M.P.H.W.(Male) Training School. 3. Nursing College B.Sc. 1. D. Pharmacy
College. 3. Lab Technician Training Centers. 3. Radiographer Training Institutes.
3.
Family Welfare Plan of Odisha State of India
Chapter -‐ 4 DETAILED FAMILY PLANNING BUDGET: 2011-‐ 12 Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Q-‐III
Q-‐IV
Financial target for the quarter Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Remarks
Amount (Rs. Lakhs)
A3. FAMILY PLANNING A3.1
Terminal/Limiting Methods
A3.1.1
Dissemination of manuals on sterilization standards & quality assurance of sterilization services Orientation of Programme Officers (ADMOs-‐FW, DPMs & RCH Coordinators) at State level Orientation workshop at District level for Block MO I/C, empanelled operating surgeons including that of accredited institutions Quarterly Female Sterilization Camps to address backlogs -‐ one camp per qtr per district in the low performing zone NSV camp -‐ one camp per qtr per district in 10 districts ( Koraput, Rayagada, Malkangiri, Nabarangpur, Kalahandi, Nuapada, Bolangir, Sonepur, Mayurbhanj and Kandhamal) Compensation for Female sterilization Compensation for Male sterilization Total of Sterilization Budget for Sterilization (85% of Total Sterilization Budget)
Per Work Shop
Per Work Shop per district
Per camp per quarter
A3.1.1.1
A3.1.1.2
A3.1.2
A3.1.3
A3.1.4 A3.1.5
1 100,000
1
1.00
-‐
-‐ -‐ 1.00
30 15,000
30
4.50
-‐
-‐ -‐ 4.50
30 15,000
30
30
30
120
4.50
4.50
4.50 4.50
18.00
Per camp per quarter
10 35,000
10
10
10
40
3.50
3.50
3.50 3.50
14.00
Per Beneficiary Per Beneficiary
1,000 38900
38900
38900
38926
155626
389.00
1,556.26
1,500
5300
5300
5300
5320
21220
79.50 79.50 79.50 79.80 318.30 468.50 468.50 468.50 469.06 1,874.56 398.23 398.23 398.23 398.70 1,593.38
389.00
389.00
389.26
Based on the previous year trend (last year coverage was 85%)
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Per block
Per beneficiary
Per case
Rate (Rs./unit) Q-‐I
Physical Target for the quarter
Financial target for the quarter
Remarks
Q-‐III
Q-‐IV
Total Target
94
94
20
39790
39790
39790
39790
159160
7.96
7.96
7.96
7.96
31.83
Budgeted for 80% beneficiaries
100
1990
1990
1990
1990
7960
1.99
1.99
1.99
1.99
7.96
Per case
75
3315
3315
3315
9945
-‐
2.49
2.49
2.49
7.46
Budgeted for 5% of 159160 beneficiaries Budgeted for 5% beneficiaries
Q-‐II
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
A3.1.6
Accreditation of private providers for sterilization services A3.1.6.1 Accreditation of private institutions for Inst. Del. & FP services -‐ Mobility support to the appraisal team Sub-‐total A3.1 (excluding Sterilization & NSV) A3.2 Spacing Methods A3.2.1 IUD Camps A3.2.2 IUD services at health facilities/ compensation A3.2.2.1 For Beneficiary (to be utilized to meet essential requirements on IUD services at institution level) A3.2.2.2 Incentive to ASHA for ensuring retention of IUD by plants for 1yr A3.2.3
A3.2.4 A3.2.4.1
A3.2.4.2
A3.3 A3.3.1 A3.3.2 A3.3.3
Incentive to private accredited institutions for IUD insertion services Social Marketing of contraceptives One Day Contraceptive update & family planning guideline trg. for MOs (District) Contraceptive update Trg. To Paramedics (SN, LHV, HWF, HWM, HSM) per Dist. One batch at District level Sub-‐total A3.2 POL for FP/Others -‐ Trasportation of FW materials State to district District to Block Block to Sector
-‐ -‐
9.00
4.50
-‐ -‐ -‐
4.50
4.50
23.50
30/batch
440
41,025
5
5
5
3
18
-‐
30/batch
NIL
36,525
5
5
10
10
30
-‐
9.95
12.43
12.43
12.43
47.25
30% blocks having private institutions. Budget under Inst. Strgh.
Budget under training
Budget under Reg. Drug WH (NRHM Int.) State-‐B21.1.2, Dist-‐ B21.2.4 & Block-‐
31
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Physical Target for the quarter
Rate (Rs./unit) Q-‐I
Q-‐II
Q-‐III
Financial target for the quarter Total Target
Q-‐IV
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
B21.3.4
A3.4
Repair of laprascopes
A3.5
Sub-‐total A3.3 & A3.4 Other strategies/activities
-‐
Strengthening of Family Welfare Bureau for quality implementation of family planning program At State level Manpower Mobility cost for supportive supervision Operational cost At District level Manpower
Per month
Per month
20,000 10,000
Per district per month
2,500
A3.5.1
A3.5.1.1 A3.5.1.1.1 A3.5.1.1.2 A3.5.1.1.3
A3.5.1.2 A3.5.1.2.1
A3.5.1.2.2 A3.5.1.2.3
A3.5.2 A3.5.2.1
A3.5.2.2
Mobility cost for supportive supervision Operational cost for Dist. FW Bureau for meeting exp., reporting, internet, telephone, postage etc. Operationalization of fixed day static services-‐Family welfare day Mapping of availability of skilled human resources, regularly updating empanel of doctors and orientation at district level Minilap training for MO (Asst Surgeon of L3 & L2): twelve working days at District level
3/batch
154
Remarks
Amount (Rs. Lakhs)
-‐
-‐
-‐
State Eqp. Maint. Unit to look into
-‐
Funded by UNFPA -‐ Budget under Prog.
-‐
Mgt.
RCH Coordinator will be given additional responsibility Budget under Prog. Mgt.
30
30
30
30
30
To be updated in regular monthly meeting
10
10
10
30
32,580
-‐
-‐ Budget under training
32
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
Remarks
A3.5.2.3 A3.5.2.4 A3.5.2.5
A3.5.3
A3.5.3.1
A3.5.3.2
A3.5.4 A3.5.4.1
A3.5.5 A3.5.5.1 A3.5.5.1.1
A3.5.5.2 A3.5.5.2.1
NSV training for MOs five working days. State level TOT NSV training for MOs five working days. District level
5/batch
0
94,188
1
2
1
4
-‐
5/batch
62
27,375
10
10
20
-‐
Organisation of Fixed day -‐ weekly Per fixed (Contigency cost to L3:145 (100%) day weekly + L2: 219 (50%)) per inst. Promote postpartum and post abortion family planning services including sterilization in facilities having high institutional deliveries Orientation cum review of FP Per counselors/ Yashodas supervisor & training SN (bi-‐annually) to access & review FP performance & providing handholding for improving performance Biannual review of PPC I/c on FP activities at divisional level for strengthening FP service in PP centers Promote Community Based family planning services
200
300
350
364
364
1378
-‐
Supported by UNFPA
Community based distribution of non-‐clinical contraceptives (piloted in Ganjam) through ASHAs Trainings Laparoscopic sterilization training Laparoscopic sterilization training for teams (three members : MO, SN, Attendant) :twelve working days at Zonal Level IUD insertion training Six days Dist level IUCD training for MO and SN
Supported by UNFPA
10
10
10
30
-‐
10
10
10
30
-‐
3/batch
55
12/batch
378
29,360
63,755
Cost to be met from RKS
Budget under Training
33
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
Remarks
A3.5.5.2.2 A3.5.5.2.3
A3.5.5.2.4
A3.5.6 A3.5.6.1 A3.5.6.2 A3.5.6.3
A3.5.6.4 A3.5.6.5
A3.5.6.6
Six days Block level IUCD training for ANM, LHV Three Days Postpartum IUCD Training for O&G Spl., Staff Nurses of Dist., Prof. & Asso. Proff. (O&G) of MCH, Faculty of SIHFW at State Level Three days Postpartum IUCD Training for O&G Spl and Staff Nurses of Respective Districts (5MOs+5SNs) Printing Printing of sterilization case cards Printing of village wise EC register Printing of resource materials on contraceptive choices in local languages for Service provider Printing of checklist for FP Counselor Display boards depicting all benefits, side effects & contra indications of Contraceptives to be displayed in PP centers Printing of green cards
10/batch
0
49,950
20
20
20
60
-‐
25/batch
0
114,920
3
0
0
0
3
-‐
10/batch
0
32,225
4
10
10
6
30
-‐
Per card Per register Per material
10 40
180000 60000
180000 60000
500000
500000
UNFPA support
Per checklist
100000
100000
0
Per card
Met from State budget
Budget under procurement (NRHM Int.)
A3.5.7
Procurement of equipment & instrument for operationalisation of FP services
A3.5.7.1 A3.5.7.2
NSV kit Minilap kit
Per kit Per kit
2,500 6,000
251 541
251 541
A3.5.7.3
IUCD kit
Per kit
2,000
899
899
Budget under Advocacy for NRHM
34
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Remarks
Amount (Rs. Lakhs)
A3.5.7.4
A3.5.7.5 A3.5.7.6
Laparoscope machine (Total requirement is 42 to operationalise all L3 institutions having PPC, but fund request for 50% of it) Racking system at State FW store Pregnancy kit to be used before sterilization during camp
Per machine
630,000
14
14
2,000,000
1
1
GoI supply
A3.5.7.7 A3.5.8
FW material Performance Based Awards
A3.5.8.1
Performance based incentives (3 districts) to best performing districts Performance based incentives (3 awards) to best performing surgeons Performance based incentives (awards) to best Fixed Day Static Unit at district level Monitoring Bi-‐annual state level QAC review meeting (Integrated with general QAC meeting) State level quarterly review meeting of low performing districts Divisional Bi-‐annual Review meeting of ADMO and DPM Bi-‐annual review of DHIO & SA/SI for improved monitoring at state level District level QAC meeting (Integrated with general QAC meeting)
100,000
100,000
Per district
20,000
30
30
per meeting
5,000
1
1
2
1,000
30
30
30
30
120
A3.5.8.2
A3.5.8.3
A3.5.9 A3.5.9.1
A3.5.9.2
A3.5.9.3 A3.5.9.4
A3.5.9.5
Per district per quarter
-‐
-‐
Budget under Infr. & HR
Budget under M&E
UNFPA support
Budget under M&E
35
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Lump sum
Rate (Rs./unit) Q-‐I
Physical Target for the quarter
Financial target for the quarter
Remarks
Q-‐III
Q-‐IV
Total Target
-‐ -‐
-‐ -‐ -‐
0
1
0
0
1
-‐
Budget under Training
-‐ 4.50
-‐ 4.50
-‐ 4.50
-‐ 23.50
Q-‐II
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
A3.5.9.6
Quarterly family planning review by District Authorities
A3.5.9.7
Rapid assessment cum validation of FP services at all Fixed Day Static Centres IEC/BCC State Media Workshop with focus on FDSA Mass media activities – production & telecasting/ dissemination
A3.5.10 A3.5.10.1 A3.5.10.2 A3.5.10.3
Observation of World Population Week A3.5.10.4 PRI sensitization on FP issues A3.5.10.5 Create ‘Enabling Environment’ in PPC A3.5.11 Training on effective Management of Pro-‐Mis to Block level staff of Puri Dist. On Pilot basis at District level Sub-‐total A3.5 Total (excluding Sterilization, NSV & IUD)
33/batch
NIL
34,225
-‐ 9.00
Met out of Dist. Level monthly meeting (Inst. Strg.) Budget under OHSP Budget under IEC/BCC (NRHM Int.)
36
Chapter – I INTRODUCTION AND HEALTH SCENARIO 1.1: State Profile: The state of Odisha accounts for 4.74 % of India’s landmass and 3% of country’s total population (population of the state is 41.94 Million as per Census 2011 flash report) of the country. The state comprises 3 Revenue Divisions, 30 Districts, 58 Sub-‐divisions, 171 Tehsils, 314 CD Blocks, 6235 Gram Panchayats and 51,349 villages. Because of its tropical as well as coastal locations, Odisha every year gets affected with natural calamities such as floods, cyclones, droughts, etc that severely ruins the socio-‐economic status of the state. The recurrent natural calamities stand as a barrier to overall progress of the state. In Health sector, high maternal & child mortality, prevalence of acute malnutrition coupled with anaemia & malaria pose biggest public health challenges before the authorities. Health & Family Welfare Department thus has undertaken several time-‐bound initiatives in recent years to address these issues and curtailing the out of pocket expenditure for poor in availing health care services so as to ensure better health standards among citizens. Table 1.1: Orissa in Figures Date of formation of the state State Capital Area Area under forest (total) Literacy rate Per Capita Income (03-‐04) No. of Districts Urbanization Ratio Religion Official Language Temperature Annual average rainfall
1st April 1936 Bhubaneswar 155,707 square kms 58,136.23 Sq. Kms 73.45 Rs.6, 487.00 30 14.97% Hindu, Muslim, Christian and Buddhist Oriya Max 40.0 C (summer); Min 7.0 C (winter) 150 cm
Population (2011) - Male - Female
41947358 21201678 (50.54%) 20745680 (49.45%)
Child Sex Ratio
934/1000 boys 13.97%
Decadal Growth Rate Density of Population District Population - Highest (Ganjam) - Lowest (Deogarh)
269 per Sq. Km.
