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Sonebhadra City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

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NATIONAL URBAN

HEALTH MISSION

Programme Implementation Plan

of

Sonebhadra 2013-14

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TABLE OF CONTENT

Preamble 3

Acknowledgement 4

Acronyms 5

City Profile 6-11

Key Issues 12

Strategies, Activities & Work plan under NUHM 13-16

Programme Management Arrangements 17-18

City level targets & indicators 19-21

PREAMBLE

National Urban Health Mission aims to improve the health status of urban population in general and

the poor and other disadvantaged sections in particular. This would be made possible by facilitating

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equitable access to quality health care through a revamped primary public health care system,

targeted outreach services and involvement of the community and urban local bodies. Under the

scheme, the government proposes to strengthen and enhance the health care service delivery in

urban areas with targeted focus on urban poor and the disadvantaged.

Sonebhadra with a population of 1862612 (Census: 2011) constitutes 0.93 percent of total Uttar

Pradesh Population. The current sex ratio for the urban areas is 868 females per thousand males

(census-2011) which is an area of grave concern. In the city the natural growth rate is 9.3 (AHS-2011-

12). In the district as per AHS-2011-12 reports the IMR is 68 (AHS- 2011-12) and MMR at 326

(current estimates) which again is a matter of concern.

The health indicators for Sonebhadra show are way behind in so many aspects and the launch of

National Urban Health Mission, the efforts for improving the health parameters will complement

towards betterment of urban population and in particular to the urban poor and slum dwellers.

The NUHM planning for this financial year based on the data, surveys and available information at

city level and hoping that we will initiate the process very systematically so that we can make the

difference in improvement of quality life of urban people specially by reaching the unreached areas.

.

Dr. R. A. Yadav Chandrakant, IAS

Chief Medical Officer District Magistrate Sonebhadra Sonbhadra

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ACKNOWLEDGEMENT

Considerable efforts have been made by the team in preparing this Project Implementation Plan for

Sonebhadra under the newly announced National Urban Health Mission. This has been possible

through dedication, perseverance and hard work. This exercise of planning would not have been

complete without the help and support of the team.

We do not have hesitation in saying that this work would not have come up without the valuable

support and continuous encouragement of Sri Chandrakant, IAS District Magistrate, Sonebhadra. His

great confidence in team has spurred us into action.

My special gratitude goes to Dr. R.A. Yadav, Chief Medical Officer, Sonebhadra, a dynamic and

enthusiastic professional. He has always been a source of great encouragement for us. The initiation

and completion of this work has been possible due to his sincere and able guidance, expertise,

precious opinion, keen attention, constructive suggestions and constant help. His critical reading of all

the parts of the work has helped shape the NUHM planning in its present form.

I express my gratefulness to Shri. Amit Kumar Ghosh, IAS, Mission Director, National Health Mission

& Mr. Shashank Vikram, IFS, Additional Mission Director, NUHM for overarching support and

building the thoughts in our mind.

I owe my sincere gratitude to Dr. M. R. Gautam (General Manager), Dr. Usha Gangwar, (Deputy

General Manager-NUHM) and HUP-PFI who have helped us immensely by providing relevant

information and valuable suggestions. This planning work got accomplished with their valuable

support and eagerness to help.

I am privileged to have such good city level team especially Shri. Santosh Kumar Singh (DPM

NRHM) and DPMU team, who have supported and helped in contributing their great efforts towards

planning of this city level plan under the NUHM.

I would also like to appreciate the precious help and motivation which I received from government line

department - DUDA, ICDS, Nagar Palika Parishad, Education department, CMS & DTO.

Last but not the least; I would like to thanks all those people who were involved in the planning

process directly or indirectly.

