202 D Disease Control Programme D1 National Vector Borne Disease Control Program (NVBDCP) Background In Tripura context, NVBDCP is implemented mainly for intervening Malaria since it is endemic with preponderance of P. Falciparum (92%). High risk areas are as under: District Affected areas Sub-division Blocks West District 1. Khowai 2. Teliamura 1. Jampuijala South District 1. Amarpur 1. Hrishyamukh 2. Rupaichari North District - 1. Dasda 2. Bungnung Dhalai District As a whole The state is prone to malaria transmission mainly due to: Topography & Climatic condition – highest incident during the months of March to August i.e. monsoon and post monsoon period. Efficient malaria vectors like An.Minimus, An.Dirus and An.Fluviatilis are prevalent. Malaria hard core areas are scattered mainly in the inaccessible forested and tribal areas. Prevalence of drug resistant (Chloroquine) P. Falciparum – Three districts declared as a High Endemic Districts (South, North & Dhalai). The Strategies adopted in the state for malaria control are in line with the recommended strategies of Government of India. The details are as under:- Early Diagnosis and prompt treatment. Integrated Vector Control (DDT Spray). Information, Education and Communication (IEC/BCC) for personal protection and Community Participation. Training and capacity building of Medical and Para-Medical Workers. Outbreak/Epidemic Preparedness and response. Supply and use of impregnated mosquito bed nets. Monitoring and Evaluation including effective utilization and computerized Management Information System.
Transcript
202
D Disease Control Programme D1 National Vector Borne Disease Control Program (NVBDCP) Background In Tripura context, NVBDCP is implemented mainly for intervening Malaria since it is endemic with preponderance of P. Falciparum (92%). High risk areas are as under:
District Affected areas Sub-division Blocks
West District 1. Khowai 2. Teliamura 1. Jampuijala
South District 1. Amarpur 1. Hrishyamukh 2. Rupaichari
North District - 1. Dasda 2. Bungnung
Dhalai District As a whole The state is prone to malaria transmission mainly due to:
Topography & Climatic condition – highest incident during the months of March to August i.e. monsoon and post monsoon period.
Efficient malaria vectors like An.Minimus, An.Dirus and An.Fluviatilis
are prevalent.
Malaria hard core areas are scattered mainly in the inaccessible forested and tribal areas.
Prevalence of drug resistant (Chloroquine) P. Falciparum – Three
districts declared as a High Endemic Districts (South, North & Dhalai).
The Strategies adopted in the state for malaria control are in line with the recommended strategies of Government of India. The details are as under:-
Early Diagnosis and prompt treatment. Integrated Vector Control (DDT Spray).
Information, Education and Communication (IEC/BCC) for personal
protection and Community Participation.
Training and capacity building of Medical and Para-Medical Workers.
Outbreak/Epidemic Preparedness and response.
Supply and use of impregnated mosquito bed nets.
Monitoring and Evaluation including effective utilization and computerized Management Information System.
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Tripura State Annual Action Plan Year : _2011-12_ Population : 38,15,410 (Projected)
Status of Health facilities
S. No Health facility No 1 District Hospital 02 2 Block CHC/RH 11 3 Add PHC 79 4 Sub centre 627 5 Villages 1040 (Including ADC Village) 6 Rapid response team ---- 7. Any other ----
Human Resource
S. No Health facility Sanctioned / Required In Place
15 ASHA 7367 7367 7367 * GFATM/World Bank # Applicable to states that have been sanctioned
GFATM / World Bank Project States Only
State PMU In Place Consultant M&E 00 Project Director/ Programme Officer 01
Finance Consultant 01 IEC Consultant 00 Other Consultants 00 Data entry operator 01 Secretarial Assistant 01
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D. District wise Epidemiological Situation: Brief analysis on the following parameters has been given to assess performance (ABER- Surveillance) & impact (API, cases, deaths etc) to enable identify gaps and areas requiring improvement D1. The State had organized meetings for development of district wise Action Plan by analyzing the data on following parameters. EPIDEMIOLOGICAL SITUATION REPORT FOR THE YEAR: 2005 to 2009 Sl.No. Name of
N.B. The districts have also held similar meetings for development of PHC wise Plan
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D2 High Risk Areas: Based on the epidemiological data in the above table the high risk areas have been identified in accordance with definition in Malaria Action Programme for the prioritization criteria developed by expert committee 2002.
S. No Districts
High risk PHCs (No.)
High risk Sub centre (No.)
High risk Village (No.)
High risk Population (No.)
Tribal Population (No.)
1 West 10 125 202 4626854 426854 2 South 17 117 225 545359 234504 3 North 17 54 100 338991 148502 4 Dhalai 15 68 130 398092 236812 Total : 59 364 657 5909296 1046672
D3. Classify the areas as per following API ranges
GIS mapping: (Based on epidemiological data for the years 2009 for identified high endemic districts) is under preparation.
Status of Village wise data entry of the district for 2009 in GIS format for identified high
endemic districts cannot be done due to afore-mentioned facts. I. Outbreak: Yes/ No, if yes, give details as follows:-
No. of outbreaks : No Area affected : No
Period of outbreak : No
No of Cases & deaths reported during outbreak : Need not arise
Reasons for outbreak : Need not arise
Containment measures taken : Need not arise
Outbreak Containment Report(s) submitted to Centre : Need not arise
II. Specific Activities: a) RD Kits (selected Pf endemic districts only) A. No. of Rapid Diagnostic Kits for the plan year based on epidemiological and
operational data
District
No. PHCs where RDTs are to be used in emergency hours
No. sub-centre areas with SFR>2% and no microscopy result within 24 hrs.
No. blood examinations in those sub-centre/ PHC areas last year (A)
Expected RDT requirement in remote high Pf areas and PHCs [Ax 1.25] (B)
RDTs for buffer stock and distribution to other areas: [B x 0.20] (C)
Total annual RDT supply [B+C]
Nos. to be distributed in prioritized areas
West 33 118 48526 72789 145578 218367 0 South 23 125 49072 61340 12268 73603 36804 North 19 11 50852 63565 12713 76278 19 Dhalai 15 68 69446 86808 17362 104170 104170 Total 90 322 217896 284502 187921 472418 140993
Planning for RDTs is based on annual blood examinations in areas and health facilities,
where it is not possible to obtain a microscopy result within 24 hours (no later than day after slide is taken and where the risk of P. Falciparum rate is >2%.
Villages planned to be equipped with RDTs would have trained ASHA/ CHVs
(including AWW) In the above, sub-centre area means the sub-centre and the villages under it, while
PHC means the PHC health facility, e.g. "PHC (new). The distinction is made, because in some cases, the PHC has microscopy, but many of the sub-centre areas under it do not.
In general, it should be assured that as minimum RDTs are supplied to cover all blood
examinations in the eligible PHCs and sub-centre areas. The number of blood examinations is estimated by adding 25% to the number of blood examinations during the last complete calendar year, because RDTs may attract additional patients.
If possible, a buffer stock of approximately 20%, depending on the availability of
supplies is added, to cover needs in other areas and health facilities, where individual patients may be considered highly suspect of Falciparum malaria on account of symptoms or travel history, or where microscopy may be temporarily unavailable and to provide a reserve for supplies to the eligible areas.
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B. Requirement of Rapid Diagnostic Kits based on epidemiological data for 2011-12
III. Areas for Supply of ACT A. Allocation of ACTs and quinine for a plan year based on epidemiological and operational data Data latest complete year Allocation for plan year
Total 3812022 21768 10740 2054 1632 1189 7310 13713
Planning for ACTs is based on the number of Falciparum cases found in eligible areas in previous year.
Estimated adult Pf cases will be 60% of total Pf cases and 40% of total Pf cases will be
Children.
Like for RDTs, 25% is added to account for RDTs, 25% is added to account for increased patient -loads resulting from more attractive services and an extra buffer quantity of approximately 20-25%. This leads to the multiplication factor, 1.5
Sl Details Slide Collection
Sub centres
Villages
Total Population
Tribal Population
1 Areas with high Pf % 180763 413 727 1593273 763457
2 Of the above prioritized to be equipped with RDT during the year
2013 244 427 5876681 674297
3 No of RDTs Required 2011-12 537058
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B. Allocation of ACTs for Next Plan Year
C. Bed nets: Based on enumeration of bed nets in households by Bed net Survey the Planning for distribution of Bed nets is enumerated as follows:-
(Fig. in Lakhs)
Dist.
Eligible Sub centre (nos)
Eligible villages (no.)
Eligible Population (no)
Tribal population (no)
Total Bednet required (no)
Number of bed nets available in community based on household survey (no)
Required in the Current Year (no)
Total Planned to be distributed in the year (no) as per allocation
Total planned to be treated (no)
ITNs LLINs
A B C D = A-
(B+C)
ITNs LLINs G=B+
E E F West 281 408 11.56 3.12 4.50 0.28 0.38 3.85 0 0.10 0.28 South 168 319 8.75 3.50 2.44 0.92 0.24 1.28 0 0.80 0.92 North 22 43 2.50 0.11 1.04 0 0.63 0 0 1.04 0 Dhalai 68 130 3.98 2.37 1.12 0 0.40 0.43 0 0.43 0.43 Total 539 900 26.79 9.10 9.10 1.20 1.65 5.56 0 3.27 1.63 N.B. 2 nets per household; Avg. size of household taken as 5
E. Associated activities for IRS IEC activities: It would be carried out for sensitization & mobilization of community for
Spray as well as a medium to give advance information regarding spray dates operations. IEC will be carried out two months prior to IRS at village level during Village Health and Nutrition day which is used to be held every month at A/W Centre. Details meeting will be organized in Panchayet level regarding the spray fifteen days before the operation.
Supervision Plan (within the PHC and from district level (Sub centre/ village wise).
1. Supervision Plan with village level date of spray and SC/PHC district level supervision – Yes
2. Selection of sites for dumping insecticides completed? Yes 3. Whether safeguards for storage & handling of insecticides ensured? Yes 4. Certification on functional status of equipment by DMO by day/ month/ Yr.- Yes 5. Spare parts of spray equipments like lance available- No 6. Provision of protective gear for spray workers present- Yes 7. No. of functional stirrup pumps? 105 (West), 100 (South), 0 (North), No. required:
150 (West), 50 (South), 72 (North) 8. No required to be repaired: 50 (West), 100 (South), 0 (North) 9. Certification by Panchayat for coverage of IRS – Planned.
F. Innovations
Sl. Innovations Describe details Fund Allocated (Rs) 1 Patient referral e.g. Like
use of NRHM/ RKS flexi funds for transport of sever e cases
During the active transmission period i.e. April to September @ Rs 30,000/ per PHC should be given for transport of severe cases. Maximum Rs 500/ can be incurred for each transport.
Allotted through RKS fund. In PIP money may be allotted for Malaria Programme in relation with VHND
2 Transportation of slides E g. Use of Public transport system
It will not be of much benefit as RDK are being used.
