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National Rural Health mission. STATE PROJECT IMPLEMENTATION PLAN CHHATTISGARH 2008-2009. New Delhi. 27 March 2008. Revised after Sub-Group Review. NRHM in Chhattisgarh: Key Achievements. Major Health Sector Reforms implemented
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National Rural Health mission STATE PROJECT IMPLEMENTATION PLAN CHHATTISGARH 2008-2009 New Delhi 27 March 2008 Revised after Sub-Group Review
NRHM in Chhattisgarh: Key Achievements • Major Health Sector Reforms implemented • Could become model on community based health initiatives innovative programmes viz Mitanin, Swasth Panchayat, Jeevan Deep etc • Achieved norms in health facility levels and staff sanctions, though actual gaps are yet to be addressed • The State Health Budget outlay has increased to almost double • Brought Down IMR to almost at par with national average (from 79 to 61 in total and 95 to 62 in rural) • MMR shows an encouraging trend too (408 to 379) • Health Services /Health Status Indicators shows good improvement, though much more to beachieved
Specific Gains of 2007-08 • Improved Institutional delivery to 27% (CES 2007) and (30%) Rural Health Watch Report • Shishu Sanrakshan Maah- campaign of immunization, Vit A, deworming and IT bednets. Session cancellation came down to 9% from 33%. • Mitanin Help Desk in 128 CHCs and 15 District Hospitals- Improving treatment and care of referrals • Promoting participatory planning through Swashth Panchayat Yojana- Community diagnosis and prioritization of health issues by sensitizing about 20,000 PRI members – HHDI for 9300 out of 9820 GPs completed for the second year. • Massive training of Mitanin in management of neonatal and childhood illnesses (based on IMNCI and HBNC) – over 20,000 covered so far • Quick control of diarrhoea outbreak during monsoon in 3 dists • Energising Health system by clearing pending promotions- 23 dist. Officers, 250 specialist, 354 male supervisors, 161 LHVs
Major Bottlenecks • Difficulty in getting sufficient number of doctors, specialists, staff nurses, paramedics and even ANMS • Insufficient medical/nursing/paramedic education institutional capacities • Huge infrastructure gaps, though budget allocation made available to bridge them to a major extent • Inadequate administrative workforce at all levels from top to bottom- including in NRHM PMUs • Issues related to role-clarities after introduction of NRHM yet to be addressed fully
NRHM- 2007-08: What did not work well? • Delays in managing timely fund flow leading to slow absorption of funds- more than 100 crores yet to be absorbed fully • Inadequate Human Resource for District Health Management- Many DPM, and NRHM consultants posts vacant-BPMU posts yet to be filled. More posts needed too, to correct the problems in programme implementation • Slow pace and unsatisfactory quality of district level training of doctors, Para-medicals in general -especially in SBA and family planning. • SIHFW could not be made fully functional. • Poor operationalization of FRUs- Trained doctors transferred out, mismatch of equipment supplied, lack of adequate support at district level.
Response on those Remarks made by Subgroup Review Dated 03.03.2008, on the first draft of state PIP 2008-09
Revised NRHM PIP : Focus Activities • Creation of a Rural Medical Corp exclusive cadre of health staff for underserved areas. • Filling up of vacancies of staff nurse in CHC/PHC. • Deployment of Rural Medical Assistants pooled from 1300 three year medical course graduates. • Technical assistance through management professionals in public hospitals- Jeevandeep • Training of Nurse Practitioners specially for underserved areas. • Fool proof disbursement of incentives to lower level health staff and volunteers.
Revised NRHM PIP: Focus Activities contd.. • Massive micro-planning campaign through Village Health and Sanitation Committee and Panchayat activation. • Mitanin led Behavior Change initiation through innovative BCC kit. • Launching Third Party Monitoring and Community Monitoring for health services. • Panchayat linked posting of additional ANMs. • Facility based Sick Newborn Care Unit (SNCU) • Special screening and prevention against Sickle Cell Anaemia. • Integration of AYUSH
NRHM PIP Chhattisgarh: Revised Budget Totals compared to earlier Budget
Part A RCHBudget:Procurement, Programme Management, Convergence
Thank You State Health Mission Chhattisgarh