District Health Society, Bhagalpurstatehealthsocietybihar.org/pip2011-12/districthealth...7 Foreword The District Health Society (DHS) of Bhagalpur was formed in the year 2006-07.

District Health Society, Bhagalpur

State Health Society, Bihar

District Health Society, BhagalpurBIHAR

Submitted to:

State Health Society, Bihar

1



Compiled and Approved by :-

----------------------------------------------

-

Dr. (Mrs.) Pratima Modi

Civil Surgeon cum Member Secretary


District Health Society, BhagalpurBIHAR

DISTRICT HEALTH SOCIETY, BHAGALPUR

--------------------------------------------

Mr. Rahul Singh

District Magistrate Cum Chairman


2


DISTRICT HEALTH SOCIETY, BHAGALPUR

--------------------------------------------

Mr. Rahul Singh

(IAS)

District Magistrate Cum Chairman


3

Comments : � Mr. Ajit Pal (DPC, Bhagalpur)

Layout and Design : � Md Zafrul Islam and Md. Infaque Alam

Compiled on :� December-2010.

4

PREFACE

The National Rural Health Mission(NRHM) was launched on 12 April 2005 with the goal of

improving the availability of access to quality health care by people, specially for there

residing in rural areas, the poor, woman and children.

The process of writing DHAP 2011-12 and compiling information from all health

institution was a daunting exercise and would not have been possible without due support

and guidance from various sources. The detailed process documentation gave us an insight

into the efforts, challenges and lessons learned at the block level. The further information

provided by the district level nodel officer where the motivation to put together

information and findings.

This report consists of 8 chapter. Chapter 1 talks about Introduction, methodology

and profile of the district, Chapter 2 talks about SWOT analysis of the part A, B, C, D.

Chapter 3 talks about Part A, Chapter 4 talks about Part B (NRHM additionalties). Chapter 5

talks about Part C, Chapter 6 talks about Part D, Chapter 7 talks about budget and chapter 8

talks about district profile.

We hope this report will provide comprehensive overview of the extensive process

that was carried out in the district.

5

ACKNOWLEDGEMENT

We wish to acknowledge our sincere gratitude for all the support, input and feedback that

we have received.

Firstly we are grateful to Mr. Rahul Singh IAS, DM Cum Chairman District Health

Society Bhagalpur, Mrs Dr. Pratima Modi Civil Surgeon Cum Member Secretary District

Health Society Bhagalpur, Dr. Janardhan Prasad ACMO Cum Nodal Officer District planning

Bhagalpur and all other department for their confidence in us and constant support to us

through out the preparation of DHAP 2011-12 and also for disseminating the experiences

through the meeting.

We would like to thank Mr. Sanjay Kumar Sinha (District Planning Officer,

Bhaghalpur), Mrs Shoba Keshri (District Programme Officer) and others for his./her

support through our the process.

We would also like to thank District level officer of all national programme for

providing inputs in different section of the report. Their inputs have a major source of

information and inspiration of this report.

Colleagues from our department provided us valuable information and deserves a

special mention:

1. Mr. Md Faizan Alam Ashrafi, DPM Bhagalpur

2. Mr. Prem Kumar Jha, DAM Bhagalpur

3. Mr. Dhananjay Kumar D, M & E Bhagalpur

4. Mr. Ajit Pal, DPC Bhagalpur

5. Mr. Md Zafrul Islam, DDA, ASHA Bhagalpur

6. Mr. Md. Infaque Alam, Data Entry Operator Bhagalpur

We would also like to acknowledge the support provided by the ICCHN team in the process

of preparing plan.

1. Mr. Rabi Parhi (ICCHN)

2. Mr. Ziauddin (ICCHN)

And finally we would like to express our gratitude to all staff of DHS who were engaged in

the process of preparing District Health Action Plan 2011-12.

6

CONTENTS

Page Number

Contents…………………………………………………………………….. 6

Foreword………………………………………………………………….. 7

Summary of planning process……………………………………. 8

Chapter I

Introduction, Methodology & Profile……………………… 9-19

Chapter II

SWOT Analysis..……………………………………………………… 20-21

Chapter III

Part – A…………………………………………………………………… 22-54

Chapter IV

Part – B(NRHM Additionalties)………………………………… 55-79

Chapter V

Part – C…………………………………………………………………… 80-83

Chapter VI

Part – D…………………………………………………………………… 84-97

Chapter VII

Budget Envelope……………………………………………………………. 98

7

Foreword

The District Health Society (DHS) of Bhagalpur was formed in the year 2006-07.

Since past 5 years, DHS Bhagalpur has been working dedicatedly to improve the

health scenario in the district.

The National Rural Health Mission lays emphasis on preparation of District Health

Action Plan (DHAP) as means to make public health system efficient and improve

service delivery. The first Health Action Plan was prepared by the District

Programme Management Unit of DHS Bhagalpur for the year 2009-10. Successively

second Health Action Plan was made for 2010-11.

This is the third year when we have undertaken an elaborate health planning

exercise. It is my pleasure to present the Bhagalpur District Health Action Plan

for the year 2011-2012. This plan is a result of collective endeavor of our

programme management unit. Various rounds of consultation workshops at the

district and sub-district level were conducted. Trainings were organized for the

Block Programme Management Unit teams. Based on the requirements at various

levels and the priorities concerning the district, an attempt has been made to come

up with a plan that addresses the problem regional disparity in availability of

health services and also improve quality of services in existing institutions.

I congratulate the members of DPMU and BPMUs for successful completion of this

plan. It is because of their hard work and commitment that this plan has been

possible. The Fast Track Capacity Building Training organized by State Health

Society, Public Health Resource Network and National Health Systems Resource

Centre has been very helpful for writing this plan. I also thank the ICICI

Foundation for Inclusive Growth for facilitating the planning process in the

district.

_______________________

Dr. (Mrs.) Pratima Modi C.S cum Member Secretary District Health Society, Bhagalpur.

8

Fast Track Capacity Building Fast Track Capacity Building Training of district team for

preparation of DHAP

Preliminary meeting with CMO and ACMO along with other concerned officials

Data Collection for Situational Analysis

Block level consultations with MOICs and BHMs

Writing of the Situation Analysis

District Planning workshop to review situation analysis and prepare draft

District Consultations for preparation of 1st Draft

Preliminary appraisal of 1st Draft

Final appraisal of Draft

Approval of the Plan at district level

Submission of the Plan by DHS to State Health Society

Printing and Dissemination

Summary of the Planning Process

9

CHAPTER- I

Introduction

The National Rural Health Mission (NRHM) was launched on 12 th April, 2005 with an

objective to provide effective health care to the rural population. The NRHM covers the

entire country, with special focus on 18 states where the challenge of strengthening poor

public health systems and thereby improve key health

indicators is the greatest. These are Uttar Pradesh, Uttaranchal, Madhya Pradesh,

Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Himachal Pradesh, Jammu and

Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram, Sikkim and

Tripura. NRHM is a comprehensive health programme launched by Government of India to

bring about architectural corrections in the health care delivery systems of India. The

NRHM seeks to address existing gaps in the national public health system by introducing

innovations, community orientation and decentralisation in its workings. The mission aims

to provide quality health care services to all sections of society, especially for those residing

in rural areas, women and children by increasing the resources available for the public

health system, optimising and synergising human resources, reducing regional imbalances

in the health infrastructure, decentralisation and district level management of the health

programmes and community participation as well as ownership of the health initiatives.

District level health planning and management facilitate improvement of health systems by

1) addressing the local needs and specificities 2) enabling decentralisation and public

participation and 3) facilitating interdepartmental convergence at the district level. Rather

than funds being allocated to the States for implementation of the programmes developed

at the central government level, NRHM advises states to prepare their perspective and

annual plans based on the district health plans developed by each district. DHAP seeks to

achieve pooling of financial and human resources allotted through various central and state

programmes by bringing in a convergent and comprehensive action plan at the district

level.

10

Figure 1: Map of Bhagalpur

11

Introduction to Bhagalpur District: There are thirty eight districts in Bihar. Bhagalpur district is located in the south-east

region of state. It has adjoining administrative boundaries with six other districts of Bihar,

namely Munger, Khagaria, Madha, Purnea, Kathiar & Banka and two districts of Jharkhand,

namely Godda & Sahebganj. It is situated 220 km east of Patna, the state capital of Bihar,

and 410 km north-west of Calcutta.

Geographically, it lies on the plains of the Ganga basin at a height of 141 feet above sea

level. It covers an area of 2569.50 sq. km. It lies between 25o 07- 25o 30' N Latitude and

between 86o 37 '- 87o 30'E Longitude.

There are 16 administrative Blocks in Bhagalpur, namely Bihpur, Gopalpur, Goradih

Jagdishpur, Kahalgaon, Pirpaithi, Sabour, Sanahaulla, Shahkund, Sultanganj,

Naugachhia, Kharik, Narayanpur, Nathnagar, Rangra, and Ismailpur.

History:

Bhagalpur was the kingdom of Anga rulers. The city has been described as one of the

biggest trade centers in eastern India in the 7th century by Chinese travelers Hiuen

Tsang and Fa Hien. The city in ancient era was also called Champanagar. During an

archaeological excavation, many boats and coins of the Middle and far east found

here.

Bhagalpur was also one of the prominent centres of Buddhist learning in Ancient

India. The evidence of its historical prominence is the remnants of the Vikramshilla

University, still a pilgrimage and tourist site in Bhagalpur. The Vikramshila

University was considered only next to Nalanda University and was counted among

the few prominent centers of learning in Asia. It was built during the rule of King

Dharmapala (770-810 AD).

Ancient cave sculptures of Emperor Ashoka’s regime (274BC – 232 BC) have been

found here and at Sultangunj, 20 km west of Bhagalpur, a temple of the Gupta period

(320-500) still exists. The tomb of Suja, brother of Moghul emperor Aurangzeb, in

12

the heart of the town is reminiscent of the city's association with the Mughal period.

During the Tughlaq period it was a mint town and was greatly patronised by the

Mughals.

Bhagalpur has had a rich cultural history. It is said that the legendary Rabindranath

Tagore lived in Bhagalpur, as did the two great personalities of Hindi Cinema, Ashok

Kumar and Kishore Kumar. Kishore Kumar’s ancestral home is still present in

Bhagalpur. One of the most famous literary figures of Hindi literature, Sharat

Chandra Chattopadhyay is reported to have written his classic work “Devdas”

amidst the scenic beauty of the river Ganges in Bhagalpur.

Agro-Climatic Situation in Bhagalpur District:

The climate of Bhagalpur district is sub- humid and sub-tropical monsoon type with

average annual rainfall around 1167.16 mm. The farming situations in the district are

extremely diverse. The largest area consist of old alluvial soils in south of river Ganges.

These are typical rice producing sole crop grown in these lands during kharif season

followed by wheat, gram and a number of Para crops during rabi season. A sizeable areas of

the district is under ‘Diara lands’ which remains unde flood water during rainy season.

However these lands are intensively cultivated in post – flood kharf season, rabi season,

summer season and pre-kharif seasons. Maize, wheat, green gram are the most important

crops of the area while banana is the cash crop covering a sizeable area in Naugachia sub-

division falling north of the river Gangs. The soil here is highly permeable with sand layers,

The alluvium brought during flood serves as a good source in replenishing soil fertility. In

the southern flank of the river Ganges there is some area referred to as ‘Teal lands’. These

are bowl Shaped depressions where accumulates during rainy season. When this

accumulated water percolates or evaporates the land is available for cultivation some times

in the months of October. These are heavy montmorrilonite type clays which develops wide

ad deep cracks during summer season, which also forms means for speedy percolation of

accumulated water. Such lands are ideally suited for pulses and oilseeds during season. A

part of the area of Bhagalpur district is also in the foot hills of mountain ranges if

Kharagpur, Munger and Rajmahal. These lands are sloppy and highly permeable. Arhar,

13

groundnut and maize are the major crops during kharif season and pulses and oilseeds

having low water requirement are preferred during rabi season. Rice is also cultivated in

plane low lying area known as done lands.

The Rainfall is mainly influenced by the south west monsoon which sets in the second week

of June and continues up to end of September. Sometimes cyclonic rain also occurs. The

rainfall distribution is marked seasonal in character. Greatly limiting water availability in

certain times of the year and sometime it requires of excess water during monsoon. In

Bhagalpur, rainfall influenced mainly by the south-west monsoon state in the second week

of June and continues up to the end of September. The average rainfall in the district is

1167.16 mm.

Soil of Bhagalpur district is grey to red in colour, medium to heavy in texture; slightly to

moderately alkaline in reaction, cracks during summer (1 cm to more than 5 cm wide and

more than 50 cm deep) become shallow with onset monsoon, with clay content neatly 40

% to 50 % throughout the profile. Based on the agro climatic condition and topography of

the area, Bhagalpur can be divided into four regions: Diara, Tal, Plain Hilly regions.

Due to lack of information facilities in the area, modern technologies have not percolated

down to the farmers. There is immense potential of increasing agricultural income through

the initiation of improved agricultural income through the initiation of improved

agriculture in the area.

RIVER SYSTEM:

The Ganges flows from west to east cutting the district in its northern side. In the middle, a

great mass of granite divides the river in to two great bends, one north ward round the

town of Bhagalpur, the second south wards to Kahalgaon, where it meets a range of hills.

The average width of its bed is three miles. During summer, the water course is only half a

mile wide, whereas during monsoons, it is five to ten miles wide.

The chandan is the largest of the hill streams in the south of the district. It originates from

the hills of North Parganas, and joins the Ganga. It floods the plains of south Bhagalpur

during the rainy season.

14

Bhagalpur District at a Glance

Population Male

1549129

Female

1406312

Total

295544

1

Literacy Rate 59.2 58.13 49.5%

SC Population % - - 10.51%

ST Population % - - 2.29%

Population Growth (1991 –2001) 26.90

Population Density 943

Number of

Household

Total

492573

Rural

389132

Urban

103441

Type of house (%) Pucca 24.70 Kuchha 75.30

Number of electrified villages 445

No. of villages with primary school 642

No. of villages with middle schools 216

Villages with mud approach road 804

Percentage of net area sown to geographical

area 2006-07

56.65

Particulars Data

Number of Sub-Division 3

Number of Blocks 16

Number of Municipality 4

Number of Gram Panchayat 242

Number of Police Station 48

Number of Inhibited Villages 951

Number of Uninhibited Villages 585

Number of Villages 1536

15

Name of

Sub

Divisions

Name of

the

Blocks

Total

Popul

ation

No. of G

P

Rev

enue

Villa

ge

% o

f

Liter

ate

s

% o

f SC

Popula

tion

% o

f ST

Popula

tion

Sex

Ratio

Sadar

Bhagalp

ur

Jagdishpur 124471 15 164 67.1 9 - 873

Nathnagar 125267 14 153 45.43 11 - 876

Shahkund 156554 19 170 46.79 13 2.8 895

Sultanganj 149771 19 150 54.74 17 - 876

Goradih 115816 15 119 38.82 14 - 872

Sabour 112782 14 84 51.22 12 0.2 863

Kahalg

aon Kahalgaon 294970 28 211 47.93 13 4.4 868

Pirpainti 222706 29 113 42.65 11 14.8 875

Sanhoulla 154083 18 177 40.12 13 - 912

Naugach

ia

Naugachia 125956 10 22 47.7 6 0.1 864

Narayanpur 85118 11 31 44.68 6 - 881

Bihpur 100180 13 42 48.59 9 - 881

Kharik 105972 13 35 42.06 8 - 881

Ismailpur 40752 5 15 34.98 5 - 877

Gopalpur 79567 9 20 47.19 8 0.5 875

Rangra 75927 10 11 43.88 8 3.9 862

Bhagalpur is administratively divided into three sub-divisions – Bhagalpur Sadar,

Kahalgaon and Naugachhia. As shown in the table, six blocks come under Bhagalpur

Sadar, three under Kahalgaon and seven under Naugachhia. Kahalgaon has the

highest population around three lakhs. Average Literacy rate in the district is 45%.

Jagdishpur has highest literacy rate of 67% followed by Sultanganj at 54%.

16

BLOCK WISE STATUS OF DRINKING WATER

Block Total

no. of

habitati

on

Functional

sources of

drinking

water

Category wise functional

sources

Hand

Pump

Tube

Well

Piped

water

Jagdishpur 373 1022 1019 3 3

Nathnagar 279 1048 1047 1 1

Shahkund 409 1159 1159 2 3

Sultanganj 400 1184 1181 3 2

Goradih 208 1015 1014 1 1

Sabour 195 1048 1044 4 4

Kahalgaon 208 1985 1982 3 4

Pirpainti 288 2102 2102 0 0

Sanhoulla 157 1126 1122 4 4

Bihpur 46 1175 1175 0 0

Narayanpur 31 819 819 0 0

Kharik 50 1121 1121 0 0

Ismailpur 28 345 345 0 0

Gopalpur 28 700 700 0 0

Rangra 31 579 578 1 1

Naugachia 76 907 905 2 2

Safe drinking water is essential for maintenance of good health. Availability of safe

drinking water is an important Public Health requirement. In Bhagalpur, a large

number of people have access to functional sources of water. Most of the people us

wells, rivers and hand pumps and the provisioning of piped water is very low. The

poor people have to commute to fetch water for their use. The Dalits and landless

people, marginal farmers are dependent on other classes and communities for

availing water. The wells and tube wells are not regularly cleaned and sanitized. In

the interest of the common people, and reduce frequent disease occurrences in the

district, it is very important that more and more people are provided with safe

drinking water.