Total Literacy Rate - Male - Female Highest District Literacy Rate (Khurda)
3520151 312164 73.45% 82.40 % 64.36% 87.5%
Lowest District Literacy Rate (Nawarangpur)
48.2%
No. of C.D. Blocks - Tribal - Non Tribal
314 118 196 171
No. of Tehsils No. of Towns No. of Panchayat
138 6235
2
1.2 Salient Features of Odisha’s Demography: v
Odisha is state with sizable proportion of both Scheduled Tribe & Scheduled Caste populations wherein ST & SC constitute around 22.13% and 16.53% respectively of the total population in the state. Together they constitute 38.66% of the state’s total population as per Census-‐2001. This is higher than the national average where SCs contribute 16.20% & STs contribute 8.19% to the total population of the country respectively.
v
Since last few decades the percentage of SC population to total population has been increasing in the state while the ST population has been declining marginally.
v
ST population declined from 22.43% in 1981 to 22.21% in 1991 down to 22.13% in 2001. Considering heavy concentration of ST and SC population in as many as 13 districts of the state which accounts for 44.70% of the total area has been declared as Scheduled Area, as per 1991 Census.
1.3 Health Infrastructure in Orissa: Odisha has a three tier infrastructure such as Primary, Secondary & Tertiary. While PHCs along with Health Sub-‐centers & CHCs serve as primary service points, SDH & DHH are placed at secondary level. Medical Colleges & Hospitals which are at tertiary level provide specialized services to the patients at affordable/no price. The table mentioned below shows the overall Health Infrastructure of the state. Table 1.2: Existing Health Infrastructure in Orissa (as on 01.01.2011) Medical College and Hospitals (Government) Dist. Hospitals (Capital Hospital, & R.G.H ) Sub-‐Divisional Hospitals Community Health Centers Primary Health Centers (N) Rural Family Welfare Centers Urban Family Welfare Centers Postpartum Centers Sub-‐Centres Health & Family Welfare Training Centers (Cuttack & Sambalpur) Rural Health Centers (Jagatsinghpur, Attabira & Digapahandi) G.N.M Training Schools A.N.M. Training Schools M.P.H.W.(Male) Training School Nursing College B.Sc D. Pharmacy College Lab Technician Training Centers Radiographer Training Institutes Ayurvedic Hospitals Ayurvedic Dispensaries Homoeopathic Hospitals Homoeopathic Dispensaries Unani Dispensaries
3 32 26 377 1228 314 10 79 6688 2 3 3 18 (2 approved by GoI in recent past) 3 1 3 3 3 5 619 4 560 9
3
1.4: Human Resource Position: Access to quality services is largely dependent upon the availability of quality human resource at health institutions. Attempts have been made by the Dept. to fulfill vacancies in different categories. Contractual mode of appointments has been in operation in many categories to avoid the short fall in human resources. Similarly specialized skill development training is also being imparted as part of the government initiative for multi-‐skilling the service providers. Table 1.3: Human Resource Position Human Resource Position (Regular) Category Doctors
Sanction 4385
Position 3675
Vacancy 710
Staff Nurse Pharmacist
2046 1945
1775 1812
271 133
Radiographer
235
115
120
MPHW(M) MPHW(F)
4667 7607
3083 7072
1584 535
LT
897
653
244
Concerted efforts are being made by the state to ensure availability of trained and quality health personnel to address the gap and to provide equitable and quality health care services to the community across the state especially in the vulnerable areas. Focus has been given for making provisions for paramedic service providers like GNM, ANM and nurses by providing incentives like special scholarship schemes both partial and full scholarships in KBK districts to encourage eligible students to take on paramedic studies. 1690 GNMs, 2005 ANMs, 620 B.Sc Nursing students have been enrolled in both private, public sector and government schools as part of these innovative schemes. To address the shortage of doctors, the state has undertaken proactive steps such as adhoc appointments, contractual appointments to retired doctors, streamlining recruitment through Orissa Public Service Commission and restructuring the promotional avenues for assured job satisfaction. The scenario is changing fast and yielding positive results in both retaining the doctors and streamlining the process of health care services. . 1.5: Intervention Rationale: In order to intensify the efforts made during the past years to improve the reach and range of health services in the state, the Government of Orissa has made special efforts to ensure quality services to socially, geographically and economically vulnerable population. Need based & locality specific interventions are designed based on assessments carried out across the state to grade vulnerable areas, map vulnerability of institutions based on their 4
access and performance. Similarly, institutions are also identified at strategic locations for better access to health services. The NRHM PIP introduces the concept of High Focus (most vulnerable with low health indicators) concept for effective implementation of the health programme. 1.6: Priority Areas for Improved Access: The current NRHM PIP focuses on the block as the unit of implementation. Considering the strong inter district inequalities prevailing in the state because of geographical inaccessibility for tribal population and left wing extremism activities, comprehensive measures are being undertaken to ensure equity-‐based health services reach the community. Equity in health service provision has been the underlying principle of the NRHM PIP for 2011-‐12. A state level assessment was carried out to map the difficult and most difficult blocks so as to enable differential focus on planning and programme interventions. Table 1.4: Outcome
Most Difficult Blocks Difficult Blocks Total Blocks
50 46 314
5
1.7: RCH Focus and vulnerability indexing of Health Institutions:
A composite set of indicators were identified in order to assess the areas where RCH program implementation & results thereof are not satisfactory. This vulnerability mapping will allow us to identify vulnerable institutions and make specific resource allocation for strengthening RCH services in those areas.
1.8 Vulnerable Institutions:
Engaging and retaining staff in institutions situated in vulnerable and difficult areas still remains a major health challenge for the state. In order to increase retention period for the service providers, an incentive based scheme has been launched the state government. However, this scheme is based on the extent of vulnerability of a particular institution in a locality. It was in this context that all institutions were assessed for vulnerability based on their inaccessibility and location, characteristic of service area and assessment of conflict situations. Four levels of institutions were identified based on their vulnerability. 1.9: Outcome Total Districts High Focus Districts Names of Districts 30 18 Angul, Bargarh, Bolangir, Boudh, Deograh, Gajapati, Jharsuguda, Kalahandi, Kandhmal Keonjahr, Nuapada, Malkangiri, Koraput, Nabarangpur, Nayagarh, Rayagada, Sambalpur and Sundergarh
NAME OF DISTRICT HIGH FOCUS DISTRICTS OTHER DISTRICTS GRAND TOTAL
TOTAL VI 629 2291 2920
HEALTH INSTITUTIONS TOTAL V2 TOTAL V3 TOTAL V4 2977 546 177 1742 12 11 4719 558 188
6
1.6: Leveling of Institutions for Facility Up-‐gradation Since up gradation of all health institutions based on composite indicators (HR, Infrastructure, Equipments, non-‐clinical services) was not possible at one go, a mapping exercise was initiated across all districts wherein institutions were identified at strategic locations on the basis of access and present performance as important parameters. At least one institution of any level (L1/2/3) in that area was identified to cater to at least 30,000 populations. Category L1 L2 L3
1.10: Outcome Target By (2010-‐11) 781 357 107
Target By (2011-‐12) 899 438 145
Over the years, there is gradual improvement in the health service delivery and uptake of services in the state .The major achievements are shown below 1.11: Progress in the Health Scenario from 2005 onwards:
State MMR has decreased from 358 (SRS, 2003) to 258 (SRS, 2011) -‐ 100 point decline State IMR has decreased from 95 (SRS 2000) to 65 (SRS 2009) -‐ 30 point decline Prevalence Rate of Leprosy is 0.87, 19 districts sustaining elimination level State API for Malaria reduced from 10 to 8.8 Institutional delivery coverage state is 81% (HMIS -‐2010-‐2011)against reported & 58 % against Estimated Delivery (HMIS-‐2010-‐11) 23.45 lakh mothers have benefited under Janani Surakhya Yojana (JSY) (2006-‐2010) [5.33 Lakh in 2010-‐11] Full immunization coverage has increased from 53% ( CES – 2005) to 74% (2006-‐07) 81 hospitals upgraded as L3 (CEmONC) institutions , 261 hospitals upgraded as L2 (BEmONC) institutions , 617 hospitals upgraded as L1 (SBA) institutions 16 SNCU-‐II units operational in Angul-‐1, Balasore-‐1, Capital Hospital-‐1, Kandhamal-‐ 1, Koraput-‐1, Mayurbhanj-‐1, MKCG MCH-‐1, Nawarangpur-‐1, Nuapada-‐1, Puri-‐1, Rayagad-‐1, Sambalpur-‐1, SCB, MCH-‐1, SDH, Jeypore, Koraput-‐1, Sonepur-‐1, VSS MCH-‐1 50 SNCU-‐I made functional 452 New born corners established across the state 2 No. of Nutritional Rehabilitation Center made functional (Baripada & Bhabanipatna DH hospitals) 6 No. of Maternity waiting Homemade functional 156 YASHODAs are engaged in 16 districts to support mothers during delivery 1806 tribal residential school included under Intensive School Health Program & 57972 schools included under Extensive School Health Program 81 MBBS Doctors are trained on Life saving Aesthetic skills (LSAS) and 37 MBBS Doctors trained on Emergency care (EmOC). 1263 AYUSH Doctor, 17 Medical Officers, 856 Staff Nurses, 1081 Addl. ANM & 112 LTs are in position 421 Ambulances deployed across the state for providing 2nd referral transport. 7
304 Janani Expresses are engaged for promoting referral transport for delivery 40,701 ASHA in place against a total target of 41,102. 249 ASHAs in urban slums in position out of 458 45,417 GKS have been constituted in the State (Target : 46928 ) Mamata Diwas (Village Health & Nutrition Day) -‐ 619634 sessions held out of 677018 planned in 2009-‐10 & 2010-‐11 203005 Malnourished Children treated through Pustikar Diwas in 2009-‐10 & 2010-‐11 IMNCI( Integrated Management of neonatal & Childhood Illness)implemented in 20 districts 210 MHUs operationalised in most inaccessible areas. MHU-‐Arogya+ new initiatives in PPP mode for Naxal affected areas. 21 PHC(N) of 11 districts are managed by the NGOs 1.12: RCH Outcome Indicators: INDICATORS
ORISSA Trend (year & source)
Maternal Mortality Ratio (MMR) Infant Mortality Rate (IMR) Total Fertility Rate (TFR)
358 (SRS 01-‐03) 83 (SRS 2003) 2.6 (SRS 2003)
INDIA Current status
258 (SRS 07-‐09) 65 (SRS 2009) 2.4 (SRS 2007)
212 (SRS 07-‐09) 53 (SRS 2008) 2.7 (SRS 2007)
Sl. No. 1. 2. 3. 4. 5. 6. 7. 8.
INDICATORS Mothers who received 3 or more antenatal care checkups (%) Mothers who had full antenatal check-‐up (%) Institutional deliveries (%) Children 12-‐23 months age fully immunized (%) Children age 6-‐35 months exclusively breastfed for at least 6 months (%) Children with diarrhea in the last 2 weeks who received ORS (%) Use of any modern contraceptive method (%) Total unmet need for family planning -‐ both spacing methods and terminal methods (%)
ORISSA
INDIA*
DLHS–2 DLHS–3 DLHS–2 DLHS–3 (2002–04) (2007–08) (2002–04) (2007–08)
41.7
54.6
50.4
51.0
13.7 30.8
23.3 44.3
16.5 40.9
19.1 47.0
53.3
62.4
45.9
54.1
20.7
42.6
22.7
24.9
48.3
49.0
30.3
33.7
40.3
37.8
45.2
47.3
19.8
24.0
21.4
21.5
8
Chapter-‐ 2 SITUATIONAL ANALYSIS Orissa is a least urbanized (14% of the total population lives in urban set up as per Census-‐ 2001) state, wherein high percentage of population lives below poverty line (46%). The state has about 38 percent of population belonging to SC/ST category. An analysis of critical indicators related to health and reproductive health are as follows. 2.1: Dependence on Public Medical Health Care System: More than three quarters of households in Odisha, depend on Public sector medical set up for availing health care services. 62% urban households and 79% rural households use public medical facilities for health care. The National average for households seeking services of public health facilities is 35%. In India, seven states, Himachal Pradesh, Odisha and five North-‐ Eastern states have high dependence for medical care on public health system as per NFHS-‐III. 2.2: Fertility: 2.2.1: Age at first Marriage: The median age at first marriage is 17.9 years among women aged between 25-‐49 years (2011 Census), which is about one year less in comparison to the national counterpart. 2.2.2: Fertility Levels The Total Fertility Rate (TFR) of the state as per NFHS-‐III is 2.37 against National average of 2.7. Fertility in Odisha is approaching the replacement level, however fertility decline between NFHS-‐II & III is slower than the rate recorded between NFHS-‐I & NFHS-‐II. As per the NFHS-‐III, fertility in rural areas is 2.5 children per women. Fertility rates are higher for Scheduled Tribe women (TFR-‐3.1) than that for women from schedule caste, other backward classes and from general category (2.0 to 2.3 TFR).
