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HARYANASTATE REPORT
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Haryana1
Haryana
Index
S. No. Content Page No.
1 Summary of Approvals 2 5
2 Demographic Profile 6 7
3 Progress of NRHM 8 11
4 Reproductive & Child Health 12 15
5 Immunization 16 16
6 Revised National Tuberculosis Control Programme (RNTCP) 17 20
7 National Vector Borne Disease Control Programme (NVBDCP) 21 22
8 National Leprosy Eradication Programme (NLEP) 23 23
9 Integrated Disease Surveillance Project (IDSP) 24 24
10 National Programme for Control of Blindness (NPCB) 25 25
11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 26 26
12 RoP Approvals under Mission Flexible Pool 27 29
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HARYANA
Summary of Approvals
Financial Management under NRHM (Rs. in crore)
Years Allocation Release Expenditure
% Release
against
Allocation
% Expenditureagainst Release
2005-06 69.33 85.14 53.88 122.80 63.29
2006-07 117.69 134.69 90.66 114.44 67.31
2007-08 137.59 131.79 105.83 95.78 80.30
2008-09 151.84 186.08 105.59 122.55 56.74
2009-10 149.69 0.00
Total 626.14 537.69 355.95 85.87 66.20
S. No. Timeline Activities Achievement %
1 ASHA Selection 13152 88Training 5000
2 VHSC 6282 90
3 24X7 PHCs 160 39
4 Mobile Medical Unit 6 29
5 Rogi Kalyan Samiti 2938 554
Budget Allocations (2005-09) ( Amount in Crores)
Allocation Releases Expenditure
RCH Flexipool
2005-06 25.31 11.43 8.34
2006-07 33.99 30.13 20.942007-08 26.11 27.75 21.95
2008-09 41.92 49.16 13.77
2009-10 42.71
Total (A) 170.04 118.47 65.00
NRHM Flexipool
2005-06 23.50 1.12
2006-07 28.75 34.32 2.10
2007-08 50.25 46.51 31.83
2008-09 36.52 42.39 21.94
2009-10 37.69
Total (B) 153.21 146.72 56.99
National Disease Control Programme2005-06 8.26 6.19 4.27
2006-07 9.12 7.74 11.14
2007-08 9.69 5.44 8.32
2008-09 15.24 8.99 2.98
2009-10 13.12 0.40 0.00
Total (C) 55.43 28.76 26.71
Grand Total (A + B + C) 378.68 293.95 148.7
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Record of Proceedings (2005-2009) for Mission Flexible Pool
Approval for Infrastructure (Rs. in Crore)
S. No Health Facilities 2005-06 2006-07 2007-08 2008-092009-
10
1 Sub C 2.43 0.00 0.00 0.00
2 PHC 0.00 0.00 1.53
3 CHC 11.60 2.40 0.00 0.00 0.67
4 DH 0.00 66.00 66.00
5 Equipment 0.00 0.00 0.00
6 Transport 0.00 6.27
7 Others 6.96 0.00 5.95 0.78
Total 14.03 9.36 0.00 71.95 75.25
Approval for Human Resource Support (Rs. In Lakh)
S. No Personnel 2005-06 2006-07 2007-08 2008-092009-
10
1 Doctors 0.00 0.00 2.27
2 Specialists 0.00 0.00 0.00
3 Staff Nurses 0.00 0.00 15.49
4 ANM 0.00 14.00 23.96
5 Others 0.00 0.00 8.41
Total 0.00 0.00 0.00 14.00 50.13
Approval of other activities (2005-2009) in Rs. Lakh
S.No Initiative2005-06 2006-07 2007-08 2008-09 2009-10 Re
ma
rksReleasedApproved Approved Approved Approved
ASHA
1 ASHA 888.5
TOTAL 888.5
Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
2 Rogi Kalyan Samiti 590
3Rogi Kalyan Samiti HQ
Hospital 105
4
Rogi Kalyan Samiti
CHC/ Sub Divisional
Hospital 116
5 Rogi Kalyan Samiti-PHC 336
6 Untied funds to CHC
1427 Untied Fund for PHC 102 315.75
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8 Untied Fund for SC 243 46.3 246.5 246.5
9 Untied Fund for VHSC 671.25 628.2
10Annual MaintenanceGrants CHC
274.511
Annual Maintenance Grant
-PHC204
12
Annual MaintenanceGrant- SC 246.5
TOTAL 243 942.3 1233.5 2094.7
Infrastructure related matters
13
Emergency & Referral
Services544.66 580
14 MMU 695.6 47.34
TOTAL 695.6 544.66 627.34
Status of Infrastructure 2005-2010
Health Facilities As per RHS 2008 New Construction Upgradation / Renovation
Number of Sub Centre 2433 269 63
Number of PHC 420 63 23
Number of CHC 86 10 11
Number of DH 21As per State Data
Sheet, NRHM
6 8
Status of NRHM as on 15.05.2009
1 ASHASelection 13152
Training 5000
2 VHSC 5331
3 Joint A/C 5287
4 24X7 Facility 207
5 FRU 67
6 Contractual Manpower
Doctors & Specialist 26
AYUSH Doctors
Staff Nurse 179Paramedics 260
ANM 2174
7 JSY Beneficiaries (in Lakhs) 0.92
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National Disease Control Programme
NLEPThe state has already achieved the goal of elimination of leprosy. The state is advised to carry out
in depth situational analysis in districts/blocks reporting large number of new cases and take
suitable actions.