Nil
3 NGO/ CBO involvement Refer to PPP guidelines on www.nvbdcp.gov.in
JUST, VHAT
Nil
4 Community mobilization e.g. Mobilizing using street plays, puppet plays, self help groups
Panchayet level Health & Sanitation Committee involvement to be intensified. In 40 nos village market ICAT will conduct street plays @ Rs. 500/ per play.
Nil
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G. Commodity Requirement
H. PPP involvement
I. Larvivorous Fish
J. Proforma for Urban Malaria Scheme
Status of hatcheries/ up-scaling of Larvivorous fish in the States:-
Name of states/UTs. No. of hatcheries at District level
SWOT Status Actions to be Taken to match the requirements
Stre
ngth
s PHC/CHC functions 24 x 7 SDH = 11, CHC/R.H = 11, PHC = 79, HSC = 677, FTD = 4311. Good PRI, 7367 ASHAs
Strengthening facilities through RKS mechanism leading to improve the programme by a process of discussion on local specific issues and circumstances.
Wea
knes
s
Tropical climate, Hilly terrain, Jungles, slow flowing streams, water bodies, irrigation canals which are favorable for mosquito breeding.
Inaccessibility and poor communication facility
Limited mobility and limited motorable areas.
Poor socio-economic conditions, low literacy, superstition, marriage at the early ages, Malnutrition, lack of pure drinking water, low hygienic condition.
Lack of NGOs.
Minimum health kit package to ASHA workers.
To develop better communication facility and roads and free accessibility to all areas for 24x7.
Access for all to quality education, pure drinking water through VHSC mechanism and regular organization of VHND in coordination with RCH programme.
To engage incentive based male health volunteers in some areas where ASHA workers cannot work actively.
Opp
ortu
niti
es
Support (consultative/kind) of GOI. Presence of ASHA at grass-root
level. Inter sector co-operation.
Take corrective measures as per suggestion/s of GOI.
More IEC campaign in remote areas.
Motivation of ASHA workers. Better inter-sectoral co-ordination.
Thre
ats
Slow in execution of programme activities.
Lack of Supervision and monitoring activities.
Self medication and attending Quack Doctors & False security filling.
Vacancy of vital officials for a long period (M&E consultant).
Prompt implementation of approved activities within given time frame.
Streamlining flow of effective instructions with simple information/guideline for compliance by field staffs.
Effective School and Adult Health Education aligning with regular School Health Programmes of RCH-II
Annexure K-21
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME Annual Planning Format - 1
Allocation of Rapid Diagnostic Kits for a plan year based on epidemiological and operational data Name of District: North Tripura.
S.N
o.
PHC
Sub
cent
re/
Vill
age
Sub
cent
res:
Sf
R>
1%
and
no
mic
rosc
opy
resu
lt
Tota
l Po
pula
tion
Tot
al T
riba
l Po
pula
tion
N
o. b
lood
ex
amin
atio
ns
last
ye
ar (A
) R
DT
requ
irem
ent
in r
emot
e &
hig
h Pf
SC
s an
d PH
Cs
[A x
1.
25] =
(B)
RD
Ts fo
r bu
ffer
st
ock
and
dist
ribu
tion
to
oth
er
area
s:
[B x
0.2
0] =
(C
) To
tal
annu
al R
DT
Req
uire
me
nt
[B+C
] V
illag
es/
sub-
cent
re
area
s (A
) pr
iori
tize
d fo
r th
e ye
ar
(D)
No.
to
be
dist
ribu
ted
in
prio
riti
zed
area
s
1 2 3 4 5 6 7 8 9 10 11 12 1 PHC 1 PHC
Emergenc
Sub centre 1 11 70661
20295 50852 63565 12713 78278 41 S/C 41
Village 1 Village 2 Total
Sub centre 2
Village 1 Village 2 PHC 2 Total * Planning for RDTs is based on annual blood examinations in areas and health facilities, where it is not possible to obtain a microscopy result within 24 hours (no later than day after slide is taken and where the risk of SfR is >1%. * Villages planned to be equipped with RDTs should have trained ASHA/ CHVs (including AWW) * In the above, sub-centre area means the sub-centre and the villages under it, while PHC means the PHC health facility, e.g. “PHC (new). The distinction is made, because in some cases, the PHC has microscopy, but many of the sub-centre areas under it do not. * In general, it should be assured that as a minimum. RDTs are supplied to cover all blood examinations in the eligible PHCs and sub-centre areas. The number of blood examinations is estimated by adding 25% to the number of blood examinations during the last complete calendar year, because RDTs may attract additional patients. * If possible, a buffer stock of approximately 20%, depending on the availability of supplies is added, to cover needs in other areas and health facilities, where individual patients may be considered highly suspect of falciparum malaria on account of symptoms or travel history, or where microscopy may be temporarily unavailable and to provide a reserve for supplies to the eligible areas.
Annexure K-22
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME Annual Planning Format - 2
Areas for supply of ACT
Allocation of ACTs for a plan year based on epidemiological and operational data Data latest complete year, District: North
Tripura. Allocation for plan year
S. No Name of block
Total Population
Pf cases reported in
previous year
Adults ( 60% of Pf cases)
Children ( 40% of Pf cases)
=B= (A*0.40)
Adult ACT Blister 9-14 Yrs (38%)
5-8 Yrs (30%)
1-4 Yrs (22%) Under 1 yr (10%)
A x 0.60 x1.5 B x 0.38 x 1.5 B x 0.30 x 1.5 B x 0.22 x 1.5 B x 0.10 x 1.5
2 Sub-centre 2 Village 1 Village 2 Village n Sub-centre 2 total PHC total * LLINs within life span to be counted
This form is prepared by DMO and DVBDC consultant in coordination with BMOs. Include only villages and subcentres with high risk populations (eligible for vector control). Total population in each sub-centre area is the high-risk population. The cell at the bottom of col.3 becomes the total high risk population of the block, which is smaller than the total population which is noted in upper left cell of the table. Population figures should be best available data for mid-year population in year under planning. Criteria for high risk should be based on programme guidelines.
Annexure K-24
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME Annual Planning Format - 4 MICROPLANNING FOR IRS
1. Training Programme Training of Supervisors and Spray Squads
Total number No. of training Sessions Dates Venue
MPWs and other Supervisors
484MPWs 150 health sup
4 session Quarterly Block level
Spray squads 200 2 March & May
2. Spray Programme (District wise list enclosed) PHC Spray Programme
This form is prepared by DMO and DVBDC consultant in coordination with BMOs. Include only villages and sub-centres with high risk populations (eligible for vector control). Total population in each sub-centre area is the high-risk population. The cell at the bottom of col.3 becomes the total high risk population of the block, which is smaller than the total population which is noted in upper left cell of the table. Population figures should be best available data for mid-year population in year under planning. Criteria for high risk should be based on programme guidelines. Population of each village is copied to col. 7,11 or 15. Thus the sum of columns 7 & 15 is equal to col. 3. Col. 16 shows the number of Total Bednets required: (pop in col.15 / 2.5) col. 8,9 & 10 The insecticide quantities should be those, which will be used IN EACH ROUND. col.7,8,9 &10 These columns pertain to IRS as per actual requirement without any resource constrain. col. 11,12,13 &14 pertain to IRS plan as per actual allocations for the year. col.16 & 20 These columns refer to bednet requirement as per distribution norm. col. 23 & 24 refer to Distribution Plan as per bednet allocation.
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** Expenditure was incurred during the year 2008-09 & 09-10 & was beyond PIP approval of the programme. Several correspondences was made with Dte of NVBDCP, Delhi regarding the issue. Fund under this head has not been received )
Financial Proposal for the Year 2011-12 Components Unit cost/
Month (in Rs) No. of months Total requirement
A. GFATM Capacity building 2.00 2. Human Resource a) State project monitoring unit (PMU)
01 (one) Medical Officer 01 (one LT)
New recruitment for sentinel site hospital for Malaria
40,000 09 4.50 10,000
VBD Project Manager (04 nos new recruitment) 50,000 09 18.00 MIS Project Manager (01 no . new recruitment) 45,000 09 4.05 BCC/ PP Manager(01 no . new recruitment) 35,000 09 3.15 PSCM Manager (01 no . new recruitment) 30,000 09 2.70 Financial Consultant 35,000 12 4.20 IEC Consultant 30,000 09 2.70 District level BCC expert to strengthen the IEC activities (New recruitment- 4nos) 12,000 08 3.84
Assistant/Computer Operator- State (existing) 12,000 12 1.44
Secretarial Assistant (02 at state level) – 01 existing & 01 new recruitment. 12,000 12 2.88
Statistical Asstt, (New recruitment) 12,000 09 1.08 b) Consultant M&E 54,000 08 4.32 c) Project Director/Coordinator 50,000 12 6.00 c) Accountant for Project Districts (New recruitment)- 04 nos 12,000 08 3.84 d) Remuneration to Lab (10 nos) 10,000 12 12.00 e) Remuneration to MTS (10 nos existing & 02 nos new recruitment) 10,500 12
09 14.49
f) Secretarial Asstt. Cum Data entry Operator for four districts (new recruitment) 10,000 09 3.60
Sub-Total 94.79
Existing GFATM staffs are in stagnant salary for a long period. Their remuneration may be increased because other contractual staffs working in the same posts of Other societies and NRHM are drawing higher salary/ remuneration in the same post.
3. Training ( Detail in Table-I) Sub-Total 13.39 4. Planning and Administration a) Office expenses for the state level per year 3.60
b) Office expenses for the district level per year 20000 x4 districts 12 9.60
c) Accounting and Auditing Cost per year (unit cost per year for state) 200000 1 2.00
LLIN storage facility on rental 5.00 5. Monitoring and Evaluation 20.20
a) Hiring of vehicles for field visit and supervision at state level each year (@ 1000/ day ) (unit cost per year for state) SPO
Consultant (M&E) IEC consultant Official work
50,000 12 6.00
a) Hiring of vehicles for field visit and supervision at district level 10,000x4 districts 12 4.80
b1) Travel related expenses for State & District Level Officers ( D.A & field contingency) 30,000 12 3.6
b2) DA expenses for Consultant M&E For 10 days in a month (Unit cost per month) 3,000 12 0.36
b3) DA for MTS (Unit cost per month) 500*10 MTS 12 0.60 c) Quarterly Review meeting of States / district
25000 20000*4 districts 4 4.20
d) Maintenance of provided motor cycles for MTS (10 nos) 50,000* 4 - 2.00 e) POL (Rs 2500 per months) (unit cost per month/ MTS) 2500x10 MTS 12 3.00 Sub-Total 24.56 6. Carrying of LLINs a) carrying of LLIN to the districts/ sub-division/ PHCs & making provision of rental Go-down to keep the LLIN 5.00
b) Committed expenditure for Impregnation of bednets under south district of the state Tripura (**) 22.17
Sub-Total 27.17 7. (i) IEC on malaria (ii) conduction of health fair (iii) Malaria Camps in Village Health & Nutrition Day
9000 nos 500 5.00 0.50 4.50
Sub Total 10.00 Grand Total GFATM 197.11
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B. NVBDCP (DAC) Unit cost 2011-12
a) Salary for contractual MPW(500 NOS) 500 nos @ 10,000 600.00
B) Operational Expenses including spray wages Operational expenses in reang refugee camps. 200 nos teams. 244.00
C) Purchase of Blood Lancets, JSB stain, blood slides & Spray machines
6.00 8.00
12.00 d) Training Spray workers/FTD etc. 2.00 e) ASHA incentives = Rs.16.00 Lakhs ASHA Facilitator incentives=Rs. 2.00 Lakhs 18.00
f) NAMMIS , Internet connectivity, training for district staff, purchase of 2 nos laser printer 5.00
g) Transportation charge of medicine from godown to State NVBDCP store, DDT carrying from state NVBDCP Store to the O/o CMOs, PHCs, CHCs etc.