17

BLOCK WISE SCHOOL INFRASTRUCTURE

Sl

No.

Block Total no

of school

% of

schools

without

own

building

%of

school

without

Drinking

water

facility

%of

school

without

toilet

facility

% of school

without

kitchen for

mid‐‐‐‐day

meal

1 Jagdishpur 108 12.96 16.67 36.11 67.59

2 Nathnagar 106 9.43 9.43 16.04 45.28

3 Shahkund 153 3.27 4.58 13.73 49.02

4 Sultanganj 167 9.58 10.78 23.95 57.49

5 Goradih 105 10.48 7.62 19.05 53.33

6 Sabour 70 7.14 4.29 12.86 7.14

7 Kahalgaon 186 11.83 13.98 24.19 62.37

8 Pirpainti 184 8.15 9.24 20.65 52.72

9 Sanhoulla 144 13.19 15.97 36.81 43.06

10 Bihpur 81 12.35 12.35 19.75 45.68

11 Narayanpur 67 14.93 12.5 26.87 55.22

12 Kharik 72 20.83 2.94 25 54.17

13 Ismailpur 34 5.88 8.33 17.65 47.06

14 Gopalpur 60 8.33 8.33 30 33.33

15 Rangra 46 2.17 8.7 23.99 54.35

16 Naugachia 91 13.19 12.09 21.98 64.84

17 Nagar

Nigam

149 20.81 30.87 36.91 83.22

Total 1823 10.85 11.1 23.85 51.52

Source: SSA, BEP Bhagalpur

Education plays a complementary role in Public Health. If people are educated, they

become more aware of their rights and entitlements, become more asserting in

demanding their rights. Thus an educated citizenary strengthens the functioning of

government system. Education also inculcates behavior of hygine, sanitation in

personal life and citizens understand the actual causes of disease and illness.

In Bhagalpur district, the public schooling system is functional, but the quality of

education and school infrastructure still needs a lot of improvement. A large number

of schools in Bhagalpur do not have a proper school building which a very minimal

and basic requirement of any schooling system. Of the 1823 schools in the district, a

large number of districts do not either drinking water facility or toilets.

Unavailability of these basic infrastructure is an impediment in enhancing both

health and education of the people of Bhagalpur.

18

BLOCK WISE STATUS OF PDS BENEFICIARIES

Sl

No

Block No. of BPL

Cards

No. of

AAY

Cards

No. of APL

Cards

No. of

Annapur

na Cards

1 Jagdishpur 17307 3049 17954 193

2 Nathnagar 13169 2392 14182 80

3 Shahkund 18184 3451 16159 163

4 Sultanganj 22863 4221 19623 413

5 Goradih 16290 2978 9075 127

6 Sabour 12616 2198 14459 84

7 Kahalgaon 31590 5382 33437 248

8 Pirpainti 32606 5431 27917 39

9 Sanhoulla 20475 3977 12384 121

10 Bihpur 13562 2405 13129 84

11 Narayanpur 9013 1436 14997 51

12 Kharik 15475 2541 12771 102

13 Ismailpur 4684 650 4753 58

14 Gopalpur 8985 1434 9795 74

15 Rangra 9939 1813 7311 96

16 Naugachia 11050 1803 9879 94

17 Bhagalpur

Town

21076 5974 70411 282

18 Sultanganj

Town

7134 2022 4804 78

19 Kahalgaon

Town

2386 676 4524 18

20 Naugachia

Town

7135 2022 3439 18

Total 295539 55855 321000 2423

Though Bihar’s share in India’s population is one-twelvth, it accounts for one-

seventh of those living below the poverty line, and one-sixth of the malnourished

children. The Public Distribution System (PDS) is an important public provisioning

of food grains for the poor people of the country. From the data above, it cannot not

be said that the whether all the needy people of the district are covered under the

scheme, though the likelihood of the deserving poor remaining excluded is very

high. There are 29 lakhs 55 thousnd BPL card holders in the district and 321000

Above Poverty line beneficiaries. There are 55855 beneficiaries of Antodaya Anna

Yojna. There are 2423 beneficiaries of AnnaPurna Yojna.

19

BLOCK WISE NUTRITIONAL STATUS OF CHILDREN (0-6 YEAR)

Block Tota

l no.

of

AW

C

Total

no. of

childr

en (0-

6

year)

% of

children

weighed

Normal

grade

childre

n (%)

Grade

I

childre

n (%)

Grade

II

children

(%)

% of

severely

malnouris

hed

children

Jagdishpur 121 9600 44.14 38 22 14 25.82

Nathnagar 122 4760 42.84 10 29 33.29 27.71

Shahkund 153 12000 100.00 42.75 27.25 20.84 9.16

Sultanganj 200 39131 36.09 40 17.25 13.04 29.71

Goradih 113 6996 82.73 28.4 27.09 22.17 22.34

Sabour 110 21856 25.87 0 40 37 23.48

Kahalgaon 301 58483 38.44 19 32.4 23.4 25.20

Pirpainti 219 17520 27.83 31 28 26.33 14.67

Sanhoulla 151 12080 94.70 40.5 28.75 22.75 8

Bihpur 97 17460 54.07 22.8 26.2 38.7 11.17

Narayanpur 82 12049 59.89 23 24 38 15.01

Kharik 103 18540 61.11 32 24 33 10.91

Ismailpur 38 3040 100.00 0 34.7 50.23 15

Gopalpur 76 10260 65.19 24 28 37 11

Rangra 67 9112 64.71 24 28 37 10.99

Naugachia 123 9280 32.50 0 37.86 25.66 36.47

Bhagalpur

Town

129 10320 100 50 13.87 21.12 15

Total 2205 27248

7

1030.09 425.45 468.37 493.53

Bhagalpur has 2205 Anganwadi Centers. This is much lower compared to the

mandated norm of one Anganwadi Center for every 40 children in 0-6 year age

group. As per the data available, Naugachhia has the highest number of

malnourished children, followed by Sultanganj and Kahalgaon. But this could be

possible because the reporting from other blocks is either very low, cases go

unreported or because all these are large areas with higher population, closer to

district headquarters and reporting is better. A comparative conclusion based on

this data could be unreliable.

20

Chapter -II

SWOT Analysis of Part A,B,C & D

Strength Weakness Opportunity Threat

Part

-A

1. Owing to decentralized

planning process MCH

service is easily

accessible to the

community.

2. Strength of infrastructure

and human resource

provided facility to the

community.

3. By multi skilled trained

doctor and paramedical

staff provided health

service for the

community.

1. Poor

infrastructure

status that is not

up to IPHS norms

hence challenge

for maternal

health, child

health, family

planning service.

2. Earlier shortage of

human resource is

challenge for

maternal health,

child health,

family planning

service.

3. In adequate

training session

for the MO and

paramedical staff.

1. Decentralized

planning ensured

community

participation

2. Optimum utilization

of allocated budget

that is ensured better

financial absorption.

3. HMIS assisted to

make the plan

realistic and

implementable.

1. Poor health service at

facility that is

maternal health, child

health and family

planning can generate

chaos among the

community.

2. Poor infrastructure

status and shortage of

manpower leads to

discontentment of

community.

3. Unavailability of

medicine and

equipment can

generate the

dissatisfaction.

Part-

B

1. Due to decentralization,

strengthening of physical

infrastructure, contractual

manpower, referral and

emergency transport

under NRHM

additionalties got strength

for smooth functioning of

health program.

2. Involvement of ASHA

became threshold for the

different health activities

3. Innovative schemes can

be launched such as birth

preparedness and

construction of rest room

for ASHA at health

institution will add

upliftment in health

service.

1. Earlier there was

no PPP initiatives

2. There was no

concept for

decentralized

planning for

District Health

Action Plan.

3. There was lack of

fund for

infrastructure

strengthening.

1. Due to PPP mode

health facility can

be ensured to entire

vulnerable section

of the community to

their doorstep.

2. Community got the

help through

ASHA/Volunteer

workers for their

demand.

3. Untied fund for

VHSC, HSC, PHC

provided better

health facility for

the community.

1. Hurdles in actual

expenditure of

allocated budget due

to involvement of

RKS/PRI members

etc.

2. Untimely completion

of government

building due to

different department

agency.

3. Delay payment of

outsourcing agency.

21

Strength Weakness Opportunity Threat

Part

-C

1. With the introduction of

incentive for

ASHA/AWW/ANM under

Muskan Ek Abhiyan

Scheme increased the

immunization coverage.

2. With the recruitment of

ANMR/Outreach service

has been improved

sharply.

3. Budget provision for

mobility support, cold

chain maintenance and

focused on slum and

under served area in urban

made the RI coverage

satisfactory.

1. Earlier there was no

such incentive for

AHSA/AWW/ANM

for RI program.

2. Owing to lack of

paramedical staff

health service was

unsatisfactory.

3. RI session planned

and held was not

monitored.

1. By the incentive

provision to

ASHA/AWW/ANM

immunization coverage

has shoot up

considerably.

2. Budget provision

assisted in monitoring

of RI session.

3. Budget provision paved

the way to recruit MO

and Paramedical staff.

1. Lack of

monitoring

and

supervision

can hamper RI

activities.

2. Untrained

paramedical

staff is

challenge to

injection

safety.

3. AEFI can be

panic if not

handled in the

supervision of

MO or trained

Paramedical

staff.

Part-

D

1. Convergence of all

national program within

NRHM paved the way for

integration with all health

programs.

2. Due to decentralization

specific plan for each

national program can be

made.

3. Allocated expenditure of

all national program can

be monitored through

DHS.

1. Earlier all national

program were

running vertically.

2. There was no

opportunity to make

specific plan for each

program.

3. Monitoring and

supervision of all

national program was

unsatisfactory.

1. Chance to integrate all

national program under

NRHM.

2. Close supervision of

expenditure of all

national program

through DHS.

1. Poor BCC/IEC

of national

program can

deprive the

community

from health

facility.

2. Untrained

paramedical

staff can be

hurdle for the

program.

22

CHAPTER III

(PART – A)

Health Institutions/Facilities at a Glance:

Type No. of Facilities/Institutions

1 District Hospital 1 (At Bhagalpur headquarter)

2 Sub-Divisional

Hospital

1 (At Naugachhia)

3 Referral Hospital 3 (At Pirpaithi, Nathnagar and Sultanganj)

3 Primary Health

Centers

13 (Bihpur, Gopalpur, Goradih Jagdishpur, Kahalgaon,

Sabour, Sanahaulla, Shahkund, Naugachhia, Kharik,

Narayanpur, Rangra, and Ismailpur)

4 Additional PHC 54

5 Health Sub-Centers 280

Gaps in Health Infrastructure

Type Building Blood

Storage Unit

New Born

Corner

Labour

Room

OT

1 District

Hospital (1)

Yes Not in

Operation

Avail Yes Yes

2 Sub-DH (1) Yes Not in

Operation

Avail Yes Yes

3 Referral

Hospital (2)

Yes Not Available 1 Avail 1 NA Yes Yes

4 Primary

Health Centers

(14)

Yes ?? Not

Available

?? Not

Available

??Yes Yes

5 Additional

PHC (54)

?? Not Available Not

Available

Not Available

6 Health Sub-

Centers (280)

?? Not Required Not Required Not

Required

Not Required

23

Human Resources at a Glance – Part I Human Resources at a Glance – Part II

Specialisation

Regular Contract

Medical Officer 47 59

Medical Officer

(Ayush)

6 49

Grade A Nurse 13 62

LHV 14 0

ANM 354 211

MPW-Male (BSW) 40 0

Compounder 6 0

Dresser 10 0

Pharmacist 11 0

OT Assistant 0 0

X-Ray Technician 0 1

Lab Techinician 2 25

Total 503 407

Sanction Posted Gap

MPW (M) 59(R) 40(R)

Compounder 57(R) 06(R) 51

Radiologist -- -- --

Anesthetist -- -- --

Dresser 71(R) 10(R)

Pharmacist 73(R) 11(R)

OT Assistant 4(R) 0

X-ray technician 4(R) 0(R), 1(C)

Specialisation Regular Contract

MD (physician) 0 1

Surgery 4 3

Gynaecologist 0 2

Paediatrician 4 0

Orthopaedics 1 1

Ophthalmologists 2 0

MO (Pathology) 0 0

ENT 1 0

Radiologist 1 0

Bio-chemistry 0 0

Physiology 0 0

Anesthetist 1 1

Total 14 8

Sanction Posted Gap

Specialist 14(R), 8(c)

MO 134

(R)

56 78

MO

(Ayush)

16(R) 6(R),

49(c)

10

Grade A

Nurse

18(R) 13(R),

62(c)

5

LHV 54(R) 14(R) 40

ANM 397

(R)

354(R),

211(c)

43

24

Health Services at a Glance

April’09 to March’10

Sl

N

o

Name of

Facility

Facility

Level

Facilities Available

OPD Institutional

Delivery

Immuni

sation

Family

Plannin

g

1 Sadar Hospital, Bhagalpur

DH 142492 4079 472

2 SDH, Naugachia FRU 76530 4364 787

3 RH Pirpaiti 24*7 78750 3425 1172

4 RH Sultanganj 24*7 122515 3455 862

5 PHC Kahalgaon 24*7 84683 3121 1093

6 PHC Nath Nagar 24*7 95888 2363 564

7 PHC Gopalpur 24*7 50897 2338 333

8 PHC Jagdishpur 24*7 77949 2523 584

9 PHC Sabour 24*7 125848 3043 1087

10 PHC Shahkund 24*7 83683 2572 617

11 PHC Narayanpur

24*7 40950 0 0

12 PHC Kharik PHC 2770 0 0

13 PHC Goradih PHC 33525 0 0

14 PHC Rangra PHC 00 00 00

15 PHC Naugachia 24*7 32901 0 559

16 PHC Ismailpur PHC 00 00 00

17 PHC Sanhaulla 24*7 47983 1920 509

18 PHC Bihpur 24*7 65249 3204 274

25

Reproductive and Child Health

Situation Analysis - Maternal Health and Child Health:

Summary-Apr'09 to Mar'10

ANC

ANC Registration

against Expected

Pregnancies

46434/90470 TT1 given to Pregnant women

against ANC Registration 39228/46434

3 ANC Check ups

against ANC

Registrations

25100/46434 100 IFA Tablets given to

Pregnant women against ANC

Registration

45212/46434

Deliveries

Unreported

Deliveries against

Estimated

Deliveries

39315/63329 HOME Deliveries( SBA&

Non SBA) against Estimated

Deliveries

209/63329

Institutional

Deliveries against

Estimated

Deliveries

24014/63329 HOME Deliveries( SBA&

Non SBA) against Reported

Deliveries

209/24014

Institutional

Deliveries against

Reported Deliveries

24014/24223 C Section Deliveries against

Institutional Deliveries( Pvt

& Pub)

17/24014

Births & Neonates Care

Live Births

Reported against

Estimated Live

Births

21008/82246 New borns weighed against

Reported Live Births 16306/21008

Still Births

(Reported) 538 New borns weighed less

than 2.5 kgs against

newborns weighed

2350/16306

Sex Ratio at Birh -- New borns breastfed within

one hr of Birth against

Reported live Births

12310/21008

26

Child Immunisation( 0 to 11 mnths)

BCG given against

Expected Live

Births

70478/82246 Measles given against

Expected Live Births 68582/82246

OPV3 given against

Expected Live

Births

75619/82246 Fully Immunised Children

against Expected Live Births 68582/82246

DPT3 given against

Expected Live

Births

76144/82246

Family Planning Family Plannig

Methods Users (

Sterilisations-Male

&Female)+IUD+

Condom pieces/72

+ OCP Cycles/13)

31256 IUD Insertions against reported FP

Methods 6788/31256

Sterilisation

against reported FP

Methods

20742 Condom Users against reported FP

Methods 2032/31256

OCP Users against reported FP

Methods 694/31256

Other Services OPD Major Operations

IPD Minor Operations

The Health care services in Bhagalpur have been improving over the years. With

more facilities being operational, and PHCs providing better in-patient and out-

patient services, the patient load on facilities have been increasing. Of total, in the

financial year April 2009-March 2010, around 11 lakhs 62 thousand out-patient

cases were handled, while 36thousand 400 hundred deliveries took place in

government health facilities. Around 8900 family planning operations were done.

While 46000 women registered for Ante-Natal Care, only 25000 could be provided 3

Ante-Natal Check up. The government of India’s latest guidelines on ANC

recommend 4 ANC checkups. Thus, a large number of women are dropping out from

complete ANC and steps need to be undertaken to cover all pregnant women for

ANC.

27

Operationalisation Plan 2011-12

1) Institution strengthening for Critical Emergency Obstetrics and Neonatal

Care (CEmONC)

1. Strengthening of First Referral Units (FRU) at District Hospital to

provide CEmOC services. Presently, it is not fully operational as a

CEmONC facility.

2. Up gradation of Sub-Divisional Hospitals at Naugachhia as a CEmONC

facility. SDH Naugachhia is presently designated as a FRU but not fully

operationalised.

3. Upgradation of 2 Referral Hospitals at Nathnagar and Sultanganj as a

CEmONC Center.

4. Strengthening of Primary Health Center at Pirpaithi as a CEmONC

facility. Presently, PHC Pirpaithi is designated as a FRU but not fully

operationalised.

