1. Workshops for State, District and Block level Mission Teams
Workshops will be conducted for all the activities under NRHM. This will be a part of updating knowledge and skill at all level. The details are as below:
2. Orientation of PRI on NRHM activities.
The District Health Mission, led by the Zila Pramukh enables to coordinates, plan and supervise all NRHM intervention in the district. At the village level, the gram Panchayat/ Village Health team is responsible for planning, monitoring, coordination of health and related function and supervision of ASHA. The Panchayat Samiti (block level) supports the Gram Panchayat and serves as the link between DHM and the gram Panchayat. To facilitate coordination between the PRI and the service delivery system, linkages are envisaged at the following levels:
Level1. Community level and Sub centre, primary health centre- Gram Panchayat.
Level 2. PHC, Community Health Centre – Panchayat Samiti.
Level 3. Over all responsibility of NRHM and District Hospital – Zila Parisad.
3. Untied grants to Village Health and Sanitation Committees
The existing Village Health Committee at the Gram Panchayat level oversees all NRHM activities. However, at the state the constitution of the committee is broad based and is called as Village Health and Sanitation Committee. It is headed by ASM at the Gram Panchayat level and by Panchayat representative at the village level.
The roles of VHSC are as follows:
1. Ensuring discussions on Health issues in Gram Sabha.
2. Attendance and participation of women and marginalized groups and Gram sabha.
3. Formulation/synthesis of village health plan.
4. Facilitate birth and death registration, conduct maternal, new born and under five deaths audits; report of outbreak of epidemics.
5. ASHA being accountable to VHSC and Gram Panchayat, payments will be made to her after the approval of Gram Panchayat.
6. Gram Panchayat will be responsible for safety and protection of women workers in that area.
7. To ensure vigilance against indulgence of the provider in unethical and harmful treatment practices; counter stigma against people with particular illnesses, minorities and equitable asses to health services are the responsibilities of VHSC.
Untied grants to every village with a VHSC will be ensure upto Rs. 10000/- for 3862 VHSC provided the committee is constituted, notified and bank account in the name of VHSC is opened. This untied grant would be used for household surveys, health camps, sanitation drives, revolving fund etc.
4. Selection and training of Community Health Workers (ASHAs, AWWs) etc.
The implementation of ASHA is done by Gram Panchayat Committee in consultation with the District Health Society and training conducted as per the guidelines.
5. Performance related incentives for ASHAs, AWWs.
Performance related incentive would be linked up with other vertical programmes and to the schemes of line departments determining the health. Village health committee and Rogi Kalyan samity may decide on release of performance related incentive to ASHAs.
6. Selection, remuneration and training of ANMs.
A total number of 118 ANMs have been recruited so far, under RCH-II and 20 from NRHM additionality. The majority of them are already in SCs. They will be continued this year also and further requirement will be met from the existing ANMs in the state by relocating them to SCs.
7. Selection, training and remuneration of Staff Nurses at PHC/CHC level.
So far 52 (31-RCH + 21 – NRHM) Staff Nurses have been recruited on contract basis. In order to functionalize 2 DH and already functioning 1 DH + 2 GH, 35 SNs will be recruited during the year (7 each in DH / GH) as the gap has been identified during facility survey. This will enhance the relocation of the existing ANMs in these hospitals due to absence of SN.
8. Selection, training and remuneration of Medical Officers at PHCs
As per the envisaged plan under NRHM, it is proposed that 20 Medical Officers (Allopathy), 32 AYUSH MOs would be recruited on contract to be posted in the non functional PHCs. As on date, out of 85 PHCs, 50 are functional in terms of 24X7. It is envisaged that at least 10 PHCs would be made functional during the year. The monthly salary would be Rs 15,000/- Per month for AYUSH MO and MBBS MO.
9. Selection, training and remuneration of Specialists at CHC level.
As proposed in the RCH II PIP,2 DHs will be made functional during the year in terms of providing specialists (trained MOs in Anesthesia, Obstetrics and Paediatrics). Since the training plan is taking time to take off, it is proposed that one each of specialists in in Anesthesia, Obstetrics and Paediatrics will be recruited during the year (n=6). The remuneration would be of Rs. 25,000/ month. The approved activity last year could not be completed as only one Obstetrician only joined the duty. Remaining specialist requirements along with this year’s proposal would be recruited and continued during the year.