4.00
h) purchase of fogging machine for AMC areas 20.00 i) maintenance/ repairing of existing spray machines 20.00
Sub total 939.00 5. IEC a) IEC Awareness (Annexure-I) b) Through NGOs
54.20 10.00
6. Op. expenses for treatment of bed net- 2,00,000 nets 20.00
Sub-Total 64.20 Grand TOTAL (DAC) 1023.20 Procurement of Decentralized Anti-malarial 67.35 Therapeutic efficacy study (Annexure-II) 4.98
GRAND TOTAL 1. GFATM total = Rs 197.11 lakhs 2. NVBDCP (DAC) total = Rs.1023.20 Lakhs 3. Purchase of decentralized Anti-malarials = Rs 67.35 lakhs 4. THERAPATIC EFFICACY STUDIES = Rs 4.98 lakhs
TOTAL = Rs 1262.97 Lakhs Provision under NRHM fund ( proposed in chapter 8): Total RDK required- 2,50,000 nos. & total ACT required is 40,000 packets to be as per direction of GOI, 25 % of these are to be procured from the NRHM fund. Budget estimate for this purpose: RDK= Rs 18,75,000/- ACT =Rs 6,00,000/- TOTAL= Rs 24,75,000/-
11 Others Specify a)District level Accountant/ Related persons of SDPMU / MPW (Contractual)etc
0.15 0 2 2 2 6 0.90
b) NAMMIS Training TA-Rs. 16200/- , DA-Rs. 16200/- Refreshment- Rs.30,000/- Stationeries- Rs. 20,000/- Trainers Honourium- Rs. 2,000/-
1 0 0 0 1 0.84
TOTAL
13.39
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BUDGET ESTIMATE FOR 2 (TWO) NOS OF THERAPATIC EFFICACY STUDIES / Training under the guideline of ROH&FW, Kolkata.
Sl. No.
Item/ Budget Head Amount Proposed (Rs)
1 Honorarium to Chief Coordinator 5000.00
2 Per Diem @ Rs 500/- for 40 days for investigator (Medical) + SPO (NVBDCP)
40000.00
3 Per Diem @ Rs 200/- for 40 days for 4 (four) Lab Tech 32000.00
4 Per Diem @ Rs 200/- for 40 days for 1(one) Driver 8000.00
5 Per Diem @ Rs 125 /- for 40 days for 2 (two) local staffs 10000.00
6 Patient care allowances @ Rs. 150/- per patient for average 60 (sixty) Patients
9000.00
7 Secretarial assistance @ Rs. 250 /- per person for 20 (twenty) days
5000.00
8 Stationary / Chemicals 25000.00
9 Contingency including reagents , laboratory materials, medicines etc. & rent for field lab set up
25000.00
10 POL & repair of hiring vehicle & incidental charges 40000.00
11 TA/DA
a) TA for 4 lab tech ,1 RO & 1 SPO 25000.00
b) DA for 4 lab tech ,1 RO ,1 SPO & 1 Driver for 40 days 25000.00
Total for 1 (one) study 2,49,000.00
Total for 2 (two) study 4,98,000.00
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IEC/ BCC Activities
Detailed Activities budget allocations (In Rupees)
Setting up and development of IEC/BCC unit at the state level/ district level Goal: Strengthening of District IEC / BCC wing Objective: 1. To maintain records in order to ensure proper monitoring of IEC/BCC activities 2. To ensure documentation of IEC BCC activities 3. For making designs of IEC proto types 4. To organize Audio Visual shows in peripheral areas 5. To ensure extensive coverage of Health activities Strategy: 1. To procure various equipments/ instruments a) Laptops @ Rs 45000/-x1= 45,000/- b) still Camera @ Rs 10000/- c) Video Camera 1 no. With tripod @ Rs. 50000/- Total-Rs. 1,05,000/-
105000.00
Formative research/ situational analysis/ baseline study to identify focus areas
Objective: 1. To assess awareness level , impact of IEC curriculum, media habits of common people. Strategy: 1. Conducting Field survey covering whole District. Activity: 30 cluster survey covering whole district Components of survey 1. Design of Survey. 2. Questioner formulation 3. Training on Questionaire 4. Field Survey 5. Supervision of Survey 6. Data Tabulation 7. Analysis 8. Report writing 9. Feedback A survey on assessing Media Habits and awareness level among common people Financial break up for each cluster: Printing and stationary: Rs. 1000 /- Transportation: Rs. 400/- x 3 days Honarium : Rs. 200 x 2 persons x 3 days Refreshment: Rs. 100 x 2 persons x 3 days Miscellenous: Rs. 500/- Total Rs. 4500/-
135000.00
Activity One day Interpersonal Communication and awareness campaign among Self-Help Groups may be an effective BCC intervention to increase awareness. This Programme. may be done among 100 members of SHG from each 40 Blocks of the state. The financial involvement for organizing the training will be Rs.25000/- for each Block.
Break-up:
222
1. Hall rent-Rs1000/- 2. Study materials @ Rs.30/- for 100 members =Rs.3000/- 3. Lunch @Rs.100/- = Rs.10,000/- 4. TA @Rs.100/- =Rs. 10000/- 5. PA system/Banner/Misc. cost- Rs.1000/- Total 25000 x 40 = Rs. 1000000/- � Group Discussion at Panchayet level: Workshop comprising PRI, ASHA, Health Workers, NGOs (Total Participant- 50 nos per GP) Break-up: 1. Hall rent-Nil (AWW Centres/ Sub centres) 2. Study materials to be supplied from the state 3. Tea & Snacks @Rs.10/- x50 nos= Rs.500/- 4. PA system/Banner/Misc. cost- Rs.500/-
1000000.00 1040000.00
b) Community media 100000.00 � Folk arts � Street plays
For generating awareness among the rural masses Street Drama @
Rs. 2000 total 50. Nos in the district. Total Rs. 100000/- Participation in State level Health melas: Objective: � To aware common people on health related messages Strategy: � Generating awareness through display of IEC materials Activity: � Printing of flex � Conducting quiz competition � Distribution of IEC materials � Drama/ puppet show � Audio-visual show Total 50000.00 Rallies in Anti Malaria Month Objective: To generate Health awareness messages through special day observance A Health Jatha may be organized on the day with help from IM/ATGDA/NGO. The Health educators, MPWs, MPS, IEC personels may take part in the Jatha. Road shows will be organized at the middle of Jatha. Organizing Jatha (includes decoration of tableaux, cost of cultural programmes, Road show, hiring vehicles etc.) in each district @ Rs 20000/-. X 17 Subdivisions
Total 3,40,000.00
A BCC campaign in all the four Districts for conducting IPC namely ‘Haat Divas’ – an interactive stall at local market / Haat in market days. Drama, Traditional Song & Dance, Puppet show, Quiz Competition, attractive exhibition will be conducted; Health workers, ASHA will communicate with local people in the campaign. Budget: 1. Organizing the Stall – Rs. 1000 2. Organizing Exhibition: Rs.1000 3. Drama, Traditional Song and other cultural programmes –Rs.1000/- 5.Transportation and Misc. –Rs.1000/-
480000.00
Total Rs.4000/- Grand Total: 40 Blocks x 3 months x Rs. 4000
223
Television spot Financial Involvement Rs. 10000x2 language=20000. Telecasting 4 nos. of spots through Doordarshan Agartala at Local News time @ Rs. 2000/- per spot for 180 days (every alternative days of the year)
Total Rs. 360000/- Telecasting through 3 local cable channels @ Rs. 5000/- per channel for one month. Total telecasting for six months on every alternative days. Total Rs. 5000 x 6 x 3 = Rs. 90000/-
Total 470000.00 Audio Visual Show Activity: One Audio visual show in Malaria prone 40 block (2 places) @ Rs. 5000 Sub Total (40x2x 5000 ) 400000.00 e) Radio programmes 100000.00 f) Newspaper advertisements
Total Rs.100000/- g )Print materials � Pamphlets Brochure in Bengali and Kokborok @ Rs.20 x 40000 nos. = Rs.8,00,000/- Pamphlets & Poster (10000) @ Rs 15/- = Rs. 150000/- Folders 10000 nos @ Rs 10/-=Rs 100000/-
Sub Total 1050000.00 Capacity building and training of manpower Designate responsibilities as per task/Identify coordinator and design activity chart � Capacity building of staff Monitoring and evaluation � Midterm monitoring Monitoring by District/ SD/ PHC level For monitoring the different IEC activities fund is required for mobility support of IEC personnels.
Rs. 150000/- for District and Sub divisions. Total 150000.00 Grand Total 5420000.00
224
D2 Revised National Tuberculosis Control Program (RNTCP) 1. Situational Analysis Epidemiological patterns of Tuberculosis as a public health problem have changed over a period of time. From being a highly infectious lung disease primarily affecting lower socio-economic strata of the population, it now has manifestations in economically well to do populations with extra-pulmonary manifestations. Incidence of drug resistance is coming up. TB HIV co-infection further compounded the problem. This has necessitated a change in programme implementation strategies whereby each case needs to be given treatment under Direct Observation Treatment (DOT) & followed up regularly. In the state’s context Annualized case detection rate for new sputum +ve cases at present is 57%. Cure rate is 90% as against the programme minimum objective of 85%. Sputum conversion rate is 91% as against programme objective of achieving 90%. Nearly 20,998 suspects were examined in 2009-10 against our target 21,600 and 1526 NSP cases were registered against our target 1908. The total number of Designated Microscopy Centers (DMCs) present in the state is 53 (fifty-three). The norm is 1 DMC per 1,00,000 population. Five more new DMCs will be established. There are 10 nos. Tuberculosis units in the state and one more TB unit will be established at Sabroom SDH, South Tripura for better supervision and monitoring with additional man power under the programme. Private sectors are yet to gain involvement, however efforts are being taken to involve them. ASHAs are involved in sputum transportation & follow-up of cases as well as DOT provider. ASHAs are given Rs.250/- as honorarium as DOT provider. For sputum collection and transportation, incentive amounting Rs.200/- is provided to ASHA if she visits more than once in a week to DMC. Status of 2009-2010
Sputum examined
Sputum +ve case detected
Total patients registered for treatment
New Sputum +ve case registered
Annualized new sputum case detection rate
Sputum conversion at the end of 3 (three) months.