IDSPIt is a Phase II state. The recruitment of key human resources needs to be fast tracked andcompleted in a time bound manner. The data reporting should start from all the districts.
NBCPUCs for GIA released to State Blindness Control Society not being received timely. SOE forCash Grant are also not being received timely. Performance of School Eye Screening Programme
needs to be improved.
NVBDCPMalaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs to
identify the areas for focused interventions. Capacity building for case management and
strengthening of health facilities need to be taken on priority basis for diagnosis and casemanagement. Filaria and Kala-azar, are not reported from the state of Haryana.
RNTCPOverall performance of the State is not good. Total Case Detection and cure rate need to beimproved. This appears to be due to gaps in key HR (STO, DTO and other levels), weak supply
chain management and supervision.
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Demographic, Socio-economic and Health profile
HEALTH INDICATORS OF HARYANA
The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 55 and
Maternal Mortality Ratio is 186 (SRS 2004 - 06) which are lower than the National average.
The Sex Ratio in the State is 861 (as compared to 933 for the country). Comparative figuresof major health and demographic indicators are as follows:
Table I: Demographic, Socio-economic and Health profile of Haryana State as
compared to India figures
S. No. Item Haryana India
1 Total population (Census 2001) (in million) 21.14 1028.61
2 Decadal Growth (Census 2001) (%) 28.43 21.54
3 Crude Birth Rate (SRS 2007) 23.4 23.1
4 Crude Death Rate (SRS 2007) 6.6 7.4
5 Total Fertility Rate (SRS 2007) 2.6 2.7
6 Infant Mortality Rate (SRS 2007) 55 557 Maternal Mortality Ratio (SRS 2004 - 2006) 186 254
8 Sex Ratio (Census 2001) 861 933
9 Population below Poverty line (%) 8.74 26.10
10 Schedule Caste population (in million) 4.09 166.64
11 Schedule Tribe population (in million) 0 84.33
12 Female Literacy Rate (Census 2001) (%) 55.7 53.7
Table II: Health Infrastructure of Haryana
Particulars Required In position ShortfallSub-centre 3005 2433 572
Primary Health Centre 500 420 80
Community Health Centre 125 86 39
Multipurpose worker (Female)/ANM at Sub
Centres & PHCs
2853 2592 261
Health Worker (Male) MPW(M) at Sub Centres 2433 2031 402
Health Assistant (Female)/LHV at PHCs 420 285 135
Health Assistant (Male) at PHCs 420 106 314
Doctor at PHCs 420 350 70
Obstetricians & Gynaecologists at CHCs 86 8 78
Physicians at CHCs 86 9 77
Paediatricians at CHCs 86 18 68
Total specialists at CHCs 344 45 299
Radiographers 86 63 23
Pharmacist 506 372 134
Laboratory Technicians 506 388 118
Nurse/Midwife 1022 411 611
(Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)
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The other Health Institution in the State are detailed as under:
Health Institution Number
Medical College 3
District Hospitals 21
Referral Hospitals
City Family Welfare CentreRural Dispensaries
Ayurvedic Hospitals 8
Ayurvedic Dispensaries 472
Unani Hospitals 1
Unani Dispensaries 19
Homeopathic Hospitals 1
Homeopathic Dispensary 20
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Note on Progress of NRHM in Haryana
(June 2009)
National Rural Health Mission has been launched with a view to bring about improvement in
health system and health status of people, especially those who live in rural areas of the country. The
State of Haryana is steadily progressing towards attaining the goals and objectives shared underNational Rural Health Mission (NRHM), National Population Policy (NPP) and MillenniumDevelopment Goals (MDG). The activities under National Rural Health Mission are transforming the
health care delivery to rural populace with increasing accessibility to quality services and theopportunity to participate actively in managing these services as well. The state has increased
coverage under JSY; improvement in infrastructure; availability of paramedical and medical
personnel. Brief information on the progress is as follows:
Institutional Framework of NRHM
Meeting of State & District Health Mission have been held regularly. Meeting of State HealthMission held 8 times and of District Health Mission held 210 times. Merger of societies is completed
in 21 districts. 6282 VHSCs have been constituted & 6282 joint accounts have been operationalised at
sub centre level. Rogi Kalyan Samities are operational at 21 DH, 91 CHCs & 336 PHCs. 9 districtshave started developing their own IDHAP.
Infrastructure Improvements
A total of 160 PHC have been strengthened with three Staff Nurses each to make them
functional for 24x7 work. About, 40 CHC are functioning on 24X7 basis & facility survey iscompleted in 40 (including others health institution below district level). A total of 25 SDH, 40 CHCand others below district level and 21 District Hospitals are functioning as FRUs. 6 districts have
functional Mobile Medical Unit (MMU) to provide services to remote areas.
Human Resources
A total of 13,152 ASHAs have been selected & 5000 are trained in 1st Module. ASHAs need
to be provided the drug kits. About 1675 Sub-centers are functional with an ANM and 2212 SCs arestrengthened with 2nd ANM. The contractual appointment of AYUSH Doctors is not done. As far as
manpower augmentation is concerned, 26 specialists, 415 SN, 2174 ANMs have been recruited on
contractual basis to meet the demand for the health services.
Services
Institutional deliveries have improved from 2.16 lakhs (2006-07) to 2.75 lakhs (2007-08).