9
2.2.3: Teenage Pregnancy: 14 percent women in Orissa, in the age group of 15-‐19 years, begin child bearing, which is lower than the national average of 16 percent. The ASFR (Age Specific Fertility Rate) for the same group (15-‐19 years) is 35 per 1000 currently married women. This rate is again much lesser than the national average of 41 per 1000 women as per SRS 2007 estimates. But at the same time, a large segment of population is expected to enter the reproductive age. About 32% (one third) of Odisha’s population is under 15 years. They need to be given information and services for contraception to attain their reproductive intention in the next five to ten years period through promotion of informed choices. 2.2.4: Birth Intervals: The median interval between births in Odisha is 34 months against national average of 31 months. As per NFHS-‐III, 9 percent of births take place within 18 months of the last birth and 23 percent take place within 24 months. 2.2.5: Fertility Preferences (NFHS-‐III): About 70 percent of currently married women and men aged 15-‐49 years want no more children, are already themselves sterilized, or have a spouse who is sterilized. Among those who want another child, 44 percent of women and 40 percent of men would like to wait at least two years before having another child. The ideal family size for ever-‐married women and men is 2.3 children. The table 2.1 indicates difference in the total wanted fertility and total fertility rate Table-‐2.1: Wanted Fertility Rates by States (NFHS-‐III) Total wanted fertility rates and total fertility rates for the three years preceding the survey by States, India – 2005-‐06 State Total wanted fertility TFR Differential India 1.9 2.7 0.8 Rajasthan 2.2 3.2 1.0 Madhya Pradesh 2.1 3.1 1.0 UP 2.3 3.8 1.5 Bihar 2.4 4.0 1.6 Odisha 1.8 2.4 0.6 Andhra Pradesh 1.5 1.8 0.3 Kerala 1.8 1.9 0.1 Source – Strategy note UNFPA The differential of 0.6 for Odisha indicates that unplanned pregnancies are relatively less common than the other States compared in the Table mentioned above. If all women were to have only the number of children they want the TFR would be 1.8 children instead of 2.4 children for Orissa. 2.2.6: CPR: The CPR (Contraceptive Prevalence Rate) amongst currently married women aged between 15 – 49 years is 50.4% as against the national average of 56.3%.
10
2.3: Family Planning: India launched the National Family Planning Program in 1951 with the objective of reducing the birth rate to the level of population stabilization. In 1997, the services and interventions under Family Welfare program and CSSM program have been integrated with Reproductive and Child Health Programs. The 11th five year plan has three major goals for RCH program. These are reducing TFR to the replacement level, reducing IMR and MMR to 30 and 100 respectively by 2012. The National Family Health Survey–III, 2005-‐06 came out with the status of various indicators related to Family Planning. 2.3.1: Knowledge of Family Planning Methods: Knowledge of Contraception is almost universal among currently married women in Orissa. Female sterilization is the most widely known method, known by virtually all married women and men. The government family planning program promotes three temporary methods: the Oral pill, the IUCD and condoms. Out of all these contraceptive methods, currently married women know about the pills (89%) and currently married men are aware about both the pill (87%) and condoms (84%). The least known method is IUCD (56%). Knowledge of sterilization has been high since NFHS-‐I, but knowledge of temporary contraceptive methods has increased substantially since NFHS-‐II. For example, among currently married women, 89 percent now know about pill, compared to only 52 percent in NFHS-‐I and 75 percent in NFHS-‐2. The DLHS-‐3 (2007-‐2008) indicates that awareness of contraceptive methods among unmarried women is also high. As per DLHS-‐3 in Odisha, 67 percent of unmarried women know about condom, 81 percent unmarried women know about pills and about one fourth of unmarried women discuss about contraception with others. Table 2.2: Family Planning (Currently married women age 15-‐49 years) Current Use NFHS-‐III Any Method 50.7 Any modern method (%) 44.6 Female Sterilization (%) 33.1 Male Sterilization (%) 1.0 IUD (%) 0.6 Pill (%) 7.0 Condom (%) 3.2 Unmet need for Family Planning Total Unmet Need 15.0 For Spacing (%) 6.9 For limiting (%) 8.1
Urban 59.4 49.9 30.3 1.1 1.5 10.2 6.9
Rural 49.0 43.6 33.7 1.0 0.4 6.4 2.4
NFHS-‐II 46.8 40.3 33.9 1.7 0.8 3.0 0.9
NFHS-‐I 36.3 34.7 28.3 3.4 1.5 0.9 0.6
12.5 5.6 6.9
15.5 7.1 8.4
15.5 8.7 6.8
22.4 12.7 9.7
Source – Strategy note UNFPA 11
The female sterilization accounts for around 65% of all contraceptive use as per NFHS-‐III. The service statistics of Odisha indicates that minilap is the most popular method with 70 percent of acceptors of limiting method prefers to avail it. The spacing methods most commonly used by currently married women are the oral pill (7%), followed by the withdrawal method and condoms (3% each). In general, better-‐educated and wealthier women are more likely to use spacing methods than other women. Ninety-‐seven percent of sterilized women had the operation in a government facility, usually in a sterilization camp (45%), Community Health centre/rural Hospital/Primary Health Centre (32%), or a government/municipal hospital (18%). Odisha is one of the states of India having highest dependency of households for health care on public health facilities. The Table 2.3 indicates comparison of different states with dependency on public health sector as source of modern contraceptives services. Table2.3: Public Sector as source of modern contraceptives by state (NFHS-‐III) Percentage of current users of modern contraceptive methods for whom the most recent source of contraceptives was the public sector, by specific method and residence, according to state, India, 2005-‐06 Female Male Pill Sterilization Sterilization 83.5 85.3 15.3
State India
IUD 45.6
Condom/ All modern methods Nirodh Urban Rural Total 13.4 56.8 78.2 70.6
Rajasthan
93.8
96.7
27.0
77.0
23.2
62.8
91.9
81.1
Madhya Pradesh
95.9
96.8
25.5
43.9
19.2
66.1
94.2
86.3
Bihar
62.1
-‐
0.0
-‐
6.3
40.6
57.3
53.9
Orissa
96.5
94.9
14.4
-‐
19.3
60.9
82.9
78.8
Maharashtra
79.3
90.5
15.3
31.8
12.5
53.2
83.5
69.1
Andhra Pradesh
78.3
76.1
1.6
14.7
16.2
68.1
81.4
77.1
Kerala
66.9
89.9
-‐
51.8
17.3
58.8
63.7
62.0
Tamil Nadu
77.1
-‐
-‐
32.7
12.0
67.0
78.3
73.1
2.3.2: Informed Choice: Table 2.4: Comparison of states on informed choice as per NFHS-‐III State
India Rajasthan Madhya Pradesh Bihar Orissa
% who were informed about side effects or problems of method use
% who were informed about what to do if experienced side effects
% who were informed by a health or family planning worker about other methods that could be used
32.2 29.9 44.7 10.8 21.6
26.0 23.3 34.6 8.5 15.7
27.9 24.0 41.1 27.0 14.4
Source – Strategy note UNFPA 12
Women who know about all available contraception methods and their side effects can make better & informed choices about methods to be used and has high possibilities of making sustainable decisions. However, most of the time they receive information from the mass media channels & only twenty-‐two percent of current users were told by a health worker about side effects of the method. This is much lesser than the National average in Odisha. DLHS-‐III (2007-‐08) also reported similar findings. Only 18 percent currently married non-‐users ever received counseling by health personnel to adopt family planning in the state whereas only 13 per cent current users of contraceptives ever had been told about side-‐effects. The follow up services for IUCD/sterilization acceptors within 48 hours of intervention is 88 percent of the users. 2.3.3: Men’s attitudes for Contraception: Almost all men in Orissa reject the idea that contraception is women’s business and a man should not have to worry about it (97%) and reject the idea that women using contraception may become promiscuous (92%). However, 52 percent of men incorrectly believe that a woman who is breastfeeding cannot become pregnant. Large proportions (72%) of men know that a condom, if used correctly, protects against pregnancy most of the time. 2.3.4: Unmet Need: Unmet need for family planning is defined as the percentage of currently married women who either want to space their next birth or stop childbearing entirely but are not using any method of contraception.24% of the currently married women have an unmet need for family planning (8.2% for spacing and 15.8% for limiting) as per DLHS III. However, unmet needs in 12 districts are much below the state average.
13
2.3.5: Methods of Contraception: Analysis of various methods of Family Planning and contraception used by couples reveals that about 80% of them accept limiting methods. Use of spacing methods is less than 20% among the eligible couples effectively using protection. Female sterilization accounts for about 75% of all contraceptive use and mini lap is most popular method. As per (NFHS III) In Odisha, discontinuation rates for spacing methods are quite high. Half of condom users and 42 percent of pill users discontinue use within the first year after they adopt the method as per NFHS-‐III. Condom, 3.20%
Natural & Others, 5.80%
Oral Pill, 7%
IUD, 0.60%
Not using any method, 49.30% Male sterilisation, 1%
Female sterilisation, 33.10%
2.4: Key Issues in Family Planning: a. Availability of information and services is a perennial concern b. Poor logistics and supply chain management c. Need based communication activities for family welfare activities d. Slow progress in capacity building of human resources e. Weak procurement systems for family planning equipments f. Techno-‐ managerial capacity for family welfare activities at district and block levels g. Male sterilization is virtually non-‐existent. 2.5: Analysis and Interpretations: The analysis and interpretation of secondary data is done with an objective to draw linkages for programmatic interventions: i. In Odisha public health system is a major source of availing health care services including Family Planning services. The majority of population resides in rural area. This implies that 14
efficiency and effectiveness of Primary health care system has a bearing on the performance of Family Planning Program in the state. ii.
The TFR of the state is reaching replacement levels. But, the fertility rates of scheduled tribes and rural population are higher than state average. There is a need to ensure access to quality information and services for contraception to the above population segments.
iii.
Among limiting method, female sterilization is the most popular method. Within this segment, minilap is 70 percent of all acceptors. The quality of services offered by facilities at the peripheral level is crucial to improve acceptance. NSV is to be promoted in order to balance method choices among men and women for contraception.
iv.
The unmet need for family planning although reduced from NFHS-‐I to NFHS-‐III, it is still very high. An analysis of service provision for limiting and spacing methods for each district will throw light into gray areas and inter-‐district variations.
v.
Among spacing method users, the acceptance of IUCD is least and knowledge among currently married women in reproductive age is also low for IUCD. One of the reasons assigned by the service providers is that more than 60 percent of women in reproductive age group are anemic and IUCD increases blood loss during menstruation. Hence, IUCD is least preferred as it causes inconvenience to the users. It is necessary to carry out a systematic study on the clinical and socio-‐cultural determinants resulting to low acceptance of IUCD for developing programmatic interventions in the State.
vi.
Odisha is having relatively comfortable levels of age at marriage, as well as sufficient spacing between pregnancies. The state witnesses high in and out migration of male population. There is a need to promote condom as a means of dual protection to prevent HIV/AIDS.
vii.
Counseling offered to present and potential users for contraception is poor. There is a need to promote “Community Based Distribution (CBD) of contraception” through ASHAs. This will help in overcome barriers and reach the unreached for spacing methods particularly counseling for IUCD and clubbing information and services for oral pills and condom. Source – Strategy note UNFPA
2.6: Assessment of Service Utilization and Trends in family planning: 2.6.1: Trends in Sterilization performance: Table 2.5: The comparison of sterilization performance among states with high TFR (2008-‐09) Sl. Parameters No. 1. Eligible couples (in 000’s)
Odisha Bihar
UP
MP
Rajasthan Kerala
6507
16376
31405
12022
11286
5414
Tamil Nadu 11302
2. 3.
TFR No. of sterilizations per 1000 population 2007-‐08
2.5 3.3
4.2 3.5
4.2 2.8
3.5 7.46
3.5 5.8
1.7 6.7
1.7 5.65
4.
Sterilization per 10000 unsterilized couples exposed to higher order births of 3 & 3+ Ratio of Minilap to Laparoscopy Proportion of NSV to total sterilization (2007-‐08) Present Performance (2007-‐08) in lakhs
664
320
319
1331
867
2212
3039
71:29 2.2%
99:.05 2.9%
14:86 1.3%
19:81 6.8%
20:80 3.8%
86:14 0.9%
87:13 0.4%
1.2
3.01
4.7
4.5
3.3
3.5
3.5
5. 6. 7.
15
8.
ELA for 2008-‐09 In lakhs
1.6
4.7
8.1
4.8
4.7
-‐
-‐
9.