5. Upgradation of 2 PHCs at Kahalgaon and Sanahaulla to CEmONC level.

A Critical and Emergency Obstetrics and Neonatal Care (CEmONC) facility is

understood to mean a facility that provides following services:

1. C-Section Delivery

2. Blood Storage Unit

3. Referral Transport

4. Sick and New-born care unit/ Neo-natal Stabalisation unit

5. Clinical Management of PPH

6. MTP in second trimester

7. Management of Post-abortion complications

8. ICTC

9. NSV

10. Tubectomy

11. Blood Grouping/cross matching/RH typing/Weight

mount/VDRL

In total, it is planned that 7 facilities will be developed as CEmONC centers in

Bhagalpur district during the plan period 2011-12

28

2) Development of Basic Emergency Obstetrics and Neonatal Care (BEmONC)

centers

1. Up gradation of 8 PHCs to provide BEmONC care at :

Gopalpur, Jagdishpur, Sabour, Shahkund, Kharik, Narayanpur,

Naugachhia and Goradih

A BEmONC Center is understood to mean a facility that provides following set of

services:

1. 24x7 SBA Asisted Delivery

2. New Born Corner

3. Blood Grouping/RH typing/Weight mount/VDRL

4. Episitomy and Suturing Cervical tear

5. Assisted Vaginal Deliveries (Outlet forceps vaccum)

6. Management of Eclampsia/PPH/Sepsis/Shock

7. MVA Abortion

8. First Trimester MTP

9. Management of RTI/STI

10. NSV

11. Tubectomy

12. Referral Transport

3) Strengthening of 2 PHCs – Rangra and Ismailpur to function at SBA level

4) Strengthening ____ APHCs and ____ HSCs to function at SBA level

A Skilled Birth Attendant (SBA) level facility is understood to mean institutions that

provide following facilities:

5) Other Strategies:

1. Normal Delivery with the use of partograph

2. Referral Linkage

3. 0 day Immunisation (OPV,BCG Immunisation)

4. Emergency Contraceptive Pills

5. Copper T

29

� Strengthen the Outreach services to increase ANC and PNC coverage

� Increase coverage of Child Immunisation in hard-to-reach areas

through special sessions and camps etc and organization of Village

Health and Nutrition Day (VHND)

� Promotion of contraception use among eligible couples, unmet needs

of NSV and Tubectomy

Situation Analysis of Infrastructure of existing and Proposed FRUs:

Sr

No

Name and

place of

facility

Type of

facility

Total

Number

of beds

Blood

Bank /

BSU

Available

(Y/N)

SNCU/NSU/

New Born

Corners

(Y/N)

Labour

Room

OT

Wa

ter

Ele

ctr

icit

y

To

ile

ts

Functional FRU

1 Sadar Hospital

DH 30 NO Yes Yes Yes Yes Yes Yes

Proposed FRUs

2 SDH Navgachiya

Designated FRU

30 Yes Yes Yes Yes Yes Yes Yes

3 RH Pirpainti

Designated FRU

30 Yes Yes Yes Yes Yes Yes Yes

5 PHC Nathnagar

Referral Hospital

30 NO Yes Yes Yes Yes Yes Yes

6 RH Sultanganj

Referral Hospital

30 NO Yes Yes Yes Yes Yes Yes

PHC Kahalgawn

24*7 PHC 06 NO Yes Yes Yes Yes Yes Yes

7 PHC Sanhoula

24*7 PHC 06 NO No Yes Yes Yes Yes Yes

30

Up-gradation and Operationalisation Plan of Existing and Proposed FRUs as CEmONC

Name of

facility

Beds

to be

increa

sed

BSU to

be

started

SNC

U/

NSU/

NBC

New

Work*

Repair/

Rennov

ation*

Major/Min

or Repair

ILR

Points

Required

Functional FRU

1 Sadar

Hospital

70 Y N Ward (2) N Y (4) N

Proposed FRU

2 SDH

Navgachiya

70 N N N N N N

3 Pirpaithi 40 N N Ward (2) N Y (4) N

4 Nath Nagar 40 Y N Ward (2) N Y(4) N

5 Sultan Ganj 40 Y N Ward (2) N Y(4) N

6 Kahalgaon 64 Y Y Ward (2) N Y 4 N

7 Sanhaula 24 Y Y Ward (2) N Y(4) N

Based on the above Situation Analysis, it is understood that there are seven key

institutions in the district of Bhagalpur which can be developed as CEmONC centers.

They already have the basic infrastructure required to develop a facility into a

CEmoNC center like hospital building and number of beds and new born corner etc.

District Hospital, SDH Naugachhia, Referral Hospital at Nathnagar and sultanganj,

PHC at Pirpaithi, all have 30 beds infrastructure. Thus, these facilities have been

selected amongst others because other facilities do not have a required base. The

Primary health Center at Sanahoulla has been selected to be developed as a

CEmONC center because of its geographical marginality in the district. It is one of

the remotest and under-developed regions in Bhagalpur and there are no significant

health facility in the vicinity of Sanahaulla Block. People from this block have to

come all the way to the district headquarter at Bhagalpur for any case complicated

treatment etc.

31

Thus it is proposed that the Blood Storage Units shall be provided in all the five

facilities, say Sadar Bhagalpur, PHC Nathnagar, Sultanganj, Kahalgaon, Sanahaulla

where there is no Blood Storage Unit. (Naugachia and Pirpaithi already have Blood

Storage Units, so it is not being demanded).

The number of beds needs to be substantially increased across all facilities. It is

planned that at least 70 more beds need to be added each to Sadar Hospital and SDH

Nauagachia, 40 more beds each in Pirpaithi, Sultanganj, and Nathnagar, at least 65

beds in Kahalgaon and 24 beds in Sanahoulla.

If more beds have to be added to accommodate more in-patients, two more wards

need to be constructed in all facilities to house the same.

Major Repair and renovation work needs to be undertaken in all facilities to make

them functional. Funds would be required accordingly.

Situation Analysis of Human Resources in existing and proposed FRUs:

Name of

facility

Obs/

Gynac

Anes

thet

ist

Ped

iatr

icia

n

Surg

eon

MO SN ANM LT

Existing FRU

1 Sadar

Hospital 1 1 1 1 5 4 1 1

Proposed FRUs

2 SDH

Navgachhiya 1 1 0 1 4 4 0 1

3 Pirpaithi 0 0 1 1 8 4 1 1

4 Nath Nagar 1 0 0 1 7 3 1 4

5 Sultanganj 0 1 0 1 11 4 1 1

6 Kahalgaon 0 0 0 0 7 4 2 1

7 Sanhaula 0 0 0 0 7 0 1 0

Total 3 3 2 5 49 23 7 9

32

The district of Bhagalpur has a population of approximately 29 lakhs. To be able to

provide effective and quality health care services to such a large population, an

skilled cadre of medical practitioners is a must. However, unlike the rest of Bihar,

Bhagalpur also suffers from acute shortage of specialist doctors in the Public Health

System.

There are only 3 specialist doctors in Obstetrics and Gynecology. With such a

miniscule number of specialists in Obs/gync, it is difficult to control maternal deaths

and delivery related complications. Similarly there are three Anesthetists for the

entire district, of which one has been provided via multi-skilling of an MO. The

district manages with only 2 pediatricians and 5 surgeons!

Recruitment and Hiring Plan for filling up of required HR positions :

Name of

facility

Obs/

Gynac

Anes

thet

ist

Ped

iatr

icia

n

Surg

eon

MO SN ANM LT

Existing FRU

1 Sadar

Hospital 0 0 0 0 0 0 0 0

Proposed FRUs

2 SDH

Navgachhiya 0 0 1 0 0 0 4 0

3 Pirpaithi 1 1 0 0 0 0 1 0

4 Nath Nagar 0 1 1 0 0 0 1 0

5 Sultanganj 1 0 1 0 0 0 0 0

6 PHC Kahalgawn 1 1 1 1 0 0 0 0

7 Sanhaula 1 1 1 1 0 3 0 1

Total 4 4 5 2 0 5 5 1

33

It is planned that 4 more Gynecologists will be hired on contractual basis and posted

at Pirpaithi, Sultanganj, Kahalgaon and Sanahoulla.

The district urgently needs at least 4 Anesthetists for SDH Naugachhia, Nathnagar,

Kahalgaon and Sanahoulla. The role of an Anesthetist is crucial to undertaking

critical operations at CEmONC centers. Without the adequate number of

Anesthetists, it will not be possible to reduce deaths resulting from child birth and

delivery.

5 Pediatricians, 2 surgeons, 5 more medical officers, 5 Staff nurses, 5 ANMSs and 1

Lab techinician is also required.

CEmONC level Training: Situation Analysis:

Sl.

No

Name of

Facility

Available Specialist’s Skills

Gynec / Ob Gen. Surgeon Anesthetist Pediatricia

ns

Reg

ula

r /

contr

act

ual

Tra

ined

in

Em

OC

Tra

ined

in

Laparo

scopic

ster

iliz

ation

Reg

ula

r /

contr

act

ual

Tra

ined

in

Laparo

scopic

ster

ilisation

Tra

ined

in N

SV

Reg

ula

r /

contr

act

ual

Tra

ined

in

LSA

S

Reg

ula

r /

contr

act

ual

F-I

MN

CI

Tra

ined

1 Sadar

Hospital 1 0 1 1 1 1

2 SDH

Navgachhiy

a

1 1 1 0

3 RH

Pirpainti 0 0 0 1 0 0 0 0 2 1

4 Nathnagar 1 1 0 0

5 Sultanganj 0 1 0 0

6 PHC

Kahalgawn 0 0 0 0 0 0 0 0 0 1

7 Sanhaula 0 0 0 0 0 0 0 0 0 0

34

Situation Analysis of Medical officer’s Training:

Sl. No Name of Facility

Medical Officers

Total MOs in

position

(regular /

contractual)

Trained in

BEmOC / SBA

Trained in MTP

Trained in

NSSK

Trained in

Minilap / lap

sterilization

Trained in NSV

Trained in

IUCD insertion

1 Sadar Hospital

9 0 0 4 0 1 0

2 SDH Navgachhiya 5 0 0 0 0 0 0

3 Pirpaithi

8 0 0 4 0 0 0

4 Nath Nagar

7 3 2 0 2 1 2

5 Sultanganj 7 0 0 0 0 0 0

6 Kahalgaon 7 0 0 4 0 0 0

7 Sanhaula 7 0 0 0 0 0 0

Situation Analysis for CEmONC Training of Staff Nurses and ANM:

Sl.

No.

Name of

Facility

Staff Nurses ANMs

Total SNs

(regular /

contractual)

Trained in SBA

Trained in NSSK

Trained in F-

IMNCI

Trained in IUCD

insertion

Total ANMs

(regular /

contractual)

Trained in SBA

Trained in IMNCI

Trained in IUCD

insertion

1 Sadar Hospital 5 4 0 0 2 0 0 0 0

2 SDH Navgachhiya

5 2 0 0 0 4 0 0 0

3 Pirpaithi 4 1 1 0 0 2 1 1 0

4 Nath Nagar 3 1 0 0 0 4 2 2 2

5 Sultanganj 3 2 2 0 2 4 2 2 2

6 Kahalgaon 3 1 1 0 0 2 1 1 0

7 Sanhaula 1 0 0 0 0 2 0 0 0

35

Training Plan for Staff Nurses and ANM:

Sl.

No.

Name of

Facility

Staff Nurses ANMs

Total SNs

(regular /

contractual)

Trained in SBA

Trained in NSSK

Trained in F-

IMNCI

Trained in IUCD

insertion

Total ANMs

(regular /

contractual)

Trained in SBA

Trained in IMNCI

Trained in IUCD

insertion

1 Sadar Hospital 5 4 0 0 02 0 0 0 0

2 SDH Navgachhiya

5 2 0 0 0 4 0 0 0

3 Pirpaithi 4 1 1 0 0 2 1 1 0

4 Nath Nagar 3 1 0 0 0 4 2 2 2

5 Sultanganj 3 2 2 0 2 4 2 2 2

6 Kahalgaon 3 1 1 0 0 2 1 1 0

7 Sanhaula 1 0 0 0 0 2 0 0 0

Basic Emergency Obstetrics and Neonatal Care

Situation Analysis: Infrastructure

S.No Name of facility

SNCU / NSU/ New Born Corners

(Y/N)

Labour Room

OT Wards

(adequate / Inadequate) W

ater

Electricity

Toilets

(Adequate /

Inadequate)

ILR Points (P/A)

OT Toilets

adequate / Inadequate W

ater

1 PHC Gopalpur

N

Y Y adequate Y Y Y P Y

Adequate Y

2 PHC Jagdishpur

N Y Y adequate Y Y Y P Y Adequate Y

3 PHC Sabour Y Y Y adequate Y Y Y P Y Adequate Y

4 PHC Shahkund


5 PHC Kharik N Y Y adequate Y Y Y P Y Adequate Y

6 PHC Nararyanpur


7 PHC Goradih N N N Inadequate N N Inadequate N

36

While 7 facilities have been planned to be developed as a CEmONC center, it is

proposed that the 7 PHCs can be developed to provide Basic Emergency Obstetrics

and Neonatal Care (BEmONC). PHCs are Gopalpur, Jagdishpur, Sabour, Shahkund,

Kharik, Narayanpur and Goradih will be developed as BEmONC centers. Except

Sabour, all the rest PHCs require a Sick and New born corner, Goradih needs a

labour room as well as an Operation Theatre. Goradih also needs provisions of

water, electricity and ILR points.

Operation theatre is present in all proposed BEmONC center except Goradih. Some

renovation and minor repair work is required at all places. Jagdishpur, being closer

to the district headquarter is well connected. It has good infrastructure. It has a well

maintained hospital with basic health care facilities.

Facility Upgradation Plan 2011-12 - Infrastructure:

Sr No

Name and place of facility

Total Institution Deliveries ( last Year)

Beds to be

increased

SNCU/ NSU/ NBC

New Work*

Repair/ Renovation*

Toilets ILR

Points Required

1 PHC Gopalpur

2338 10 Y 1 ward NR N N

2 PHC Jaadishpur

2523 10 Y 1 ward NR N N

3 PHC Sabour 3043 10 N 1 ward NR N N

4 PHC Shahkund

2572 10 Y 1 ward NR N N

5 PHC Kharik 0 10 Y 1 ward NR N N

6 PHC Nararyanpur

0 10 Y 1 ward NR N N

7 PHC Goradih 0 10 Y 1 ward NR N Y

It is planned that at least 10 more beds need to be added to all the 7 selected PHCs.

Presently, the 6 beds are not sufficient to handle the patient load. The situation

becomes very bad during winters and rainy season when there is no space to admit

the patients who somehow manage to stay in campus area. During peak seasons,

there is more number of women who come to institutions for delivery. Post delivery,

a woman should ideally stay back in the institutions for 48 hours. However, due to

shortage of beds and lack of space, women are not being able to stay back in the PHC

after delivery. Therefore, is required that atleast 10 more beds need to be added in

all PHCs. This requires construction of a new ward to house the beds.

Sick and New born care unit need to be build in all 6 PHCs except Sabour which

already has a SNCU.

37

Basic Emergency Obstetrics and Neonatal Care:

Human Resources Requirement 2011-12

Sr No


Medical Officer

Staff Nurse ANM Lab Technician

Avail Req Avail Req Avail Req Avail Req

1 PHC Gopalpur 4 1 0 3 1 1 1 0

2 PHC Jagdishpur 5 0 0 3 2 0 1 0

3 PHC Sabour 3 2 0 3 2 0 0 1

4 PHC Shahkund 5 0 0 3 1 1 1 0

5 PHC Kharik 5 5 0 3 1 1 2 0

6 PHC Narayanpur 3 2 0 3 1 1 0 1

7 PHC Goradih 4 1 4 0 1 1 2 0

Total 36 11 10 18 14 0 7 2

36 Medical Officers are available and 11 more MOs are required. 5 MOs are required

for Kharik PHC, and 2 each for Sabour and Narayanpur. 10 Staff nurses are available

and 18 more Staff Nurses are required. All the facilities have ANM, 2 more Lab

technicians is required in Narayanpur and Sabour.

There is a complete shortage of Staff nurses in Bhgalpur. Except Goradih which has

4 SNs, they are required in the remaining 6 PHCs.

The required HR will be hired on a contractual basis. It is planned that

advertisements for the same will be issued and candidates will be selected by

second quarter.

38

BEmONC Training Plan:2011-12

Sr. No


Training Requirement for

MOs

Training Requirement for SBA

Training Requirement for IMNCI

Training Req for IUCD

IMNCI

BEmOC

MTP

NSSK

for Staff Nurse

For ANM

Total Training load for SBA

Staff Nurse

ANM Staff Nurse

ANM

1 PHC Gopalpur 5 5 2 5 3 2 5 3 2 3 5 2 PHC Jagdishpur 5 5 2 5 3 2 5 1 2 3 2 3 PHC Kahalgaon 5 5 2 5 0 0 0 0 1 3 2 4 PHC Sabour 3 5 2 3 3 2 5 1 1 3 2 5 PHC Shahkund 5 5 2 5 1 1 2 2 1 3 2 6 PHC Kharik 7 PHC Narayanpur 5 5 2 5 3 2 5 2 1 3 2 8 PHC Goradih 5 5 2 5 3 2 5 3 2 3 2 Total

Level 1: Facility Upgradation Plan:


Type of facility ( SC/ APHC/ NPHC/ Accredited pvt.)