During the year 2008-09 there were 3.18 lakhs Institutional deliveries in the state. JSY beneficiaries
have increased from 0.23 lakhs (2006-07) to 0.57 lakhs (2007-08). The number of JSY beneficiaries
was 0.48 lakh during the year 2008-09. Female sterilisation has increased from 0.55 lakh (2006-07) to0.71 lakh (2007-08) and male sterlisation has increased from 9744 (2006-07) to 9752 (2007-08).During 2008-09- 77,409female & 10030 male sterilisation have been reported. A total of 19 districts
are implementing IMNCI & 3486 people are trained so far. About, 98169 VHND held since thelaunch of NRHM. First Phase of Community Monitoring has been operationalised in the state.
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General
Overall improvement in health system since NRHM
Achievements Made
VHSC are formed in 6282 village Panchayats in Haryana
Dental Surgeons with dental equipments and Dental Units are available in - all DistrictsHospitals/Sub Dist Hospitals, CHCs and PHCs.
ASHAs have been selected. Special Incentives for Doctors working in difficult/Rural Areas (Mewat).
Availability of quality drugs. Untied Funds, Annual Maintenance Grants, Rogi Kalyan Samitis (RKS) funds being utilized.
There are different schemes to increase institutional deliveries.
Voucher Scheme for Promotion of Institutional Deliveries in Urban Slums
Areas for Further Improvement
The State need to strengthen the existing referral transport system in the State. Strengthening of Financial Management Systems and improving capacities of functionaries is
required.
RKSs are operational at most places and their capacity to use funds should be improved.
SPMU and DPMUs are formed and BPMU is in progress which needs to be strengthened. Streamline system for Inventory Management
Mewat needs special focus as a high priority district for all RCH indicators.
Infrastructure
Facility survey is under process to identify the gaps in the infrastructure, manpower andservices.
Satisfactory progress in infrastructure development. Well managed physical infrastructure which includes cleanliness, availability of water and
drainage system and other basic facilities
Human Resources
Haryana has separate directorate for Ayurved which looks after all the AYUSH componentsin the state.
There are manpower mismatches in the State. State needs to focus on multi-skilling of doctors for anesthesia and obstetrics.
State need to strengthen SPMU and DPMUs.
The State needs to strengthen the 24x7 PHCs with 3 staff nurses.
Service Delivery The state government has initiated Janani Suvidha Yojana,Jaccha Baccha and Delivery Hut
Scheme to increase institutional deliveries and reduce maternal and infant mortality.
There is an urgent need to strengthen the referral transport system in the State.
State had established Trauma Centres at Karnal, Ambala and Sirsa, Rewari and TraumaCentres at Bahadurgarh, Palwal, Gurgaon from State Budget along with equipments andmanpower
Poor convergence and support at the lower levels of the systems.
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An Analysis ofFinancial Monitoring Report for the FY 2008-09
A. RCH Flexible Pool
Component wise expenditure & Utilization under RCH against the approved PIP
Haryana Rs. in lakhs
Activities SPIP Expenditure
% Utilization
against PIP
A.1 Maternal Health 816.42 332.38 40.71%
A.2 Child Health 59.92 6.77 11.31%
A.3 Family Planning Services 982.66 675.58 68.75%
A.4Adolescent Reproductive andSexual Health/Arsh 91.15 7.88 8.64%
A.5 Urban RCH 261.34 47.01 17.99%A.7 Vulnerable Groups 20.00 0.00 0%
A.8 Innovations/PPP/ NGO 503.37 88.58 17.60%
A.9Infrastructure & HumanResources 1110.01 482.37 43.46%
A.10 Institutional Strengthening 269.70 316.57 117.38%
A.11 Training 444.37 210.90 47.46%
A.12 BCC / IEC 95.34 88.49 92.82%
A.13 Procurement 872.60 801.39 91.84%
A.14 Programme Management 243.66 155.95 64.00%
Total 5770.54 3213.86 55.69%
Based on table above and records available in FMG, the observations and areas of concern are asunder:-
General Observations:1. Only, Rs.32.13 crore i.e. 56% of the approved PIP of Rs.57.71 crore has been utilized under
RCH-II as compared to national level expenditure of 71%.
2. There is 53% increase in expenditure as compared to 2007-08.3. Since the launch of RCH-II, Rs. 82.24 crores, i.e. 69% has been utilized by the state against
the release of Rs. 118.46 crores during the period 2005-06 to 2008-09.
4. Remarkable expenditure of 117.38% has been noticed under Institutional Strengthening.5. More than 90% expenditure in BCC/IEC, Procurement is quite appreciable.
Areas of Concern:
1. Nil expenditure is reported under Vulnerable Groups.2. FMR wasnot sent on prescribed format.3. Expenditure reported under the head Child Health is less than 12% of the amount approved in
PIP, Rs.59.92 lakhs.4. Expenditure reported under the head Adolescent Reproductive and Sexual Health / ARSH is
less than 10% of Rs.91.15 lakhs the amount approved in PIP.