10. Construction and maintenance of physical infrastructure of SHCs.
There are 381 SCs in the state. However, out of which 273 are functional and for which, an annual maintenance grant of RS. 10,000 will be available to every SC. This amount will be used for provision for improvement of water supply, toilets, SC building etc as per the GoI guidelines.
For maintenance of 273 SCs @ 10000/ SC as untied fund, the total amount required would be Rs. 0.273 Crores.
For construction of new SC building for Functionalization, 50 SCs at the rate of Rs. 9 Lakhs per SC will be constructed during the year. Rest SCs will be taken up in a phased manner in the ensuing years.
11. Construction and maintenance of physical infrastructure of PHCs.
During the year, 10 PHCs will be made fully functional as 24x7, the infrastructure inputs would be in place.
20 PHC new building will be constructed during the year @ Rs 12 lakhs. This requirement is such that even if the PHC is functional, many PHC buildings are of very bad quality / on the verge of being collapse.
Apart from this, an annual maintenance grants of Rs 50000/- will be made available to each PHC (n=85). Provision for water, toilets, their use and their maintenance, etc, has to be maintained from RKS fund.
Untied fund of Rs 25000/- would be provided to all 85 PHCs during the year.
12. Construction and maintenance of physical infrastructure of CHCs.
Construction of infrastructure for all the identified CHCs would be carried out during the year. The will be an additional requirements required during the year. The putting in of new inputs in the form of OT, blood storage facilities, labour room etc is envisaged for all these CHCs. As per the survey report, the need s are many but the requirement are set on priority. The status of CHC upgradation is as below;
Rogi Kalyan Samiti will undertake maintenance of CHCs from an Annual maintenance grant of Rs. 1 lakh to every CHC to ensure quality services through functional physical infrastructure.
13. Pocurement and distribution of quality equipments and drugs in the health system.
The Drug Kits has already been supplied to the districts for 2006-07. However, with an enhanced funding, it is proposed to include all the existing health facilities. Therefore, additional fund requirements for the year ending March 2008 has been submitted to GoI.
14. Untied grand to SCs, PHCs and CHCs
It will be provided to 273 SCs at the rate of Rs 10,000/- per annum
To 85 PHCs, untied fund of Rs 25000/- will be provided during the year.
Untied fund for CHCs will be provided to 31 CHCs at the rate of Rs 50000/- per annum.
15. Supports for Mobile Medical Unit.
The state will require MMU during the year at the rate approved by GoI. However, during 2006-07, 16 units were approved and released to the state. No maintenance fund for the MMU will be required for this year as the MMU is being operationalized this year. Maintenance fund will be required from 2008-09. The MMU has already been ordered to the companies.
16. Improving physical infrastructure at SC / PHC / CHC /DH.
All the areas for improvement of SC / PHC / CHC have been articulated. The DH upgradation is under way from the fund received from GoI @ Rs 1 crore. Further fund requirements will be put in as additional need as and when the activity is completed.
Requirement of residential quarters for the facilities mentioned below are proposed as per the requirement.
1. PHC: It is proposed to construct 105 quarters for PHC staff (3 additional quarters – one for Mo, 3 for SNs) for 35 PHCs.
2. DH : Due to scarcity of quarters, it has become very difficult to perform round the clock service from far away location and lack of building for hiring. It is proposed to provide 70 quarters (Specialist, MO & SN) at the rate of 5 quarters per DH for 14 districts.
17. Ambulance for PHC / CHC / DH.
The perennial problem of non availability of transport system for referral etc is very evident in all the districts.The ambulances approved last year (4) has already been ordered and have been placed at Tawang(Mukto), Darak, Diyun PHC and Dirang CHC.
18. Rogi Kalyan Samitis / Hospital Management Committees.
To establish a management structure called Rogi Kalyan Samity (RKS) /Hospital Management Committee to ensure a degree of permanency and sustainability of the GH,DH, PHC and upgrade CHCs to Indian Public Health Standards.