Cure rate among registered patients
20998 1845 2814 1526 57% 91% 90%
2. Objectives
1. To maintain present cure rate of 90% among newly detected infectious (new sputum smear positive) cases.
2. To achieve and maintain a detection rate of at least 70% of such cases in the population, present case detection rate is 57%.
3. Establishment of treatment facility for Multi Drug Resistant TB (MDRTB) 4. Strengthening of TB HIV cross referral mechanism to detect TB HIV co-infection.
3. Strategies/ Activities for the year 2011-12 The strategic approach being-followed in Tripura conforms to the national agenda & strategy. The emphasis will be on universal access to Tb care particularly increasing the service coverage in the tribal & hard to reach areas. The areas where Designated Microscopy Centers (DMC) is not available, the facilities for sputum transport to the nearest DMC shall be continued through ASHA/Voluntary workers. Screening of diabetic patients, old people, and malnourished child will result in an increase in proportion of sputum positive cases detection will be continued. To improve the quality of management of the detected cases the high standard of modular
225
training will be provided newly recruited doctors and paramedical staff. Regular sensitization training will be organized for trainee doctors of both medical colleges. The training of general health system staff shall be continued for accurately diagnosing the TB cases as well provide treatment as per WHO guidelines. Patient behavior focused IEC activates shall be instituted to ensure behavioral change and ACSM activities with the help of NGOs will continue. Keeping in view the possibility of emergence of drug resistant cases, ward for treatment of MDR-TB will be established at AGMC. Supervisor and Medical officer will be recruited for treatment of MDR TB.
Training of health system staff to be continued Prevent emergence of Multi Drug Resistance (MDR) cases by minimizing the number of
defaulters & ensuring that all cases are treated with DOTS strategy. Further strengthening of monitoring & supervision through training of MOTCs Medical
Officer TB Control) at Tuberculosis unit level. Encourage community based volunteers/ASHAs for providing DOTS and transport
sputum samples to DMCs from village by continuing incentives from programme. Ensure all defaulters are followed up by ANMs and ASHAs so that defaulter rates are
brought to zero. Quality microscopy services through implementation of EQA in all the DMCs to be
continued Establishment of treatment facilities for MDR-TB cases and recruitment of Medical
Officer, supervisor for said purpose. Establishment of culture & sensitivity facility at Agartala Govt. Medical College.
Implementation of intensified TB-HIV package by providing training of all categories of staffs.
Strengthening IEC through patient provider meeting and regular meeting at community level. ACSM activities through NGOs will be continued.
4. Annual Plan for Programme Performance & Budget for the year 2011-12
Objectives: 1. To achieve and maintain a cure rate of at least 85% among newly detected infectious (new sputum
smear positive) cases, and 2. To achieve and maintain detection of at least 70% of such cases in the population
This action plan and budget have been approved by the STCS, Tripura. Section A: General Information about the State
1 State Population (in lakh) please give projected population for next year 36 Lakh 2 Number of districts in the State 04 3 Urban population 5,45750 4 Tribal population 9,93426 5 Hilly population 500000 6 Any other known groups of special population for specific
(Source: Census data /State Statistical Dept/ District plans) No. of districts without DTC: Nil. No. of districts that submitted annual action plans, which have been consolidated in this state plan: All four districts. Organization of services in the state:
* Public Sector includes Medical Colleges, Govt. health department, other Govt. department and PSUs i.e. as defined in PMR report ^ Similarly, Private Sector includes Private Medical College, Private Practitioners, Private Clinics/Nursing Homes and Corporate sector
RNTCP Performance Indicators:
Performance for the last 4 quarters (October 2009 to September 2010)
* Patients put on treatment under DOTS regimens only are to be included.
Name of the District (also
indicate if it is notified hilly or tribal district).
Section B – List of Priority areas at the State level for achieving the Objectives planned: Activities Priority areas
Activity planned under each priority area
Awareness in community All Blocks Through banner, poster, leaflets & electronic media.
Gear up School level awareness activities. All 4 (Four) districts through NGOs
2a Dissemination of information on TB among Teachers and High School students at least 8 (eight) School each Quarter in collaboration with NGOs engaged in district.
Block level Awareness meeting involving ASHAs All 4(Four) Districts 4a At least 2(Two) each quarter. Priority Districts for Supervision and Monitoring by State during the next year
Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at the State Level.
Sl District Reason for inclusion in priority list
1. Tripura (South) Further improvement of case detection 2. Tripura (North) Poor case detection and to improve cure rate 3. Dhalai Poor record keeping & reporting, to improve case detection. 4. Tripura (West) To improve recording and reporting.
1. Civil Works: Rs.18,93,800/-
Activity No. required as per the norms in the state
No. already upgraded/ present in the state
No. planned to be upgraded during next financial year
Justification for an increase in plan in excess of norms
Estimated (Fig. in Rs.)
Quarter in which the planned activity expected to be completed
(a) (b) (c) (d) (e) (f)
DTC 04 02 01 150000 4th Qtr. 2011 for renovation of one DTC.
DTC maintenance 9000 TU maintenance 11 10 0 7800 TU maintenance works DMC maintenance 37000 DMC Maintenance Works
Establishment of New DMC 58 53 (04 under process)
01 (Ganganagar PHC, Dhalai District) 39000 Establishment of New
DMC SDS (Renovation for second line drugs) 195000 Renovation of SDS for
second line drugs. DOT plus site 1300000 For Renovation
Renovation of District DOT plus drug store of West & South District
156000
For renovation of DOT plus site drug West, South, North & Dhalai districts
TOTAL (In Rs) 1893800 2. Laboratory Materials: Rs.5,75,000/-
Activity Amount permissible as per the norms in the
state
Amount actually spent in
the last 4 quarters
Procurement planned during 2010-11 (in
Rupees)
Estimated Expenditure for 2011-12 for which plan is
being submitted (Rs.)
Justification/ Remarks for (d)
(a) (b) (c) (d) (e) Procurement of Lab. Materials
599500 5,50,738 4,90,000 5,75,000 Due to establishment of 5 DMC, 1 TB–Units
Total Rs.5,75,000/-
3. Honorarium: Rs.8,00,000/-
Activity Amount permissible as per the norms in the state
Amount actually spent in the last 4 quarters
Expenditure (in Rs) planned for 2010-11
Estimated Expenditure for 2011-12 for which plan is being submitted (Rs.)
Justification/ Remarks for (d)
(a) (b) (c) (d) (e) Honorarium for DOT provider both Tribal & Non Tribal Districts
Actual Basis 364500 600000 800000 Includes expenditure as honorarium under Tribal Action Plan
Rs.8,00,000/- Community Volunteers
No. presently involved in RNTCP Additional enrolment proposed for 2011-12
Community volunteers in all the districts* 1600
* These community volunteers are other than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc. 4. Annual Action Plan (2011-12) Advocacy, Communication and Social Mobilization (ACSM) for RNTCP 4.1 State IEC Action Plan for RNTCP (Self)
Program Challenges to be tackled by ACSM during the Year 2011-12
WHY ACSM
Objective
For WHOM Target Audience
WHAT ACSM Activities
WHEN Time Frame
By WHOM
Monitoring and Evaluation
Budget
Q1 Q2 Q3 Q4 Based Desired Activities Media/ Key implementer Output Outco Total
on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )
behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)
Material Required
and RNTCP officer responsible for supervision
s; Evidence that the activities have been done
mes: Evidence that it has been effective
expenditure for the activity during the financial year
Challenge 1 Advocacy Activities
Increase of case detection
Common People/PRIs/Patients /Providers
World TB Day-2012 / observance of “World TB Day Week”
Rally/ tableau/ RNTCP Chariot/Banners/ Group meetings Invitation for participation of Rally, Group meeting & IPC after discussion quiz competition
March 24/3/12 to 30/3/12
STO/DTO/MOTC/STS/IECO/NGOs
Rs.50,000 /-
Communication Activities
Increase of case detection
For awareness of Community.
Tin Plate for Sub Centers
Display in front of all Sub-centers/ DOT centers
300nos
300nos
STO/IECO/DTOs Rs.1,20,000/- (@Rs.200 X 600 nos. )
with Wooden structure .
Social Mobilization
Increase of case detection
Common people
Mela/ Festival
Jan-Mar,2012
STO/IECO Rs.50,000/-
Challenge 2 Advocacy Activities
Improving DOT services
DOT Provider & Community
Block wise Sensitization meetings with ASHAs.
Nov-03 Dec-03
Jan-02 Feb-02
Rs. 250000/- (@ Rs. 25000 x 10 nos prog.) Mike-Rs. 1000/- each programme, Hall rent- Rs. 5000/- each, ASHAs Honorarium -@ Rs. 100/- x 100 nos- Rs. 10000/- each programme, Lunch- @ Rs. 80/- x 100 nos= Rs. 8000/- , Misc cost- Rs. 1000/-
each prog. Communication Activities
Improving DOT services
Community Hoarding (Iron) renovation
Display Messages
April May June
Rs.50,000/-
Improving DOT services
Common people /Patients/ Provider
Printing of Poster/Leaflet/Booklet/any other printing
Display & Distribution.
Within July August
STO/IECO Rs.1,00,000/-
Community Advertisement Print/electronic media / Spot making
STO/IECO Rs.30,000/-
Social Mobilization
Improving DOT services
Members of NGO
District wise Workshop with NGOs
June-01
July-01
Sept-01
Jan-01
STO/ DTO/ IECO/ MOTC/ STS
Rs.1,00,000/-
Grand Total Rs.7,50,000/-
4.2 District IEC Action Plan for RNTCP (West Tripura district)
Program Challenges to be tackled by ACSM during the Year 2010-11
WHY ACSM
Objective
For WHOM Target Audience
WHAT ACSM Activities
WHEN Time Frame
By WHOM Monitoring and Evaluation
Budget
Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )
Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)
Activities
Media/ Material Required
Q1
Q2
Q3
Q4 Key implementer and RNTCP officer responsible for supervision
Outputs; Evidence that the activities have been done
Outcomes: Evidence that it has been effective
Total expenditure for the activity during the financial year
Challenge 1. Advocacy Activities Increase of Case detection
To gain support from District administration and Community To gain support
DM, Community leaders CMO, SDMO,MOIC, Community Private- Practitioner including Quack Practitioners/
World TB Day Souvenir
Printing of Folder, Leaflets IPC leaflet in local languages campaigning & IPC Discussion with quiz competition
March (24/3/2011)
Rs. 10000/- For World TB
Day(2500X4 TU)
1 1 Rs.10000/-
(5000x2=10000/-)
Communication Activities Increase of NSP Case detection
Generate awareness in people encourage people to self reporting early
Patient- DOT Provider Interaction meeting
Speech/ Leaflet /Poster distribution
April May June-
Jul- 50 Aug-50 Sep-50
Oct-50 Nov-50 Dec-50
Jan-100 Feb-100 Mar-100
DTO/STS/MOTC/MOIC
Rs. 60,000/- (@ Rs.100/-X 600nos)
Advocacy Activities: Minimize the defaulter
To sensitize the Panchayet members/ Pradhan community leaders ,
Patients, Panchayet, Patients family, Community, Health Care provider
Community meeting, Sensitization Workshop involving opinion of leaders.