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B. Mission Flexible Pool:-
Component-wise expenditure under NRHM against approved PIP
Haryana Rs. In Lakhs
Activities SPIP Expenditure
% Utilization
against PIPB1 ASHA 0.00 22.36 Error
B2 Untied Funds 1233.50 944.93 76.61%
B3 Hospital Strengthening 6600.00 8984.33 136.13%
B4 Annual Maintenance Grants 0.00 246.94 Error
B5 New Constructions/ Renovation and Setting up 0.00 11.88 Error
B6 Corpus Grants to HMS/RKS 0.00 284.92 Error
B7 District Action Plans (Including Block,
Village) 0.00 5.31
Error
B10 IEC-BCC NRHM 0.00 12.63 Error
B11 Mobile Medical Units (Including recurringexpenditures) 0.00 2.83
Error
B12 Referral Transport 544.66 4.82 0.89%B14 Additional Contractual Staff (Selection,
Training, Remuneration) 1400.00 2023.78 144.56%
B16 Training 25.72 0.00 0%
B19 Procurements 0.00 278.08 Error
B22 New Initiatives/ Strategic Interventions (As per
State health policy) 285.72 0.00
0%
B25 State level health resources center(SHSRC) 0.00 15.37 Error
Total10089.60 12838.18 127.24%
Based on table above and records available in FMG, the observations and areas of concern are as
under:-
General Observations:
1. As compared to 2007-08, 651% increase has been noticed in expenditure during 2008-09, butthe expenditure in 2007-08 was as low as Rs.17.10 Crores against the releases of 46.51
Crores.
2. Since the launch of the programme, Rs.146.72 Crores were released to the state and utilisationis appreciable Rs.148.83 Crores (101%).
Areas of Concern:
The expenditure under ASHA, Annual Maintenance Grants, New Construction, Corpus
Grants to HMS/RKS, Distrct Action Plans, IEC-BCC NRHM, MMU, Procurements and
SHSRC to be looked into as no provision made in PIP.
Out of Rs.100.89 crores approved by the NPCC and Rs. 42.39 crores released, the state has
utilised Rs.128.38 crores i.e. 127.24% of approved PIP, while the national average of
expenditure is 68.14%.The reason of excess expenditure booked is that the state has booked
previous year expenditure during 2008-09.
3. More than 100% expenditure has been incurred under Hospital Strengthening, AdditionalContractual Staff (Selection, Training and Remuneration).
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BRIEFING NOTE ON RCH II: HARYANA
A. Background/ current status
1. RCH II Goals
Haryanas MMR has increased from 162 in SRS 01-03 to 186 in SRS 04-06. The IMR (SRS 2007) at
55 has reduced from 59 (SRS 2003), is the same as the national average. TFR at 2.6 (SRS 2007) is
only marginally lower than the national average of 2.7 (refer Annex 1).
2. RCH II Outcomes
Haryanas progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) ismixed (refer Annex 1):
Mothers having full ANCs has increased from 10.3% to 13.3%.
Institutional deliveries have increased from 35.7% to 46.9%.
Full immunisation in children 12-23 months has increased marginally from 59.1% to 59.6%. Children with diarrhoea receiving ORS has decreased from 32.3% to 31.7%.
Unmet need for family planning has increased from 14.7% to 16.0%. Further, use of moderncontraceptives has increased marginally from 54.3% to 54.5%.
3. Expenditure
Audited expenditure has increased from Rs. 8.34 crores in 05-06 to Rs. 20.71 crores in 06-07 and thendecreased to Rs. 18.82 crores in 07-08; reported expenditure in 08-09 is Rs. 32.14 crores i.e. 55.7% of
allocation (Rs. 57.70 crores). JSY accounted for 9.8% of the reported expenditure in 08-09.
B. Key achievements
1. Maternal Health, including JSY
Number of JSY beneficiaries in the state increased from 0.23 lakh in 06-07 to 0.35 lakh in 07-
08 to 0.48 lakh in 08-09. State has accredited 276 private institutions under the scheme. State has operationalised 160 PHCs as 24x7 so far against the target of 204 PHCs by 2010.
32 MBBS doctors have been trained in Life saving anaesthesia skills (LSAS) and 49 incomprehensive Emergency Obstetric Care (EmOC) so far against the target of 59.
279 Staff Nurses and 527 ANMs/LHVs have been trained in SBA as against a target of 1167.
The state has taken several steps to promote safe motherhood and institutional deliveries, andthey include: Delivery Huts with improved access to safe delivery in rural areas. They provide
safe delivery services with privacy, clean & hygienic environment locally in health facilitiesnearest to community at village level and have strong referral linkages with higherinstitutions. There are 564 functional delivery huts operational in 21 districts in the state.
Janani Suvidha Yojana a voucher scheme for women in urban slums to increase access toavailable private infrastructure by involving existing private healthcare providers and is
operational in 8 districts in the state; and Vikalp a state scheme for BPL women to accessMCH through private providers.
Jaccha Baccha scheme which incentivises SBAs performance for institutional deliveries andcovers ante natal, neo natal, and post natal care, emphasizes gender equity, ensures
monitoring and audit by community.
2. Child Health
IMNCI is ongoing in 19 (out of 21) districts of the state. 3,486 personnel have been trained inIMNCI so far.
Breastfeeding promoted by establishing counseling centres in each district hospital
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3. Other initiatives
Referral Transport strengthened by outsourcing to Red Cross Society in five Districts.Vehicles of Health Department and Red Cross pooled together and fitted with GPS. Control
Room established with hotline no. 102. Free ambulance services for all delivery cases, BPL
& Road side accidents. One ambulance to be provided per lac population.
6,200 registered societies consisting of educated women called SMS (Sakshar MahilaSamooh) have been engaged for intensive BCC.
C. Key issues
1. Maternal Health
Haryana along with Punjab, are the only two states which have shown an increase in MMR.
While monthly NRHM report submitted by the state reports 86 FRUs (including 21 DH, 25SDH & 40 CHCs) as functional, there are 46 FRUs that fulfil all the 3 critical criteria offunctionality (as reported during a recent review) as against the target of 59. State needs toensure that multiskilled MOs are placed at designated FRUs, since in a recent review the state
mentioned that EmOC and LSAS trained doctors were posted at PHCs, as were MOs trained
in blood storage.