Dr. Ganesh Prasad

Add. CMO (RCH/Nodal NUHM)

Sonebhadra

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Acronyms

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Aanganwari Center

AWW Aanganwari Worker

BSGY Bal Swasthya Guarantee Yojna

BSUP Basic services for urban poor

BSA Basic Shiksha Adhikari

CDPO Child Development Project Officer

DH District Hospital

DHS District Health Society

DUDA District Urban Development Authority

ICDS Integrated Child Development Scheme

IDSMT

Integrated Development of Small &

Medium Towns

IDSP Integrated Diseases Surveillance

Program

IHL Individual House level

IMR Infant Mortality Rate

KFA Key Focus Area

LHV Lady Health Visitor

LT Lab Technician

MAS Mahila Arogya Samiti

MMR Maternal Mortality Ratio

NHM National Health Mission

NPP Nagar Palika Parishad

NPSP National Polio Surveillance Program

NRHM National Rural Health Mission

NUHM National Urban Health Mission

OD Open Drainage

RSAP Remote Sensing Application Center

UA Urban Agglomeration

UCHC Urban Community Health Center

UFWC Urban Family Welfare Center

UHI Urban Health Initiative

UHP Urban Health Post

UPHC Urban Primary Health Center

SAM Severely acute Malnourishment

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National Urban Health Mission- Programme Implementation Plan

Sonebhadra 2013-14

1. Sonebhadra Profile

The district Sonebhadra, lies between Latitude 23052’ and 25032’ north and Longitude 82072’ and

83033’ East, with total geographical area of 6788 Sq. Km. It is bounded by districts Mirzapur and

Chandauli in North and inter state borders of four states e.e. Madhya Pradesh, Chattis garh, Bihar

and Jharkhand. The district Sonebhadra was carved out from the Mirzapur district in the year 1989.

The district is very much endowed with natural blessings of forest area and rich in minerals, But the

majority of population belong to socially and economically backward and educationally deprived

SCs/STs and OBCs.

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Table.1: Sonebhadra District and Sonebhadra Urban in Census 2011

Description Sonebhadra District

2011

Sonebhadra

Urban 2011

Actual Population 1862612 314063

Male 971397 167999

Female 891215 146343

Population Decadal Growth rate 27.27% -

Density/km2 270 -

Sex Ratio (Per 1000) 918 871

Child Sex Ratio (0-6 Age) 925 868

Average Literacy (%) 64.03 % -

Male Literacy (%) 74.92 % -

Female Literacy (%) 52.14 % -

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Table 2: Demographic profile of Sonebhadra (Robertsganj) City

Total Population of city 36689

Slum Population 32000

Slum Population as percentage of urban population 86.49

Number of Notified Slums 25

Number of slums not notified 0

No. of Slum Households 6196

No. of slums covered under slum improvement programme

(BSUP,IDSMT,etc.)

0

Number of slums where households have individual water connections* 0

Number of slums connected to sewerage network* 0

Number of slums having a Primary school 4

No. of slums having AWC 25

No. of slums having primary health care facility 1

Table 3: Selected indicators of slum conditions in Sonebhadra (Robertsganj) City

Characteristic Percentage of people/families

Water Supply Facilities

Individual tap The entire house hold of the urban

area depends either on individual or

community tap water supply and

handpumps. Separate data not

available.

Community tap

Others

Sanitation

Individual toilet facility 33%

Community toilet facility 0.0003%

Others 0%

Employment

Employed NA

Unemployed NA

Self employed NA

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Table-4

Sl. No. Name of Slums Population Robertsganj City Sonebhadra 32243 (2011) 1 Dalit Basti Mahal North 1111*

2 Dalit Basti Mahal South 1455* 3 Ambedakar Nagar Mahal East 1351* 4 Jogiya Baba Mahal 1115* 5 Sanskrit Mahavidyala Mahal 1132*

6 Nai Basti Mahal North 1474* 7 Arya Nagar Mahal 1361* 8 Mandi Mahal 1390* 9 Nai Basti mahal South 1441*

10 Amid Nagar Mahal 1242* 11 Tahasil Colony mahal 1230* 12 Ambedakar Nagar Mahal West 1132* 13 Teachers Colony Mahal west 1443*

14 Hydel Colony Mahal 1131* 15 Deep Nagar Mahal 1429* 16 Akhada Mahal 1265*

17 Brahm Nagar Mahal 1450* 18 Harsh Nagar Mahal 1209* 19 Sankat Mochan Mahal 1099* 20 Bhuas Mahal 1098*

21 Ashok Nagar mahal 1415* 22 Nirala Nagar 1197* 23 Adhatiya Mahal 1245* 24 Basnahi Mahal 1480*

25 Teachers Colony Mahal East 1348*

Note- *refers population as per Rapid Survey 1997-98 provided by DUDA

1.3 Urban Governance

There are multiple agencies responsible for urban governance and provision and management of

infrastructure and services. While, the Sonebhadra Nagar Palika Parishad (NPP) and Sonebhadra

Jal Sansthan, are the key urban service providers, other agencies include the Public Works

Departments (PWD), Transport Department, Industries Department and the Department of

Environment. It appears overlapping of roles and responsibilities and fragmentation in service

provision and management of infrastructure, which makes it difficult to hold institutions accountable

and to coordinate.