RKS are proposed to be established in all GH, DH, Community Health Centres, and Primary Health Centres in the state. The initiative would bring in the community ownership in running of rural hospitals and health centres, which will in turn make them accountable and responsible.
A support of Rs.5.0 lakhs per District hospital fund as corpus fund for 14 DH / GH in the state during the year.
Rs.1.00 lakh per CHC (n=31) and Rs.1 lakh per PHC per annum (85) would be given to these societies.
19. Ceiling on civil works
The proposal is for construction of residential quarters in all the identified health facilities. The quarter would be required to pool Medical Officers, GNM, Laboratory Technicians and Grade IV staff who are otherwise posted to the adjoining CHCs, PHCs and SCs. These staff would visit the adjoining facilities as frequent as possible to provide quality services to the nearby health facilities. The facilities covered are as follows:
1. Basar CHC: This covers 2 CHCs, 3 PHCs and about 15 SCs.
2. Namsai CHC: This is covering 2 CHC, 5 PHCs and 20 SCs
3. Deomali CHC:This will cover 1CHC, 3 PHCs and 15 SCs.
The pooled health staff would visit as per a work out plan to all the health facilities that it covers. Therefore, it is proposed that the following residential quarters may be provided to the identified health facility on priority.
Technical parameters & blueprint
It is proposed to construct RCC type quarters under this proposal as per the technical designs/layouts developed by the State PWD for quarters. The State PWD rate / CPWD for all types of quarter will be followed. Therefore, Type III quarter will cost Rs. 600000/- (Six lakhs) per unit.
20. MAINSTREAMING OF AYUSH.
The state has proposed to incorporate the Medical Officer proposal and co-location / relocation of AYUSH facilities only and the rest of activities for AYUSH will be covered from AYUSH fund through AYUSH Department, GoI.
In Arunachal Pradesh, initially during 1980 Govt. of Arunachal Pradesh introduced the Indian systems of medicine and homoeopathy at various places like District HQ, Hospitals, PHCs and the places where no other health care facilities was not provided to render ISM and Homoeo facilities to the people of the State. Later on, during the course of time seeing the people’s response and gaining popularity of these traditional systems in the state, the Govt. opened the dispensaries. Even though, the concept of bringing all systems of treatment under one umbrella as conceived now under NRHM; in Arunachal Pradesh this concept has been already prevailing i.e. several Ayurvedic and Homoeopathy units are functional under one roof only at District Allopathic Hospitals, PHCs and CHCs.
The Average out patient attendants at each Ayush health care unit is reported 45 to 60 per day as per the District Health reports.
A part of that there are more than 500 known species of medicinal plants are available in Arunachal Pradesh which can be put to use for manufacturing the allopathy, ayurveda and homoepathy, unani, siddha drugs.
Existing manpower and infrastructure:
1.Eleven AYUSH Medical Officers posted in 11 District Hospitals. 8 of them are in CHCs, 10 in PHCs and 8 in GH / Dispensaries under specialty clinic.
2.10 Bedded specialty wing in DHs in 10 DHs, the activity of which is going on and GoI has released the fund.
3.GoI has released funds for 51 facilities with AYUSH manpower @ Rs 25000/ only for essential drugs.
Proposal for sanction of Manpower and infrastructure
There are 23 CHCs, 75 PHCs without AYUSH Doctors. The total requirement of AYUSH Doctor is 98 Nos. Under State Deptt.of Health & FW there are 39 Homoeopathy doctors and 3 Ayurvedic doctors are working on regular basis. During 2006-07, 10 Ayush doctors are appointed on contractual basis under NRHM.
In continuation of mainstreaming of AYUSH under NRHM, it is proposed that 32 AYUSH Doctors will be appointed on contract at a consolidated monthly salary of Rs 15000/- per month.
Proposal for co-location/relocation of AYUSH facilities:
All the AYUSH set up are already a part of existing PHC / CHC / DH / GH. The AYUSH set up are not a separate entity in the state. However, specialty clinic in 3 areas will be co-located to the nearby PHC / CHC. Otherwise, facilities are provided under the broad umbrella of PHC / CHC /DH/GH only.
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