DLHS-3 facility surveys highlighted the following key gaps: only 32.2% and 45.8% of the24-hour PHCs provide newborn care and referral services respectively; and 21.4% of theCHCs designated as FRUs provide C-section.
Drop out between 1st trimester ANC and full ANC has increased from 3.4% points to 42.4%points (between DLHS-2 and DLHS-3). This is a serious concern, and state needs to ensuretracking of ANC dropouts during VHNDs.
2. Child Health
Reduction in IMR is slow; 1 point per year between SRS 2003 and SRS 2007. Neonatal mortality rate (NMR infant deaths within 4 weeks of life per 1000 live births) at
34 (SRS 2007) accounts for 61.8% of the IMR, while early NMR (infant deaths within oneweek of life per 1000 live births) at 23 (SRS 2007) accounts for 67.6% of the NMR.
Recent results from DLHS-3 show low progress or decline in the outcome indicators: full
immunisation in children 12-23 months (59.1% to 63.6%) and a decrease in coverage of DPTand OPV; initiation of breastfeeding within one hour of birth has remained static at 17.4% &
and a sharp decline in exclusive breastfeeding for 6 months from 33% to 5.3% (DLHS 2-3)and a decline in ORS use in children with diarrhoea (32.3% to 31.7%).
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ANNEX 1
A. Progress on Key Indicators
1. RCH II Goals
INDICATOR HARYANA INDIA
Trend (year & source) Current status RCH II/ NRHM(2012) goal
Maternal Mortality Ratio
(MMR)
162
(SRS 01-03)
186
(SRS 04-06)
254
(SRS 04-06)
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2. Technical interventions
S.
No.
Indicators Achievement upto March 2009
Number %
1. No. of First Referral Units (FRUs) operationalised 86 145.8 (against thetarget of 59 FRUs)
2. No. of PHCs operationalised to provide 24-hourservices
160 78.4 (against thetarget of 204 PHCs)
3. No. of private institutions accredited under JSY 276 NA4. No. of districts implementing Integrated Management
of Neonatal & Childhood Illness (IMNCI)
19 90.4 (out of 21
districts)
5. No. of people trained in IMNCI 3,486 NA6. No. of Village Health & Nutrition Days (VHNDs)
held
98,169NA
(Source: NRHM MIS report, April 2009)
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Immunization
Haryana
Evaluated Immunization Coverage
Survey
Indicator
NFHS 1
(1992-93)
NFHS 2
(1998-99)
NFHS 3
(2005-06)
CES
(2005)
CES
(2006)
DLHS 2
(2002-04)
DLHS3
(2007-08)
FI 63.2 83.4 74.2 57.2 74.9 59.1 63.6
BCG 84.8 94.6 97.2 81.9 85.1 83.5 87.1
Measles 71.8 89.1 86.3 70.5 76.8 65.4 73.6
DPT3 78.5 88.8 85.1 66.5 76.7 73.6 70.4
Progress
As per the evaluated survey the full immunization is 63.6 % in 2007-08 (DLHS 3)
The State has trained 665 Health workers out of 3633.
The State has constituted 19/20 district level AEFI committees.
Issues
The State continues to have high dropoutfrom BCG to DPT 3 at 19% and BCG to Measles at
15% which is critical for further improvement in full immunization coverage.
The state needs to expedite the Immunization training of Health Workers as it has trained only
18.3% (665/3633) of health workers.
The State needs to strengthen AEFI reporting further to improve reporting of AEFI cases.
The State should consider revision of microplans and better tracking of beneficiaries by ensuring
availability of beneficiary/due list with the ANM/AWW/ASHAs at the session sites.
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Brief on National TB Control Programme in Haryana
1. Infrastructure
Total Population 241 lakhNo. of Districts 20No. of Tuberculosis Units (TUs) 54
No. of Designated Microscopy Centres (DMCs) 208
2. Status of Implementation
5 districts of Faridabad, Gurgaon, Jind, Karnal and Sonepat were implementing RNTCPcovering nearly 36% of the State population since year 2000.
Later whole of the State was approved for coverage under RNTCP with assistance ofUSAID.
6 more districts (Ambala, Fatehabad, Mahendragarh, Panchkula, Rewari andYamunanagar) started service delivery during 4
thquarter 2003.
Remaining districts started service delivery latter and by 1st quarter 2004 whole of the
State was covered under RNTCP.
3. State-wise performance: (Based on quarterly reports for 1st quarter 2009)
Overall 162 TB Suspects/lakh pop are examined in 1st quarter 2009 which is satisfactory.
Inspite of good referral of TB suspects total case detection rate of 145/lakh and newsmear positive case detection rate of 53/lakh (56%) are low.
Sputum conversion rate of 91% is satisfactory but cure rate of 84% in new smear positivepatients is marginally low.