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Table 5: Urban Governance and Service delivery institutions

City Level

Sonebhadra, Nagar

Palika Parishad (NPP)

Local level governance; Primary Collection of Solid Waste; Maintenance of Storm

Water Drains; Maintenance of municipal roads; Allotment of Trade Licenses under the

Prevention of Food Adulteration Act; O&M of internal sewers and community toilets;

Street lighting; O&M of water supply and sewerage assets; Collection of water tariff

District Urban

Development Agency

(DUDA)

Implementing agency for plans prepared by SUDA.

Responsible for the field work relating to community development – focusing on the

development of slum communities, construction of community toilets, drainage,

assistance in construction of individual household latrines, awareness generation etc.

Table 6: Overview of existing public health facilities

Sl. No.

Name & type of facility (DH, Maternity Home, CHC, other ref. hospital UFWC, UHP PHC,Dispensary etc.)

Managing Authority (Municipal Council, State Health Department, facilities functioning on PPP basis)

Location of Health facility

Population covered by the facility

Services provided Human Resources available –

list type and number of

HR available i.e. ANM, LT,

SN, MOs, Specialists

etc.

No. and type of

equipment available: X-ray machine,

USG, autoclave

etc.

1. District

Combind

Hospital,

Sonebhadra

State Health

Department

Lodhi Hole

District

Populati

on

OPD, ANC, PNC,

Immu., Indoor

Patient, Spaciliest

services, JSY & JSSk

MO – 20,

SN – 7,

ANM – 0,

LT – 5,

Other – 12

X-ray

Machine – 2,

USG

Autoclave - 2

2. PPC

Robertsganj

State Health

Department

City

Robertsga

nj

Above

50000

Immunisation,

ANC, PNC, Family

Planning camp &

Conducting

delivery

MO – 1,

ANM – 1,

LT – 0,

Other – 1

Nil

3. Urban Health

Post

Robertsganj ,

Sonebhadra

NRHM City

Robertsga

nj

Above

50000

OPD,

Immunisation,

ANC, PNC, Family

Planning Services

MO – 1,

SN – 1,

ANM – 0,

LT – 0,

Other – 1

Nil

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2. Key Issues

The Eleventh Plan had suggested Governance reforms in public health system, such as Performance

linked incentives and Devolution of powers and functions to local health care institutions and making

them responsible for the health of the people living in a defined geographical area. NRHM’s strategy

of decentralization, PRI involvement, integration of vertical programmes, inter-sectoral convergence

and Health Systems Strengthening has been partially achieved. Despite efforts, lack of capacity and

inadequate flexibility in programmes forestall effective local level Planning and execution based on

local disease priorities.

Following would be the issues for the city to address: City Health Planning, Public Private

Partnership, Convergence, Capacity Building, Migration, Communitization, Strengthen Data,

Monitoring and Supervision, Health Insurance, Information Dissemination and Focus on NCDs/ Life-

Style Diseases.

After considering the available data, city scenario and analysis, the City planning team has identified

issues at both service delivery & demand generation level. Following are the details of issues which

would be addressed through NUHM at the city level:

1) Need of community volunteers (ASHAs) for taking up the community mobilization activities

2) Need of Mahila Arogya Samiti (MAS- a group of 10-12 women) for wider spread of information/

rights and entitlements

3) Strengthening of ANC, PNC & identification of high risk pregnancies at community level

4) Home based care of neonates at community level

5) Promotion of institutional deliveries

6) Health education for all, especially for adolescent group

7) Complete immunization of pregnant women & children

8) Needs to strengthen the existing health care facilities by recruiting human resources

9) Need assessment of community in health scenario

10) Need a better convergence with other programs and wider determinants

11) Need of training & capacity building of human resources

12) Need of Strengthened program management structure at district level

13) Need of intensive baseline survey to start the community processes and identifying local needs

14) Involvement of local bodies in decision making and managing the program locally

15) Gap analysis of HR and recruitment

16) Promotion of family planning methods through basket of choice approach and counselling

because unmet need for family planning is high in Sonebhadra

17) Management of communicable and non- communicable diseases

18) Strengthening AYUSH

19) Identification and management of SAM children

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3. Strategies, Activities and Work plan

The key overarching strategies under NUHM for 2013-14 include data based planning, strengthening

of management and monitoring systems at district level, improving the primary health care delivery

system and community outreach through ASHAs, MAS and Urban Health and Nutrition

Days(UHNDs).