Status (Specify numbers wherever applicable)

Staff Quarters

No. of beds

Labour Room

Toilets

PHC Sanholla APHC Tarar Existing 0 0 0 0

Required: New 4 6 1 2

RH Sultanganj APHC Rashidpur Existing 1 1 0 1


PHC Kharik APHC Telghi Existing 0 6 1 2


PHC Sahkund APHC Sajour Existing 0 6 0 4


PHC Pirpanti APHC Barahat Existing 0 0 0 0


PHC Kahalgaon APHC Akbarpur Existing 2 6 0 1


PHC Naugachia APHC Dholbajja Existing

Required: New

RH Sultanganj HSC Rampur kamrai Existing 0 0 0 0


PHC Sahkund HSC Radhanagar Existing 0 0 0 0


Total Required

39

Eight APHCs and two Sub-centers will be equipped as level 1 facilities. They will

provide basic medical care through trained Skilled Birth Attendants.

Tarar APHC in Sanahoulla, Rshidpur APHC in Sultanganj, Telghi in Kharik, Barahat in

Pirpaithi, Akbarpur in Kahalgaon and Rampur HSC in Sultanganj, and Radhanagar

HSC in Shahkund will be developed as level 1 SBA facilities.

Level 1: HR and Training Plan:


Type of Training status

MO (In Numbers) ANM/ SN (In Numbers)

IUCD

NSSK

Oth

ers

NSSK

SBA

F-IMNCI

IMN

CI

IUC

D

Oth

er

PHC

Sanholla

APHC Tarar Completed 0 0 0 0 2 0 2 3 0

Required 0 1 0 3 1 1 1 0 0

RH

Sultanganj

APHC Rashidpur

Completed 0 0 0 0 3 1 1 0 0

Required 0 1 0 3 0 0 2 3 0

PHC

Kharik

APHC Telghi

Completed 0 0 0 0 0 0 1 0 0

Required 0 1 0 3 3 1 2 3 0

PHC

Sahkund

APHC Sajour

Completed 0 0 0 0 1 0 1 0 0

Required 0 1 0 3 2 1 2 3 0

RH

Pirpainti

APHC Barahat

Completed 0 0 0 0 2 0 2 2 0

Required 0 1 0 3 1 1 1 1 0

PHC

Kahalgaon

APHC Akbarpur

Completed 0 0 0 0 0 0 3 0 0

Required 0 1 0 3 3 1 0 3 0

RH

Sultanganj

HSC Rampur Kamrai

Completed 0 0 0 0 1 0 0 0 0

Required 0 1 0 3 2 1 3 3 0

PHC

Sahkund

HSC Radhanagar

Completed 0 0 0 0 1 0 0 0 0 Required 0 1 0 3 2 0 3 3 0

Total required

0 8 0 24 14 5 14 19 0

40

Reproductive and Child Health

A.1 Maternal Health Health and well being of mother is of prime importance. The nutrition and health status of the mother during pregnancy and after child birth as well as the care during child birth are detrimental for the growth and development of children. The district plans to upgrade 7 institutions in the district to comprehensive care level and rest 8 block level PHCs to the basic obstetric care level to provide better delivery care to the expectant mothers. Besides it suggests strengthening the outreach service to cover all the pregnant mothers for complete immunisation, activate the Sub Centres and the ASHA programme to help mothers learn better delivery care. It also aims to collaborate with the ICDS department for supplementary nutrition for the pregnant and lactating mothers. The PHCs/ Health Institutions suggested for up gradation to the CEMONC level are 1. Sadar Bhagalpur 2. SDH Naugachia 3. RH Pirpainti 4. RH Sultanganj 5. PHC Nath nagar 6. PHC Kahalgaon 7. PHC Sanhoulla And the Institutions proposed for upgradation to BEMONC level are 1. PHC Gopalpur. 2. PHC Sabour 3. PHC Jagdishpur 4. PHC Sahkund 5. PHC Kahalgaon 6. PHC Kharik 7. PHC Goradih 8. PHC Narayanpur For up gradation of facilities to the aforesaid level the following activities are proposed under maternal health for the year 2011-12. A.1.1.1: Operationalise Block PHCs/CHCs/SDHs/DHs as FRUs For the year 2011-12, we propose to operationalise 7 health institutions in our district. The health institutions have been selected based on its strategic location in the district and also taking critical inputs such as its infrastructure and human resources. Budget Head

Particulars Units Unit cost Total Cost

A.1.1.1. Operationalise FRUs (Diesel, Service Maintenance Charge, Misc. & Other costs) Operationalise Blood Storage units in FRU

7 2@3,84,000 5@6,12,000

37,44,000.00

41

A.1.4: Janani evam Balsurksha Yojana (JBSY): The deliveries at home outnumber the deliveries that take place in the institutions. With up gradation of 7 health institutions to CEMONC and rest of the block institutions to BEMONC level, we hope to achieve increased institutional deliveries in 2011-12. Therefore we plan less number of deliveries to be assisted under JBSY. Budget Head


A1.4.1 Cash Incentive in home deliveries 314 @500 1,57,000.00

Support for Institutional Deliveries: In order to provide better care and to meet the immediate complications of the delivering mother and the neonates’ institutional deliveries are encouraged under NRHM. A 63329 number of deliveries are expected in the district and we hope that 40100 pregnant women will come to the institutions for delivery. Therefore we budget for 69169 numbers of women including previous year’s backlog of 29069 numbers for the cash assistance under the JBSY programme. Budget Head


A1.4.2.1 Institutional Deliveries-Rural 69169 @2000 138,338,000.00

For urban area, the district had planned to disburse JBSY assistance for 625 beneficiaries, however till the month of October we have been able to disburse advance to 192 beneficiaries. Some of the beneficiaries have not been paid the assistance due to unavailability of fund and delay in cheque books from the local banks. We hope to overcome the problem and be able to utilise the entire grant for 2010-11. For 2011-12, we propose for 1500 beneficiaries since the institutional deliveries have gone up. Budget Head


A1.4.2.2 Institutional Deliveries-Urban 1500 @1200 18,00,000.00

Similarly the district proposes to assist 666 institutional deliveries which might require a C-section. Since the FRUs will be functional we hope that the public institutions will be able to provide the comprehensive care to the delivering mothers. Budget Head


A1.4.2.3 Institutional Deliveries- C-section 666 @1500 9,99,000.00

Over the years in implementation of the JBSY programme, we are faced with delay in payment, validation in identity of the beneficiaries, maintaining a database of the beneficiaries, the birth outcome and well being of the mother. We plan to do a quality assessment of the JBSY programme in 2011-12. We propose to follow up 5180 cases in 2011-12 including 2180 cases that were not followed up previous year.

42

Budget Head


A1.4.3 Monitor Quality and Utilisation of services 3000 @3000X820 @2180X750

22,80,100.00

A.2 Child Heath The child population in Bhagalpur district is 272487. Newborns are more susceptible to infections because of their low immunity. Management of newborn and childhood illness had been a problem in the past since the knowledge and skills were not available at the village level and in order to get a medical advice people were to travel quite a distance. Since the IMNCI training have been imparted to the ANMs and AWWs, people are benefiting in addressing the minor illnesses and are only coming to higher up centers on advice of the local service providers. This has resulted in subsidizing the pressure on the PHCs and has also helped in reduction of morbidity and mortality amongst the children. Budget Head


A2.1 Integrated Management of Neonatal and Childhood illness 135000.00 1,35,000.00

Newborns those are ill and could not be managed at the sub centre level and the newborns those have illness just after delivery is being treated in the facilities. This year we have proposed for 7 FRUs where we plan to make the New Born Corner functional. With the new born corner we propose funding support for monitoring, and procurement consumables, maintenance of the facilities, purchase of drugs for facility based new born care. The monitoring officers at the district level will make sure that facility for Resuscitation of newborn with asphyxia, Prevention of hypothermia, Prevention of infections, Exclusive breast feeding, Referral of the sick new born are available and are provided from the facilities. Budget Head


A2.2 Facility Based Newborn Care 1,14,000.00 1,14,000.00

With the introduction of the school health programme in the districts, all the school going children are getting a chance to get themselves checked and diagnosed for illnesses. Through this programme case of heart ailment, vision problem are also detected and referred to appropriate hospitals for treatment. This year we propose to organise 2000 camps in our district. Budget Head


A2.4 School Health Programme 2000 @3000 60,00,000.00

Out of the 272487 child population in the district, 54497 number of children are severely malnourished who need urgent attention for nutritional support and also medical care. We propose to establish NRCs for the severely malnourished children in the district so that 54497 children without medical complications and are only in need of nutritional supplementation could be supported. The protocol in setting up of these institutions will

43

be provided to us from the state and we at the district level will strictly follow the protocol in establishment of the NRCs. Budget Head


A2.6 Care for malnourished children 38,29,170.00 38,29,170.00

Most of the childhood morbidities are diarrhea, ARI and sometimes deficiency of micronutrients. Diarrhea management could save a lot of life and morbidities in children. Same in the case of ARIs. Budget Head


A2.7 Management of Diarrhoea, ARI and Micronutrient 5,87,000.00 5,87,000.00

A.3 Family Planning Small family going forward should be encouraged in order reduce the burden on the women in the household. Thankfully the days are gone when we had high mortality and sometimes it was necessary to produce more children. Medical science has moved on and from a life expectancy of 35 during independence we have reached 65 in 2010. The coercive family planning programme is no more exist and now this a time to promote choices of family planning and family welfare in order to enable people to choose from a range of services and products available for birth control. It has been observed where ever there is a demand for family welfare services; we are not able to meet those demands. For Bhagalpur district, the estimated that would be required for 2011-12 are as follows Tubectomy: 14022 Vasectomy: 804 Contraception: OCP 24322, Condoms14368, Copper-6082 For 2011-12, we propose to undertake the following activities in the district Dissemination of Manuals on sterilization standards: Budget Head


A3.1.1 Dissemination of Manuals on sterilization standards 2 @1X22000 @1X25000

47,000.00

Female Sterilisation Camps: Budget Head


A3.1.2 Female Sterilisation Camps ( 384 of previous year and 100 for this year)

484 @384X1000 @100X1200

5,04,000.00

Male Sterilisation Camps (NSV):

Budget Head


A3.1.3 Male Sterilisation Camps (NSV)- 30 camps of previous year and 20 camps for this year

50 @30X10000 @20x15000

6,00,000.00

44

Compensation for female sterilisation: Budget Head


A3.1.4 Compensation for female sterilisation 40266 (15264+25000)

@1000 402,64,000.00

Compensation for Male Sterilisation: Budget Head


A3.1.5 Compensation for male sterilisation 885 @1500 10,57,500.00

Accreditation of Private Providers: Budget Head


A3.1.6 Accreditation of Private Providers-cases 3000 @1500 44,99,500.00

IUD Camps Budget Head


A3.2.1 IUD camps 500 @1500 7,50,000.00

IUD services at health facilities: Budget Head


A3.2.1 IUD services at health facilities 9006 @50 900600.00

Contraceptive Update Seminars, Quality Assurance (Minor Procurement, Field Visit, Review meeting : Budget Head


A3.2.5 Contraceptive Update Seminars, Quality Assurance (Minor Procurement, Field Visit, Review meeting

16 PHC @7135 1,14,160.00

POL support for family planning below sub district level: Budget Head


A3.3 POL support for family planning below sub district level

16 PHC @7135 1,14,160.00

45

New proposed

In the year 2011-12 we are proposing recruitment of female counselor for all FRUs to be

operationalised in the district to decrease the maternal and infant mortality. The budget required

for the same is as follows.

Budget for 2011-12 Budget Head


New

proposed

Salary for family planning counselor 7 12,000.00 1,00,800.00

New proposed

This year in 2011-12 we are proposing establishment of Urban Health centre at the

district to provide optimum health service to the community. The budget required for the same is

as follows.



New

proposed

Establishment of Urban Health centre 1 40,000.00 4,80,000.00

New proposed

This year in 2011-12 we are initiating facility of two mobile trainer in a district to

enhance the skill of health staff in all PHCs. through continuous training by the mobile trainer.

The budget required for the same is as follows.



New

proposed

Salary of mobile trainer 2 40,000.00 9,60,000.00

New proposed

In 2011-12 we have planned to setup a district skill lab at the district level. The budget

required for the same is as follows.



New proposed

Establishment of district skill lab 1 15,00,000 15,00,000

46

New proposed

In 2011-12 we have planned to setup a district skill lab at the district level. The budget


Budget for 2011-12 Budget Head Particulars Units Unit cost Total Cost

New proposed

Establishment of district skill lab 1 15,00,000 15,00,000

A.9.1.2 Lab technician in Blood storage Unit:

In order to oprationalized cemoc facility in the district we need to establish BSU. To meet

this demand Lab technician are required to oprationalized BSU. The budget required for the same

is as follows.

Budget for 2011-12

Budget Code Particulars Unit cost Total Cost

A.9.1.2

Lab technician for BSU 10,000.00 2520000.00

(including previous year and this year)

A.9.1.3 Staff Nurse

In order to provide to better care and to meet the immediate complication of the

delivering mother’s and neonates the educate requirement of staff nurse is most important. Since

next year we promoting cemoc and bemoc facility in the district the additional staff nurse is

mandatory. The budget required for the same is as follows.

Budget for 2011-12


A.9.1.3

Salary of the Staff Nurse 12,000.00 15552000.00 (including previous year and this year)

A.9.1.4 Doctor & Specialist

In context of 2011-12 budget we have proposed 7 unit to cemoc facility & 8 unit to have

bemoc facility. To meet this demand we need to appoint additional specialist doctors. The budget


Budget for 2011-12


A.9.1.4

Salary of Doctor’s and Specialist 35,000.00 15,00,000.00


47

A.9.1.5 Honorarium to volunteer workers

Volunteer workers are delivering excellent service in outreach area and other health

related programme and some how assisting ANM and BHW in the field. The budget required for

the same is as follows.

Budget for 2011-12


A.9.1.5

Honorarium of Volunteer workers 100.00 63,157.00


A.9.1.6 Incentive for ASHA and ANM for Muskan ek Abhiyan

ASHA and ANM were doing excellent job for the immunization of pregnant women and

children. This year by the sincere efford of the said workers the immunization covered has been

shoot up sharply. In this context provision of incentive played a crucitial role in the RI

programme. Hence next year budget required for the same is as follows.

Budget for 2011-12


A.9.1.6

Incentive for ASHA and ANM for Muskan ek Abhiyan

-------- 1,75,00,000.00 (including previous year and this year)

A.9.3.2. Minor Civil works

As we know number of Patient is increasing alarmly at the PHC to get desired medical

service. In order to meet the requirement of service receiver PHC need minor civil work to

upgrade their infrastructure and facility. The budget required for the same is as follows.

Budget for 2011-12


A.9.3.2

Minor civil works ------ 16,00,000.00 (including previous year and this year)

A.10.3. Monitoring Evaluation / HMIS.

As we know we are focusing on Monitoring Evaluation/HMIS for the district health action

plan 2011-12 to make it realistic and implementable. In order to strengthen M&E /HMIS we need

budget for the same as follows.

Budget for 2011-12


A.10.3

Monitoring Evaluation / HMIS ------ 1325780.00


48

New proposed

To make HMIS data more effective and realistic we need extensive monitoring of by

district M&E officer to meet this we need vehicle hiring. The budget required for the same is as

follows.

Budget for 2011-12


New proposed

Vehicle hiring for M&E 15,000.00 1,80,000.00

New proposed

We are constantly looking there are discrepancies in the HMIS report send by the PHCs.

In order to get realistic and correct data we need to analyzed HMIS report minutely. In this

context we nee to appoint 2 Data Analyst from the field of Public health. Apart from it 2

Computer is also required. The budget required for the same is as follows.

Budget for 2011-12


New proposed

Salary of Data Analyst

2 Computer

15,000.00

70,000.00

3,60,000.00

1,40,000.00 5,00,000.00

A.10.4. Sub centre and Contingencies

As we are facing acute shortage of Government building for HSC. We need rent for

HSCs to keep logistics safe and sitting place for ANM and other health staff to provide adequate

health service for the community. The budget required for the same is as follows.

Budget for 2011-12


A.10.4

Rent for Sub centre

500.00 3,75,000.00 (including previous year and this year)

A.10.5.1. Other Strategy/ Activity (Operationalize FRUs through supportive supervision)

In order to Operationalize FRUs efficiently we require supporting supervision by

medical college faculty / SHSB official . The budget required for the same is as follows.

Budget for 2011-12


A.10.5.1

Other Strategy/ Activity (Operationalize FRUs through supportive supervision)

-------- 2,85,000.00

49

A.11.3.1 SBA training

As we know still maximum delivery is being conducted at home. In order to make home

delivery safe, we are proposing SBA training this year also so that all service provider is

aquainted with skill of SBA training . The budget required for the same is as follows.

Budget for 2011-12


A.11.3.1

SBA training 88,110.00 17,62,200.00


A.11.3.4 MTP training

As we know MTP is carried out in marginal manner at the PHC. We have need to provide

training of MO to do MTP successfully at the PHC. The budget required for the same is as

follows.

Budget for 2011-12 Budget Code Particulars Unit cost Total Cost

A.11.3.4

MTP training -------- 50,0000.00

A.11.6.2 Minilap training

In order to continue family Planning operation constantly Minilap training of MO is

mandatory’s. So that she can conduct family Operation successfully and smoothly. The budget


Budget for 2011-12


A.11.6.2

Minilap training -------- 1,50,000.00

A.11.6.3 NSV training

Family Planning can play major role in population stabilization. At present there is lack

of NSV train doctors in the district. So we are focusing on NSV training so that vasectomy target

of the district can be achieved. The budget required for the same as follows.

Budget for 2011-12


A.11.6.3

NSV training -------- 33,900.00

50

A.11.6.4 IUD insertion training

IUD is an idea tool of spacing for family planning. A Grade Nurse / ANM should get

IUD insertion training so that she can able to do IUD insertion successfully at the institution.