Expected TFR in 2012 as per ELA set
2.18
3.42
3.47
2.4
2.4
-‐
-‐
*Source-‐ Operational guidelines of FDS, MOHFW, GoI The sterilization performance of Odisha has been showing increasing trends during the past six years with NRHM playing a supportive role. Table 2.6: Sterilization Performance of the State Year 2005-‐06 2006-‐07 2007-‐08 2008-‐09 2009-‐10 2010-‐11
Sterilization acceptors Orissa 84,267 94,309 120,983 119,889 122,171 138174 (* Demography wing, DFW, GoO,)
2.7: Spacing Methods: The trend analysis of contraceptive use as per NFHS-‐III indicates that a) The current use of condom by eligible couples is 3.2 percent out of 44.6 per cent CPR. There is a steady increase in condom use from 0.6 per cent point (NFHS-‐I) to 0.9 per cent point (NFHS-‐II). Still condom use as a part of CPR is lesser than the National average of 5.2 per cent point. b) The oral pills are popular spacing method in the State. This contributes to 7 per cent of the contraceptive prevalence rate of Orissa as per NFHS-‐III. The use of oral pills and contribution in CPR of Orissa is double the national average. c) The IUCD is least preferred spacing method in Orissa with 0.6 per cent contribution in the CPR by modern contraceptive method in the state. The trend in contraceptive use and comparison with National level pattern is given in Table 2.7. Table 2.7 – Emerging Trends in family Planning Orissa Emerging Trends in Family Planning – Orissa Sl. Method NFHS-‐I NFHS-‐II NFHS-‐III NFHS-‐III No (1992-‐93 (1998-‐99 (2005-‐06 (2005-‐06) Orissa) Orissa) Orissa) (India) 1. Any Method 36.3 46.8 50.4 64.0 2. Any modern method 34.7 40.3 44.7 55.8 3. Female Sterilization 28.3 33.9 33.1 37.8 4. Male Sterilization 3.4 1.7 1.0 1.1 5. Pill 0.9 3.0 7.0 3.1 6. IUD 1.5 0.8 0.6 1.7 7. Condom/Nirodh 0.6 0.9 3.2 5.2 At present distribution channels for spacing methods exist through public health care delivery facilities like DHH/SDH/CHC/PHC & Sub Centre. For every 1,000 population there is one ASHA. Each ASHA receives supplies of OP & CC through ASHA kit. 16
2.8: Performance during 2010-‐11: During last year (2010-‐11) state had recorded highest number of acceptors in sterilization i.e.87% of the expected level of achievement. The graphs and tables on the performances 2009-‐10 2010-‐11 shows an encouraging trend in 257083 family planning achievements in Odisha. It is also observed that in 214597 last five years there is constant 174922 173335 148727 rise in number of acceptors of 138174 133658 122171 various family planning methods per 1000 population. The 86% 60% 82% 83% average acceptors per method in 76% 77% 89% 80% last five years as per service statistic Sterilisation IUCD CC Oral P ills Sterilization (2.8) IUCD (3.65) CC (7.25) OP (4.52). However in last five years there is substantial improvement in performance for all methods other than CC. The reason for the same can be attributed to the erratic supply. The achievement during the year 2010-‐11 reflects that 16 districts have achieved better performances in family planning than the state average with Boudh (45%) was being the poorest & Malkanagiri (152%) being the highest among all districts in sterilization. Similarly, IUCD insertion, 17 districts are above the state average, Nuapada has performed lowest (27%) and 5 YRS T REND IN STERILIZATION IN ORISSA Jharasuguda performing highest (128%). In case of other spacing methods 17 districts are above state average in CC and 19 in use of oral contraceptives pills. Ganjam is at the bottom in CC performances with 26% achievement and Malkanagiri leading the list at 140.In the case of OCP performances Nuapada at the bottom (30%) with Bhadrak leading the table (125%). With concentrated efforts the state is moving gradually towards the replacement level. ELA
Achievement
127714
160008
134423
120983
160706
138174
134423
119889
122170
89%
76%
94309
74%
2006 -‐0 7
90%
2007 -‐0 8
2008 -‐09
2009-‐10
86%
2010-‐11
17
The approach and provisions to ensure the family planning service of limiting and spacing is categorized in this section. It is observed that there is seasonality in terms of acceptance of various family planning methods. The table below reflects the same. Table 2.8: FP performance of last three years
2008-‐09 2009-‐10 2010-‐11
Quarter wise Progress on Family planning method mix in % Sterilization IUCD 1st 2nd 3rd 4th 1st 2nd 3rd 13.4 17.6 18 27 4 8 31.4 14 19 23 24.4 3 8 34 12 27 20.3 23.7 2.5 18.5 31
4th 44.6 31 34
Quarter wise Progress on Family planning method mix in % CC OP 1st 2nd 3rd 4th 1st 2nd 2008-‐09 16 18 21 25 15 19 2009-‐10 20 25 23 21 17.5 21.5 2010-‐11 13 21 22 25 13 17
3rd 21 20 14
4th 24 18 16
The general trend indicates maximum performance in the 3rd and 4th quarter aimed to reach ELA. But the change was conceived by all stake holders (Service Providers, beneficiaries and others) after the phenomenal success during the last population week of July 2010. State had recorded more than 13,000 sterilization cases during usually reported low acceptance season for family planning. This brought back believe and restored the conviction that systematic and routine service delivery on family planning yield results. Further a coordinated and planned effort can bring better result by ensuring quality of care. This policy level conviction led to undertake various initiatives spearheaded by the SFW Cell established with UNFPA support during last year. 1. Developing District Family Planning Plans: As part of the effort to promote differential planning and evidence-‐based strategy in line with mandate of National Rural Health Mission, district family planning plan documents’ for all the 30 Districts were developed through a consultative process. 2. Orientation on Family Planning Program Guidelines: As part of the effort to promote prudent clinical practices, district level program officers and operating surgeons were sensitized on various standards and guidelines published by MoHFW, Government of India. A total of 122 program Officers from state and districts were oriented. Also practitioners, i.e. surgeons from the accredited and private intuitions providing sterilization and other family planning services were oriented. 3. Contraceptive Update Training: Service providers, particularly medical officers were oriented on various technical aspects of contraception through contraceptive updates which is expected to improve the contraceptive services at the district level and would help address the unmet need.
18
4. Promoting Emergency Contraceptive Pills and Need-‐based Communication Activities: Various communication activities utilizing the channels of mass media, mid media & community mobilization interventions along with developing and distribution of information and resource material on different aspects (MTP, Cu T 380 A, FP methods, myths & misconception regarding FP services, contraceptives, etc) of family planning were taken up during the year. 5. Promoting Post-‐Partum & Post-‐Abortion Contraception Services: Orissa has witnessed a steep rise (39% in 2005-‐06 to 78% in 2010-‐11) in the numbers of institutional deliveries after implementation of ‘Janani Surakshya Yojana’ (JSY), which has created ample opportunities for promoting both limiting & spacing services among the clients visiting the health facilities for institutional delivery. 5.1: Post-‐Partum Contraception through ‘Yashoda’: Realizing the importance of the facility-‐based volunteer (Yashoda) working to promote post-‐partum & newborn care among the clients visiting the health facility for delivery, an attempt was made to improve her knowledge & build her capacity on counseling skills on family planning and enabling her to promote post-‐partum contraception. 5.2: Post-‐Partum Contraception through ‘Family Planning Counselors’: As part of the state’s innovation, steps have been taken to re-‐designate Yashoda coordinators placed under NIPI intervention as ‘FP counselors’ in 16 Districts. They have been sensitized through a one-‐day orientation workshop to promote post-‐partum family planning services among the clients visiting the health facilities through counseling & motivation. 5.3: Orientation of Staff Nurses of Labour Rooms & Post Partum Centers: In order to promote counseling and provider client interface more than 78 staff nurses were trained through one day orientation workshop on “post partum & post abortion family planning counseling” at regional levels in an attempt to promote informed choices among clients. In order to move away from camp mode to fixed day services, the state has made conscious efforts to provide fixed day services throughout the year. Monday has been designated as “Parivar Kalyan Diwas”. This was announced by the Hon’ble Chief Minister on the occasion of “World Population Day” 2010. All functional L3 and L2 centers are providing fixed day family planning services on the designated days. Presently, it is reported that 291 fixed day static centers are in operation.
19
Table 2.9: FDS Centers in the State District Angul Balasore Baragarh Bhadrak Bolangir Boudh Cuttack Deogarh Dhenkanal Gajapati Ganjam Jagatsinghpur Jajpur Jahrsuguda Kalahandi Kondhamal Keonjhar Kendrapara Khurda Koraput Malkangir Mayurbhnaj Nawarangpur Nayagarh Nuapada Puri Rayagada Sambalpur Sonepur Sundargarh
No. of FDS Centers (Target) 12 17 14 7 20 4 21 04 13 09 35 10 12 06 18 14 17 10 14 17 8 34 11 10 06 13 14 15 07 23
No. of FDS Centers (Functional) 12 09 10 7 19 2 19 04 13 08 35 10 10 06 18 09 5 10 14 14 7 22 07 09 05 10 04 15 05 13
No of Empanelled Surgeons as on 30.04.2011 33 31 -‐-‐ -‐-‐ -‐-‐ 30 6 23 -‐-‐ 52 -‐-‐ -‐-‐ -‐-‐ 27 20 -‐-‐ -‐-‐ -‐-‐ -‐-‐ -‐-‐ 40 6 31 -‐-‐ -‐-‐ -‐-‐ 44 6 -‐-‐
20
Chapter -‐ 3 PLAN FOR 2011-‐12 Based on the above facts and analysis of secondary data sources, the following priorities have been assigned to the family planning program by the state. The priorities are 3.1: State Priorities during the Year: a. Continuous effort to strengthen State Family Welfare Bureau for better program management b. Strengthening Quality Assurance Mechanism -‐ Improved monitoring and feedback system for prudent clinical practices and quality of care c. Promoting facility-‐based monitoring of Family Welfare Programs d. Operationalising Fixed Day Centers in all L1, L2, L3 institutions with appropriate for each level e. Promoting IUCD as a spacing method f. Increasing Focus on Promotion of NSV – 10 backward districts prioritized g. Promoting Post Partum & Post Abortion Family Planning Services – L3 institutions with high delivery load and post partum centers h. Robust Logistics & Supply Management System for ensuring Contraceptive Security i. Promoting Informed Choices for FP Services by promoting ASHA and staff nurses as family planning counselors. Mamata Divas platform will be used to provide information and supplies for family planning j. Community Based non-‐ Clinical Contraceptive Distribution through involvement of ASHA 3.2: Service provisions in institutions at respective levels: Table 3.1: Service Provision – State mandate Services
L3 Institutions
L2 Institutions
L1 Institutions -‐-‐-‐-‐-‐
Laparoscopic
L3 Institutions with PPC -‐79
-‐-‐-‐-‐-‐
Mini Lap
All Institutions
All Institutions -‐-‐-‐-‐-‐-‐
NSV/ Conventional
All Institutions
All Institutions -‐-‐-‐-‐-‐-‐
IUD
All Institutions
All Institutions All Institutions
Distribution of OP, CC All Institutions
All Institutions All Institutions
Family Planning Counseling
-‐-‐-‐-‐-‐-‐
All Institutions – YASODHA in L3 DHH, Staff Nurse/ANM in other institutions
-‐-‐-‐-‐-‐
3.3: Service Environment: State mandate on levels of institutions defined the minimum service provisions for family planning .It emphasizes the necessary equipments and instruments at respective levels-‐for example in all the L3 institutions “Laparoscope” and IUCD insertion kit in L1 institutions. In order to strengthen and streamline the fixed day static centres and to ensure quality services, these instruments and equipments are essential. Lack of the adequate & requisite facilities also 21
affects the service delivery and poses a threat on quality of care, compromising infection prevention practices. Table 3.2: Presently the institutional readiness for limiting procedure s as follows Category Targeted Functional Facilities with following of Institutions services Institutions By 2012 Laparoscopy Minilap NSV
Functional Fixed day Centers (Any one of the limiting Procedures available
1 2 1 1 1 0 0 0 0 1 2 1 0 1 0 0 0 3 14 1 1 0 1 0 1 0 1 1 0 1 0 7 21
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 1 1 1 0 0 0 0 1 2 1 0 0 0 0 0 3 13 1 1 0 1 0 1 0 1 1 0 1 0 7 20
1 3 1 4 2 2 2 3 3 2 2 1 8 2 2 3 2 5 48 3 3 8 3 5 2 2 2 15 2 3 2 50 98
1 2 1 2 2 2 2 2 1 2 1 1 5 2 2 2 2 4 36 1 1 5 3 3 2 2 2 8 1 1 2 31 67
Functional Institution
Functional Institution
3 3 2 1 1 0 0 0 2 1 2 1 0 0 0 0 3 4 23 2 1 1 1 0 1 0 2 1 0 2 0 11 34
No. of Doctor
13 9 9 5 3 7 5 11 13 14 13 7 3 9 4 4 14 12 155 11 8 17 5 26 8 11 10 11 29 9 5 150 305
Functional Institution
11 9 9 5 3 4 5 11 13 7 1 3 3 9 4 4 14 9 124 14 8 17 5 26 7 11 10 7 28 9 5 147 271
NSV
Non Functional
11 13 18 6 4 5 7 19 15 7 1 4 5 22 5 7 16 9 174 15 17 41 6 55 11 15 18 10 35 22 6 251 425
Laparoscopic Machine Functional
Angul Baragarh Bolangir Boudh Deogarh Gajapati Jharsuguda Kalahandi Kandhmal Keonjhar Koraput Malkangiri Nawarangpur Nayagarh Nuapada Rayagada Sambalpur Sundargarh High Focus Balasore Bhadrak Cuttack Dhenkanal Ganjam Jagatsinghpur Jajpur Kendrapara Khurda Mayurbhanj Puri Sonepur Other Total
No. Functional facility (observing in every Monday) No. Functional facility (observing weekly sessions)
District
No. of Doctors available
Minilap
Laparoscopic Surgeon (Yes/ No)
L3 145 20 119 43 127 L2 438 -‐-‐-‐ 152 32 164 L1 899 -‐-‐-‐-‐ -‐-‐-‐-‐ -‐-‐-‐-‐-‐ -‐-‐-‐-‐-‐ Total 20 271 67 291 Table 3.3: District wise Institutional Readiness status for providing limiting Procedures
12 10 9 5 4 5 5 11 13 7 3 4 6 10 4 5 14 11 138 14 8 17 7 26 7 11 10 11 28 9 5 153 291
22
In order to provide services in L1, L2, L3 level institutions as per mandate, the state has made provisions for procurement of instruments and equipments as detailed below. Table 3.4: District wise procurement plan Q1
Q1
Q1
Laparoscope machine Q1
1
ANUGUL
9
17
31
2
BALASORE
12
27
24
3
BARAGARH
9
19
47
4
BHADRAK
12
20
33
5
BOLANGIR
9
24
39
6
BOUDH
2
7
14
7
CUTTACK
12
28
16
1
8
DEOGARH
2
5
14
9
DHENKANAL
7
17
25
10
GAJAPATI
3
9
26
1
11
GANJAM
19
35
63
1
12
JAGATSINGHPUR
7
13
27
13
JAJPUR
10
24
38
1
14
JHARSUGUDA
3
8
11
1
15
KALAHANDI
9
22
32
1
16
KANDHAMAL
9
17
47
1
17
KENDRAPADA
12
20
17
18
KEONJHAR
7
20
21
1
19
KHURDA
10
14
19
20
KORAPUT
9
21
44
21
MALKANGIRI
5
11
36
22
MAYURBHANJ
16
34
51
1
23
NABARANGPUR
7
20
28
1
24
NAYAGARH
7
16
26
25
NUAPADA
3
9
26
1
26
PURI
9
19
29
27
RAYAGADA
5
14
18
1
28
SAMBALPUR
5
17
21
1
29
SONEPUR
5
10
19
1
30
SUNDERGARH
17
24
57
251
541
899
14
Sl. No.