The key activities at the district level will include convergence with key urban stakeholders,

sensitization of ULBs on their role in urban health, strengthening UPHCs for provision of primary

health care to urban poor, community outreach through selection, training and support to ASHAs and

MAS, conducting UHNDs and outreach camps to get services closer to the community and reach

complete coverage of slum and vulnerable populations.

With the aim to improve the health parameters of urban population in the city, structures and

strategies as recommended for the NUHM in its framework will be adopted and operationalized

rapidly over the years.

Listing and Mapping of Households in slums and Key Focus Areas-

Listing and mapping of households will provide accurate numbers for population their family size and

composition residing in slums. Currently, estimates of population residing in slums are available from

District Urban Development Agency (DUDA) provide updated estimates of slum and vulnerable

populations and are expected to be fairly complete. The current plan for covering slums is based on

the currently available data of urban population of the city.

Once the ASHA are deployed they will list all households and fill the Slum Health Index Registers

(SHIR) including the number and details of family members in each household. This data will be

compiled for city and will provide the population composition of slums and key focus areas. This will

also help the urban ASHA know her community better and build a rapport with the families that will go

a long way in helping her advocate for better health behaviours and link communities to health

facilities under the NUHM. It is expected that once the household mapping is completed in cities, the

number of ASHAs will be reviewed and adjusted upwards or downwards and the geographical

boundaries of the coverage area for each ASHA would be realigned. This is due to the reason that

the actual population may be higher or lower than the original estimate used for planning.

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Facility Survey for gaps in infrastructure, HR, equipment, drugs and consumables-

Facility survey will be carried out in the public facilities to assess the gaps in infrastruc ture, human

resource, equipment, drugs and consumables availability as against expected patient load. Further

planning, particularly for UPHCs, will be based on these gaps. This work will be outsourced to a

research agency. Development Partners like Health of the Urban Poor project will technically support

this effort.

Baseline Survey-

The District envisions monitoring progress in health indicators in urban areas and among urban poor

over the period of implementation of NUHM. This proposed Baseline survey will generate data on the

health and related indicators which will be reviewed during the course of implementation of the

program to assess the impact of implementation and necessary course corrections can accordingly

be made and use of resources can be optimised.

Training and Capacity Building

ULB, Medical and Paramedical staff, Urban ASHAs and MAS will be trained. The trainings will have

to be followed by periodic refresher trainings to keep these frontline health workers motivated. NUHM

will engage with development organisations to develop the training modules and facilitate the

trainings.

Monitoring & Evaluation

The M&E systems would also capture qualitative data to understand the complexities in health

interventions, undertake periodic process documentation and self evaluation cross learning among

the Planning Units to be made more systematic.

The Monitoring and Evaluation framework would be based on triangulation of information. The three

components would be Community Based Monitoring, HMIS for reporting and feedback and external

evaluations.

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Strengthening of health facilities

Urban - Primary Health Centre (U-PHC) –

During the first year of implementation of the program, the existing urban health post (1 NRHM

funded) will be attempted to be strengthened. Towards this, the UHP existing in rented

accommodations will be shifted to adequately larger premises which would help in rendering the

mandated services. A provision of Rs. 15,000/- per month per UPHC is being proposed for immediate

service provision capacity enhancement, but over the period of time the said rented accommodations

will be shifted to owned premises for sustained services. Accommodations belonging to other

stakeholder government line departments will be explored and then adopted after entering into

necessary agreements/ arrangements with the said department.

