II Family Planning(Proposal) • Female sterilization target – 1,60,000 NSV -- 10,000 IUD -- 2,00,000 • Sterilization and NSV on fixed days • Training Contraceptive update (MOs) - 500 Mini Lap - 180 Laparoscopy - 180 NSV - 50 • Establishing Condom vending machine • Piloting female condoms • NSV campaign • Accreditation of Private institutions

  35. Compliance • BCC/ IEC plan on Family Planning included under BCC/ IEC Component • Fixed day sterilization and NSV concept specified in the PIP. • Progress Monitoring, quality and audits by QA committee proposed in PIP • Trainers for minilap, laparoscopic, NSV, IUD already available • NSV, minilap, IUD kits have been included under procurement • Repair, maintenance and procurement of laparoscopes are being undertaken from 2007-08 funds • Incentive to the MOs to be provided for achieving highest sterilization after a fixed benchmark

  36. BUDGET SUMMARY OF FAMILY PLANNING FOR THE YEAR 2008- 09

  37. RCH-II AdolescentHealth (Progress) • TOT for five districts completed. • Training Manual for ANMs & LHVs developed in Oriya language • Sensitisation training of district level personnel undertaken. • Planning for operationalisation of adolescent Health clinics. • Convergence with MNGOs and establishment of adolescent ‘Saathi’ Centres. • The budget for the component proposed – Rs.42.30 lakhs

  38. Compliance on ADOLESCENT HEALTH • Monitoring & evaluation Matrix - Shared with Prog Managers • Use of Matrix for - Shall be used monitoring & evaluation • Standards of services - Included in the revised PIP • State Adolescent Health - monitor the accessibility & Centre quality of services in the AFHC. • Indicators for monitoring - Being Developed ARSH services

  39. Monitoring quality of ARSH services - During monitoring of other NRHM activities. • The budget for repair - Amount has been excluded. • Implementation Guidelines would be followed to expand quality, access and profile of services. • Operational plan included in the PIP and also the training budget for ARSH has been included under the training component. • Proposed to designate SCB Medical College, Cuttack as the State Adolescent Health Centre. The terms of reference have been included in the PIP.

  40. RCH-II Urban Health(Progress) • Guidelines developed for PPP in Urban Slum Health for Tier-I and Tier – II Programme • 11 NGOs selected and supported to manage Tier-I Urban Health Centres. • Urban Health Advisory Committee under the Chairmanship of Municipality Chairman formed.

  41. Proposal for Urban Health • 6 Additional Tier-I and 4 Tier-II Urban Health Centres to be established • Laboratory services and other services under National Health Programmes like DOTS, NVBDCP and Family Planning services including IUD, NSV, RTI, STI and referral to the 2nd Tier. • Two Tier Referral Centre of Municipal areas will be strengthened and upgraded. • Appointment of Urban ASHAs. • Mega Slum Health Mela. • A total budget Rs. 324 lakhs is proposed

  42. Compliances • Designated Nodal officer at State & District for Urban Slum Health Programme • Advisory committee for USHP constituted for policy & technical support • Programme has already been started during 07-08, Rs-28.01 lakhs disbursed • During 2007-08 substantial time taken in developing process and NGO selection. In 08-09 activities shall be accelerated

  43. RCH-II Tribal Health Proposal • Regional Workshop on tribal health needs and issues. • Prototype message design on IEC/BCC • Tribal study. • Swasthya Mela in 118 Tribal sub plan blocks. • Maternity waiting hall at 10 blocks on pilot basis. • RCH camps in approximately 2330 Tribal dominated sub centres.

  44. Compliances • Designated state consultant to look after Tribal Health programme. • Local specific strategies developed to address Tribal health issues. • Innovative strategies- Delivery Huts in tribal dominated Blocks. • Expenditure made – Rs - 23.73 lakhs against released amount- Rs.68.43 • Total budget proposed Rs 284.29 lakhs

  45. RCH-II Vulnerable Groups Proposal • Workshops/Consultative meeting on health needs • Mapping of facilities, needs of vulnerable group • Referral transport for pregnant women to the institution • Establishment of maternity waiting hall • Undertaking need based health intervention for Vulnerable groups. • A total of Rs. 67.10 lakhs proposed

  46. Behaviour Change Communication • Provision in PIP for Skill Enhancement Training for District & Block level Health Officials • Innovative BCC Programmes are in line with Activities Outlined in PIP • Strategies & Activities have been designed to suit District & Local requirements • Many BCC Activities in current PIP were not before implementation of NRHM

  47. Behavior change communication • Strategies & Activities as per the Provisions of ‘Intra-Communication Flow Chart’. • BCC Consultants & Officials of different Programmes made to Operate from SIHFW-Nodal BCC Directorate. • ‘Supervision & Monitoring’ streamlined by appointing District-wise Nodal Officers. • Innovations/Advocacy Tools to be Publicized through a ‘News Letter’ for use by Stakeholders.

  48. Behaviour change communication • Steps have been taken for Integrating BCC at Implementation level • Details of Activities have been enumerated in both District & Sub-District level Action Plan • Discrete BCC Activities have been planned under each Component with emphasis on ‘Theme-based Campaign’

  49. New BCC Initiatives by State • SIHFW - officially made to function as the Nodal Centre for all IEC/BCC Activities • ‘Communication Facilitators’ placed in Strategic locations for facilitating Integrated BCC Implementation • Exhaustive Guidelines (both Operational & Financial) supplied to Districts better ‘Programmatic Intervention’ • ‘Monitoring & Supervision’ strengthened by appointing District wise Nodal Officers

  50. New BCC Initiatives by State • Initiatives taken to set up an ‘Integrated BCC Cell’ that will work as Technical Hub • NRHM is making the best use of GRAMSAT platform for sensitizing & educating Stakeholders • A total of Rs. 210.35 lakhs is proposed

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