District
Total
NSV kit
Minilap-‐kit
IUCD kit
In order to promote infection prevention practices, an amount of Rs 20/-‐ is allocated per each IUCD inserted. 3.4: Human Resource Development Plan (Training Plan): Lack of adequate human resource, especially trained professionals to conduct sterilization operation is one of the bottlenecks in making the targeted institutions to ensure family planning services as per the state mandate. The focus is to make all the L3 intuitions and 70% of L2 institutions to provide at least one of the family planning services. This year emphasis is 23
being given on training. Each district has developed a training plan identifying specific personnel to provide services at each identified institution. 3.5: The training load for the state on Family Planning and special skill development trainings:
Q1
Q2
Q3
Q4
Total target (batches)
Remark
IUCD
Medical officer & Staff Nurses
10
10
10
30
Dist.
ANM & LHV
20
20
20
60
Dist.
O&G specialists
3
3
State
Minilap
10
10
10
30
Dist.
NSV(ToT)
1
2
1
4
State
NSV
10
10
20
Dist.
Contraceptive update(doctors)
5
5
5
3
18
Dist.
Contraceptive update(paramedics)
5
5
10
10
30
Dist.
Laparoscopy
10
10
10
30
State
Logistics & Supply chain management
Any other
State Family Welfare Cell will support and supplement the efforts of State Institute of Health & Family Welfare in expediting and monitoring of the sessions by providing techno managerial support. The trainees will be selected with preference to levels of MCH centers. (District wise training load)
24
Family Planning Training Sl. No
District
Laparoscopic Sterilization Training
Minilap Training
NSV Training
Q2 Q3 Q4 Total Q2 Q3 Q4 Total Q2 Q3 Q4 Total
Q2 Q3 Q4 Total
1
ANUGUL
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
2
BALASORE
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
3
BARAGARH
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
4
BHADRAK
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
5
BOLANGIR
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
6
BOUDH
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
7
CUTTACK
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
8
DEOGARH
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
9
DHENKANAL
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
10 GAJAPATI
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
11 GANJAM
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
12 JAGATSINGHPUR
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
13 JAJPUR
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
14 JHARSUGUDA
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
15 KALAHANDI
0
0
1
1
0
0
1
1
0
0
0
0
0
0
1
1
16 KANDHAMAL
0
1
0
1
0
1
0
1
0
0
0
0
0
1
0
1
17 KENDRAPADA
0
1
0
1
0
1
0
1
0
0
0
0
0
0
0
0
18 KEONJHAR
0
1
0
1
0
1
0
1
0
0
0
0
0
1
0
1
19 KHURDA
0
1
0
1
0
1
0
1
0
0
0
0
0
0
0
0
20 KORAPUT
0
1
0
1
0
1
0
1
0
0
0
0
0
1
0
1
21 MALKANGIRI
0
1
0
1
0
1
0
1
0
0
0
0
0
1
0
1
22 MAYURBHANJ
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
23 NABARANGPUR
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
24 NAYAGARH
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
25 NUAPADA
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
26 PURI
1
0
0
1
1
0
0
1
0
0
0
0
0
0
0
0
27 RAYAGADA
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
28 SAMBALPUR
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
29 SONEPUR
1
0
0
1
1
0
0
1
0
0
0
0
0
0
0
0
30 SUNDERGARH
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
31 State
0
0
0
0
0
0
0
0
1
2
1
4
0
0
0
0
9
6
15
30
9
6
15
30
1
2
1
4
7
4
9
20
Total
25
Sl. No.
District
Training of MO & SN
Training of ANM & LHV
Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total
Trng. of OG Spl. (State)
IUD Insertion Training Training of OG SPl. & SN (3 days)
Q1
Q1 Q2 Q3 Q4 Total
1
ANUGUL
1
0
0
1
0
1
0
1
2
0
1
0
0
0
1
2
BALASORE
1
0
0
1
0
1
0
1
2
0
1
0
0
0
1
3
BARAGARH
1
0
0
1
0
1
0
1
2
0
1
0
0
0
1
4
BHADRAK
1
0
0
1
0
1
0
1
2
0
1
0
0
0
1
5
BOLANGIR
1
0
0
1
0
1
0
1
2
0
1
0
0
0
1
6
BOUDH
1
0
0
1
0
0
0
1
1
0
0
1
0
0
1
7
CUTTACK
1
0
0
1
0
1
0
1
2
0
0
1
0
0
1
8
DEOGARH
1
0
0
1
0
0
0
1
1
0
0
1
0
0
1
9
DHENKANAL
1
0
0
1
0
1
0
1
2
0
0
1
0
0
1
10
GAJAPATI
1
0
0
1
0
0
0
1
1
0
0
1
0
0
1
11
GANJAM
0
0
1
1
1
1
1
2
5
0
0
1
0
0
1
12
JAGATSINGHPUR
0
0
1
1
0
0
1
0
1
0
0
1
0
0
1
13
JAJPUR
0
0
1
1
0
1
1
0
2
0
0
1
0
0
1
14
JHARSUGUDA
0
0
1
1
0
0
1
0
1
0
0
1
0
0
1
15
KALAHANDI
0
0
1
1
0
1
1
0
2
0
0
1
0
0
1
16
KANDHAMAL
0
0
1
1
0
1
1
0
2
0
0
0
1
0
1
17
KENDRAPADA
0
0
1
1
0
1
1
0
2
0
0
0
1
0
1
18
KEONJHAR
0
0
1
1
0
1
1
0
2
0
0
0
1
0
1
19
KHURDA
0
0
1
1
0
1
1
1
3
0
0
0
1
0
1
20
KORAPUT
0
0
1
1
0
1
1
0
2
0
0
0
1
0
1
21
MALKANGIRI
0
1
0
1
0
0
1
0
1
0
0
0
1
0
1
22
MAYURBHANJ
0
1
0
1
0
0
3
2
5
0
0
0
1
0
1
23
NABARANGPUR
0
1
0
1
0
0
1
1
2
0
0
0
1
0
1
24
NAYAGARH
0
1
0
1
0
0
1
0
1
0
0
0
1
0
1
25
NUAPADA
0
1
0
1
0
0
1
0
1
0
0
0
1
0
1
26
PURI
0
1
0
1
0
0
1
1
2
0
0
0
0
1
1
27
RAYAGADA
0
1
0
1
0
0
1
1
2
0
0
0
0
1
1
28
SAMBALPUR
0
1
0
1
0
0
1
1
2
0
0
0
0
1
1
29
SONEPUR
0
1
0
1
0
0
1
0
1
0
0
0
0
1
1
30
SUNDERGARH
1
0
0
1
0
0
2
2
4
0
0
0
0
1
1
31
State
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
11
9
10
30
1
15
23
21
60
3
5
10
10
5
30
Total
26
Contraceptive Update Training Sl. No.
District
Training of MOs ( 1 day) dist.
Training of paramedics
Q1
Q2
Q3
Q4
Total
Q1
Q2
Q3
Q4
Total
1
ANUGUL
0
0
0
0
0
1
0
0
0
1
2
BALASORE
0
0
0
0
0
1
0
0
0
1
3
BARAGARH
0
0
0
0
0
1
0
0
1
2
4
BHADRAK
0
0
0
0
0
0
0
0
1
1
5
BOLANGIR
0
0
0
0
0
1
0
0
0
1
6
BOUDH
0
0
0
0
0
0
1
0
0
1
7
CUTTACK
0
0
0
0
0
0
1
0
0
1
8
DEOGARH
0
0
0
0
0
0
1
0
0
1
9
DHENKANAL
0
0
0
0
0
0
1
0
0
1
10
GAJAPATI
0
0
0
0
0
0
1
0
0
1
11
GANJAM
0
0
0
0
0
0
0
1
0
1
12
JAGATSINGHPUR
0
0
0
0
0
0
0
1
0
1
13
JAJPUR
0
0
0
0
0
0
0
1
0
1
14
JHARSUGUDA
0
0
0
0
0
0
0
1
0
1
15
KALAHANDI
0
0
0
0
0
0
0
0
0
16
KANDHAMAL
0
0
0
0
0
0
0
1
0
1
17
KENDRAPADA
0
0
0
0
0
0
0
1
0
1
18
KEONJHAR
0
0
0
0
0
0
0
1
0
1
19
KHURDA
0
0
0
0
0
0
0
1
0
1
20
KORAPUT
0
0
0
0
0
0
0
1
0
1
21
MALKANGIRI
0
0
0
0
0
0
0
0
1
1
22
MAYURBHANJ
0
0
0
0
0
0
0
0
1
1
23
NABARANGPUR
0
0
0
0
0
0
0
0
1
1
24
NAYAGARH
0
0
0
0
0
0
0
0
1
1
25
NUAPADA
0
0
0
0
0
0
0
0
1
1
26
PURI
0
0
0
0
0
0
0
0
1
1
27
RAYAGADA
0
0
0
0
0
0
0
0
1
1
28
SAMBALPUR
0
0
0
0
0
0
0
0
1
1
29
SONEPUR
0
0
0
0
0
0
0
0
1
1
30
SUNDERGARH
0
0
0
0
0
0
0
0
1
1
31
State
5
5
5
3
18
0
0
0
0
0
5
5
5
3
18
4
5
9
12
30
Total
27
3.6: Logistics and Supply System: To address the existing bottlenecks in supply chain management and to strengthen the logistics and supply chain of the family planning supplies, major initiatives planned for the year are as follows. • Establishment of Mobile SMS based CLMIS (Contraceptive Logistics Management Information Systems) is one of the major activities planned. This innovative system has been developed with an intention to track the entire supply chain accurately and in time up to sub center level. This will control the supply chain operation to reduce supply imbalance and regulate the flow of supplies up to sub center level through mobile SMS. • Capacity building program for district and block level store officials on demand forecasting, inventory management and warehouse management will be carried out. 3.7: Quality assurance Plan: All districts have constituted quality assurance Committees. The committee meets every quarter and discusses issues pertaining to sterilization complication, failure, insurance, quality standards and empanelment of doctors for sterilization operations. This year the thrust is to sensitize the members of district Quality Assurance Committee and ensuring their involvement and active participation in performing the six activities of QACs i.e. Facility audit, client exist interview, review of records, empanelment of doctors, quality and technical aspects of the family planning interventions. 3.8: Plan for promoting Public Private Partnership for Family Planning: Partnership with the Private health institutions expands the horizon of service reach & accessibility. This year it is planned to accredit more private institutions for family planning services. Efforts are being made to initiate new interventions with the support and partnership of NGOs. Presently the Community Based Distribution of non clinical contraceptives is piloted in Ganjam with UNFPA support, where ASHA and spouse are engaged at the community level for promoting non clinical contraceptives and information on family planning. 3.9 IEC/BCC Plan: Given the uniqueness of initiative of the district administration to promote & revive traditional local folk theatre in Ganjam district, steps have been taken to organize community mobilization activities for promoting family planning and improve maternal and child health outcomes. Measures have been taken for devising effective communication strategy. SFW cell is making concentrated efforts to promote need based communication initiatives in family planning program. Several pathways are being adopted to reach every section of the society and to promote informed choices. 3.9.1 Promoting communication through traditional folk arts has been piloted in Ganjam with extensive engagement of community based theatres to promote family planning messages. Trainings were organized to develop standardized scripts and sensitizing the troupes for disseminating family planning messages. Efforts are underway to promote this initiative in other districts. 28
3.9.2 Engagement of mass media-‐ Several programs like live panel discussions and phone in and scrolls through popular TV channels are also planned in this year. 3.9.3 In addition to this, regular IEC activities will also continue. 3.10: Eligible Couple Survey: The last eligible Couple survey conducted in 2005-‐06. This year it is planned to re-‐ conduct the survey and update the Eligible Couple register. The survey will be conducted in each village of the 6688 sub centers around Feb-‐March 2012. In order to ensure complete coverage, ASHAs are being engaged in conducting eligible couple survey.