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4. District wise Performance : (Based on quarterly report for 1st quarter of 2009)
6 districts (Ambala, Bhiwani, Hissar, Kaithal, Mahendragarh and Yamunanagar) have
very low TCD rate of 67/
lakh)
Sputum
conversion rate
new cases
(against
>90.0%)
Cure rate
new cases
(against
>85.0%)
Ambala 197 118 40 42% 96% 86%
Bhiwani 129 125 55 58% 90% 86%
Faridabad 149 182 50 53% 90% 85%
Fatehabad 164 138 75 78% 89% 84%
Gurgaon 183 159 56 59% 90% 81%
Hisar 127 111 44 46% 89% 85%
Jhajjar 129 154 58 61% 93% 84%
Jind 133 133 52 55% 91% 83%
Kaithal 102 110 54 56% 91% 82%
Karnal 156 151 54 57% 93% 87%
Kurukshetra 165 130 59 62% 92% 88%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Qtr1-00
Qtr2-00
Qtr3-00
Qtr4-00
Qtr1-01
Qtr2-01
Qtr3-01
Qtr4-01
Qtr1-02
Qtr2-02
Qtr3-02
Qtr4-02
Qtr1-03
Qtr2-03
Qtr3-03
Qtr4-03
Qtr1-04
Qtr2-04
Qtr3-04
Qtr4-04
Qtr1-05
Qtr2-05
Qtr3-05
Qtr4-05
Qtr1-06
Qtr2-06
Qtr3-06
Qtr4-06
Qtr1-07
Qtr2-07
Qtr3-07
Qtr4-07
Qtr1-08
Qtr2-08
Qtr3-08
Qtr4-08
Qtr1-09
Annualised New S+ve CDR Success rate
Population projected from 2001 censusEstimated no. of NSP cases - 95/100,000 population per year (based on recent ARTI report)
Annualized New Smear-Positive Case Detection Rateand Treatment Success Rate in DOTS Areas, Haryana, 2000-2009*
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Mahendragarh 145 117 43 46% 98% 87%
Mewat 127 151 53 55% 89% 78%
Panchkula 281 167 65 68% 90% 83%
Panipat 154 171 46 48% 90% 85%
Rewari 177 157 43 45% 93% 73%
Rohtak 398 189 77 81% 89% 85%
Sirsa 160 129 58 61% 85% 80%
Sonipat 139 185 53 56% 93% 89%
Yamunanagar 158 118 51 54% 85% 81%
Tota 162 145 53 56% 91% 84%
5. Funds Status as on 31st
March 2009(Rs. in lakh)
C/F Released Expenditure Balance
0.00 422.00 345.39 76.61
6. Drugs
RNTCP Districts: Release Order of RNTCP drugs has been issued based on the requirementprojected in the quarterly report of 1
stquarter 09.
7. Issues
Human Resourceo Posts of 3 DTOs, 7 MO-TCs, 8 STSs and 10 STLSs are vacant.o 7 DTOs, 3 STSs and 1 STLS are not yet trained.o New District Palwal (April 09) Sanctioned for DTC staff required.o Post of contractual Microbiologist for IRL vacant. Govt. Microbiologist holds the
charge.
Logistics Some of the two wheelers for supervisory activities of STSs and STLSs arenot in good condition.
Supervision and Monitoring Internal evaluation frequency is less than expected. In2008 only 3 IE done.
Performance Overall performance of the State is not good. TCD rate of 145/lakh andNSPCD rate of 53/lakh (56%) are not good. TCD and NSPCD rate hasd been less than70% in 10 of 13 quarters since 1st quarter 2006.
Recording and Reporting Windows based EPI Centre not working at the State and 8districts are facing problem in entering data in it. Training of one DEO as TOT required.
ACSM One unit formed at the State for combined IEC activities. They proceed as pertheir own agenda. Districts own action plan not being followed.
TB-HIV Collaboration Collaboration activities have not yet started in the State.
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Intermediate Reference Laboratory (IRL)o STO is the Director of STDC. STDC is at Panchkula, IRL at Karnal and DOT Plus
Site at Rohtak.o Proficiency testing passed.o 250 sputum samples sent by the district to LRS for Culture and DST.o HR resistant cases till date are 25. Recently 10 more cases found HR resistant.o 3 LAs and 1 LT more required.o IRL Visits are sub-optimal.
DOT Plus - 12 cases are under Cat-IV treatment and 3 have died.
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Haryana21
Fact Sheet on NVBDCP-Haryana
Background Information
The State has 20 districts with a population of 21.14 million. There are 86 CHCs, 411 PHCs, 2433
Sub-centres and 6955 villages. There are 1906 Multipurpose Worker (Female)/ANM, 425 HealthWorker (Male), 73 Health Assistants (Female)/LHV, 106 Health Assistant (Male), 216
Laboratory Technician. In addition, the state has 470 Malaria Clinics.
Malaria
Epidemiological Situation
YearTotal slideexamined
Total Malariacases
Total Pfcases
Deaths
2006 2653461 47077 507 0
2007 2436431 30895 330 0
2008 2571866 35683 1397 0
2009(Upto Feb) 280268 200 3 0
Malaria has increased in the state as 35683 malaria cases and 1397 Pf cases were reported in 2008in comparison to 30895 cases and 330 Pf cases in 2007. During 2009 (Upto Feb.) there is decline
in both total malaria cases and Pf cases. However, the state needs to identify the areas for focusedinterventions.
Japanese Encephalitis: Worst affected districts in the state are Karnal, Kurukshetra, Kaithal andYamuna nagar. Out of these, Karnal, Kurukhestra and Ambala districts have been covered under
JE vaccination during 2007-08 respectively. The state is doing Malathion fogging, duringoutbreak, Health education.
Year Cases Deaths
2006 2 12007 85 46
2008 13 3
2009(Prov,upto March) 0 0
Dengue/DHF: Dengue cases and deaths in the state are indicated below:
Chikungunya
Total of 20 suspected Chikungunya fever cases and no death was reported during 2007. In the year2008, 35 suspected Chikungunya fever cases and no death were reported. In the year 2009 till 27
th
May, no suspected Chikungunya fever case and no death has been reported. For proactive
surveillance 5 Sentinel Surveillance Hospitals (SSH) with laboratory support have been identified in
Year Cases Deaths
2006 838 4
2007 365 11
2008 1137 9
2009
(Prov. Upto 27th
May.)