Interactive session/distribution of leaflets & folder
April-4 May-4 June-5
Jul- 3 Aug-3 Sep-3
Oct-3 Nov-3 Dec-3
Jan-3 Feb-3 Mar-3
NGO/DTO
Rs40,000/- (@Rs.1000/- X 40 nos)
Communication Activities Minimize the defaulter
Puppet Shows
Leaflet distribution Apr-2
May-2 June-2
Jul- 3 Aug-3 Sep-3
Oct-2 Nov-2 Dec-3
Jan-2 Feb-3 Mar-3
DTO/STS/MOTC/IECO
30 nos. @Rs.2000/- each Rs.60,000/-
Social Mobilization
4.3 District IEC Action Plan for RNTCP (South Tripura district) Program Challenges to be tackled by ACSM during the Year 10-11
WHY ACSM Objective
For WHOM Target Audience
WHAT ACSM Activities
WHEN Time Frame By WHOM Monitoring and
Evaluation Budget
Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )
Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)
Activities Media/ Material Required
Q1 Q2 Q3 Q4
Key implementer and RNTCP officer responsible for supervision
Outputs; Evidence that the activities have been done
Outcomes: Evidence that it has been effective.
Total expenditure for the activity during the financial year
Challenge 1 Advocacy Activities Low Case Detection
To gain support from administrations & PP (Private Pract).
DM 1 to 1 meeting
Success stories fact sheets publications.
DTO with WHO Consultant
Minutes, photo graphs, Reports,
Statistical improvement
No CMO No Private Pract.
Sensitization.
Rs.5000/-
Minimize the defaulter
Sensitization of District administration and Social Welfare Department
IPC, distribution of leaflets
Poster/ Information Booklets/ Folder
Total: Rs.1,80,000 /-
Communication Activities Low Case Detection
To generate awareness in society General
people Cable channel Script DTO UC
Statistical improvement
Rs.15000/-
School students Seminar Banner 2 2 2 2 DTO/MOT
C Photograph
Quiz competition Rs.12000/-
Religious Holi Occasions Poster Increased
self reporting.
Rs.10000/-
People Banner DTO/ IEC Officer
Photograph Rs.10000/-
Social Mobilization activities Low Case Detection
To encourage self reporting
PRI bodies patients, DOT Provider, Patients.
Community meeting
Banner 8 4 8 4 DTO/IEC Officer Photo
Graph
Self Reporting to OPD
Rs.36000/-
World TB Day
Message DTO/IEC Officer
Rs.40000/-
118000/-
4.4 District IEC Action Plan for RNTCP (North Tripura district) Program Challenges to be tackled by ACSM during the Year 2010-11
WHY
ACSM Objective
For WHOM Target Audience
WHAT
ACSM Activities
When
Time Frame
By WHOM
Monitoring and Evaluation
Budget
Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )
Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)
Activities
Media/ Material Required
Q1
Q2
Q3
Q4
Key implementer and RNTCP officer responsible for supervision
Outputs; Evidence that the activities have been done
Outcomes: Evidence that it has been effective
Total expenditure for the activity during the financial year
Challenge 1 Advocacy Activities Increase of Case detection
To gain support from District administration and Community To gain support from Health authority, district & sub – Div & block
DM, Community leaders CMO, SDMO, MOIC, Community Private- Practitioner including Quack Practitioners/ Health
1.World TB Day 2. School Programme 3. Group Discussion
Printing of Folder, Leaflets, IPC Audio visual add, booklet / leaflet in local languages Invitation for participation of Rally, Awareness campaigning &
30
30
30
30
500x19+1000x3+3000(DTC) 1500
Rs15,500/- For World TB Day 36000/- 06 06 06 06
level to increase referral from OPD
Workers/ Community Volunteers School Student
IPC Discussion with quiz competition Information Booklets
X X X X
Communication Activities Increase of Case detection
To inform communities the availability the DOTS service
Common people Private- Practitioner including Quack Practitioners, religious leaders Student
TV Spot Radio jingles Wall painting
Doordarshan Kendra /AIR/ local FM channel
Individual interviews, audience members Small surveys etc
Community
Haat Campaign/ Drama
By Drama & professional puppet team
DTO/IECO/MOIC/STS/NGO
Street Drama, Puppet Show
By Drama & professional puppet team
3
3
3
3
DTO/STS/NGO
Participation in Mela
Speech/ Distribution of leaflets/ Stall preparation
Rs.5000/-
Social Mobilization activities
Increase of NSP Case detection
Generate awareness in people encourage people to self reporting early
Community
Group meeting
Speech / Leaflet
DTO/MOTC/IECO/ STS
Photo
Data collected through program activities
Patient- DOT Provider Interaction meeting
Speech/ Leaflet distribution /Poster
95
100 100 100 DTO/STS/MOTC/ MOIC
100
Rs39,500
Challenge 2. Advocacy Activities Minimize the defaulter
To sensitize the Panchayet members/ Pradhan community leaders ,
Patients, Panchayet, Patients family, Community, Health Care provider
Community meeting, Patient-Provider Interaction Meeting Sensitization Workshop involving opinion of leaders.
Interactive session/distribution of leaflets & folder
NGO/DTO
1000
20,000
Communication Activities Minimize the defaulter
Patients Patients family Community , Panchayet
Community meeting involving cured patients
Interacting meeting with the help of cured TB patient
STO/ DTO /IEC Officer/ Club/NGO/ STS
Photographs with media coverage/ press release
Social Mobilization
Minimize the defaulter
Sensitization of District administration and Social Welfare Department
IPC, distribution of leaflets
Leaflet/Poster/ Information Booklets/ Folder
DTO/STS
Challenge 3:- Advocacy activities Quality DOTS
To gain support of community and patients family and Health authorities.
ASHA/MPW/ Health worker & TB Patients/Community / MO of Health institution
Inter personal Communication Group meeting Patient – Provider Meeting Community Meeting
Speech/Group discussion/Distribution of informative booklets
DTO/IECO /MOIC/STS
Interview with ASHA worker & Daily TB activity tour chart maintain.
Communication activities
Quality DOTS
TB Patients & family
Printing of Flip Chart, Flex poster, Tinplate
Leaflet, Poster, Tinplate distribution up to Sub center level
STO/DTO/ IECO
community Group meeting
ASHA / Health workers
Discussion
Social Mobilization Activities
Patients DOT Providers
Sensitization Workshop
Video Spot screening/Leafl
IECO/ DTO/ STS
Collation of advise from
Quality DOTS
Family with ASHA, MPW, ANM/ Health Workers.
et/ Poster distribution/ Prize giving
the Community members
TOTAL BUDGET
Rs1,16,000/-
4.5 District IEC Action Plan for RNTCP (Dhalai district) Program Challenges to be tackled by ACSM during the Year 2011-12
WHY
ACSM Objective
For WHOM Target Audience
WHAT
ACSM Activities
When
Time Frame
By WHOM
Monitoring and Evaluation
Budget
Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )
Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)
Activities Media/ Material Required
Q1
Q2
Q3
Q4
Key implementer and RNTCP officer responsible for supervision
Outputs; Evidence that the activities have been done
Outcomes: Evidence that it has been effective
Total expenditure for the activity during the financial year
Challenge 1. Advocacy Activities MRC/NKP/GNC
CMN DMC
PRI
VHSC
Flexi
17
17
17
17
DTO, MOTC,
Photo
Referral
Rs 20400/-
/CMN poor referral
68 S/C Level 15 x 12 = 180 15 Nos 10 Benner x 50 spots.
(a) (b) (c) (d) (e) Office Equipment (Maintenance includes computer software and hardware upgrades, repairs of photocopier, fax, OHP etc)
05, Xerox machines and OHP
246045 91000 288000
Binocular Microscope (RNTCP)
75
TOTAL Rs.2, 88,000/-
6. Training: Rs.16,70,340/-
Activity No. in the state
No. already trained in RNTCP
No. planned to be trained in RNTCP during each quarter
Expenditure (in Rs) planned for 2010-11
Estimated Expenditure for 2011-12 (Rs.)
Justification/ remarks
Q1 Q2 Q3 Q4
Training of DTOs (at National level) 04 30000 120000 To conduct training at State Medical College
Training of MO-TCs 10 04 25000 Due to transfer and retirement
Training of MOs (Govt + Non-Govt) 10 30 10 10 136000
Training of LTs of DMCs- Govt + Non Govt 10 50000 Due to transfer and retirement
Training of MPWs 20 40 20 0 50000 Training of MPHS, Pharmacists, Nursing staff, BEO etc 15 10000 Training of Comm. Volunteers 250 250 250 228 237340 Training of Pvt. Practitioners 0 Other trainings 0 Re- training of MOs 65 45 25 123000 Re- Training of LTs of DMCs 0 Re- Training of MPWs 50 180 50 70 115000 Re-Training of MPHS, pharmacists, nursing staff, BEO 17 5000 Re- Training of CVs 0 Re-training of Pvt Practitioners 0
Training of STS 6 20000 Resignation/ Discontinuation
Training of STLS 50000 TB/HIV Training of MO-TCs and MOs 0
Activity No. in the state
No. already trained in RNTCP
No. planned to be trained in RNTCP during each quarter
Expenditure (in Rs) planned for 2010-11
Estimated Expenditure for 2011-12 (Rs.)
Justification/ remarks
Q1 Q2 Q3 Q4 TB/HIV Training of STLS, LTs , MPWs, MPHS, Nursing Staff, Comm. Volunteers etc. 0
TB/HIV Training of STS 0 Training of MOs and Para medicals in DOTS Plus for management of MDR TB 95 125 105 75 403000
Provision for update Training at various levels 0 Review Meetings at State level 01 01 01 01 20000 Any Other Training Activity (STO, DTOs, Faculty members on DOT plus) 10 300000
Retraining of Accountant 05 6000 TOTAL 1670340 7. Vehicle Maintenance: Rs.3,55,000/-
Type of Vehicle Number permissible as
per the norms in the state
Number actually present
Amount spent on POL and
Maintenance in the previous 4 quarters
Expenditure (in Rs) planned for current
financial year
Estimated Expenditure for the next financial year for
which plan is being submitted
(Rs.)
Justification/ remarks
(a) (b) (c) (d) (e) (f) Four Wheelers 01 01 105262/- 335000/- 130000/- Two Wheelers 10 10 140178/- 225000/-
TOTAL Rs. 3,55,000/-
8. Vehicle Hiring*: Rs.10,05,000/- Hiring of Four
Wheeler Number permissible as per the norms in
the state
Number actually requiring hired
vehicles
Amount spent in the prev. 4 qtrs
Expenditure (in Rs) planned for current
financial year
Estimated Expenditure for the next financial year for which plan is being submitted (Rs.)