29
Chapter -‐ 4 DETAILED FAMILY PLANNING BUDGET: 2011-‐ 12 Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Q-‐III
Q-‐IV
Financial target for the quarter Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Remarks
Amount (Rs. Lakhs)
A3. FAMILY PLANNING A3.1
Terminal/Limiting Methods
A3.1.1
Dissemination of manuals on sterilization standards & quality assurance of sterilization services Orientation of Programme Officers (ADMOs-‐FW, DPMs & RCH Coordinators) at State level Orientation workshop at District level for Block MO I/C, empanelled operating surgeons including that of accredited institutions Quarterly Female Sterilization Camps to address backlogs -‐ one camp per qtr per district in the low performing zone NSV camp -‐ one camp per qtr per district in 10 districts ( Koraput, Rayagada, Malkangiri, Nabarangpur, Kalahandi, Nuapada, Bolangir, Sonepur, Mayurbhanj and Kandhamal) Compensation for Female sterilization Compensation for Male sterilization Total of Sterilization Budget for Sterilization (85% of Total Sterilization Budget)
Per Work Shop
Per Work Shop per district
Per camp per quarter
A3.1.1.1
A3.1.1.2
A3.1.2
A3.1.3
A3.1.4 A3.1.5
1 100,000
1
1.00
-‐
-‐ -‐ 1.00
30 15,000
30
4.50
-‐
-‐ -‐ 4.50
30 15,000
30
30
30
120
4.50
4.50
4.50 4.50
18.00
Per camp per quarter
10 35,000
10
10
10
40
3.50
3.50
3.50 3.50
14.00
Per Beneficiary Per Beneficiary
1,000 38900
38900
38900
38926
155626
389.00
1,556.26
1,500
5300
5300
5300
5320
21220
79.50 79.50 79.50 79.80 318.30 468.50 468.50 468.50 469.06 1,874.56 398.23 398.23 398.23 398.70 1,593.38
389.00
389.00
389.26
Based on the previous year trend (last year coverage was 85%)
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Per block
Per beneficiary
Per case
Rate (Rs./unit) Q-‐I
Physical Target for the quarter
Financial target for the quarter
Remarks
Q-‐III
Q-‐IV
Total Target
94
94
20
39790
39790
39790
39790
159160
7.96
7.96
7.96
7.96
31.83
Budgeted for 80% beneficiaries
100
1990
1990
1990
1990
7960
1.99
1.99
1.99
1.99
7.96
Per case
75
3315
3315
3315
9945
-‐
2.49
2.49
2.49
7.46
Budgeted for 5% of 159160 beneficiaries Budgeted for 5% beneficiaries
Q-‐II
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
A3.1.6
Accreditation of private providers for sterilization services A3.1.6.1 Accreditation of private institutions for Inst. Del. & FP services -‐ Mobility support to the appraisal team Sub-‐total A3.1 (excluding Sterilization & NSV) A3.2 Spacing Methods A3.2.1 IUD Camps A3.2.2 IUD services at health facilities/ compensation A3.2.2.1 For Beneficiary (to be utilized to meet essential requirements on IUD services at institution level) A3.2.2.2 Incentive to ASHA for ensuring retention of IUD by plants for 1yr A3.2.3
A3.2.4 A3.2.4.1
A3.2.4.2
A3.3 A3.3.1 A3.3.2 A3.3.3
Incentive to private accredited institutions for IUD insertion services Social Marketing of contraceptives One Day Contraceptive update & family planning guideline trg. for MOs (District) Contraceptive update Trg. To Paramedics (SN, LHV, HWF, HWM, HSM) per Dist. One batch at District level Sub-‐total A3.2 POL for FP/Others -‐ Trasportation of FW materials State to district District to Block Block to Sector
-‐ -‐
9.00
4.50
-‐ -‐ -‐
4.50
4.50
23.50
30/batch
440
41,025
5
5
5
3
18
-‐
30/batch
NIL
36,525
5
5
10
10
30
-‐
9.95
12.43
12.43
12.43
47.25
30% blocks having private institutions. Budget under Inst. Strgh.
Budget under training
Budget under Reg. Drug WH (NRHM Int.) State-‐B21.1.2, Dist-‐ B21.2.4 & Block-‐
31
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Physical Target for the quarter
Rate (Rs./unit) Q-‐I
Q-‐II
Q-‐III
Financial target for the quarter Total Target
Q-‐IV
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
B21.3.4
A3.4
Repair of laprascopes
A3.5
Sub-‐total A3.3 & A3.4 Other strategies/activities
-‐
Strengthening of Family Welfare Bureau for quality implementation of family planning program At State level Manpower Mobility cost for supportive supervision Operational cost At District level Manpower
Per month
Per month
20,000 10,000
Per district per month
2,500
A3.5.1
A3.5.1.1 A3.5.1.1.1 A3.5.1.1.2 A3.5.1.1.3
A3.5.1.2 A3.5.1.2.1
A3.5.1.2.2 A3.5.1.2.3
A3.5.2 A3.5.2.1
A3.5.2.2
Mobility cost for supportive supervision Operational cost for Dist. FW Bureau for meeting exp., reporting, internet, telephone, postage etc. Operationalization of fixed day static services-‐Family welfare day Mapping of availability of skilled human resources, regularly updating empanel of doctors and orientation at district level Minilap training for MO (Asst Surgeon of L3 & L2): twelve working days at District level
3/batch
154
Remarks
Amount (Rs. Lakhs)
-‐
-‐
-‐
State Eqp. Maint. Unit to look into
-‐
Funded by UNFPA -‐ Budget under Prog.
-‐
Mgt.
RCH Coordinator will be given additional responsibility Budget under Prog. Mgt.
30
30
30
30
30
To be updated in regular monthly meeting
10
10
10
30
32,580
-‐
-‐ Budget under training
32
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
Remarks
A3.5.2.3 A3.5.2.4 A3.5.2.5
A3.5.3
A3.5.3.1
A3.5.3.2
A3.5.4 A3.5.4.1
A3.5.5 A3.5.5.1 A3.5.5.1.1
A3.5.5.2 A3.5.5.2.1
NSV training for MOs five working days. State level TOT NSV training for MOs five working days. District level
5/batch
0
94,188
1
2
1
4
-‐
5/batch
62
27,375
10
10
20
-‐
Organisation of Fixed day -‐ weekly Per fixed (Contigency cost to L3:145 (100%) day weekly + L2: 219 (50%)) per inst. Promote postpartum and post abortion family planning services including sterilization in facilities having high institutional deliveries Orientation cum review of FP Per counselors/ Yashodas supervisor & training SN (bi-‐annually) to access & review FP performance & providing handholding for improving performance Biannual review of PPC I/c on FP activities at divisional level for strengthening FP service in PP centers Promote Community Based family planning services
200
300
350
364
364
1378
-‐
Supported by UNFPA
Community based distribution of non-‐clinical contraceptives (piloted in Ganjam) through ASHAs Trainings Laparoscopic sterilization training Laparoscopic sterilization training for teams (three members : MO, SN, Attendant) :twelve working days at Zonal Level IUD insertion training Six days Dist level IUCD training for MO and SN
Supported by UNFPA
10
10
10
30
-‐
10
10
10
30
-‐
3/batch
55
12/batch
378
29,360
63,755
Cost to be met from RKS
Budget under Training
33
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
Remarks
A3.5.5.2.2 A3.5.5.2.3
A3.5.5.2.4
A3.5.6 A3.5.6.1 A3.5.6.2 A3.5.6.3
A3.5.6.4 A3.5.6.5
A3.5.6.6
Six days Block level IUCD training for ANM, LHV Three Days Postpartum IUCD Training for O&G Spl., Staff Nurses of Dist., Prof. & Asso. Proff. (O&G) of MCH, Faculty of SIHFW at State Level Three days Postpartum IUCD Training for O&G Spl and Staff Nurses of Respective Districts (5MOs+5SNs) Printing Printing of sterilization case cards Printing of village wise EC register Printing of resource materials on contraceptive choices in local languages for Service provider Printing of checklist for FP Counselor Display boards depicting all benefits, side effects & contra indications of Contraceptives to be displayed in PP centers Printing of green cards
10/batch
0
49,950
20
20
20
60
-‐
25/batch
0
114,920
3
0
0
0
3
-‐
10/batch
0
32,225
4
10
10
6
30
-‐
Per card Per register Per material
10 40
180000 60000
180000 60000
500000
500000
UNFPA support
Per checklist
100000
100000
0
Per card
Met from State budget
Budget under procurement (NRHM Int.)
A3.5.7
Procurement of equipment & instrument for operationalisation of FP services
A3.5.7.1 A3.5.7.2
NSV kit Minilap kit
Per kit Per kit
2,500 6,000
251 541
251 541
A3.5.7.3
IUCD kit
Per kit
2,000
899
899
Budget under Advocacy for NRHM
34
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Rate (Rs./unit) Q-‐I
Physical Target for the quarter Q-‐II
Financial target for the quarter
Q-‐III
Q-‐IV
Total Target
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Remarks
Amount (Rs. Lakhs)
A3.5.7.4
A3.5.7.5 A3.5.7.6
Laparoscope machine (Total requirement is 42 to operationalise all L3 institutions having PPC, but fund request for 50% of it) Racking system at State FW store Pregnancy kit to be used before sterilization during camp
Per machine
630,000
14
14
2,000,000
1
1
GoI supply
A3.5.7.7 A3.5.8
FW material Performance Based Awards
A3.5.8.1
Performance based incentives (3 districts) to best performing districts Performance based incentives (3 awards) to best performing surgeons Performance based incentives (awards) to best Fixed Day Static Unit at district level Monitoring Bi-‐annual state level QAC review meeting (Integrated with general QAC meeting) State level quarterly review meeting of low performing districts Divisional Bi-‐annual Review meeting of ADMO and DPM Bi-‐annual review of DHIO & SA/SI for improved monitoring at state level District level QAC meeting (Integrated with general QAC meeting)
100,000
100,000
Per district
20,000
30
30
per meeting
5,000
1
1
2
1,000
30
30
30
30
120
A3.5.8.2
A3.5.8.3
A3.5.9 A3.5.9.1
A3.5.9.2
A3.5.9.3 A3.5.9.4
A3.5.9.5
Per district per quarter
-‐
-‐
Budget under Infr. & HR
Budget under M&E
UNFPA support
Budget under M&E
35
Point No.
Budget head
Unit of measure
Base-‐line (current status)
Lump sum
Rate (Rs./unit) Q-‐I
Physical Target for the quarter
Financial target for the quarter
Remarks
Q-‐III
Q-‐IV
Total Target
-‐ -‐
-‐ -‐ -‐
0
1
0
0
1
-‐
Budget under Training
-‐ 4.50
-‐ 4.50
-‐ 4.50
-‐ 23.50
Q-‐II
Q-‐I
Q-‐II
Q-‐III
Q-‐IV
Amount (Rs. Lakhs)
A3.5.9.6
Quarterly family planning review by District Authorities
A3.5.9.7
Rapid assessment cum validation of FP services at all Fixed Day Static Centres IEC/BCC State Media Workshop with focus on FDSA Mass media activities – production & telecasting/ dissemination
A3.5.10 A3.5.10.1 A3.5.10.2 A3.5.10.3
Observation of World Population Week A3.5.10.4 PRI sensitization on FP issues A3.5.10.5 Create ‘Enabling Environment’ in PPC A3.5.11 Training on effective Management of Pro-‐Mis to Block level staff of Puri Dist. On Pilot basis at District level Sub-‐total A3.5 Total (excluding Sterilization, NSV & IUD)
33/batch
NIL
34,225
-‐ 9.00
Met out of Dist. Level monthly meeting (Inst. Strg.) Budget under OHSP Budget under IEC/BCC (NRHM Int.)
36
Annexure – 1
District Wise Expected Level of Achievement for the Year 2011-‐12 Sl. No.