5 0
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Haryana22
the state and linked with PGI, Chandigarh the Apex Referral Laboratory. NIV Pune has beenentrusted the supply of IgM ELISA test kits to the identified institutes.
Filaria and Kala-azar, are not reported from the state of Haryana.
Central Assistance
(Rs. In lakhs)
Year Allocation Release/Expenditure
Cash Kind Total Cash Kind Total
2004-05 310.62 95.33 405.95 0.00 91.49 91.49
2005-06 0.00 266.43 266.43 44.64 24.58 69.22
2006-07 33.38 161.62 195.00 4.61 279.35 283.96
2007-08 35.00 107.84 142.84 10.00 162.39 172.39
2008-09 113.30 108.28 221.58 30.00 17.93 47.93
2009-10(B.E.) 68.00 52.29 120.29
Issues:
Malaria:
Malaria has shown an increase in 2008 as compared to 2007 and, therefore, the state needs toidentify the areas for focused interventions.
Acute Encephalitis Syndrome (AES)/ Japanese Encephalitis (J.E.):
Intensive surveillance in the affected areas should be carried out. Sentinel surveillance sites need to be strengthened in the state.
Most of the cases are reported at Private clinics / hospitals that need to be involved in timelydiagnosis and prompt management including transportation / referral protocols for serious
patients.
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Haryana23
STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN HARYANA
Epidemiological scenario-The state is low endemic for leprosy and has already achieved the goal of elimination of
leprosy (i.e. prevalence rate of less than 1 case /10000 population). There were 464 leprosy
cases on record as on March 2009.
New case detection and treatment completion-During 2008-09, a total of 451 new leprosy cases were detected as compared to 379 new
cases detected during the corresponding period of previous year. Out of 369 cases discharged
during the year, 309 cases (83.7%) were released as cured after completing treatment.
NLEP action plan for the year 2009-10 amounting to 107 lakhs has been approved for thestate.
Issues
1. The state has reported low level of fund utilization in 2008-09. During 2008-09, the state
action plan was approved for Rs.144 lakhs, however the state could utilize only Rs. 49.3lakhs.
2. New leprosy cases are being detected in the state every year which suggest activetransmission of the disease in the community. The state is advised to carry out in-depth
situational analysis in districts/blocks reporting large number of new cases and take suitableactions like
(i) Ensuring completion of treatment in each of the new cases detected.(ii) Enhance awareness of the community to improve self reporting of suspected
cases to health facility and(iii) Carrying out family contact survey against all multibacillary and child cases.
3. The state has listed around 150 grade II disability cases since last 5 years. There is no Govt.
institutions/NGO providing reconstructive surgery services to leprosy affected persons withdisability in the state. Hence RCS services are not been provided to disabled leprosy affectedpersons in the state. The state is advised to identify centres for conducting RCS and send the
proposals to GOI for approval so that the backlog of leprosy cases with disability could bereduced in the state.
4. There are 19 leprosy colonies in the state. The state should ensure provision of proper healthcare facilities like ulcer care, provision of supportive drugs and dressing materials to thepersons affected with leprosy residing in these colonies.
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Haryana24
State : Haryana
Integrated Disease Surveillance Project (IDSP) Fact sheet as on 17 June 2009
The State of Haryana has an area of 44212 sq. km and a population of 21 lakhs. There are 21 districts,
119 blocks and 6955 villages. The State has population density of 478 per sq. km.
Haryana is a Phase II State under IDSP and has been inducted in the program during 2004-05 Dr. O.P.
Mittal has been designated as the State Surveillance Officer (IDSP).
1. Manpower
Surveillance Officer and RRT team at State and District headquarter designated. The offerletter to the recommended candidates for the positions of state/district Epidemiologists,Microbiologists and State Entomologists were issued by State/ district NRHM society. In
addition to the above one Data Manager and Data Entry operator have been appointed in all
districts and State Headquarter.
2. IT
Data Centres & Training Centres have been installed at all locations including State head
quarters, PGI Rohtak, and all districts. Hi-End VC equipments have been installed at State Head Quarters.
3. Laboratory StrengtheningPriority district lab identified in Bilaspur and Mandi and is being strengthened.
4. Data Reporting
Haryana has 21 districts. Weekly surveillance data and outbreak reports are reported to CSU
and simultaneously to be entered in IDSP portal i.e. www.idsp.nic.in. In most of the districts,there is late reporting of data
5. OutbreaksReporting of disease out break from the state has started. In 2008 Haryana has reported 10
outbreaks.