The budget required for the same as follows.

Budget for 2011-12


A.11.6.4

IUD insertion training -------- 338900.00


A.11.8.2 DPMU training

DPMU training is essential to develop skill of district health management staff specially

on the aspect of Public Health & Community partnership. The budget required for the same as

follows.

Budget for 2011-12


A.11.8.2

DPMU training 30,000.00

30,000.00

A.12.1. IEC/ BCC

The activity like Press advertisement, Advertisement for appointment tender

advertisement & other health related advertisement is done at the district level.

In spite of it prototype for wall writing, design, Slogan, hoarding, Health Mela and other

health related activities can also be performs under the IEC/BCC. The budget required for the

same as follows.

Budget for 2011-12


A.12.1

IEC/BCC ----------- 4,00,000.00


New proposed

In 2011-12 we are proposing new post of IEC consultant at the district level. The IEC

Consultant will look after all the activities under IEC such as designing of prototype, formulating

of Slogans for wall writing, display of IEC materials at public place.

He will be responsible for liasoning with DPRO, cinema Hall owner, Dish cable operator

for health related advertisement and campaign.

51

Budget for 2011-12


New propose

Salary of IEC consultant 20,000.00

2,40,000.00

A.13.1.1.1 Procurement of equipment for BSU at FRUs

For 2011-12 plan, we are opening 5 FRUs excluding existing 2 FRUs at SDH Naugachia

& RH Pirpainti, So procurement of equipment for BSU at 5 FRUs is required. The budget for


Budget for 2011-12


A.13.1.1.1

Procurement of equipment for BSU at FRUs ----------- 4,13,275.00


A.13.2.1.1 Drug & Supply for MH (MVA Syringe / MTP)

For 2011-12 Drugs & supply for MH (MVA syringe/MTP) is required to do MTP at

PHCs. The budget for the same is as follows.

Budget for 2011-12


A.13.2.1.1

Drug & Supply for MH (MVA Syringe / MTP)

----------- 1,06,020.00

A.13.2.1.2. Drug & Supply for MH (Delivery Kit at HSC / ANM / ASHA)

For the year 2011-12 Drugs & supply for MH (Delivery Kit at HSC / ANM / ASHA)

is required to facilitate & conduct delivery at village level. The budget for the same is as

follows.

Budget for 2011-12


A.13.2.1.2

Drug & Supply for MH

( Delivery Kit at HSC / ANM / ASHA)

----------- 3,00,000.00

52

A.13.2.1.3. Drug & Supply for MH (Availability of Drug kit)

For the year 2011-12 Drugs & supply for MH (Availability of Drugs kit) is required

for maternal health at all health institution. The budget for the same is as follows.

Budget for 2011-12


A.13.2.1.3


(Availability of Drug kit)

----------- 91,860.00

A.13.2.1.4. Drug & Supply for MH (ANC 3 doses iron sucrose)

For the year 2011-12 Drugs & supply for MH (ANC 3 doses iron sucrose) is required

at all health institution. The budget for the same is as follows.

Budget for

2011-

12Budget Code

Particulars Unit cost Total Cost

A.13.2.1.4


(ANC 3 doses iron sucrose)

----------- 10,00,000.00


A.13.2.1.5. Drug & Supply for MH (IFA for tab for adolescent)

For the year 2011-12 Drugs & supply for MH (IFA for tab for adolescent) is required

at all health institution. The budget for the same is as follows.

Budget for 2011-12


A.13.2.1.5


(IFA for tab for adolescent)

----------- 40,00,000.00


New proposed - Drug and supply for MH (Children and Pregnant women)

As we are a were the Child and Pregnant women is high focus of NRHM programme

For the year 2011-12 Drugs & supply for MH (Children and Pregnant women) is required at all

health institution. The budget for the same is as follows.

Budget for 2011-12


New proposed

Drug and supply for MH (Children and Pregnant women)

----------- 30,00,000.00

53

A.13.2.3.1 – Drugs & supply for FP Procurement of Minilap sets.

For the year 2011-12 Drugs supply for FP Procurement of Minilap sets so that FP

programme can be beneficial for the desired community at all health institution. The budget for


Budget for 2011-12


A.13.2.3.1

Drugs supply for FP Procurement of Minilap sets. ----------- 24,00,000.00

A.13.2.3.2 – Drugs & supply for FP Procurement of NSV kits.

For the year 2011-12 Drugs & supply for FP Procurement of NSV kits. so that FP



Budget for 2011-12


A.13.2.3.1

Drugs & supply for FP Procurement of NSV kits. ----------- 11,000.00


A.13.2.3.3 – Drugs & supply for FP Procurement of IUD kits.

For the year 2011-12 Drugs & supply for FP Procurement of IUD kits so that FP



Budget for 2011-12


A.13.2.3.2

Drugs & supply for FP Procurement of IUD kits ----------- 30,000.00


A.13.2.3.5 – General drugs & supplies for health facilities

For the year 2011-12 General drugs & supplies for health facilities is required so that

Community can get drug facility in indoor and outdoor. The budget for the same is as follows.

Budget for 2011-12


A.13.2.3.5

General drugs & supplies for health facilities ----------- 5,00,00,000.00


54

A.14.2 Strengthening of District Society/DPMU

District health society is setup in the district to operationalize NRHM programme

smoothly. Hence district has appointment Consultants for it. Apart from it DPMU is needed to

strengthen by 10 % hike in the salary of Consultant. The budget for the same is as follows.

Budget for 2011-12


A.14.2

Strengthening of District Society/DPMU ----------- 44,42,701.00


A.14.3 Strengthening of Financial Management system.

Financial Management is desired to follow financial guideline of NRHM by adopting

double entry accounting from district to block level so that misappropriation, irregularities,

discrepancies can be avoided. The budget for the same is as follows.

Budget for 2011-12


A.14.3

Strengthening of Financial Management system. ----------- 4,80,000.00


New proposed - Upgradation of Tally at Block level

In order to simplify the accounting procedure upgradation of Tally soft-ware is required at the

district to the block level. The budget for the same is as follows.

Budget for 2011-12


New proposed

Upgradation of Tally at Block level ----------- 3,49,600.00

55

CHAPTER-IV

PART- B

NRHM Additionalities

The activities planned under reproductive child health programme, immunisation and disease control is supplemented by the resource pool from additionalities under NRHM. The NRHM flexi pool helps to achieve the goals by supporting the improvement in infrastructure, providing critical manpower, communitising the health care delivery system, risk pooling for poor and improvement in quality of health care. Thus all the activities under Component – B are to support the remaining components of the NRHM. However the utilisation of funds and execution of activities under this head has been rather poor compared to the utilisation pattern under other heads of expenditure in NRHM such as RCH, Immunisation and disease control programmes. In the year 2011-12, the district will put special emphasis on community processes such as ASHA, Village Health and Sanitation Committee, Rogi Kalyan Samitis. Efforts will be taken at the district as well as at the block level to bring convergence in the activities of health with ICDS and water and sanitation department. The situation of Malnutrition, neo-natal and infant death is still at the worst level. The Government of Bihar has launched the Muskan programme for convergence with the ICDS for immunisation and similarly the Village Health and Nutrition Day has been launched to bring all the service providers at the village level under one roof to provide services on designated days, these are the forums which need to be strengthened to bring positive change in health and nutrition situation in the villages. The other thrust area for this year would be to improve the quality in services, make suitable provisions of accommodation for the staffs working in far-flung areas, make accommodation facility for ASHAs accompanying pregnant mothers to the PHCs, establishing ASHA help desk in all PHCs of Bhagalpur for assistance to the ASHAs as well as to the patients. Section 1: Decentralisation B.1.12 ASHA support System at the District Level The activity was approved in 2010-11. District Community Mobiliser District Data Assistant for ASHA was recruited and in Bhagalpur the Data Assistant has joined. However the DCM is yet to join. The help desk is yet to set up at the district level. Although we have not been able to get a full team for the district, we propose that ASHA is an important programme to mobilize community to demand for their entitlements as well improves accountability in the system. Therefore a support system at the District level with one community Mobiliser and Data Assistant will not serve the purpose of continuous training, support in designing appropriate IEC/BCC as well as supportive supervision of the ASHAs as well as the ASHA facilitators. Therefore we propose that we should have additional manpower in the support system. We aspire to have one

56

training cum communications coordinator to undertake training needs assessment as well as develop context specific communications materials. We propose to take help of civil society organisations present in the district, members from other departments who have a direct/indirect role of promoting health to constitute a mentoring committee at the district as well as block level. The committee will help and guide the ASHA resource centre at the district and block to strengthen in implementation of the programme. Budget for 2011-12

Note – Budget required including Nov. 2010 to Mar. 2011. 589040/- Total Budget required 1656014/- B.1.13 ASHA support system at the Block level Providing continuous support to ASHAs at the field level is required for keeping them motivated in their work. It happens quite often that ASHA is left high and dry in situations without adequate support from the public health system. The nature of her work to be a link between community and system requires support from the public health system as well as the civil society organisations working in her area.

Budget

Code

Particulars Unit Cost Total Units Total

B.1.12 District Community Mobiliser 20000p.m. 12 months 2,40,000

District Data assistant 15000 p.m. 12 months 1,80,000

Office expenses 4350 pm 12 months 5,22,000

ASHA help Desk 4200 pm 12 months 50,400

ASHA Sammelan @120/- per ASHA

NGO facilitations

@ 10000/-

Organizing cost @

50000/-

Others 8787/-

4 x 12 months

10000

50000

8787

5,760

10,000

50,000

8,787

Total 10,66,974/-

57

For year 2011-12 we propose to carry on the support system at the block level and also propose to establish a mentoring committee at the block level comprised of Voluntary organisations, members from water and sanitation department, ICDS. We propose to establish ASHA help desk in all 16 PHCs. ASHAs of the block on a rotaion basis will run the help desk. We propose 150/- per day for 6 ASHAs in the PHC to man the centre 24X7.

B.1.14 ASHA Training Training for ASHA till date is managed by the State ASHA Cell. ASHAs in Bhagalpur have completed second module training. They will yet to gate trained on module 3,4 and 5.. We propose that the training of ASHAs should be decentralised to the districts to be coordinated by the District ASHA resource centre. The District and Block Resource Centre can coordinate the training. We also propose that we develop a dedicated cadre of trainers to train and support the ASHAs in their functioning. Bhagalpur district has a tribal population of 10344 and Mahadalit population of 70732 We propose that in 2011-12 besides the national/state level training, we will organise trainings for ASHA in the above said areas in different entitlements and different government schemes. This is required to spread awareness in the communities to know their rights to different schemes of government. A primer on the schemes of government could be developed for the training purpose.

Budget

Code


B.1.13 Block ASHA Manager 12000p.m. 16 blocks x 12 months 2304000

New ASHA Help Desk 150 per day per

ASHA for 6 ASHAs

for 7 day

4200 x16 blocks x 12

months

806400

Total 3110400

Budget

Code


B.1.14 Block level training @ Rs 150/ ASHA 2311 346650

New Primer for ASHA training @ Rs 50 / ASHA 2311 115550

Total 462200

58

B.1.16 ASHA Drug Kit replenishment Timely replenishment of Drug Kit is important to help ASHA to dispense basic medicine in the village. This helps are in solving minor ailments at the village level and helps people with primary treatment at the village level. We propose that for replenishment of Drug for the year 2011-12 and provision of new kit Rs.997.65/- be earmarked for this year too

B.1.18 Motivation for ASHA To keep the ASHA motivated, the state has initiated a programme where by ASHAs are given two sarees and one Umbrella each year. For this year too we propose that ASHAs be provided with the Sarees and a umbrella. In continuation of previous year’s best ASHA programme to reward three ASHAs from each block

B.1.17 Academic Support programme for ASHA We propose that ASHAs be encouraged to apply and get admission for ANM courses. This will go a long way in motivating the ASHAs to perform better and it will also be a career ladder to for the ASHAs. We propose that the state should take up opening up special ANM schools to enroll ASHAs. Since most of the ASHAs will meet the present criteria of 10th pass they should be encouraged to join the course. This will solve the problem of non local, non residential ANM problem to a great extent. For the ASHAs who are 10th fail, they could be encouraged to join integrated ANM course where they could finish the 10th exam as well as complete the ANM course.

Budget

Code


B.1.16 Drugs for ASHA Kit @ Rs 897.65/ ASHA 2311 ASHA 2074469

New Kit for ASHA @ Rs 100/ ASHA 2311 ASHA 231100

Total 2305569

Budget

Code


B.1.18 Motivational Incentive for ASHA ,2

Sarees,1 Umbrella

@ Rs. 600 for saree per ASHA

@ Rs. 150 for umbrella per ASHA

2311

2311

1386600

346650

Reward to best 3 ASHAs (Rs. 1000/-,

Rs.500/-, Rs.300/-+ Rs.200/- for

certificate printing etc)

2000 per block 16 32000

Total 1765250

59

B.1.2 ASHA Divas This is an activity that the district is doing since last year. In this year 2011-12, the district proposes to continue ASHA Divas in all the PHCs. This has been a useful meeting to discuss the roles performed by the ASHA, information on different government schemes. Her incentive is calculated based on the tasks she has performed in the month. We propose that the incentive of Rs.86/- be increased to Rs.150/-.

Budget Head

Particulars Unit Cost Total Unit Total cost

B.1.2 ASHA Divas Rs.150/-per ASHA 2311 x 12 4159800

1 Note – Budget required including Nov. 2010 to Mar. 2011.

148104/-

Total Budget required 4307904/- B.1.21 Untied Fund for Health Sub Centre and Additional Primary Health Centre Untied funds to the HSCs and APHCs are provided to undertake expenses like minor repair, referral transport, and emergency medicine purchase. However the utilisation of fund on these head has been dismal. District is trying hard to push for utilisation fund at the local level. This year we propose to provide untied fund @ 10000 to the HSCs and @ 25000 to the APHCs. Progress during 2010-11 ( Till 30th November 2010)

Institution Funds Distributed

Funds Utilised

Nature of utilisation

HSC/APHC/PHC 45,50,000 1890000 Mino repair, Emergency medicine, purchase of furniture

Budget required for untied grants 2011-12

Budget Head B.1.21

Particulars No. of

institutions

Budget required

Unit rate Total budget required

1 Health Sub-Centre 280 10000 280000

2 Additional Primary Health Centre

54 25000 1350000

3 RH/PHC 16 25000 400000

Total 4550000

Note – Budget required including Nov. 2010 to Mar. 2011. 4087000/- Total Budget required 8637000/-

60

B.1.22 Public Health Family Welfare and Rural Sanitation Committee In Bhagalpur and in entire Bihar, the Village Health Committee has been established at the Panchayat level and in each revenue village Nigarani Samitis have been formed. Funds for the VHSC are given to the PHFWRSC for the cluster of villages. The Nigrani samiti has the responsibility of putting up a proposal to spend Rs. 10000/- grant in their respective villages. In the year till November 2010, 1520 PHFWRSC committees have been formed. These committees have been provided with untied fund through NRHM. However since the committees are new and members are not aware of their roles and responsibilities the utilisation fund has been low. The Panchayat level committee is an important governance structure at the village level to mobilize the community for their health entitlements, help the ASHA to function well in the villages and make the local health system accountable. Therefore strengthening the PHFWSRC and the Nigrani Samitis will be an important step to make the system responsive to people’s need. Therefore we propose to undertake training programmes for the Nigrani samiti members and the PHFWRSC members in the year 2011-12. We suggest to print primers on the mandatory health services that are to be provided from the health institutions. Flexible Pool Fund for utilisation in IEC, household survey, preparation of health register, organisation of meetings at village level. Progress during 2010-11

Total Panchayat

PHFWRSC Bank account opened

Funds distributed November 2010

Funds utilised till November 2010

Major expenditure heads

242 242 239 9302000 Nil Nil

Budget for 2011-12

Budget Head B.1.22

No.