Targeted intervention for urban Poor –

The process of listing of households in the KFAs, mapping of KFAs and health facilities and baseline

survey of the KFA households will help determine the scope and extent of services required for

targeting of the urban poor. A deliberate effort will be made to identify the vulnerable poor on the

basis of their residence status, occupational status and social status, besides other micro-level

indicators, which will further help focusing the health care services to the most deserving.

Mahila Arogya Samiti (MAS)-

MAS will act as community based peer education group in slums, involved in community mobilization,

monitoring and referral with focus on preventive and promotive care, facilitating access to identified

facilities and management of grants received. Existing community based institutions could be utilized

for this purpose. City planning team is proposing formation of only one MAS under each ASHA in the

first year and the identification of the remaining planned MAS will be undertaken in the subsequent

years.

ASHA-

For reaching out to the households ASHAs (frontline community worker) would serve as an effective

and demand–generating link between the health facility and the urban slum population. Each link

worker/ASHA would have a well-defined service area of about 1000-2,500 beneficiaries/ between

200-500 households based on spatial consideration.

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Outreach services –

Outreach services will be provided to the slum areas and KFAs through ANMs who would be

responsible for providing preventive and promotive healthcare services at the household level through

regular visits and outreach sessions. Each ANM will organize a minimum of one routine outreach

session in her area every month.

Special outreach sessions (for slum and vulnerable population) will be organized once in a week in

partnership with other health professionals (doctors/ pharmacist/ technicians/ nurses – government or

private). It will include screening and follow-up, basic lab investigations (using portable /disposable

kits), drug dispensing, and counselling. The outreach sessions (both routine and special outreach)

could be organized at designated locations mentioned in the aforesaid Para in coordination with

ASHA and MAS members

Innovations –

An urban specific IEC strategy covering urban contexts would be developed, field tested and then

applied to cover RCH. The IEC plans should especially focus on interpersonal or group

communication which would include a description of expected behaviour change in different

community segments. For effective tracking of its implementation, benchmarks and milestones would

be developed.

Convergence –

Intra-sectoral convergence is envisaged to be established through integrated planning for

implementation of various health programmes like RCH, RNTCP, NVBDCP, NPCB, National Mental

Health Programme, National Programme for Health Care of the Elderly, etc. at the city level. Inter-

sectoral convergence with Departments of DUDA, ICDS & NPP, etc .

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4. Programme Management Arrangements

Districts Heath Society will be the implementing authority for NUHM under the leadership of the

District Magistrate. District Program Management Units have been further strengthened to provide

appropriate managerial and operational support for the implementation of the NUHM program at the

district level.

District Health Society under the chairmanship of the District Magistrate as the implementing authority for

NUHM

Fund flow mechanisms have been set up and separate accounts will be opened at in the district for

receiving the NUHM funds.

Urban Health will be included as a key agenda item for review by the District Health Society with

participation of city level urban stakeholders.

An Additional CMO has been designated as the Nodal Officer for NUHM at the district level. The District

Program Management Unit will co-opt implementation of NUHM program in the district and the ACMO will

be overall responsible for the implementation of NUHM. To support this the following additional staff and

funds are proposed for strengthening the District Program Management Units for implementing NUHM:

a. Urban Health Coordinator, Accountant and Data Entry Operators according to the following norms:

District total Urban

population

Additional Staff Proposed

Less than 1 lakh 1 Data Entry Operator

b. District Programme Manager will be nodal for all NUHM activities so extra incentive and budget for

1 laptop to each DPM has been proposed for DPM for undertaking NUHM activities.

c. A onetime expense for computers, printer and furniture for the above staff has been budgeted along

with the recurring operations expenses.

d. Onetime expenses have been budgeted for up-gradation of the office of Additional CMO and

District Programme management Unit.

The City Program Management Committee will function as an Apex Body for management of the City

Health Plan, which will lead to delivery of Maternal, Newborn, Child Health and Nutrition (MNCHN)

and water, sanitation and hygiene (WASH) services to the urban poor and will work towards the

following objectives:

1. Establish a forum for convergence of city level stakeholders for the delivery of MNCHN and

WASH services to the urban poor.

2. Serve as the nodal body for the planning and monitoring of MNCHN and WASH service

delivery to the urban poor.

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3. Provide a forum for exploring, reviewing and approving PPP initiatives and innovations to

address the gaps in MNCHN and WASH service delivery to the urban poor.