6. Training
87 Master Trainers were trained
22 DSOs were trained
2523 Health Workers were trained 58 District Lab Technicians were trained
86 Peripheral Lab Technicians were trained
7. Finance
Year Release (in lakhs) Expenditure (in lakhs)
2004-05 23.00 0.00
2005-06 194.80 15.65
2006-07 0.00 173.69
2007-08 90.00 111.64
2008-09 73.52 27.12
Balance Amount Rs. 53.22 Lakhs
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Haryana25
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
NOTE ON STATUS IN HARYANA
Magnitude:Prevalence of blindness (2003-04) 1.89 %
Estimated blind persons 3.98 lakhs
Infrastructure developed
Upgraded Medical Colleges 1Upgraded District Hospitals 6
District Blindness Control Societies 17
Mobile Eye Care Units 4Eye Banks 1
Upgraded PHCs 80
Cataract Performance
YEAR TARGET ACHIEVEMENT
2007-2008 100000 128634
2008-2009 125000 136000
School Eye Screening
YEAR TEACHER TRAINED
IN SCREENING FOR
REFRACTIVE
ERRORS
SCREENED DETECTED
WITH
REFRACTIVE
ERRORS
PROVIDED
FREE
GLASSES
2007-2008 2900 654512 25162 8298
2008-2009 845 453043 6959 1141
GIA is released to District Blindness Control Societies (IX Plan)
(Rs in lakhs)
YEARRELEASED
EXPENDITURE BALANCE
2007-2008 121.00 125.00 -4.00
2008-2009 230.55 355.14 -124.59
Issues:
UCs for GIA released to State Blindness Control Society are not being received timely.
SOE for Cash Grant are also not being received timely. Performance of School Eye Screening Programme needs to be improved.
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Haryana26
NIDDCP
Haryana
Rs. In Lakh
ActivityAmountproposed
AmountApproved
Remarks
1
Establishment
of IDD Control
Cell
7.50 6.00
The State Government may carry out the
activities as per the fund allocation of GOI.
2
Establishmentof IDD
Monitoring
Lab
4.50 3.50
3
Health
Education andPublicity
10.00 12.00
4 IDD surveys 2.00 2.50
Total 24.00 24.00
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Mapping of Record of Proceedings of the NPCC of NRHM for
2005-06 to 2009-10
The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in
following broad thematic chapters
1. ASHA (including selection, training, drug kits, mentoring, specific performanceincentives and anything else associated with ASHA)
2. Infrastructure related matters (including construction, strengthening, renovation, newconstruction etc), equipments, transport (ambulances, EMRI, associated expenses) and
others)3. Human Resource related matters (including HR salary, contractual payments,
incentives, etc)4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC,
IDHAP, M&E, Mobility support to SHS etc)
5. Untied funds, AMG & RKS related mattes
6. Training & Capacity Building related matters (including trainings, workshops, traininginstitutions including their upgradation or new construction, courses, etc)
7. Innovations (including Procurement of medicines, School Health, Health Mela,
Insurance, Accreditations, Monthly VHND etc)
NATIONAL RURAL HEALTH MISSION
Haryana
Total MFP Approvals 3036.4 10090 15025.97
RoP Approvals for Various Years in Rs. Lakh
S.No Initiative
2005-06 2006-07 2007-08 2008-09 2009-10
RemarksReleased Approved Approved Approved Approved
ASHA
1 ASHA 888.5
TOTAL 888.5
Infrastructure related matters
2
Civil works-
Sc/PHC/CHC600
3 Infrastructure 3100
4
Upgradation of Health
Institutions 35005 Upgradation of CHC 1160 240
6
Strengthening HealthInstitutions as per IPHS
6600
7
State ProjectImplementation Unit at
Consultancy Services
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8
Emergency & ReferralServices
544.66 580
9 MMU 695.6 47.34
TOTAL 1160 1535.6 7144.66 7227.34
Human Resources related matters
10
Contractual Staff
recruited and in
position at Healthsystem Resource Centre(HHSRC) 23.14
11 ANM 306 1400 2395.98
12
Special Incentive forMewat, Morni &
Difficult areas 300
13 Accounts Assistants atCHC 98.28
TOTAL 306 1400 2817.4
Programme Management related matters
14Strengthening ofSIHFW & SHRC 50 78
15 Preparation of DHAP 270
16
State convergenceCommittee Quaterlymeetings
172.5
17 Household survey 140.09
TOTAL 270 172.5 190.1 78.0
Untied Funds, Annual Maintenance Grants and RKS funds related matters
18 Rogi Kalyan Samiti 590
19Rogi Kalyan SamitiHQ Hospital 105
20
Rogi Kalyan Samiti
CHC/ Sub DivisionalHospital 116
21
Rogi Kalyan Samiti-
PHC 336
22 Untied funds to CHC
14223 Untied Fund for PHC 102 315.75
24Untied Fund for SC 243 46.3 246.5 246.5
25 Untied Fund for VHSC 671.25 628.2
26Annual MaintenanceGrants CHC
274.527Annual MaintenanceGrant -PHC
204
28Annual MaintenanceGrant- SC 246.5
TOTAL 243 942.3 1233.5 2094.7
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Training & Capacity Building related matters
29Capacity Building andExperience sharing 27
30 MIS Training 25.72 254
31Continuous MedicalEducation (CME) 10
TOTAL 25.72 291
Innovations related matters
32 Health Melas 80 80
33
Intersectoral
Convergence95.63
34 BCC/IEC 440.05
35
Improving Quality Of
Service Delivery & ISO 60
36
Strengthening ofProcurement &
Logistics 214.19
37
Comprehensive Best
Health Village Scheme 61.59
38
Free Treatment of Cleft
Lips and Palate 10.2
39Down SyndromeScreening Programme 5
40
Prevention and
Treatment of RHD 10
41
De-worming andAnemia Control
Programme 200
42
Treatment to
Hemophilia Patients 96
43
Civil Registration
System 37
44
Strengthening of Lab at
Zonal Level andDistrict level for
NVBDCP 21
45
Funds for ASHA andcommunity workers forintensifying anti larval
activities and checking
of breeding sites 175
46
Drug supply for
CHC/FRU 426
TOTAL 426 80 95.63 1410.03