No of Nigrani Samitis

Budget required

Unit rate Total budget required

1 PHFWRSC 242 1520 10,000/- 15200000

Note – Expenditure in 2010- 11 is marginal Total Budget required 930000/-

61

B.1.23 Rogi Kalyan Samitis Rogi Kalyan Samiti (RKS) has been an important step towards communitization of health care delivery. It has been established to improve the hospital services, make the services community oriented and self-sufficiency of community in planning and implementation of their health needs. This is also an important health governance institution which needs to be strengthened. Last year the State Health Society has celebrated ‘Rogi Kalyan Saptah’ which was a very positive step towards empowering the members of the committee. We would suggest that state to plan activities of this kind for VHSC, RKS in order to strengthen these important community structures. Progress during 2010-11

Sr Type of hospital

No. in district

RKS registered

Bank account opened

Fund disbursed

Funds Utilized

1 Primary Health Centre

14 11 11 1400000 179169

2 RH/SDH 3 3 3 900000 242410

3 District Hospital

1 1 1 500000 276059

Total 697638

Budget requirement for year 2011-12

Budget Head B.1.23

Type of hospital No. of

institutions

Total budget required in lakhs

Unit rate Budget required

1 PHC 13 1 lakh 13,00,000

2 RH 3 2 lakh 6,00,000

3 District Hospitals/SDH 2 2X5 lakh 10,00,000

Total 29,00,000

Note – Budget required including Nov. 2010 to Mar. 2011. 333400/- Total Budget required 6234000/- Section 2: Strengthening of Physical Infrastructure & Facilities B.2.1 Construction of Health Sub-Centres Health Sub Centre is the first contact point between people and the health system. In Bhagalpur we have a total 364 HSC sanctioned and 280 HSCs are functional. Till NRHM 10-11, Bhagalpur has received funds for construction of 47 number of HSCs. Till November 2010, 35 number HSC has been constructed. Previous year 5 HSCs were

62

sanctioned and work has started in 4 locations. Others will be initiated in this financial year. For 2011-12, we propose that we will build another 10 HSCs in remote areas far from the APHC and PHC to take them to SBA level. The present status of HSC in the district is as follows

Total Sanctioned

HSC

HSC functional

SBA level SBA level having no building

Required for 2011(Name

wise)

364 280 Nil Nil Nil

Budget for 2011-12

Budget Head

Name of HSC villages

PHC name Unit cost Total Cost

B.2.1 10 ---- 12,98,000 1,29,80,000

Note – Budget required including Nov. 2010 to Mar. 2011. 2590000/- Total Budget required 15570000/- B.2.2A Construction of APHCs Additional Primary Health Centre is the first contact point between people and a Doctor from the Public health system. In Bhagalpur we have a total 54 APHC sanctioned and 54 APHC are functional. From 2005-06 till date out of NRHM grant Bhagalpur has received 1.22 lacs funds for construction of 4 number of APHCs. Till November 2010, 0 number APHC has been constructed. Previous year APHC were sanctioned and work has started in 0 locations. Others will be initiated in this financial year. For 2011-12, we propose that we will build another 2 APHCs in remote areas far from the PHCs. The present status of HSC in the district is as follows

Total Sanctioned APHC

APHC functional

SBA level SBA level having no building

Required for 2011(Name wise)

54 54 Nil Nil Nil

Budget for 2011-12

Budget Head Name of APHC


B.2.2A 3 ----- 75,99,000 22,79,7000

Note – Budget required including Nov. 2010 to Mar. 2011. 75,99,000/- Total Budget required 30396000/-

63

B.2.2B Construction of quarters in APHCs We propose to construct staff quarters in the newly constructed APHCs. Since in Bihar Medical Services Corporation has been set up and it will undertake all the construction work we are proposing budget for at least staff quarters in two APHCs in anticipation that work will be completed on time.

Budget Head

Name of APHC


Remark

B.2.2B 3 Quat. ------- 30,00,000 75,00,000 To be executed by Medical services corp

Note – Budget required including Nov. 2010 to Mar. 2011. 60,00,000/- Total Budget required 1,50,00,000/- B.2.3 Up gradation of PHCs to CHC In 2010-11, Bhagalpur had proposed for up gradation of 2 PHC to CHC. Budget of 40 lakhs retained at the state level which could not be spent in 2010-11. We propose for 2011-12, at least 2 PHCs Gopalpur and Sanhaulla be upgraded to CHCs and staff quarters be constructed in the PHCs.

Budget Head


Remark

B.2.3 2 40,00,000 80,00,000 To be executed by Medical services corporation

Note – Budget required including Nov. 2010 to Mar. 2011. 80,00,000/- Total Budget required 1,60,00,000/- B.2.4 Up gradation of DH and SDH to IPHS standard In year 2011-12 we propose to upgrade Bhagalpur district hospital to IPHS standard. Till today the hospital functioning as a Referral hospital without adequate staff strength, inadequate infrastructure. We also propose to upgrade two other SDH of the district Naugachia and Kahalgaon to IPHS standard. Though in the facility up gradation to CEmONC we are proposing all these institutes to CEmONC level, but will feel that if the facility is upgraded to IPHS it will ensure better quality of service. For this we propose to

64

state to send a team of experts to undertake facility survey and propose for up gradation of the institutions. Therefore we are not proposing any budget. New Proposed This year we are proposing construction of residential Quarter for Doctors and Nurse at 4 PHC

Sl No Particulars Unit cost Total

1 4 Quarters 1,37,00,000 54800000

New Proposed This year we are proposing new construction of residential mate native and child ward in SDH and Sadar Hospital.

Sl No Particulars Unit cost Total

1 2 ward 30,00,000 60,00,000

B.2.5 Annual Maintenance Grant Annual maintenance grants have been very useful for all the health institutions in Bhagalpur. The meager contingency funds that were earlier available to the institutions were not able to take care of small maintenance activities in the health institutes. The utilisation of fund is done in under the supervision of the RKS of the institutes and acts as a supplementary fund to the corpus grant to the institutions. Progress during 2010-11 Distribution and utilisation of AMG during year as follows

Sl No Particulars PHC /RH

SDH DH

Total

1 Annual Maintenance Grant 16 x

100000 1x500000

1x 50000

2600000

65

Plan for year 2010-11 Annual action plan for the year for utilisation of AMG grants shall be developed institution wise with the help of the District Programme Management Unit and Block Programme Management Unit. All the Medical Officer In charge shall be called for a meeting a detailed plan will be in the first quarter so that overlapping expenditures can be stopped. We propose to provide AMG grant of Rs.10000/- per HSC and Rs.25000/- for APHC. Budget 2011-2012 Budget requirement for AMG for year 2011-12 is given in table below.

Budget Code Type of Institute No. of institutions

AMG

B.2.5 Unit rate Total

Health Sub-Centre 280 ----- -----

APHC 54 ----- -----

PHC 13 100000 130000

RH 3 100000 300000

SDH/DH 2 500000 1000000

Total 349 2600000

Note – Budget required including Nov. 2010 to Mar. 2011. 84,000/- Total Budget required 26,84,000/-

66

B.2.7 Up gradation of Infrastructure of ANM Training School

This year we are focussing on up gradation of infrastructure of ANM Training School at the District.

Sl. No Particulars Unit cost Total

1 Up gradation of Infrastructure of ANM Training School

11,30,000 11,30,000

Section 3: Contractual Manpower B.3.2 Block Programme Management Unit Bhagalpur has 16 blocks and in each block the BPMU has been established. For all the BPMUs BPMs and Block monitoring and Evaluation Officer have been recruited and are in place. This year we propose to revise the Salary of Block Programme Managers to Rs.25, 000/- and the Block Accounts Manager to 20,000/- per month. This recommendation is based on the salary offered for similar kind of responsibility of Hospital Manager in the referral hospitals. We propose to raise the mobility and office expenses from existing Rs. 17245/- to Rs. 25000/- per month.

Budget Head

Particulars Unit Cost Number Total Cost

B.3.2 Salary for the BPM 25000 pm 16 Unit x 12 4800000

Salary for the M&E off 20000 pm 16 Unit x 12 3840000

Mobility and Office Expenses

25000 pm 16 Unit x 12 4800000

Total 1,34,40,000

Note – Budget required including Nov. 2010 to Mar. 2011. 75,30,120/- Total Budget required 2,09,70,120/-

67

B.3.4 .A Hospital Manager in FRU Bhagalpur has 2 FRUs in Pirpanti and Naugachia. This year we are proposing to increase the CEmONC to 6. Therefore we propose for 4 positions of Hospital Manager in addition to existing 2 Managers. Budget 2011-12

Name of Facility

Level Number of Manager required

Unit cost Total

RH Pirpanti FRU/CEmONC 1 25000 x 12 300000

SDH Naugachia

FRU/CEmONC 1 25000 x 12 300000

PHC Kahalgaon

Proposed FRU/CEmONC

1 25000 x 12 300000

RH Sultanganj

Proposed FRU/CEmONC

1 25000 x 12 300000

RH Nathnagar

Proposed FRU/CEmONC

1 25000 x 12 300000

District Hospital

Proposed FRU/CEmONC

1 25000 x 12 300000

PHC Sanhaulla

Proposed FRU/CEmONC

1 25000 x 12 300000

Total 21,00,000

Note – Budget required including Nov. 2010 to Mar. 2011. 4,01,000/- Total Budget required 2501000/- B.3.4.B. Regional Programme Management Unit In order to strengthen the Planning and Implementation of NRHM programmes, regional programme management units are being set up at divisional places across Bihar. Since Bhagalpur is the Divisional Head quarter for Bhagalpur and Banka, from this year the office of Regional Manager has become functional. The office is housed in Regional Deputy Directors Office. We shall continue the same activity for this year and therefore propose the following budget.

68

Budget for 2011-12

Sl.No. Particular No. of Post Unit Cost Total

1 Regional Programme Manager

1 43000 (43000 x 12) = 516000

2 Regional Accounts Manager 1 35000 (35000 x 12) = 420000

3 Regional M & E Officer

1 30000 (30000 x 12) = 360000

4 Office Expenditure + Mobility

Lump sum 75000 (75000 x12 ) = 900000

5 Meeting

Lump sum 25000 (25000 x 12)= 300000

Total

208000 2496000

Note – Budget required including Nov. 2010 to Mar. 2011. 1,66,400/- Total Budget required 26,62,400/- Section 4: Referral and Emergency Transport B.4.1: 102 Ambulances Ambulance services are provided in Bhagalpur district since last year. Through Public Private Partnership, 102 Ambulance Service is provided in the district. Last year 489 numbers of patients have benefitted from the programme. For Ambulance people call on to 102 which is a toll free number and Ambulance reaches to people in 15-30 minutes. Patients are charged Rs.6.04 per kilometer. The difficulty is execution of the programme has been bogus calls that are made to the call centre. We request state to take steps to stop bogus calls which unnecessarily put the service providers to inconvenience. Budget for 2011-12

Sl. No.

Particular Unit Cost Total

1 102 Ambulance 41000 (41000 x 12) = 492000


69

B. 4.2: 1911 Call a Doctor & Samadhan

Sl. No.


1 Call a Doctors and Samadhan

16000 (16000 x 12) = 192000

Note – Budget required including Nov. 2010 to Mar. 2011. 134000 Total Budget required 326000/- B. 4.4: Referral Transport Under the referral transport, district was provided funds for 14 institutes @13,000/- last year. With the fund we have been able to operationalise referral transport in 13 blocks and at the district hospital. However it is important reiterate here is Bhagalpur has 16 blocks. Therefore provision should be made for 17 institutions including the district hospital. Besides it is difficult to find vehicles in good condition @ 13000/- in rural areas. Therefore we propose that the hiring fund should be increased to Rs. 18000/- per month keeping the market rate in consideration.

Budget Code


B. 4.4 Referral Transport

15000 (15000 x 12) = 180000

Note – Budget required including Nov. 2010 to Mar. 2011. 4518000 Total Budget required 4698000/- Include a Budget B.8.0: Setting up of Ultra Modern Diagnostic Centre in Medical College Bhagalpur

Budget Code


B.8.0: Ultra Modern Diagnostic Centre in Medical College Bhagalpur

------ 11022000

70

B.9.0: Outsourcing of Pathology & Radiology services from PHCs to DHs The outsourced Pathology and Radiology service is implemented in Bhagalpur district since last two years. The patients are benefitted since the services have been made free of cost. The performance of the units has been mixed in nature. The outsourcing of the facility is systematically weakening the effort to strengthen the public health units with public provisioning of services. The equipments that are available in the health facilities have virtually become redundant; the lab technicians have become jobless. We propose that the state should invest in reviving the pathology and radiology units in public hospitals and do away with the outsourced pathology and radiology services. Since that happens, we propose to continue the services for the benefit of the patients. Budget 2011-12

Budget Head

Type of Institute Type of Service

Unit cost Total

B.9.0: DH/SDH/RH/PHC Pathology & Radiology service

------- Rs. 7000000

B.10.0 Operationalsing MMU

Under Public Private Partnership, Mobile Medical Unit is running in our district since last

two year. This efforts has helped to deliver health services in the remote areas in our

district wherefrom accessibility to PHCs are difficult. Although we are yet to do an

evaluation of the services that has been provided through this unit, it is reported that it

has been a great help to people in the remote rural area. The Unit has a team of

Doctors and paramedics to undertake both diagnostics and dispense medicine in the

visit areas. We propose to the state to provide Bhagalpur with 2 MMUs for the year

2011-12.

Budget for 2011-12

Budget Head

Particulars Unit Cost Units Total Cost

B.10.0 Mobile Medical Unit

4,68,000 2 x 4,68,000 x 12

1,12,32,000


71

B.11.0 Monitoring & Evaluation (State, District and Block Data Centre) Health Management Information system is an important activity in strengthening the planning and implementation of health pprogrammes. In order to computerize all the information’s, reduce the reporting time between source to the planners/decision makers Monitoring and Evaluation system is being set up in the district and in state. Data Centers are being set up in Block, District, Regional and State office. Data collected is entered in the data sheets and are uploaded to the server. Previous year Bhagalpur has established data centre in all its PHC, District Office, JLN Medical College, Regional Directors Office, however the Divisional Data Centre which was to be established in Bhagalpur being the divisional place has not been established. We aim to initiate the process this year and carry on all the activities in the year 2011-12. We also propose that training (six monthly) for the computer operators be organised to correctly enter the data sets to avoid error in reporting. Budget for 2011-12

Budget Head

Type of Institution

Number of Data Centre

Unit Cost Total Cost

B.11.0 PHC 16 15000 X 16x 12 months

28,80,000

SDH 1 15000 X 12 months 1,80,000

DH 1 15000 X 12 months 1,80,000

RDD 1 15000 X 12 months 1,80,000

Medical College 1 15000 X 12 months 1,80,000

Divisional 1 15000 X 12 months 1,80,000

New (Training)

All 22 @1000 per head for 2 times

44,000

Total 38,24,000

Note – Budget required including Nov. 2010 to Mar. 2011. 23,38,000/- Total Budget required 61,62,000/-

B.14.0 Strengthening of Cold Chain

Provisions were made previous year for repair of electrical and non electrical items in

the cold chain, repair of the vaccine van, maintenance of vaccine van.

We have been able to spend Rs. Nil out of grant of Rs.80000 till 30th November 2010.

72

For 2011-12 we propose the following Budget Budget Head

Type of Institution Unit Cost Total Cost

B.14.0 Strengthening of Cold Chain ------ 8,00,000

B.15.0 Mainstreaming of AYUSH Through this scheme the district intends to encourage setting up of general & specialized treatment centers of ISM&H in allopathic hospitals in order to give choice to people to different methods of medication. In 2010-11, AYUSH doctors have been posted in 49 APHCs and 0 PHCs. We propose to open an AYUSH cell in the District Hospital as well as 2 referral hospitals.

Budget Head

Particulars Unit cost No. of units Budget required

B.15.0

Salary of Medical Officer (AYU), (Unani) & (Homeopathy)

20000/ Month

20,000 x 54 x12 1,29,60,000

Salary of Therapist 6000/ Month 6000 x 3 x 12 2,16,000

Salary of Pharmacist 6000/ Month 6000 x3 x 12 2,16,000

Salary of Attendant 5000/ Month 5000 x 3 x 12 1,80,000

Total 1,35,72,000

Note – Budget required including Nov. 2010 to Mar. 2011. 1,15,48,200/- Total Budget required 2,51,20,200/- B.18.2 Procurement of SNCU for DH & NSU for PHCs

Budget Head

Particulars Unit cost Budget required

B.18.2

Procurement of SNCU for DH & NSU for PHCs

--------- 1499904

B.19.0 De-Centralized Planning As we know, Planning has a vital role in the programme implementation of NRHM. At the district level DPC has been selected this year. We need to strengthen planning process so that quality health service can be delivered to the people especially in the remote area. In this context we propose one Additional Assistant cum Data Operator as well as a Laptop / Desktop in the DHS to facilitate adequate planning process.