The structure proposed for the City Coordination Committee :

Chairperson - DM

Convener - CMO

Members – Health - ACMO-Urban

Members - DPM

Member – ICDS - CDPO

Member – NPP - Slum Improvement Officer

Member – Water & Sanitation- Sup. En. / Ex.En. JalKal Vibhag

Member DUDA & UD - Project Officer.

Member – CMS - CMS. DCH. Sonebhadra

Members – School Education - BSA & DIOS

Members – Dev. Partners - Partners working in urban health sector

Coordinator - Lead Dev. Partner

Review Meetings at UPHC and City Level-

Nature of Meeting Periodicity Meeting

Venue

Participants

Mahila Aarogya Samiti

Meeting

Once a month

for each MAS

Slum ANM, HV, Community

Organizer, Social Mobilization

officer

Review meeting with Link

workers and MAS

representatives

Once a month UPHC All ANMs, PHN, LMO,

Community Organizer, Social

Mobilization officer

Meeting of UPHC

Coordination Committee

Once a month UPHC LMO, PHN/Community

Organizer, Social Mobilization

officer, representative from 2nd

tier facility, and reps. From other

departments

Meeting with CMO Once a month CMO

Office

CMO, Program Coord., Asst.

Program Coordinator, LMO/

PHN/ Community Organizer,

Social Mobilization officer

City Task Force Meeting Once in two

months

DM’s

office

CMO, Program Coord. UH,

Various departments’ reps. ,

private partners, NGOs

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Table.7- Important information

5. CITY LEVEL INDICATORS AND TARGETS

Name of the City: Robertsganj

Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) to be formed * 0 32

2. Number of MAS members to be trained * 0 320

3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *

0 16

Health Systems

4. Number of ANMs to be recruited * 0 5

5. No. of Special Outreach health camps to be organized in the slum/HFAs *

0 0

6. No. of UHNDs to be organized in the slums and vulnerable areas *

0 32

7. Number of UPHCs to be made operational * 0 1

8. Number of UCHCs to be made operational * 0 0

9. No. of RKS to be created at UPHC and UCHC * 0 1

10. OPD attendance in the UPHCs 0 0

11. No. of deliveries conducted in public health facilities 0 0

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Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

RCH Services

12. ANC early registration in first trimester 0 1080

13. Number of women who had ANC check-up in their first trimester of pregnancy

0 1080

14. TT (2nd dose) coverage among pregnant women 0 1080

15. No. of children fully immunised (through public health facilities)

0 1080

16. No. of Severely Acute Malnourished (SAM) children identified and referred for treatment

0 0

Communicable Diseases

17. No. of malaria cases detected through blood examination 0

18. No. of TB cases identified through chest symptomatic 0

19. No. of suspected TB cases referred for sputum examination

0

20. No. of MDR-TB cases put under DOTS-plus 0

Non Communicable Diseases

21. No. of Diabetes cases screened in the city 0

22. No. of Cancer cases screened in the city 0

23. No. of Hypertension cases screened in the city 0

* Year 2013-14 being the baseline year, the indicators for these NUHM components would be zero.

For other indicators, the figure for 2012-13 will be the base line

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Table 8: Health/Morbidity Profile of the City: Sonebhadra

The data collected from the leading public hospitals in the city and based on IDSP.

Sl. No. Name of Disease/ cause of morbidity (e.g. COPD, trauma, cardiovascular disease etc.)

Number of cases admitted in 2012

1. Injuries and Trauma 987 (From DCH)

2. Self inflicted injuries/suicide 0 3. Cardiovascular Disease 0

4. Cancer (Breast cancer) 0

5. Cancer (cervical cancer) 0

6. Cancer (other types) 0

7. Mental health and depression 0 8. Chronic Obstructive Pulmonary Disease (COPD) 0

9. Malaria 3541 (From DCH)

10. Dengue 0

11. Infectious fever (like H1N1, avian influenza, etc.) 0

12. TB 0 13. MDR TB 0

14. Diarrhea and gastroenteritis 3166 (From DCH) 15. Jaundice/Hepatitis 0

16. Skin diseases 0

17. Severely Acute Malnourishment (SAM) 0 18. Iron deficiency disorder 0

19. Others 0 (Source: )-District Combined Hospital and other dispensaries

Chief Medical Officer

Sonebhadra