District
Expected Level of Achievement (ELA) (2011-‐12) Condom Oral Pills CuT380A Sterilization 14,266 8,406 7,118 5,898
01
Bargarh
02
Jharsuguda
5,401
3,183
2,695
2,231
03
Sambalpur
9,914
5,842
4,947
4,071
04
Debagarh
2,905
1,712
1,449
1,201
05
Sundargarh
19,399
11,431
9,679
8,018
06
Kendhujhar
16,552
9,753
8,258
6,844
07
Mayurbhanj
23,561
13,883
11,755
9,738
08
Baleswar
21,453
12,641
10,703
8,867
09
Bhadrak
14,133
8,328
7,051
5,839
10
Kendrapara
13,797
8,130
6,884
5,706
11
Jagatsinghpur
11,207
6,604
5,592
4,631
12
Cuttack
24,807
14,618
12,377
10,259
13
Jajpur
17,212
10,142
8,588
7,113
14
Dhenkanal
11,305
6,662
5,641
4,672
15
Angul
12,080
7,118
6,027
4,994
16
Nayagarh
9,161
5,398
4,571
3,787
17
Khorda
19,894
11,722
9,926
8,216
18
Puri
15,923
9,383
7,945
6,568
19
Ganjam
33,492
19,735
16,710
13,749
20
Gajapati
5,498
3,240
2,743
2,272
21
Kandhamal
6,869
4,047
3,427
2,840
22
Boudh
3,956
2,331
1,974
1,635
23
Sonepur
5,742
3,383
2,865
2,370
24
Balangir
14,170
8,349
7,070
5,855
25
Nuapada
5,623
3,314
2,806
2,325
26
Kalahandi
14,152
8,339
7,061
5,849
27
Rayagada
8,807
5,189
4,394
3,607
28
Nabaranghpur
10,870
6,405
5,423
4,463
29
Koraput
12,511
7,372
6,242
5,163
30
Malkangiri
5,343
3,148
2,666
2,105
Total
390,003
229,808
194,587
160,886
Annexure -‐ II
Monitorable Indicators Family Planning 2011-‐12, Orissa 2010-‐11
2011-‐12
Baseline SN.
INDICATOR
Q1 Target
(Apr-‐Nov 2010)
Q2 Target
Q3 Target
Q4 Target
Annual Target
HF
State
HF
State
HF
State
HF
State
HF
State
HF
State
Districts
total
Dist
Total
Dist
Total
Dist
Total
Dist
Total
Dist
Total
C
Family Planning
C.1
Service Delivery % of total sterilization against ELA % post partum sterilization
35%
33%
20
20
43
45
70
70
90
90
90
90
4%
5%
4
5
6
8
6
8
8
10
10
10
5%
4%
5
6
7
9
8
10
12
12
12
12
46%
49%
20
20
45
50
65
70
90
90
90
90
C.1.5
% male sterilizations % of IUD insertions against planned % IUD retained for 6 months
39%
42%
C.2
Quality
C.2.1
% of complications following sterilization
2.90%
2.71%
C.3
Outputs
Cur.Yr
Cum
Cur.Yr
Cum
C.3.1
% doctors trained as minilap
20 (48%)
69 (51%)
45 (50%)
136 (15%)
-‐-‐-‐-‐
-‐-‐-‐-‐
18 (60%)
30 (33%)
18 (60%)
30 (33%)
18 (60%)
18 (60%)
54 (60%)
90 (100%)
C.3.2
% doctors trained as NSV
14 (14%) 30 (50%)
59 (8%) 49 (21%)
-‐-‐-‐-‐
% doctors trained as laparoscopic sterilization
32 (55%) 15 (30%)
-‐-‐-‐-‐
C.3.3
9 (68%) 14 (45%)
-‐-‐-‐-‐
-‐-‐-‐-‐
32 (65%) 18 (60%)
50 (33%) 30 (33%)
32 (65%) 18 (60%)
50 (33%) 30 (33%)
32 (65%) 18 (60%)
50 (33%) 30 (33%)
96 (65%) 18 (60%)
150 (100%) 90 (100%)
C.1.1 C.1.2 C.1.3 C.1.4
2010-‐11
2011-‐12
Baseline SN.
INDICATOR
C.3.4
% ANM/LHV/SN/MO trained in IUD insertion
C.4
HR productivity
C.4.1 C.4.2
C.4.3
C.4.4
C.4.5 C.5 C.5.1 C.5.2
Average no. of NSVs conducted by trained doctors Average no. of minilap sterilizations conducted by minilap trained doctors Average no. of laparoscopic sterilizations conducted by lap sterilization trained doctors Average no. of IUDs inserted by MO trained in IUD insertion Average no. of IUDs inserted by SN/ LHV/ ANM trained in IUD insertion Facility utilization Average no. of sterilizations performed in FRUs Average no. of sterilizations performed in 24x7 PHCs
Q1 Target
(Apr-‐Nov 2010)
Q2 Target
Q3 Target
Q4 Target
Annual Target
HF
State
HF
State
HF
State
HF
State
HF
State
HF
State
Districts
total
Dist
Total
Dist
Total
Dist
Total
Dist
Total
Dist
Total
111 (49%)
117 (32%)
228 (76%)
366 (49%)
-‐-‐-‐-‐
-‐-‐-‐-‐
528 (55%)
320 (33%)
528 (55%)
320 (33%)
528 (55%)
320 (33%)
528 (55%)
960 (100%)
21
20
35
40
45
50
50
55
60
67
60
21222 (67)
115
127
120
130
140
145
145
150
150
155
150
88423 (155)
487
270
150
185
175
200
200
240
240
288
240
49516 (288)
79
58
30
50
50
75
60
100
100
112
100
44764 (112)
268
196
75
86
80
90
80
90
75
114
75
134292 (114)
311
332
75
100
100
125
120
150
150
177
150
177
108
68
150
200
210
250
255
275
275
304
275
304
39
Annexure -‐ III
STERILISATION PERFORMANCE 2010-‐11 Sl.No. Name of the District
Expected Level Achievement from % increase(+) or April to March of achievement decrease(-‐) 2010-‐11 2010-‐11 2009-‐10
% of achievement to ELA
1
MALKANGIRI
2102
3193
1445
120.97
152
2
NAWARANGPUR
4458
5736
5108
12.29
129
3
KORAPUT
5157
6080
6938
-‐12.37
118
4
DHENKANAL
4667
5013
4402
13.88
107
5
BHADRAK
5833
6207
5834
6.39
106
6
ANGUL
4988
5213
4058
28.46
105
7
MAYURBHANJA
9727
9860
8014
23.03
101
8
KEONJHAR
6836
6811
5695
19.60
100
9
PURI
6561
6261
5420
15.52
95
10
BARAGARH
5891
5609
5421
3.47
95
11
BOLANGIR
5848
5326
5829
-‐8.63
91
12
GAJAPATI
2270
2065
2053
0.58
91
13
BALASORE
8857
7781
7027
10.73
88
14
JAJPUR
7105
6199
5291
17.16
87
15
NUAPARA
2323
2019
1917
5.32
87
16
NAYAGARH
3782
3276
1970
66.29
87
17
KENDRAPARA
5700
4697
2136
119.90
82
18
KALAHANDI
5842
4794
5188
-‐7.59
82
19
SAMBALPUR
4067
3324
3332
-‐0.24
82
20
SUNDARGARH
8009
6143
6107
0.59
77
21
CUTTACK
10248
7762
7381
5.16
76
22
JHARSUGUDA
2229
1606
1624
-‐1.11
72
23
SONEPUR
2367
1602
1174
36.46
68
24
KHURDA
8206
5522
3291
67.79
67
25
GANJAM
13734
8195
7693
6.53
60
26
RAYAGADA
3603
2140
2101
1.86
59
27
JAGATSINGHPUR
4626
2736
2744
-‐0.29
59
28
DEOGARH
1200
685
614
11.56
57
29
KANDHAMAL
2837
1580
1328
18.98
56
30
BOUDH
1633
739
1036
-‐28.67
45
ORISSA
160706
138174
122171
13.10
86
Annexure -‐ III
IUCD PERFORMANCE 2010-‐11 Sl. No.
REVIEW OF F.W.&MCH PROGRAMME DURING AND UP TO END OF MARCH,2011 Expected Achievement from % of Name of the % increase(+) Level of April to March achievement District or decrease(-‐) achievement to ELA(10-‐11) 2010-‐11 2009-‐10 2010-‐11
% of achievement to ELA(9-‐10)
1
JHARSUGUDA
2491
3177
2673
18.86
128
107.3
2
BHADRAK
6517
7949
10409
-‐23.63
122
159.7
3
MALKANGIRI
2464
2957
2293
28.96
120
93.1
4
NAYAGARH
4224
4750
4762
-‐0.25
112
112.7
5
KENDRAPARA
6362
6476
5255
23.24
102
82.6
6
PURI
7343
7449
4102
81.59
101
55.9
7
JAJPUR
7937
7958
7827
1.67
100
98.6
8
MAYURBHANJA
10864
10621
8555
24.15
98
78.7
9
ANGUL
5570
5375
4930
9.03
96
88.5
10
KORAPUT
5769
5468
4286
27.58
95
74.3
11
NAWARANGPUR
5012
4634
3062
51.34
92
61.1
12
KANDHAMAL
3167
2910
3828
-‐23.98
92
120.9
13
DHENKANAL
5213
4663
4740
-‐1.62
89
90.9
14
KEONJHAR
7632
6814
4420
54.16
89
57.9
15
SUNDARGARH
8945
7971
6966
14.43
89
77.9
16
BALASORE
9892
8674
8170
6.17
88
82.6
17
CUTTACK
11439
10019
9127
9.77
88
79.8
18
JAGATSINGHPUR
5168
4207
5255
-‐19.94
81
101.7
19
SONEPUR
2648
2078
2361
-‐11.99
78
89.2
20
BARAGARH
6579
5128
4743
8.12
78
72.1
21
BOLANGIR
6534
4861
5490
-‐11.46
74
84.0
22
KHURDA
9173
6549
5600
16.95
71
61.0
23
BOUDH
1824
1241
746
66.35
68
40.9
24
DEOGARH
1339
885
451
96.23
66
33.7
25
GAJAPATI
2535
1532
1572
-‐2.54
60
62.0
26
RAYAGADA
4061
2410
1996
20.74
59
49.2
27
KALAHANDI
6526
3318
3216
3.17
51
49.3
28
SAMBALPUR
4572
2112
1761
19.93
46
38.5
29
GANJAM
15444
5846
3844
52.08
38
24.9
30
NUAPARA
2593
695
1218
-‐42.94
27
47.0
179838
148727
133658
11.27
83
74.3
ORISSA
41
Annexure -‐ III
CC PERFORMANCE 2010-‐11 REVIEW OF F.W.&MCH PROGRAMME DURING AND UP TO END OF MARCH,2011 Sl. No.
Name of the District
Expected Level of achievement 2010-‐11
Achievement from April to March 2010-‐11
2009-‐10
% increase(+) or decrease(-‐)
% of achievement to ELA (10-‐ 11)
% of achieveme nt to ELA(9-‐10)
1
MALKANGIRI
4938
6916
4102
68.60
140
83.07
2
JAJPUR
15908
19344
15449
25.21
122
97.12
3
JHARSUGUDA
4992
5886
5760
2.19
118
115.38
4
SONEPUR
5306
5918
4655
27.14
112
87.72
5
KANDHAMAL
6348
6427
10532
-‐38.98
101
165.91
6
ANGUL
11165
10980
9732
12.82
98
87.17
7
JAGATSINGHPUR
10358
10008
13169
-‐24.00
97
127.14
8
KENDRAPARA
12751
10694
8318
28.57
84
65.23
9
DHENKANAL
10448
8750
8820
-‐0.79
84
84.41
10
KEONJHAR
15297
10833
11683
-‐7.28
71
76.37
11
BHADRAK
13062
9090
21455
-‐57.63
70
164.25
12
NAYAGARH
8467
5828
9570
-‐39.10
69
113.04
13
GAJAPATI
5081
3481
4924
-‐29.32
68
96.91
14
NAWARANGPUR
10046
6644
6900
-‐3.70
66
68.68
15
DEOGARH
2684
1771
2864
-‐38.18
66
106.70
16
BARAGARH
13185
8566
14242
-‐39.85
65
108.02
17
BOUDH
3657
2204
4918
-‐55.19
60
134.49
18
KHURDA
18386
9544
7767
22.88
52
42.24
19
SAMBALPUR
9163
4567
5972
-‐23.52
50
65.17
20
MAYURBHANJA
21775
10802
14536
-‐25.69
50
66.75
21
CUTTACK
22927
11310
14240
-‐20.57
49
62.11
22
KORAPUT
11562
5550
6968
-‐20.36
48
60.27
23
SUNDARGARH
17929
7913
7207
9.80
44
40.20
24
RAYAGADA
8139
3388
3563
-‐4.92
42
43.78
25
BALASORE
19827
6951
7515
-‐7.51
35
37.90
26
KALAHANDI
13079
4024
4430
-‐9.18
31
33.87
27
NUAPARA
5197
1533
1356
13.06
29
26.08
28
BOLANGIR
13096
3840
10247
-‐62.53
29
78.24
29
PURI
14716
3937
7369
-‐46.57
27
50.07
30
GANJAM
30953
7901
8821
-‐10.43
26
28.50
ORISSA
360444
214597
257083
-‐16.53
60
71.32
42
OCP PERFORMANCE 2010-‐11 REVIEW OF F.W.&MCH PROGRAMME DURING AND UP TO END OF MARCH,2011 Sl. No.