73

A letter has been issued from SHSB Patna having memo no 21663, dated 29-11-10 for the DPC’s to do monitoring of RI along with DIOS. So a simultaneous work has been assigned to the DPC’s. For this act an additional vehicle in needed in the DHS to strengthen the planning and monitoring process. Budget for 2011-12

Budget Head

Particulars Unit Cost Total Budget required

B.19.0

Salary of DPC 20,000 20,000 x 12 = 2,40,000

Assistant cum Data Operator 10,000 10,000 x 12 = 1,20,000

Laptop / Desk top & Accessories 60,,000 = 60,000

vehicle 20,000 20,000 x 12 = 2,40,000

Total = 6,60,000

Note – Budget required including Nov. 2010 to Mar. 2011. = 1,52,000/- Total Budget required = 8,12,000/-

B. 21. Additional ANM at Health Sub Centre There are 280 health sub-centres in the district. To help the HSCs function well additional ANMs are appointed to the HSCs. Till this year the district has been to recruit and post 55 ANMs. 225, 384 Present status

Budget Head

Name of the Block

Number of HSC

Additional ANM in position till 2010-11

Additional ANM required in 2011-12

B. 21

PHC Naugachia 14 10 4

PHC Kharik 13 8 5

PHC Ismailpur 6 5 1

PHC Gopalpur 11 6 5

PHC Rangra 9 5 4

PHC Narayanpur 10 7 3

PHC Bihpur 19 7 12

PHC Sanhaulla 18 10 8

RH Pirpainti 36 21 15

PHC Kahalgawn 35 28 7

PHC Goradih 12 14 0

PHC Sabaur 16 11 5

PHC Jagdishpur 15 14 1

PHC Nathnagar 17 20 0

PHC Sahkund 23 18 5

RH Sultanganj 26 27 0

Total 280 211 75

74

Plan 2011-12

District Total SC Total Regular ANM

Total Additional ANM

Required Additional ANM

Bhagalpur 280 354 (Including APHC+PHC)

211 75

Budget 2011-12 Salary, travel allowances and honorarium to Part Time Lady Attendant (PTLA) of regular ANM is borne though regular funds. Similar to regular ANM, additional ANM will require budget for salary, daily allowances during travel and honorarium for PTLA. Accordingly, budget required to for additional ANM is as follows:

Budget

Head

Particulars Monthly

amount

Total ANMs Total

(In lakhs)

B. 21 Salary for existing

ANMs

Rs.8000/- 211 x 8000 x12 2 ,02 ,56,000

Salary for ANMs to

be recruited for

2011-12

Rs.8000/- 75 x 8000 x 12 72 ,00,000

Total 2,745,6,000

Innovative Schemes Birth Preparedness Centre

Bhagalpur is a populous district and because non demarcation of health institutions, some PHCs cater to almost 3 lakhs population. Block level PHCs have only in patient facility and the APHCs do OPD services. Even if pukka roads are available, there is no reliable transportation system for transferring pregnant women in labour to nearby PHC which is at a distance of 15-20 kilometres. This is the one of the important cause of high maternal and neonatal mortality and morbidity. Since accurate predication cannot be made on the time of delivery, hence it puts the mother in danger if she develops complicacies and does not find transportation facilities. Hence Birth Preparedness Centre scheme is proposed in 6 CEmONC facilities in which one room is build in PHC premises where pregnant woman will get admitted one week before her due date. Following facilities are proposed in ‘Birth Preparedness Centre’

• One room of 5×5 meters

• One sanitary block (Toilet and bathroom)

• One kitchen with smokeless chulha

• One solar water heater system on roof of the room

75

‘Birth Preparedness Centre’ will be maintained by local Self Help Group. When mother is admitted, mother and one attendant will be provided food three times a day. It is proposed to provide Rs. 125/- per mother per day to SHG for this purpose. Budget requirement for Birth Preparedness Centre Scheme

Sr. Particulars Unit cost No. of units Budget required

1 One room construction

3,00,000 6 18 ,00000

2 Maintenance cost to SHG

@70 per pregnant women per day for 200 persons in a month for 12 months in 6 institutes

6 10,08,000

Other contingent expenses

@20000/- per centre for 6 centres

6 1,20,000

Total 29,28,000

Innovative Schemes Construction of Rest Room for ASHA in all the PHCs , Sub District Hospital and District Hospital There is no denying of the fact that ASHAs have been able to mobilize pregnant women to the PHCs, SDH, DH for safe delivery. ASHAs stay till the mother delivers and is discharged from the hospital. Though the pregnant women get a bed in the hospital (sometimes they even don’t get a bed- which we have proposed in RCH plan) the ASHA does not find a suitable place to rest. She is always in the danger for her safety and security. Out of the meager amount she gets to take care of her food and stay she almost spends the entire amount sometimes in filthy food which makes her ill. Therefore taking the instance of neighbouring state Orissa, we propose to establish ASHA Griha in all the PHC, SDH, DH to give resting facility to ASHA as well as other attendants of patients. The proposed room will be 14X10 ft size with attached toilet, a kitchen. Water and Electricity will be provided to the house.

76

Budget for 2011-12

Sl. No Name facility Type of

facility

Average Monthly

Delivery

(April 2009 to March 2010)

Budget

1 Sadar Hospital DH 339 400000

2 SDH Naugachia FRU 363 400000

3 PHC Naugachia 24*7 0 -----

4 PHC Kharik 24*7 0 ------

5 PHC Ismailpur 24*7 0 ----

6 PHC Gopalpur 24*7 194 400000

7 PHC Rangra 24*7 0 -----

8 PHC Narayanpur 24*7 0 ----

9 PHC Bihpur 24*7 267 400000

10 PHC Sanhaulla 24*7 160 400000

11 RH Pirpainti 24*7 285 400000

12 PHC Kahalgawn 24*7 260 400000

13 PHC Goradih 24*7 0 0

14 PHC Sabaur 24*7 253 400000

15 PHC Jagdishpur 24*7 210 400000

16 PHC Nathnagar 24*7 196 400000

17 PHC Sahkund 24*7 214 400000

18 RH Sultanganj 24*7 287 400000

Total 3028 48,00,000

77

New proposed

Next year we are proposing new construction of ANM School at the district to provide

health services for the community.

Budget 2011-12

Sl. No. Particulars Unit Cost Total Budget required

1

New construction of ANM School

39400000 39400000

New proposed

Next year we are proposing recruitment of Block M&E officer at all PHCs in the District.

Timely reporting of data is mandatory for execution of programme. The budget required

for the same is as follows –

Budget 2011-12


1

Salary of Block M&E officer

15,000 16 x 15,000 x 12 = 28,80,000

New proposed

Next year we are proposing recruitment of District Programme Manager (AYUSH) at the

district to strengthen the AYUSH wing at the PHC level. The budget required for the

same is as follows –

Budget 2011-12


1

Salary of District Programme Manager

(AYUSH)

25,000 16 x 25,000 x 12 = 3,00,000

78

New proposed

Next year we are proposing recruitment of (AYUSH) Specialist and two Data Operator

at the district / sub-divisional Hospital and Pharmacist at district / sub-divisional Hospital

as well as at the APHC level to provide AYUSH treatment for the community . The

budget required for the same is as follows –

Budget 2011-12


1

Salary of (AYUSH) Specialist

at the district / sub-divisional Hospital

35,000 2 x 35,000 x 12 = 8,40,000

2 Pharmacist (AYUSH) 6,500 56 x 6,500 x12 = 43,68,000

3 Salary of Data Operator at the district / sub-divisional Hospital

6,500 4 x 6,500 x 12 = 3,12,000

Total = 55,20,000

New proposed

Next year as per MCH sub plan we need procurement of beds for PHC and district

Hospital. The budget required for the same is as follows –

Budget 2011-12


1

Procurement of beds (PHC and district Hospital)

9,000 9,000 x 50 = 45,00,000

New proposed

Next year as per MCH sub plan additional ANM(R) needed to functional APHC and

HSC for day time service. The budget required for the same is as follows –

Budget 2011-12


1

Salary ANM(R) 8,000 18 x 8,000 x 12 = 17,28,000

79

New proposed

Next year we are proposing MPW at all HSCs in the district. The budget required for the

same is as follows-

Budget 2011-12


1

Salary of MPW 8,000 280 x 8,000 x 12 = 26880000

80

CHAPTER-V

PART- C

Routine Immunization:

The immunization situation of the district is bleak and only 55 % of the total children are fully

immunized. Although the situation has improved compared to the DLHS-2 (43.4) in full

immunization coverage, the individual vaccine coverage in the period from DLHS-2 to DLHS-3

is not inspiring either. In order to reach the aim of 100% full immunization in the district, focus

on the underserved and unserved areas, vulnerable communities, and migrant population is

required. There is a need of strengthening the cold chain infrastructure, skilled vaccinators, and

timely supply of vaccines from the state to the districts, districts to the PHCs and till the

immunization sites.

Focus of the district in 2011-12 will be to hold regular immunization sessions in all its HSCs

and AWCs. The process of development of micro plans will be strengthened and follow up the

micro plans will be ensured for each HSCs. Besides the district will focus to map the

underserved and unserved area in terms of distance and in terms of living of the vulnerable

communities. So catch rounds will be planed to cover all the beneficiaries. The other important

focus of the district will be to focus on building the skill of the ANMs in administration of the

vaccines. Since many ANMs have become old and many new ANMs have joined in without

much of on the job experience, hence they find it difficult in administering the vaccines which

affects the immunization coverage.

Name of PHC ILR Deep Freezer Cold Boxes Delivery of

Vaccines at site Pirpaithi � � � �

Kahalgaon � � � � Sanahoula � � � � Gaouradih � � � �

Sabour � � � � Jagdishpur � � � � Nathnagar � � � �

Shahkund � � � � Name of PHC ILR Deep Freezer Cold Boxes Delivery of

Vaccines at site Suntanganj � � � � Navagachia � � � �

Kharaik � � � � Bihpur � � � � Narayanpur � � � �

Rangra � � � � Gopalpur � � � � Ismailpur � � � �

81

There is shortage of cold chain equipment such as ILR and deep freezer at PHC level. Most of

the PHCs are operating with either ILR or deep freezer. The District does not have a vaccine

van which obstructs timely supply of vaccines to the district. DPT and needle supply is not

timely. The maintenance and repair of cold chain equipment is not being done properly by the

company currently appointed. The District also needs to adopt better waste management

practices for the disposal of syringe and needles. Funds for Printing of RI formats are

underutilized.

The strategies to be adopted to increase the coverage of individual vaccine coverage and full

immunization will be

1. Improving availability of skilled vaccinators.

• Organizing regular routine immunization training for ANM and AWW and

IPC/IEC/BCC trainings for ASHA and AWWs.

2. Increasing utilization of immunization services through awareness generation by ASHAs and

AWWs.

• Organising immunization camps at every sub centre level on every Wednesday and at

the AWCs on every Saturday.

3. Ensuring continued tracking of pregnant women and children for full immunization

• Regular house to house visits for registration of pregnant women for ANC and children

for immunization

• Developing tour plan schedule of ANM with the help of BHM and MOIC.

• Regular house to house visits for registration of pregnant women for ANC and children

for immunization

• Developing tour plan schedule of ANM with the help of BHM and MOIC.

4. Improving availability and maintaining quality of cold chain equipments and improving

timely supply of the vaccines, timely supply of DPT and syringes.

• Timely payment to MOICs to arrange transportation of vaccines from district hospital to

PHCs.

• Regular disbursement of funds from the DIO to MOs for providing incentives to ANMs

• Regular disbursement of funds for ANMs to provide incentives to AWWs and ASHA

workers

• Providing per diem for health workers, mobilisers, supervisors and vaccinators and

alternative vaccinators

• Maintaining the disbursement records and for evaluating the performance of the

health

5. Adopting safe disposal policies for needles and

• Procure stock of hub cutters for all the PHCs for safe disposal of needles and syringe.

82

Budget:

Sl Activity Unit Number

of Units

Total Cost

Mobility support for

supervision @Rs.62500 per District

for district level officers

(this includes POL and

maintenance) per year

1

62500

Cold chain

maintenance @ Rs 500 per PHC/CHC

per year District Rs

12500 per year

12500

Focus on slum &

underserved areas in

urban areas:

Hiring an ANM

@Rs.300/session for four

sessions/month/slum of

10000 population and

Rs.200/- per month as

contingency per slum of

i.e. total expense of Rs.

1400/- per month per

slum of 10000 population

30

375000

Mobilization of

children through

ASHA/mobilizers

Rs.150/- per ASHA per

session 4X16X36

2X12 347520

Vaccine Delivery Rs.100/per session for

HRTA and Rs.50/- for

other ares

4X77X12

X100 462000

Computer Assistant RI Rs. 10000/- p.m 10000X12 150000

Printing of formats Rs.5/- per children 200000

lakh

children 1250000

Review meeting by

DIO of CDPO , MOs

and BHMs

1 meeting per dist. Per

month@100 per ppts 48X100X

12 72000

Block coordination

committee meetings @Rs 50/-pp as

honorarium for ASHAs

(travel) and Rs 25 per

person at the disposal of

MO-I/C for meeting

expenses(refreshments,

stationery and misc.

expenses)

75X2312

216750

District level orientation

training for 2 days

ANM, Multi Purpose

Health Worker (Male),

LHV, Health Assistant

(Male / Female), Nurse

Mid Wives, HEs

1000000

83

One day Training of

block level data

handlers by DIO and

District Cold chain

Officer to train about

the reporting formats

of Immunization and

NRHM

Rs 200 per ppts and

Resource person fee of

Rs.300/-

=100X20

0+300X4

26500

To develop sub-center

and PHC microplans

using bottom up

planning with

participation of ANM,

ASHA, AWW

@ Rs 100/- per sub-

centre (meeting at block

level, logistic)/ For

consolidation of

microplan at PHC/CHC

level @ Rs 1000/- block

& at district level @ Rs

2000/- per district

=362*100

+16X100

0+2000

67750

Health Workers

Training on

immunization

ANM, LHV,BHW 694

1337750

Honorarium +

TA to

Participants

@Rs 400 per

participants,

Honorarium

for

trainers/faculty

@600 per day

( subject to at

least 2 lecture

per guest

faculty per

day) for 2

days, Working

lunch &

Refreshments

Rs 200 per

participants +

faculty per day

for 2 days,

Incidental Exp

for Photocopy

, Job aids, flip

charts,

T.V./LCD

hiring etc @

250 per

participants

per days for 2

days

PART –D

CHAPTER -VI

Chapter: 6 Problem Identification

Kala Azar is a chronic and fatal disease which is caused due to infection called leishmania

donovani. The disease of the viscera particularly affects the liver, spleen bon

nodes. The vector thrives in cracks and crevices of mud plastered houses, poor housing

conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.

disease particularly affects the poor people since th

spread of the disease.

There are around 500,000 cases of kala

largest burden for this disease in the world, and Bihar state has the highest disease burd

country (around 20,000 new cases every year).

The eradication of Kala Azar is possible with simple but timely and continuous efforts. This

needs awareness in the community on the disease and its cause along with prompt services from

the system in control of vector and treatment of affected.

Kala-Azar affected blocks

Programme-specific Plan

Chapter: 6 Problem Identification and Prioritisation

KALA –AZAR


donovani. The disease of the viscera particularly affects the liver, spleen bone marrow and lymph


conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.

disease particularly affects the poor people since they live in conditions which are conducive for

There are around 500,000 cases of kala-azar annually, and 200,000 related deaths. India has the

largest burden for this disease in the world, and Bihar state has the highest disease burd

country (around 20,000 new cases every year).



n control of vector and treatment of affected.

affected blocks

84

and Prioritisation


e marrow and lymph


conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses. This

ey live in conditions which are conducive for

azar annually, and 200,000 related deaths. India has the

largest burden for this disease in the world, and Bihar state has the highest disease burden in the



85

The district Bhagalpur is considered to be an endemic zone w.r.t Kala Azar in Bihar. The poor

living conditions of people make them most vulnerable to the disease. Kala Azar is ‘poor

person’s disease’ and is one of the most apparent examples of the vicious cycles of disease and

poverty, of how poverty causes disease, which in turn pushes poor people, further into poverty.

For one, is the burden of disease, two is the wage loss due to disease. The blocks of Pirpainti,

Kahalgaon, Sonhaula, Sultanganj and Naugachia are the endemic blocks and there are also

sporadic cases in the other blocks such as Nathnagar, Bihpur, Gopalpur.

The following are thr districts in which Kala-Azar cases have been reported in the year 2011.

However in other adjacent district the incidence of the disease has been sporadic.

Sl.no. Name of the

phcs

Popula

tion o

f affec

ted P

HC

s

Till

November

10

In the month

of December

10

Cumulative

2010-11

Case

s under

tre

atm

ent

Untr

eate

d c

ase

s

Res

ista

nt ca

ses

Pkdl ca

ses

No o

f aff

ecte

d v

illa

ges

Case

s

Dea

th

Tre

ate

d

Case

s

Dea

th

Tre

ate

d

Case

s

Dea

th

Tre

ate

d

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

2 Sultanganj 25198 13 4 Nil 4 2 Nil Nil 6 Nil 4 2 Nil Nil Nil

3 Kahalgaon 84090 35 8 Nil 8 Nil Nil Nil 8 Nil 8 Nil Nil Nil Nil

4 Pirpanthi 109372 70 20 1 14 2 Nil 1 24 1 15 3 2 Nil 1

5 Sanhaula 26505 13 2 Nil 2 Nil Nil Nil 2 Nil 2 Nil Nil Nil Nil

6 Naugachia 70890 14 2 Nil 2 Nil Nil Nil 2 Nil 2 Nil Nil Nil Nil

Total 148 36 1 30 4 0 1 42 1 31 5 2 0 1

The challenge for the district to control the spread of Kala-Azar has been poor follow up.

Control measures for Kala-Azar like spraying of DDT (50%) in the affected area has been

minimal due to inadequate manpower and inadequate supply of the insecticide.

The other constraint has been that the PHCs do not initiate the spraying activities simultaneously

which makes the vector to resurface.

The third constrain is that budgetary provision is made for focal sprays, where as there is a need

of spraying in the peripheries to control the vector.

In order to control the spread of the disease the following strategies will be adopted at the district

level

86

- Effective disease surveillance

• ASHA and AWW will be trained on the signs and symptoms of the disease. The

training will be of one day. They will also be informed about the service provision

available at different levels of institutions in the district.174 ASHAs and 174 AWWs

will be trained.

• The PRI members of the area will also be trained on the signs and symptoms of the

Kala-Azar. One day training will be organized in the district and 174 PRI members

will be trained from the affected villages.

• The traditional healers will be mapped and shall be trained on the disease. They will

be motivated to refer the patients to the nearest PHC for treatment. One day training

for 60 traditional healers will be organized in the district.

-Vector control through IRS with DDT up to 6 feet height from the ground twice annually

• Spray in the affected areas and in the periphery areas as well. The spray activity will

be taken up twice a year; one round is Feb-March and the other round in May-June.

In the endemic areas additional spraying will be carried after the monsoon. (plan

attached in the budget)

• Mop up spray in the hotspots.

- Use of impregnated bed nets

• Bed nets 2 in number will be distributed in the affected villages to all the househols.

• Impregnation of bed nets will also be done in the area in a campaign mode.

- Early Diagnosis and Complete treatment

• ANMs and ASHAs will be provided with the diagnostic kit.

• ASHAs, AWW and other volunteers whosoever brings Kala Azar patients will be

incentivsed..

• The Kala Azar patients will be paid wage loss for a month along with free treatment

in the government hospital.