13. Research and Studies (excluding OR in Medical Colleges): Not Budgeted 14. Medical Colleges: Rs.22,17,200/- Activity Amount permissible as
per norms Estimated Expenditure for 2011-12 (Rs.)
Justification/ remarks
(a) (b) (c) Contractual Staff:
MO-Medical College (Total approved in state ___) LT for Medical College (Total no in state ___) TBHV for Medical College (Total no in state___)
303600 224400 211200
Research and Studies: Thesis of PG Students Operations Research
1130000
Travel Expenses for attending STF/ZTF/NTF meetings 58000 IEC: Meetings and CME planned 40000 Training of internees 110000 Training of Nursing Staff & Para Medical Workers 140000
Total Rs.22,17,200/- 15. Procurement of Vehicles: Rs.50,000/-
Equipment No. actually present in the state
No. planned for procurement 2010-11
Estimated Expenditure for the next financial year 2011-12 (Rs)
Justification/ remarks
(a) (b) (c) (d) 4-wheeler 0ne 01 (DTC, North) Nil 2-wheeler 50,000 One for new TU, Subroom
SDS under South Tripura District
16. Procurement of Equipment: Rs.1,85,000/-
Equipment No. actually present in the state
No. planned for this 2010-11
Estimated Expenditure for the next financial year 2010-11 (Rs)
Justification/ remarks
(a) (b) (c) (d) Computer 05 120000 One for SDS & One for DOT plus site Any Other 65000 Dhalai District one to by another computer
Matrix of District-wise Tribal Area Action Plan Financial Year 2011-12
Districts West Tripura South Tripura North Tripura Dhalai
Brief Information
Total Tribal population: 387081. Total PHC: 12 Nos. Total S/C: 120 Nos. Sub-Division Hospital: 1 Total DMC: 8 Nos Total Out Patient: 15916 Nos. Total Sputum Examined: 311. Total NSP Target: 392.
Total Population - 8.5 lakh Tribal Population – 3.5 lakh No of PHI in tribal
dominated area – 20 No of DOT Centre – 90 No of DMCs – 11 Expected no of Tribal
patient registration - 100
Total Tribal population: 2 Lakh
Total No PHC: 5 (Five) Total No of Sub-Centre:50
(Fifty) Total DMC: 2 (Two) Total Sub-Divisional
Hospital: 1 (One)
Total Tribal population: 219698
Total No PHC: 12 (Twelve) Total No of Sub-Centre:
68(Sixty Eight) Total DMC: 5 (Five) Total Sub-Divisional
Hospital: 2 (Two)
Goals 80% NSP & 90% Cure rate. To decrease mortality & morbidity due to Tuberculosis
To decrease mortality & morbidity due to Tuberculosis
To decrease mortality & morbidity due to Tuberculosis
Objective Increase Case Detection rate & Cure rate.
To detect & maintain at least 70% case detection & to maintain 85% cure rate.
To detect & maintain at least 70% case detection & to maintain 85% cure rate.
To detect & maintain at least 70% case detection & to maintain 85% cure rate.
Strategies
1. To reach the un-reached area by establishing Sputum Collection Centres.
2. To extend DOTs coverage by engaging more numbers of Community Volunteers
1. To reach the un-reached area by establishing Sputum Collection Centres.
2. To extend DOTs coverage by engaging more numbers of Community Volunteers
1. To reach the un-reached area by establishing Sputum Collection Centres.
2. To extend DOTs coverage by engaging more numbers of Community Volunteers.
1. To reach the un reached area by establishing Sputum Collection Centres.
2. To extend DOTs coverage by engaging more numbers of Community Volunteers.
Districts West Tripura South Tripura North Tripura Dhalai
Activities
1. To establish 150 nos. of Sputum collection centre.
2. Engagement of 150 nos. ASHA for sputum collection as community volunteer & DOT provider.
3. Training for community volunteer (ASHA):-
1. Honorarium to the Cured/Treatment Completed Tribal Patient.
1. To establish 25 nos of Sputum collection Centre.
2. Sputum Collection very remote area no
1. Training of the1000 ASHA for utilization of their service as DOT provider also to generate awareness in Tribal people
2. Honorarium to the Cured/Treatment Completed Tribal Patient.
3. IEC activities to organised monthly meeting with workers at every sub-centre.
Budget
Training Budget = 31500/- 150 nos. of ASHA Worker Refreshment: - Rs.80/- DA: - Rs.100/- Course material: - Rs.30/- each Trainee.
Amount of honorarium at the end of Cure/Completion of treatment: Rs. 250 x 100 = Rs.25,000
Honorarium to 120 no of Tribal Patient 120 x 250 = Rs.30,000/-
Honorarium to DOT provider of Tribal Patient 120 x Rs.250/- = Rs.30,000/-
Total= Rs. 60,000/-
Honorarium to the Cured/Treatment Completed Tribal Patient @ Rs.250/- x 350 patients = Rs.87,500/-
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Section D: Summary of Proposed Budget– Rs. 2,24,80,540.00/-
Sl.No Name of Head
Budget estimate for the coming FY 2011-2012 (To be based on the
planned activities and expenditure in Section C)
1 Civil works 1893800.00
2 Laboratory materials 575000.00
3 Honorarium 800000.00
4 IEC/ Publicity 1418400.00
5 Equipment maintenance 288000.00
6 Training 1670340.00
7 Vehicle maintenance 355000.00
8 Vehicle hiring 1005000.00
9 NGO/PP support 1539000.00
10 Miscellaneous 885000.00
11 Contractual services 8804800.00
12 Printing 230000.00
13 Research and studies 0.00
14 Medical Colleges 2217200.00
15 Salaries of regular staff** 0.00
16 Procurement – drugs 0.00
17 Procurement –vehicles 50000.00
18 Procurement – equipment 185000.00
19 Tribal Action Plan 564000.00
Total 2,24,80,540.00
*****
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D3 National Blindness Control Programme (NBCP) Introduction The programme is aimed at reducing prevalence and burden of avoidable blindness by 2020 by adopting strategies advocated for Vision 2020: “The Right to Sight”. Major Objectives of the Programme
Sub-Divisional Hospital and Community Health Centres to have fixed Eye O.T. facility. One-vision Center/ 50000 populations managed by one PMOA Expanding coverage of eye care services to reach underserved. Reducing the backlog of blindness by identifying and providing services to the affected
population; and Developing institutional capacity for eye care services by providing support for
equipment and material and trained personnel. Activities
Human Resource Management. Training of Medical Personnels. Procurement of Equipments (ophthalmic), Drugs & Supplies. IEC/ BCC Activities. Establishment and management of Vision Centre.
(Rs. in Lakhs) National Programme for Control of Blindness Grant-In-Aid to States /UTs for various component during 2009-10
Physical Target
Funds Required
Recurring Grant-in-aid (*)
For free cataract operations @ Rs.750/- per case and other approved schemes per financial norms (*)
7000 212.70
Non recurring Grant-in-Aid (*)
For RIO (new) @ Rs.60.0 L - - For medical colleges @ Rs.40.0 L - - For Vision Centres @ Rs.0.50 L 05 2.50 For Eye Bank @ Rs.15.0 L - - For Eye Donation Centre @ Rs.1.0 L - - For NGOs @ Rs.30.0 L - - For Eye Wards & Eye O.T. @ Rs.75.0 L
01 75.0
For Mobile Ophthalmic Units with tele-network @ Rs.60.0 L
- -
Contractual Manpower
Ophthalmic Surgeon @ Rs.25,000/- p.m.
03 9.0
Ophthalmic Assistant @ Rs.8,000/- p.m.
05 4.80
Eye Donation Counselor @ Rs.10,000/- p.m.
- -
Total Grant-in-Aid 304.00
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Proposed Budget against planned activities for FY: 2011-12 under NBCP: Sl no Name of the Activity Financial Involvement
1
Salary: Recurring GIA to meet Salaries of Ophthalmic Manpower (on contract) 1. Opthalmic Surgeon @35000X4nos.X12month 2. Opthalmic Asst. @10800 X 67 nos X 12 month 3. Driver @8000 X 1 nos. 12 month N.B : 27 for vision centre & 40 for tele opthalmology centre
10459200
2
Salaries (existing manpower): Recurring GIA to meet Salaries of opthalmic manpower & other contractual staffs 1. Eye bank counsellor @ 13500 X 1 nos. X 12 month 2. Data entry operator @ 10500 X 1 nos. X 12 months 3. Administrative Asst. @10500 X 1 nos. X 12 months 4.Opthalmic Asst. @ 10800 X 3 nos. X 12months NB; DEO & Administrative Asst of SHFWS (Blindness are presently drawing monthly remuneration of Rs. 7000/- only for a long period. Tjhere remuneration may be increased because other contractual staffs working in the same posts of other societies and NRHM draw there monthly remuneration of Rs. 9800/- to 10500/- only)
802800
3 State Opthalmic Cell: Salary: Rs. 850000/-, TA: Rs. 50000/- Over head expenses Rs. 60000/-, POL Maintainance Rs.60000/-
1020000
4 GIA for cataract operation: 7600000 5 School Eye screening programme 600000 6 Training 600000 7 IEC 4998000 8 Vision Centre 500000 9 Maintenance of ophthalmic equipments 2905000
10
Commodity Assistance for upgradation of IOL facilities in SDH, SH, Med.Col., DH etc (Procurement of modernized & sophisticated ophthalmic equipments)
30300000
11 Fixed Eye OT & Ward (Construction of 5 nos. 10 bedded fixed Eye OT & Ward)
37500000
12 Contingency expenditure for State society 300000
13
Establishment & recurring cost of Tele ophthalmology centre (Tripura Vision Centre) Establishment & running cost 2008-09 = Rs.6615034/- Running Cost of 2010 (Jan-Dec10) = Rs. 16007857/- Running cost of 2011(Jan- Dec10) + Rs. 16007857/-
38630748
136215748 *****
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D4. National Leprosy Eradication Programme (NLEP) Situation Analysis: Tripura State belongs to north region surrounded by Bangladesh and Mizoram in one side. The State itself is low endemic for Leprosy. Tripura have achieved Elimination of Leprosy in the year 2000-01 when P.R. was brought down to 0.59 per 10,000 populations. At present the P.R. has further declined to 0.24 per 10,000 populations. The district wise prevalence rate is as follows:- West Tripura : 0.44/10,000 population South Tripura : 0.04/10,000 population North Tripura : 0.04/10,000 population Dhalai Tripura : 0.24/10,000 population
Status during 2009-10
Sl. No.
Old cases New cases detected
Cases discharged
U.T. Patient P.R. per 10,000 population
1. 76 56 42 90 0.24
Status during 2010-11 (up to October 2010) Sl. No.