Name of the District
Expected Level of achievement 2010-‐11
2010-‐11
2009-‐10
Achievement from April to March
% increase(+) or decrease(-‐)
% of achievement to ELA(10-‐11)
% of achievement to ELA(09-‐10)
1
BHADRAK
7697
9612
14814
-‐35.12
125
124.88
2
ANGUL
6579
8009
8825
-‐9.24
122
121.75
3
KORAPUT
6813
8138
7273
11.90
119
119.44
4
JAJPUR
9374
10785
9871
9.25
115
115.05
5
MALKANGIRI
2910
3166
3384
-‐6.43
109
108.82
6
BOUDH
2155
2249
3146
-‐28.51
104
104.38
7
JAGATSINGHPUR
6103
6338
7939
-‐20.16
104
103.85
8
NAYAGARH
4989
5139
5801
-‐11.41
103
103.02
9
BALASORE
11683
11815
9556
23.64
101
101.13
10
DHENKANAL
6157
6169
5938
3.90
100
100.20
11
RAYAGADA
4796
4766
5397
-‐11.68
99
99.38
12
KENDRAPARA
7514
7103
7520
-‐5.54
95
94.53
13
KANDHAMAL
3741
3502
6088
-‐42.48
94
93.61
14
NAWARANGPUR
5919
5178
4919
5.27
87
87.48
15
MAYURBHANJA
12831
11055
6858
61.19
86
86.16
16
JHARSUGUDA
2941
2501
2201
13.64
85
85.02
17
SONEPUR
3127
2648
2129
24.38
85
84.68
18
BARAGARH
7769
6489
4526
43.37
84
83.53
19
DEOGARH
1582
1312
1075
22.10
83
82.94
20
KEONJHAR
9014
6559
7776
-‐15.66
73
72.76
21
GAJAPATI
2994
2090
2427
-‐13.87
70
69.81
22
CUTTACK
13510
9426
7527
25.23
70
69.77
23
PURI
8672
5907
5673
4.13
68
68.11
24
KHURDA
10834
6923
5996
15.47
64
63.90
25
SAMBALPUR
5399
3441
3370
2.08
64
63.72
26
BOLANGIR
7717
4758
6895
-‐30.99
62
61.66
27
SUNDARGARH
10564
6310
6774
-‐6.85
60
59.73
28
KALAHANDI
7707
4163
3844
8.30
54
54.01
29
GANJAM
18239
6877
6222
10.54
38
37.71
30
NUAPARA
3062
907
1161
-‐21.89
30
29.61
212390
173335
174922
-‐0.91
82
81.61
ORISSA
43
Annexure – IV GUIDELINES FOR QUARTERLY FEMALE STERILIZATION CAMPS TO IMPROVE DISTRICT PERFORMANCES
FAMILY PLANNING PIP-‐11-‐12
(BUDGET HEAD: A3.1.2) Out of the Expected Level of Achievement (ELA) 60% to be achieved in the Fixed Day Static Centers approach and 40% in the camp mode. Prerequisite for the quarterly sterilization camps: 1. 2. 3.
District must have analyzed the performance of the quarter and identify the poor performers with the context of the achievement in Fixed Day Static Centers. The poorest performing blocks to be identified and the camp to be held in the identified block. A minimum of 50 cases to be operated in a camp.
Client Load: From the quarterly review the district Nodal Officer, ADMO (FW) must finalize the tentative load for the camp. The Quality norms led down by GoI to be strictly adhered to. Empanelled surgeon to operate to a maximum number of cases per day as per the GoI guidelines. • 30 laparoscopic Tubectomy • 30 minilap Tubectomy For such quarterly camp, the organizing officer in consultation with the ADMO (FW) must see that at least two empanelled doctor and their team to conduct the sessions/operations in the camp. The organizing officer i.e. the concern MOI/c/MO or the Medical Officer assigned by ADMO (FW) is to be responsible for the prerequisite checkups, screening and other needful as per the GoI directives. ADMO (FW) will be the overall charge of the camps and he/she will assign the concern MOI/c/MO/SDMO (as per the case) as the Camp organizing officer. Camp Site: The camp to be organized in established health facilities as per the directives laid down in GoI “SOP”. Under no circumstances it should be held in other facilities other than health institutions having all the requisites laid down in government of India programme guidelines. The district Quality Assurance Committee must approve the venue even in level-‐ 1 institutions considering the expected case load (camp mode). Planning & Coordination for the camp: 1. 2. 3.
After the quarterly review the proceedings to be shared with the District Quality assurance Committee. The date and venue for the camp along with the list of empanelled surgeons to be finalized by the QAC in consultation with the Nodal Officer, ADMO (FW). The camp to be organized within 2weeks of succeeding quarter. For example the camp to be held within 14th July for the quarter ending in June 2011.
44
CAMP ARRANGEMENT: 1.
ADMO (FW) to intimate the concern MO or MOI/c regarding the date and venue of the camp at least before one week. Necessary arrangement for the camp to be the responsibility of the concern MOI/c. BEE will be exclusively responsible for the publicity and needful IEC activities and venue arrangement in consultation with MOI/c. MOI/c in consultation with the ADMO (FW) arrange the availability of the concern /enlisted surgeons for the camps. BEE, SA & BPO to ensure the necessary logistics support required for the camps. This includes necessary screening, waiting place for the beneficiaries both pre and post operation phase. Drinking water facility, parking places, medicine distribution, facility for screening etc. and needful emergency services to be arranged properly. The concern SA /person assigned by MOI/c of the block to support the beneficiary in filling the consent form & registration or other formalities thereof. The concern MOI/c will be the overall in charge of the camp SA/BPO to support for the needful.
2. 3. 4. 5.
6. 7.
FUND RELEASE: 1.
Once the QACs approved the date and venue, the fund as earmarked in the budget to be placed directly to the concern MOI/c through e-‐transfer or as soon as possible including that of loss of Wages ( LOW ) and camp cost Rs. 15000/-‐
Financial Breakup: Sl. No 1 2
3 5 6 7 8
Activity Camp /Venue arrangement IEC/Publicity in the area :(Intimation to ASHAs, information to all GKS of the area, intimation to the SHG Federation members of the Grampanchayat, leaflet, banner, mike) Focus to be on IPC through ASHA & AWWs) Mobility support for the camps Contingency : Stationery, emergency drugs etc. Perdiem @Rs.150/-‐ to HW(M)/HW(F)/LHV/MPHS(M)/BEE/SA/BPO/BADA to a maximum of 10 persons those who participated and supported the camp . Sub-‐staff and any community volunteers involved @Rs.100/-‐ Payment to loss of wages to be done on posting of eligible couple Number(Case card/Sterilization Register) The outside cases accepted sterilization need to be reported to the concerned medical institution to which they belong for reference. Total
Budget (Rs) 4000 4000
3500 1500 1500 500 15000
45
OPERATIONAL COST FOR DISTRICT FAMILY WELFARE BUREAU
[email protected]/-‐ PER MONTH BUDGET LINE ITEM NO: A3.5.1.2.3 It is only to maintain and suffice the need of District Family Welfare Bureau (DFWB) towards better planning, coordination and communication and correspondence. This fund to be utilized for a) b) c) d)
Support the expenditure relating to correspondence, internet charges, couriers chargers, fax, postage etc. . For the photocopy circulars, letters, documents etc. . Timely submission of reports i.e. HMIS, other reports Stationeries for office, computer maintenance etc.
46
GUIDELINES FOR QUARTERLY NSV CAMPS TO IMPROVE DISTRICT PERFORMANCES FAMILY PLANNIG PIP-‐11-‐12 BUDGET LINE ITEM NO : A3.1.3 Koraput, Rayagada, Malkangiri, Nabarangpur, Kalahandi, Nuapada, Bolangir, Sonepur, Mayurbhanj and Kandhamal Quarterly NSV Camps to improve district performances The NSV camps will be organized at the district Headquarters/Sub divisional head quarter/or only in L3 institutions once in a quarter @ Rs.35000/-‐ per camp. The camp site and venue is to be decided by ADMO (FW) in consultation with the QAC of the district. Preference to be given in areas having low or poor performances for NSV. Minimum number of cases to be planned for the camp 35 to 60 for operation. At least two empanelled NSV surgeons to attend the camp along with their team. Rest to be as per the guideline mentioned below. Sl. No
Activity –cum-‐ Budget Head
Amount Earmarked
1
IEC/BCC
Rs. 10000
2
Banners, posters and leaflets printing and display in strategic locations. Mike publicity, Folk shows IPC through ASHA & AWWS Intimation and information to the GKS of the area. (Breakup of each activity and fund allocation to be decided by the concern MOI/c, SDMO, MO of the hospital. Special focus to cover the weekly markets ( hattas) in the area. Camp Arrangement :
Responsibility Concern BEE of the CHC/PHC if at the Dist. Level MIEO/DyMIEO to be responsible.
A week before the camp
Rs. 15000
MOI/C and BPO
All the arrangements and the needful to be completed before the camp day.
Rs. 10000
MOI/c of the Block or MO as per the case
To be done during the camp day after completion of the camp.
Arrangement for the beneficiaries, waiting place, drinking water , transportation of surgeons , preparatory meeting and contingency Counter for the screening test, filling up of consent forms and other requisites ( person to be ear marked for each by the MOI/c) 3
Performance Incentives to the GKS having more than 5 persons accepting NSV, Qualifying is 5 (best three), will get Rs1000/-‐ incentive award. The GKS can utilizes the fund in organizing meeting to sensitize on the various family planning methods, recognizing and facilitating the Motivators and beneficiaries .
Timeline
Rs.500/-‐ to the ANMs/HW(M) who have motivated more than 07 cases for NSV on their own,(Best two) DA to the (officers & paramedics)SA, BPO, Supervisors, LHV & BEE) 10 % as an institutional overhead to the RKS of the institutions where the camp is organized.
47
GUIDELINES FOR INFECTION PREVENTION & CONTROL ON IUCD @ RS.20/-‐ PER CASE BUDGET LINE ITEM NO : A3.2.2.1 The Rs.20/ is to be used by the service provider towards promotion of the IUCD community. It’s to be used as institutional overhead for the promotion of IUCDs. This can be used specially for infection prevention and management. Due emphasis is to be given for use of globes, sterilization of instruments, proper follow up & monitoring. The modalities for the fund: The service providers have to submit a report to the concern supervisor in every month during the health sector meeting. The details report to state the TC No. and date of insertion of the IUCD. The reporting format to be printed and supplied to all the reporting units. The fund for the printing to be made from this fund and printing to be done at h district level. Modalities for the Payment: The respective supervisor submits the report to the MOI/c in every month after due verification. The allocated Rs.20/-‐ to be used for the infection control mechanism relating to IUCD insertion i.e sterilizing of the instruments and equipments for insertion, purchase of liquid soap, plastic gloves, medicines for minor complications, instruments for IUCD insertion. The amount to be directly placed to the concern MOI/c from the block and MOI/c to provide the requisite materials to the concern service provider and institutions. The records maintain by the service providers as the procedure at present.
3.
Name of the acceptor Address : Village SC and CHC/ PPC etc.
EC No.
Acceptor
Spouse
4. S. No
Date of Insertion
Age
Living Children
1
2
M
F
Educational Status
Age of last child with Sex
Religion / Caste of the acceptor
Signature of Acceptor
Signature of the Inserter
Remarks
Spouse
2.
Acceptor
1.
48
INCENTIVES TO THE PRIVATE ACCREDITED INSTITUTIONS FOR IUCD INSERTION SERVICES BUDGET LINE ITEM NO : A3.2.3 Steps: 1.
The beneficiary may directly approach the accredited institutions and avail the benefit.
2.
The amount of Rs.75.00 will be given to the accredited institutions only after the verification of the TC No. by the concern ADMO (FW) as the case may be.
3.
Government will not provide any IUCD to the accredited institutions.
4.
The accredited institutions will be given the amount through e-‐transfer only after the institutions submit the name of the beneficiaries along with their respective TC. Numbers authenticated or endorsed by the concern MOI/c.
5.
The institutions will receive payment bi-‐monthly against the authentication with TC number duly verified by MOI/c or ADMO (FW).
6.
Unlike sterilization operation, the amount to be paid to the institutions bi-‐monthly manner as per the number of cases inserted IUCD.
7.
The institutions will be responsible for any complication therefore.
8.
The institutions must have to submit a report every month with details of the beneficiaries to ADMO (FW) in soft and hard copies as per the format below.
9.
The institutions must not take any service charges from the beneficiaries. EC No
Date of Insertion
Age
Living Children
M
F
Age of last child with Sex
Educational Status
Religion / Caste Of the acceptor
Signature of Acceptor
Remarks
1
2
Acceptor
Spouse
Name of the acceptor Address : Village SC and CHC/PPC etc.
Acceptor
Sl. No.
Spouse
49