• Private hospitals will be brought under the programme for referral to the government

facilities. One district level workshop and one block level workshop will be organized

for the same.

• Patient cards will also be developed for tracking of the Kala-Azar patients. 1000 cards

will be printed for the year 2011-12

- Information Education Communication

• Kalajathas in each village will be organized on Kala- Azar theme. 200 such shows

will be organized in the district for 2010-11

• Wall paintings in prominent places on the programme services will be done. In the

district 500 wall paintings will be carried out

All the IEC/BCC activities to be executed through the VHSC.

87

- Capacity Building of staffs at all levels

• Training of MOs will be organized for management of Kala Azar patients. MOs at the

PHC, CHC, SDH and DH will be trained. The training will be of one day duration.

• All the ANMs of the district will be trained.

• All the staffs engaged in the programme will be trained.

Budget:

Sl. No. Activity Unit cost Total Cost Remark

1 Wages for 120 days for

Spray Workers

SFW@113 per

day

FW@92 per day

457650.00

4008940.00

For 2 rounds of

spray

2 Office expenses (Stencil,

Geru, Cloth and register

150/Spraying

Squad

10137.00 Do

3 Contingency for

Machine Instruments

(nozzles, tips, etc)

25000.00 Do

4 Transportation of DDT

from district to PHC

1500/ per PHC 60000.00 Do

5 Transportation of DDT

to Villages from PHC

750 per PHC per

day for 120 days

900000.00

6 Training for

ASHA/AWW/MO/ANM

and Squads

5000 per PHC 100000.00

7 IEC- Kalajatha 1000/per village 609000.00

8 Wall painting 2000/per village 435000.00

9 Supervision for DDT

spray for MI, BHI and

BHW

Rs 175X8X120 210000.00

Total for District 4287787.00

88

Revised National Tuberculosis Control Programme

(RNTCP)

Bhagalpur district has a population of 29.55 lakhs out of which 25.50 lakhs live in the rural

areas. 4.05 laksof its population live in urban area and out of it most of it lives in the slums. The

population density of the district is 946 persons per square kilometer (2001 census) which has

gone up in recent times to 1103. This implies that number of people living in a particular area

has increased significantly and there is obvious congestion which has lead to unhygienic

conditions. Besides, more than 50% of the populations of the district live below the poverty line.

The district has a significant population engaged in vocations like weaving, bidi making and

engaged in slaughtering activities. With this kind of socio-economic profile, the population has

greater vulnerability of contracting tuberculosis. Since it is a contagious disease it has the

potential affecting a large population living in closed environment.

Situational Analysis

Number of TB Patients put under treatment

TB Unit

Total

number of

patients put

on treatment

Annualized

total case

detection

rate (per

lakh

population)

No of new

smear

positive

cases put

under

treatment

Annualized

new smear

positive case

detection rate

(per lakh

population)

Cure rate for

cases detected

in the last 4

corresponding

quarters

DTC Bhagalpur 1180 172 380 55 85

Kahalgaon 751 127 280 47 86

Naugachia 885 129 381 55 94

Sabour 592 137 266 61 93

Sultanganj 395 96 184 45 96

Total 3803 136 1491 53 90

• Annualized Case Detection Rate for New Smear Positive Cases:

The number of new smear-positive tuberculosis cases registered for treatment per

100,000 populations in Bhagalpur on an average is 53. The national guideline says that

the estimated incidence of cases is 75 new smear-positive cases per 100,000 populations

per year. The national target is to detect at least 70% of the total estimated cases - i.e. 53

cases per 100,000 per year. However there is a need of detection of 100 % cases to

achieve 100 cure rates.

89

An analysis of the PHC wise case detection shows that in the two PHC areas i.e.

Kahalgaon and Sultanganj the case detection rate is 47 and 45 respectively. Hence there

is a need of increasing the surveillance in these two PHCs.

• Treatment Success Rate:

The success rate/cure rate percentage of new smear positive patients who are documented

to be cured, or to be successfully completed treatment is 90%for the district Bhagalpur.

We strongly feel that there is a need of documenting the other 10% who have either

abandoned the treatment halfway or those who have not been cured after the medication

for the prescribed period. There might be chances of MDR cases out of these 10%

patients who have not been cured or have not successfully completed treatment.

Organization of Services in the District

The district has five tuberculosis units (TU) including the one at the District Tuberculosis Clinic.

The other TUs are in Khalgaon, Naugachia, Sabour and Sultanganj.

Sl.

No.

Name of the Tuberculosis

Unit

Functions out of Number of Microscopy Centers

Govt.

facility

NGO

facility/Pri

vate facility

Govt.

facility

NGO Private

facility

1 District TB Clinic,

Bhagalpur

01 00 04 00 02

2 Kahalgaon 01 00 02 00 00

3 Naugachia 01 00 05 00 00

4 Sabour 01 00 04 01 00

5 Sultanganj 01 00 02 00 00

District Total 05 00 17 01 02

Tuberculosis Unit:

For a population of 5 lakhs there is a need of one Tuberculosis unit. At present Bhagalpur has 5

TB Units including the District Hospital. There is a need of another TB Unit which needs to be

located in Bihpur which is on the other side of River Ganges. By establishing a new TB Unit in

Bihpur, the surveillance of patients can be increased and also more number of patients can be put

under treatment.

Microscopy Centre

With increase in population and at a total population close to 30lakhs, there is a need of

establishment of more number of microcopy centers in the district. As per norm for

establishment of Microscopy centre at 1 lakh population, the district needs at least 30 centres.

The district presently has 20 MCs including 3 at the private sector. Hence it is proposed to have

additional 10 MCs in the district.

90

TB-HIV ward in the District Hospital

There is an absence of TB-HIV ward in the District Tuberculosis Clinic. The HIV infected

persons are susceptible to the TB infections because they are low in immunity. There is a need of

establishment of such a ward in the District TB clinic for treatment of the TB-HIV patients.

Human Resources (Contractual)

Human Resource Number present Required Planned to be

additionally

hired

Justification

STS 05 06 01 One STS at each

TU

STLS 05 06 01 One STLS at

each TU

TBHV 04 06 02 One TBHV at

each TU

DEO 01 01 0 -

LT 14 30 16 One LT at the

DMC

Accountant

(part-time)

1 1 0 0

To Stop TB spreading in Bhagalpur District and get success in treatment of infected

patients the following strategies shall be adopted with the following suitable activities.

1. By expanding the Coverage of the programme to underserved areas: By establishing

additional Microscopy Centers and TB units in the district to cater to the underserved

population. Establishment of the DMC and TU will increase the accessibility for uptake

of the TB care.

2. Pursue quality DOTS expansion and enhancement: By improving the case finding are

cure through an effective patient-centered approach to reach all patients, especially the

poor.

3. Address TB-HIV, MDR-TB and other challenges: By scaling up TB-HIV joint

activities, DOTS Plus, and other relevant approaches. Setting up a TB-HIV ward at the

District TB Clinic

4. Contribute to health system strengthening: By collaborating with other health

programmes such as RCH, HIV and general services like the department of water and

sanitation, housing, employment.

5. Involve all health care providers, public, nongovernmental and private: By scaling

up approaches based on a public-private mix (PPM) and by setting up DMCs in private

hospitals, involving the private practitioners in sputum collection, DOTs provision for

patients diagnosed by the private practitioners.

6. Engage people with TB, and affected communities: To demand, and contribute to

effective care. This will involve scaling-up of community TB care; creating demand

through context-specific advocacy, communication and social mobilization. The effort

91

can be further intensified with the involvement of the ASHA in identification of new

cases, expanding the DOTs

7. Rigorous follow-up of all patients through the ASHAs: To closely follow up the TB

cases in treatment with DOTs, to check the drop outs and also to follow up the uncured

patients for further investigations.

Budget:

Sl.

No

Activity Unit Cost Number of Units Total Cost

1 Up gradation of the DTC

with a waiting Hall for

patients, Toilets for patients,

Toilets for the Staffs,

meeting cum training hall in

the DTC

625000.00 1 625000.00

2 Setting up of 20 bedded TV-

HIV ward at DTC

62500.00 1 625000.00

3 Setting up of new TU in

Bihipur

43750.00 1 43750.00

4 Setting up of DMCs 37500.00 10 375000.00

5 Purchase of Lab materials 1.5 lacs/10 lacs

population

- 530000.00

6 Honorarium for DOTs

provider

250/per case 3200 1000000.00

7 Advocacy ,Communication

and Social Mobilisation

265312.50

8 Equipment and maintenance 73750.00

9 Training 194562.50

10 Vehicle Hiring 640500.00

11 Vehicle maintenance 312500.00

12 NGO support 343750.00

13 Printing 530625.00

14 Support to Medical college 376500.00

15 Procurement of equipment 42500.00

16 Human resources

Total 5978750.00

92

National Programme for Control of Blindness

The National programme for control of Blindness is implemented in the district with a focus on

giving sight to people from preventable blindness because of cataract. It also conducts school

health screenings to find out problems of vision amongst the students and take corrective

measures.

Since many children remain out of school in the district, the programme does not cover them. In

2010-11 the focus would be to cover the out of school children.

The strategies and Activities

1. Prompt case detection

• Screening of all children in the schools

• Including Optometric in Mobile medical unit visits to camps in villages.

• Fortnightly visit by optometrician to health sub-centres and weekly visit to APHCs

• Contracting-in of ophthalmologist services

• Distribution of spectacles from the health facilities

• Conducting in-hospital minor surgeries for cataract.

• Conducting surgeries in the NGO run hospitals and follow-up

• Distribution of spectacles for BPL population undergoing surgery in private sector

2. Ensuring proper treatment

• Contracting-in of ophthalmologist services

• Distribution of spectacles from the health facilities

• Conducting in-hospital minor surgeries for cataract.

• Conducting surgeries in the NGO run hospitals and follow-up

• Distribution of spectacles for BPL population undergoing surgery in private sector from

the PHCs, SDHs and the DH.

Sl No Activity Unit cost Number of Units Total Cost

1 Cataract operation

camp

@7500 750 5625000.00

2 School screening @1200 500 600000.00

3 Spectacles,

maintenance

1000000.00

4 Operation Unit 1200000.00 1 1200000.00

5 Hon to Secretary 2500 p.m. 12 months 30000.00

6 Hon to Assistant 1825 p.m. 12 months 21900.00

7 Office expen 1,25,000.00

Total 89827500.00

93

National Leprosy Elimination programme

Objective

• To reduce the leprosy disease prevalence rate to <1

Situation analysis

Currently disease prevalence rate per 10,000 population in the district is 1.10 (2009-10)

The disease prevalence rate till the month of November 2010 is 1.26

Disease detection rate per 10,000 population is 2.01

Detection rate till November 2010 is 1.43

Number of cases under treatment is 332 (Nov 2010)

New patients registered – 532 (Nov 2010)

% of children in new cases – 14.5 (Nov 2010)

% of deformity – 2.20 (Nov 2010)

% of SCs in new cases – 15.13 (Nov 2010)

% of ST in new cases – 2.19 (Nov 2010)

Total treated patients treated in the year 2009-10 – 642

Infrastructure:

The district does not have its own office. The office is running on rent. Similarly the unit in

Nawgachia is running on rent and the Kahalgaon unit needs major repair. The 20 bedded leprosy

hospital in Bhagalpur needs major repair.

Human Resources:

Post Approved position In position Vacant Required

Medical Officer 5 2 3 3

Physiotherapist 3 3 0 0

Medical Social

Worker

13 1 12 12

Health Educator 1 1 0 0

Non Medical

Assistant

56 22 34 34

Clerk 10 6 4 4

Grade A nurse 4 1 3 3

Lab Technician 5 1 4 4

Driver 5 1 4 4

Attendant Male 4 3 1 1

Cook 1 0 1 1

Peon 7 1 6 6

Cook mate 1 0 1 1

Sweeper 1 0 1 1

Security 1 0 1 1

94

Strategies and Activities

1. To Enhance the Case detection Rate

• House to house visits for tracing cases of Leprosy, by BHWs, ANM and ASHA

• Detected cases are to be taken to hospital for proper counselling, by professional counsellors

• The cases detected are to be monitored and followed up by health workers, mainly by

BHWs/ASHA to detect deformity.

2. Strengthening facilities at all levels for management of cases

• Construction of office for the DLO

• Major repair of the Kahalgaon Unit and that of the 20 bedded hospital of the district

• Provision of rent for the Nawagachia Unit

• Filling up all the posts on a contract basis till the posts are filled up on a regular basis

3. Awareness in the community on the disease

• Awareness creation among community by having Kalajathas

• Sensitization of AWW, ASHA

4. Re constructive surgery camps for the deformity cases

• Conduct one camp in each quarter for reconstructive surgery

95

Budget:

Sl

No

Activity Unit cost Numb

er of

Unit

Total Cost

1 Construction of

DLO office

1250000.00 1 1250000.00

2 Major repair of

Kahalgaon Unit

250000.00 1 250000.00

3 Rent provision

for Nawagachia

Unit

1250 per month 12 15000.00

4 Kalajathas in

PHC areas

12500 per PHC 16 200000.00

5 Senisitisation

meetings

@625 per meeting for

each SC area

362 226250.00

6 Incentives for

ASHA and other

volunteers

@425 per cases 1000 425000.00

7 Re constructive

Surgery camps

and provision of

artificial limbs

@ 125000 for 1 Camp 4 500000.00

8 Human resources

Medical Officer @30000 pm 3 900000.00

Medical Social

Worker

@10000 p.m 12 120000.00

Non Medical

Assistant

@6000 p.m. 34 204000.00

Clerk @6000p.m 4 288000.00

Grade A nurse @3000 p.m. 3 108000.00

Lab Technician @6000 p.m. 4 288000.00

Driver @5000 p.m. 4 240000.00

Attendant Male @4000 p.m 1 48000.00

Cook @5000 p.m. 1 60000.00

Peon @4000 p.m. 6 288000.00

Cook mate @4000 p.m. 1 48000.00

Sweeper @4000p.m 1 48000.00

Security @4000p.m 1 48000.00

Total for the District 5554250.00

96

Malaria Control ProgrammeMalaria Control ProgrammeMalaria Control ProgrammeMalaria Control Programme

Situation AnalysisSituation AnalysisSituation AnalysisSituation Analysis: : : : District faces lack of laboratory technicians and facilities at the APHC/PHC

level. This has proved to be a hurdle in prompt diagnosis of the cases. All BHW, BHI, ANM are responsible for collecting the BS of the suspected cases. The exact burden of disease in Bhagalpur is not known as reports from private sector is not collected or not reported. The BCC activities in the district are also limited. There is also shortage of mosquito bed nets but anti-malarial drugs are in abundant.

StrategyStrategyStrategyStrategy ActivitiesActivitiesActivitiesActivities BudgetBudgetBudgetBudget

• Ensuring registration of all private laboratories

• Filling-up of all vacant posts

• Enhancing BCC activities

• Ensuring adequate supply of mosquito bed nets

• Meeting with DM for issuing an order for all old and new laboratories to register with DHS.

• Following their registration, they would be expected to report all the disease specific cases to the DHS.

• All HWs would also be then requested to collect the reports.

• Training of all health workers in BCC.

• Supply of bed nets as per Kala-Azar

Health workers- 50 additional health workers for spraying DDT on daily basis @Rs 200 * 30 days= Rs.300,000.00

Total- Rs.300,000.00

97

Filaria Control Programme-

Situation Analysis- Similar to Malaria and Kala Azar, lack of laboratory technicians and facilities at the APHC/PHC level continues to pose a challenge for an effective filarial control programme in the district. In case of Filaria specifically the exact burden of disease is not known because reports from the private sector are not collected or not reported. BCC activities in the district are limited. There is a shortage of chemically treated bed nets. Mass Drug Administration has been carried out in the population where cases have been detected.

Strategy Activities Budget

1. Early diagnosis and prompt treatment

2. Ensuring registration of all private laboratories

3. Filling all vacant posts

4. Enhancing BCC activities

5. Ensuring adequate supply of mosquito bed nets

6. Ensuring adequate supply of drugs

1. House to house visits for tracing cases of Filariasis, by health workers (BHWs, ASHA, ANM)

2. Collection of reports from local private practitioners and laboratories in the village

3. Meeting with DM for issuing an order for all old and new laboratories to register with DHS.

4. Following their registration, they would be expected to report all the disease specific cases to the DHS.

5. All HWs would also be then requested to collect the reports.

6. Training of all health workers in BCC.

7. Supply of bed nets as per Kala-Azar

8. District level procurement of drugs for MDA, with funds from respective department.

Health workers-20 Additional workers on daily basis @ Rs 200 * 30 days= Rs.120,000.00

Publicity campaign- Rs.30,000.00

Handbills and hoardings for BCC and IEC campaign – Rs. 50,000.00

Total- Rs.200,000.00

98

CHAPTER VII :

Budget for 2011-12

BUDGET

AMOUNT

NRHM PART – A – RCH II

409978663.00

NRHM PART – B – Additionalties

550710327.00

NRHM PART – C – Immunization

1337750.00

NRHM PART – D – NDCP

106148287.00

`Summary of Budget

1068175027.00

---------------------------------------------- --------------------------------------------

Dr. (Mrs.) Pratima Modi Mr. Rahul Singh

Civil Surgeon cum Member Secretary (IAS)

District Health Society, Bhagalpur District Magistrate Cum Chairman


District Health Society, Bhagalpurstatehealthsocietybihar.org/pip2011-12/districthealth...7 Foreword The District Health Society (DHS) of Bhagalpur was formed in the year 2006-07.

Documents