Old cases New cases detected
Cases discharged
U.T. Patient
P.R. per 10,000 population
1. 90 11 9 90 0.25
District-wise new case detection rate 2010-2011 are as follows:- West Tripura : 1.6/10,000 population
South Tripura : 0.46/10,000 population North Tripura : 0.53/10,000 population
Dhalai Tripura : 1.1/10,000 population From the above index it is found that West Tripura District is having increasing number of Leprosy cases. Hence more intensive care and programme for Leprosy care and treatment would be implemented in West Tripura District during 2011-12. Initiatives taken during 11th Plan period:
i. Reconstructive Surgery: Medical rehabilitation is regularly done, but nobody was undertaken reconstructive surgery as there was no Reconstructive Surgeon in Tripura nor the patient can be transported outside. Tripura for Reconstructive operations with escort along with provision of money due to fear. No BPL family was provided with money of Rs.5,000/- per Reconstructive Surgery.
ii. Involvement of ASHA: ASHAs are being recently sensitized on Leprosy
as per approval of GOI within the monetary involvement of sanctioned amount of Rs. 5.0 lakhs.
iii. Programme Monitoring: It is being carried out as per Prevalence rate as
well as NCDR rate. Two Blocks mainly Khowai and Jirania RD Blocks of West Tripura District was adopted by GOI under the supervision. Moreover there is no other area remaining in Tripura where elimination was not achieved.
iv. National Sample Survey Association: Two Blocks mainly Khowai and Jirania RD Blocks of West Tripura District has been selected by GOI for
257
reassessment of Leprosy burden discrepancies and leprosy disabilities etc. under the supervision of Central Coordinator as well as through Health State Officials. The report has been sent to GOI on completion of the job during September 2010.
Proposed planned activities with projected cost under NLEP for the year 2011-12:
(Fig. in Lakhs) Sl. Activities planned for 2011-12 Unit
Cost Physical Targets
Required fund under NRHM
I NLEP
1 Operational Cost
1.1 POL for State vehicle: Rs.10,000/- p.m. 0.10x12 1 1.20 1.2 Office Stationeries (Papers/pen etc.)
1.3 Quarterly Review meeting at State including West Tripura Dist @ Rs.20,000/-
0.05 4 0.20
Quarterly Review meeting in three districts @ Rs.10,000/-
0.10 12 1.20
1.4 Field Visits (two times per month) @ Rs.3000/- by State level officials
0.03 24 0.72
2 Human Resources 2.1 State –B.F.O cum AO: Rs.16,500/-
DEO Cum Adm. Asst: Rs.10,450/- Driver : Rs.7,000/- Contingent worker : Rs.3,520/ Total : Rs. 38,100/- Add:- 20% enhanced to total existing salary : Rs.7620/ Rs: 44,720/- p.m.
0.4572 x 12
5.49
3 Trainings 3.1 Training for MPWs= i) 2 days Re-
orientation training of MPW (M/F) (500 nos. x 2days x Rs.350/-) =Rs.3,50,000/-
0.007 500 MPW 3.50
3.2 Total ASHA in the State-7367 less already trained during 2010-11= 1500nos. ASHAs to be trained for one day during 2011-12 = 2000 nos. (2000 x Rs.350/-)
0.0035 1500 ASHAs
5.25
3.3 Training for MOs: 2 days Re-orientation training (100nos x 2days x Rs.500/-) =Rs.1,00,000/-
0.005 for 2days
100 MOs 1.00
3.4 Other Training & Capacity building
programmes= ii) Out side the State = Rs.2,00,000/-
2.00 2 Nos. 2.00
4 Procurements 4.1 Procurement –Equipments
One Computer (Lap-top) with printer = Rs.60.000/-
0.60
1 No.
1.90
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Sl. Activities planned for 2011-12 Unit Cost
Physical Targets
Required fund under NRHM
One No L.C.D Projector=Rs.80,000/- One no Scanner of = Rs.10,000/- One no- Fax Machine =
6 Referral Services (Urban Leprosy Control) i. Referral services for R.C.H operation
for 4 patients @ Rs.30,000/- per patient with escort may be allowed.Rs.1,20,000/-
0.30
4 patients 1.20
7 IEC/BCC Activities: Broadcasting in T.V, Radio, local new paper, Press for Leprosy facts: Rs.2,00,000/-
2.00
Awareness campaign in school level/Block level/Panchayet level etc. Rs.1,00,000/-
1.0
Mahila Mandal/SHG and broadcasting facts rural. Rs.50,000/-
0.50
Advocacy meeting- with different NGO’s/different club/rickshaw union/ motor shramik union etc. Rs.2,00,000/-
2.00
Special campaign in Padmabill Block/ Tulashikar Block etc.Rs.2,00,000/-
1.0 2 Blocks 2.00
Translation of Leprosy materials in Bengali version of Rs. 2,00,000/- Health Mela in 1 State & 3 Dist @ Rs.50,000/- per Dist. Rs.2,00,000/-
0.50 4 districts 2.00
Grand Total (Rupees Fifty nine lakhs fourteen thousand) only.
32.86
*****
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D5 National Iodine Deficiency Disorder Control Programme (NIDDCP) Introduction National Iodine Deficiency Disorders Control Programme (NIDDCP) is implemented in the state through the IDD Cell at State HQ under Directorate of Family Welfare & Preventive Medicine, Government of Tripura since 1987. An officer from the Directorate is designated as State Programme Officer (NIDDCP) for implementation of the programme activities as per the below stated goals & objectives. Goal: The goal of NIDDCP is to reduce the prevalence of iodine deficiency disorders below 10 percent in the entire country by 2012 AD Objectives:
1. Surveys to assess the magnitude of the Iodine Deficiency Disorders. 2. Supply of Iodated salt in place of common salt. 3. Resurvey after every 5 years to assess the extent of Iodine Deficiency Disorders
and the impact of iodated salts. 4. Laboratory monitoring of iodated salt and urinary iodine excretion. 5. Health education & publicity.
As per GOI guideline each State need to have an IDD Control Cell which carries out periodic surveys regarding the prevalence of IDD and reporting to Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India. The State IDD Cell is responsible for:-
1. Checking iodine levels of iodated salts with wholesalers and retailers within the state and coordinating with the Food and Civil Supplies Department.
2. The distribution of iodated salt within the state through open market and PDS. 3. Creating demand for iodated salt. 4. Monitoring consumption of iodated salt. 5. Conducting IDD Surveys to identify the magnitude of IDD in various districts. 6. Conducting training. 7. Dissemination of Information, education & communication.
Information on IDD implementation during 2010-11 in the state is as follows:
State IDD Cell: Technical Officer – Vacant Statistical Assistant – 1 L.D. Clerk – 1 The Technical Officer which is non-medical personnel as per Government of India norm has been lying vacant since long. It is proposed for contractual recruitment @ Rs.15000/- p.m. during 2011-12. Qualification may be as per applicable Recruitment Rule (RR) available under Deputy Drug Controller/ Health Department. The Statistical Asst. & LD Clerk is in existence and their respective salaries are budgeted accordingly. State IDD Lab: Established in Regional Food & Drug Laboratory, O/o the Dy. Drug Controller in 1994 with the following staffs: Lab. Tech. – 1 Lab. Attendant – 1 Their respective salaries are budgeted accordingly as per norms
260
District Survey During 2010-11, District survey has not been done as the Technical Officer was not identified. During 2011-12, survey is proposed to be done after identification of Technical Officer for which fund amounting Rs.50,000/- per district is provisioned. Salt Sample Testing Kit For testing salt an amount of Rs.2.35 Lakhs is provisioned for procuring Salt Sample Testing Kit during 2011-12. IEC IEC activities as per Revised Policy Guidelines on NIDDCP are proposed to be followed for implementation during 2011-12. State specific activities include Community outreach through print/ electronic, visual display and IPC. NIDDCP Budget for 2011-12 Sl Activities Amount
(Rs. in Lakhs) 1 Salary & Office Expenses 12.20 2 Recruitment of Technical officer with contractual salary
@Rs.15000/- pm (n0n-medical) 1.8
3 Survey in 4 districts @ Rs.50,000/- 2 4 Survey in Agartala Govt. Medical Collage 1.00 5 Observation of Global IDD prevention Day on 21st
Oct in 40 blocks & 35 wards of AMC area for creation awareness in the entire state with health education with expenditure @ Rs.20,000/- per bocks & wards
15.00
5.1 Awarness through AIR 1.00 5.2 Awarness activity through doordarshan with
makingshort drama on IDD & key messages of awareness against Iodine Deficiency.
1.00
5.3 IEC materials through electronic, print, folk media etc 2.00
Total 38.00
*****
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D.6: Integrated Disease Surveillance Project (IDSP) Introduction: As per Government of India initiative for a decentralized state based Integrated Disease Surveillance Project (IDSP) in the country, the state is under IDSP coverage to enable detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner. It is also enabled to provide essential data to monitor progress of on going disease control programs and help allocate health resources more optimally. The core activities being implemented under the project in state’s context are as follows:-
District & State Surveillance units set up so that the program is able to respond in a timely manner to surveillance challenges in the state including emerging epidemics.
Integration of surveillance activities under various programs by using existing infrastructure for its function.
Active participation of medical colleges in the surveillance activities. Proposed planned activities for 2011-12: The state have analyzed and identified areas/ Districts that have a high burden of communicable diseases. The additional funds required to tackle the same have been budgeted for in the NRHM Mission Flexi pool. A summary of information on critical situation of communicable diseases of the sate is as follows:-
State has a burden of Meningococcal Meningitis for last two years affecting the entire state with dominance in Dhalai district. 286 people were affected during 2009 with 62 deaths while during 2010 total number. of individuals affected was 70 with 10 deaths. During 2011 one case is reported so far as on 3.1.2011.
Additional fund required for procurement of Meningococcal test kits is Rs.3.00 lakh and for IEC activities is Rs.2.00 lakh which has been budgeted under NRHM flexi pool. The details of the proposed additional activities are as follows:-
Procurement of Meningococcal test kits = Rs.3.00 Lakhs (70% for Dhalai district & 10% each for remaining three districts).
Conducting IEC activities = Rs.2.0 Lakhs (Printing of 2,00,000
posters in bi-lingual [Bengali & Kokborok] detailing with pictorial illustration of the causes and preventive measures of Meningitis including contact nos. of key persons for distribution through MMUs [Dhalai-1,50,000 nos. West-20,000, South-20,000 & North-10,000]).
262
The projected cost against proposed planned activities for the FY: 2011-12 under IDSP is as follows:- Activity Sub-
activity
Description Unit cost Sub-activity
No of units
Proposed
Budget for
2011-12
Surveillance Preparedness
Training
One day training of Hospital Doctors
Per head training cost=Rs.1100
One day raining at state level
20 per district
0.88
One day training of Hospital Pharmacist / Nurses
Per head training cost= Rs 750
One day Training at district level
60 per district x 4
1.80
One day training of Medical College Doctors
Per head training cost= Rs.800
One day Training at state level
40 doctors
0.32
One day training of DM & DEO
Per head training cost= Rs.1600
One day Training at state level
11 participants
0.176
One day training of Health Workers
Per head training cost= Rs.750
One day Training at district level
125 per district x 4
3.75
One day training of Laboratory Technicians
Per head training cost=
One day Traini
20 per district x 4
0.60
263
Activity Sub-activi
ty
Description Unit cost Sub-activity
No of units
Proposed
Budget for
2011-12
Rs.750 ng at state level
Sub total 7.52
Staff remuneration*
State/district Epidemiologist (1 at State HQs-SSUs and 1 each at district HQs - DSUs)
0.30 per month per person
5 18.00
State/ district Microbiologists (1 at State HQs- SSUs and 1 each at identified district priority labs.)
0.20 per month per person
2 4.80
Entomologist (1 at State HQs - SSUs)
0.20 per month per person
1 2.40
Consultants Finance (1 at State HQs - SSUs)
0.14 per month per person
1 1.68
Consultants Training (1 at State HQs - SSUs)
0.28 per month per person
1 3.36
Data Managers (1 at State HQs - SSUs and 1 each at district HQs - DSUs)
0.135 per month per district Data Manager & 0.14 per month for State Data manager
5 8.16
Data Entry Operators (1 at State HQs - SSUs, 1 each at district HQs - DSUs and 1 identified Medical Colleges/Other
0.85 6 6.12
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Activity Sub-activi
ty
Description Unit cost Sub-activity
No of units
Proposed
Budget for
2011-12
institutions viz. ID Hospitals)identified under IDSP
Sub Total 7.12
Operational Cost
Transport District :Rs. 1000/-x 4 visits per month per district SSU: Vehicle hiring @ RS. 15000 per month
4 1
1.92 1.82
Office Expenses,
Broadband Expenses
Printing of reporting forms
IDSP reports including Alerts
@ Rs 2000/- per DSU per month and Rs 5000 at SSU per month Rs. 1000/ Per unit per month Rs. 20000 per district Rs. 30000 for SSU
5 6 4 1
1.56 0.72 0.80 0.30
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Activity Sub-activi
ty
Description Unit cost Sub-activity
No of units
Proposed
Budget for
2011-12
Sub Total 44.52
Sub Total (Surv. Preparedness raining Remuneration + Operational cost)
59.16
Outbreak investigation and response
Collection & Transportation of samples
Rs 6000 per district per year
4
0.24
Consumables for and kits for identified priority district labs
Rs 2,00,000/-per year per priority district lab
1 2.00
Grand Total-IDSP (2011-12)
61.40
*****
266
E. Intersectoral Convergence Introduction The Inter-sectoral Convergence under NRHM is proposed for implementation to strengthen the health related activities carried out by other line Department like Social Welfare & Social Education, School Education, Higher Education, Women & Child Development, Rural Development, AIDs control society, Autonomous District Council under 6th schedule and Panchayati Raj Institution. It’s essential to build up the capacity of line Department to further strengthen the convergence activity. During 2010-11 it was proposed to orient the different stake holders for better implementation of the programme. Situation Analysis:
Mainstreaming of AYUSH: Contractual appointment of manpower (AYUSH MOs, Pharmacists, Masseurs) and collocating a PHC/ CHC/ SDH, conducting IEC and training.
VHND: AWC under the Social Welfare & Social Education Department is the
principal hub for the health care delivery at the grass root level. Previously there were 7367 AW centre which is now increased in 9909 nos. in 1040 GP/ADC villages consists of 8 to 10 AWC in an average. Monthly VH & ND is observed in each AWC in consultation with PRI, Social Welfare & Social Education & NGOs since 2008-09 to 2010-11, whereas in the North Tripura District VHND organized by accumulating fund from different organizations other than NRHM, like- ICDS, RD, Mid Day Meal, RNTCP, AIDS etc.
NRHM/ AIDS Convergence: RTI/STI services are also provided by Tipura State
AIDS Control Society (TSACS). They have established STI clinics in different health institutions. In the month of December 2009 a convergence meeting was held for implementation of RTI/STI services jointly by NRHM & TSACS.
NRHM/ICDS Convergence: Regarding Capacity Building of NRHM & ICDS
personnel for intersect oral convergence, 4 nos. District level IEC Workshop were organized at District Headquarter of each District in the month of May, 2010, where representatives from Health Department like MPW, MPS, Extension Educator and from SW & SE Department, Child Development Project Officer, ICDS Supervisor were present.
Objective: Convergence of different activities with the line department for implementing projects having similar objectives resulting optimal utilization of resources. Communications Strategies adopted/implemented through Convergence Mechanism:
Janani Suraksha Yojana:-To aid in reducing maternal and neo-natal mortality by promoting institutional delivery and making available quality maternal care during pregnancy, delivery and immediate post partum period, JSY is implemented in the state in the right earnest. It is one of the well known activities to the rural people. Institutional delivery has shown rapid growth after implementation of JSY with supportive role of ASHAs. Last year upto Dec, 2010, 20091 number of JSY beneficiary covered throughout the state. This year target proposed as planned in the District Health Action Plan. To cover the pregnant mother under the scheme, local PRI bodies of the area, ANM, AWW also takes supportive role.
Budgeted in Part-A, RCH-II
267
VHND: For strengthening Community involvement is proposed below:--
As per GOI guideline, in a mobile mood VHND approached in a holistic manner converging different activities under RCH – II, to give efforts for providing all planned services like mobilizing eligible couple, ANC, PNC, Immunization, nutritional support and Counseling services etc.
An amount of Rs. 2000/- is proposed as expenses of organizing VH & ND
consisting of MCH service, Family Planning service, refreshment & fruits (nutritious food for target mother and baby food for children), immunization, awareness activity etc. and along with that ASHA would avail @Rs. 200/- for mobilizing Eligible couple (FP), Mother & children & for Focus Group Discussion (FGD) on MCH & Family Planning issues.) Targeted number of VHND will be implemented with all the lined departments & projects involving ASHA, AWW, Link workers of AIDs, PRI members etc.
Budgeted in Part-A, RCH-II
IEC Initiative for New Born & Child Health: Observance of Breast Feeding Week (1st August to 7th August): Rally by ASHA, Health Workers in the prominent places of Gram Panchayat and ADC villages during 1st August to 7th August in all Health Institutions (Total 101) throughout the State District Media Expert, SDPM will ensure the programme. An action plan with date and place should be sent to BO, IEC in advance.
Group meeting with target groups (Mothers, Guardians and eligible couple): The
financial involvement for organizing the meeting Rs.14500/- for each Meeting (40 Meeting). All meetings will be arranged by respective AAAs and SDMEs. While implementing the activities Panchayat members are actively involved in the programs and also motivates mothers, guardians and eligible couple to take active participation.
Budgeted in Part-B, Additionalities (IEC/BCC) under NRHM
Adolescent Health: As an action for BCC to tackle the challenges concerned on adolescent issues, Students in HS+2 schools of the state has been targeted and Adolescent Health messages has been disseminated through Exhibition, puppet shows, magic shows, dramas, speeches, power point presentations etc. Awareness generation programme named “School Festival – Enjoy the Learning” in the HS +2 schools in all blocks with the support of School Education department.
Budgeted in Part-B, Additional ties (IEC/BCC) under NRHM
School Health: In Tripura, there are 2307 JB school, 1246 SB school, 504 High school and 336 H.S (+2) schools having student capacity of 811399. It is proposed to provide micro-nutrient in the form of Iron Folic Acid (IFA) to each student to prevent anemia of the school children. Total involvement of fund will be as: 811399 students x 100 tablets. The IFA tablets are proposed to be given to school authorities for distribution to the children during mid-day meal. The details budget under School Health component, Part A. It’s also proposed to do De-worming of 811399 students by providing Albendazole tablets. 2 tablet per student in a gap of 7 days.
Details budget under School Health component, Part A
Panchayati Raj Initiative: The main concept of VH&SC/ Rogi Kalyan Samity (RKS) at different level is a simple yet effective management structure. This committee which is a Registered Society except VHSC acts as a group of trustees for the different health institution to manage the affairs of the people or society. It consists of members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives and officials from Government sector who are responsible for proper
268
functioning and management of the SHC/ CHC / PHC/ SDH/ DH/ SH/FRUs. These bodies are proposed to prescribe freely, generate and use the funds with it as per its best judgment for smooth functioning and maintaining the quality of services. It is proposed to organize one day capacity building workshop for all PRI representatives associated with Health structure.
Budgeted in Part-B Additionalities (Panchayati Raj) under NRHM
RTI/STI services NRHM/AIDS Convergence: Under NACP III, TSACS has established STI clinics. Under NRHM, ARSH clinic has been established in all SDH, DH, SH, Medical College where Adolescent friendly services will be provided. Appropriate referral linkage will be established so that the gap can be reduced. Under Maternal Health, 100 SN & 100 ANM are proposed to be trained up on RTI/STI.
Budgeted in Part-A, RCH-II District Action Plans (including Block, Village): District Action Plans (DAPs)
under NRHM forms an important constituent for planning purposes especially in the context for decentralized planning involving the PRIs. In the state’s context PRI has got a strong base with operational three tier Panchayat system i.e. Gram Panchayet, Block Panchayet and Zilla Parishad. From planning and management perspective, adequate importance of involving the age long institution has been considered at all levels in the state. NRHM emphasized bottom up approach while making State Programme Implementation Plan. Conceptualizing the fact, State PIP is proposed, as planned in all the District Health Action Plan including activities under RCH-II, Construction & renovation under Additionalities & as well as Innovative approaches made by the districts.
Budgeted in Part-B, NRHM Additionalities
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Budget for Intersectoral Convergence (Part-E): 2010-11
Sl. No. Activity Remarks 1 Janani Suraksha Yojana
Budgeted under Maternal Health-Part-A
JSY home beneficiary for 3900 cases (N-900, S-500, W-1750, D- 750)
JSY Institutional beneficiary for Rural 21818 cases for cases. (N-5018, S-5500, W-7500, D-3800) including ASHAs incentive.
JSY Institutional beneficiary for Urban cases for 4128 cases .(D-350, W-2700, S- 500, N-578)
2 Organizing VH&ND in AWCs
Organizing VH&ND in 1040 GP/ADC X 2times X 12 month.(Refreshment @Rs. 15 X 100 PW/Baby + 500 contingency)
Incentive for 7367 nos. ASHA X 2 times X 12 month -
Training on RTI/STI to 100 SN/100 ANM 3 New Born & Child Health
Observance of Breast Feeding Week (1st August to 7th August) : Rally from each Health Institution by ASHA, Health Workers with Placard, Banner, cap to aware mass people
Budgeted under Part –B, IEC-BCC
Sensitization Group Meeting with target groups (Mothers, Guardians and eligible couple)
Organization of Specialist health Camps at 11 SDH & 2DH (6times) Budgeted under
Part- A, Child Health. Micro-nutrient in the form of Iron Folic Acid (IFA) to each
student. De-worming of students by providing Albendazole tab. 4 Adolescent Health
‘School Festival’ – School Health Awareness Campaign at School Level in all Blocks (40 Blocks)
Budgeted under Part-A, ARSH
Panchayati Raj Initiative Budgeted under Part- B
Training of VH&SC members Training of Block level RKS members Training of District level RKS members 5 District Action Plan Block Health Action Plan
Budgeted under Part- B
Sub-division Health Action Plan District Action Plan State Action Plan
