Greetings From Chhattisgarh

A new state Chhattisgarh is born on 1 st November 2000 with 16 districts

 Area: Sq. Km. (6 times of Kerala State)  Population: (Census 2001) Rural-80%, Urban-20% SC- 12%, ST-33%  Sex ratio:990 female per 1000 male  No. of districts:16 Blocks-146(Tribal –85)  IMR:79 per 1000 live births GENERAL INFORAMTION

Sex Ratio: 990/1000

Decadal Growth Rate: 18.06

Literacy Persons: Male: Female: 52.4

SRS 2001 (Released by RGI in October 2002)

Some Important Indicators of NFHS-2 Fertility Indicators

Some Important Indicators of NFHS-2 Maternal Health Indicators

Some Important Indicators of NFHS-2 Child Health Indicators

Infrastructure

Infrastructur e Gaps Manpower Gaps Other Gaps Only 2 Medical Colleges No District Hospital in 10 out of 16 Districts (Sanctioned in all) No CHC in 54 out of 146 Blocks Deficiency of over 500 doctors in Public Sector Major deficiency of paramedics Very few doctors, and paramedics in Private Sector in rural areas Poor Monitoring Poor Managerial and other related skills Difficult Geographical area, and poor communication

The new Strategy Health Systems Improvement Improve Routine Programme Monitoring Capacity Building at all levels - Improve Training Infrastructure and Manpower Community Health Volunteers ("Mitanins') - New Scheme of Community Participation Improve Infrastructure Better MIS based on IT Involve PRIs and ULBs Mobile Hospitals

Important Areas of Reforms  Strengthening health intelligence, surveillance, epidemiology and planning  Rational Drug Use Policy  Uniform Treatment Clinical Protocols  Improving internal systems of the Department of Public Health  Workforce management and transfer policy  Management Information System  Mainstreaming of Indian Systems of Medicine esp. tribal medicines into the state health system

The Real CNAA ItemEstimated in CNAALast Years Performance Surveyed Target Couples36,55,37134,54,248 Protected21,29,33617,47,376 CPR Need Assesment CVT4,8492,6295,852 NSVT4, ,381 CTT28,71133,44938,759 LTT62,58950,21579,215 IUD1,05,24786,8521,05,280 CC3,64,1073,50,1042,78,646 OP4,52,6444,16,2191,80,736

The New Plan of Action - Contraception  Uneven distribution of LTT surgeon (reallocation needed) – 63 trained but only 23 working –No LTT surgeon in 2 districts  18 NSVT trained surgeons but only 5 are working - Need to train in large number  Skill training in IUD needed for ANMs  Training of ANMs needed in counselling skills  Days of week fixed in each hospital for Contraceptive Services

Requirement of Equipment for Family Planning  Laproscopes - 20 are irrepairable  IUD Insertion instrument kit (3818 rural, 41 urban)  NSVT instruments kit (146-18=128)  Contraceptives –23,49,568 OP Cycles –2,11,77,096 CC pieces

 Microplanning of immunization and ANC sessions  Plan to improve outreach  Intersectoral coordination  Better Logistics including cold chain  Out of 146 blocks 66 do not have a vehicle  Community Midwifery  Improvement in FRUs The New Plan of Action - Mother and Child Health

Requirement of Cold Chain Equipment  Walk in Freezer - 1  Walk in Cooler in Bilaspur and Raipur need Replacement  Cold Chain Equipment beyond repair –ILR, Deep Freezer 140 L - 78 –ILR, Deep Freezer 300 L -88  Vaccine Vans - 6  Refrigerated Vaccine Van - 1  Vaccine Carriers -1000

The " Indira Swasthya Mitanin" Scheme  This is an innovative scheme in which the village people will select a Community Health Volunteer called "Mitanin" to help them in developing a "Village Health Plan" and for "Community Action in Health"  "Mitanin" in Chhattisgarhi means a Female Friend

Basics of the “Mitanin” Scheme  Empowerment  Participation  Sharing  Caring  Gender Equity  Self Sufficiency

Selection  Selection by the Community  Help by trained Facilitators  Approval by Gram Sabha  Training by Government

Who Can be a “Mitanin”  A woman from the same habitation  Preferably a married woman  Acceptable to the Community  Not necessarily educated

Role of Mitanin  Health Education  Leadership in Community Action for Health  First Aid & OTC Drugs  Treatment of Minor Ailments  Timely referral

Chief Minister on the "Mitanin" Scheme

Relationship with ANM Role of ANM  Support to Mitanin  Give refresher training every fortnight  Visit the Mitanin often  Give the Mitanin Legitimacy and Confidence  Help her in referral Role of “Mitanin”  Be a link between ANM and community  Help in National Programmes  Provide basic information

Relationship with PRIs Role of PRIs  Facilitate approval of Selection by Gram Sabha  Provide all inputs' support incl. irrigation of “Mitanin Land”  Monitor activities of “Mitanin”  Send “Mitanin” for training  Ensure supplies of essential medicines  Seek help from “Mitanin” for other social sector programmes Role of “Mitanin”  PRIs may seek information about health status of people  Help PRIs in developing a Health Plan  Bridge between Gram Panchayat and the community  Help PRIs in other Social Sector Programmes

Training: Method  Participative, Gradual, Repetitive, Fun filled, Practical with field experience, at the pace of learning of “Mitanins”  Initiation training: Mainly on attitudes, behavior, communication, working in groups, community participation, concepts in Public Health  Refresher training: mainly for knowledge and skills of diagnosis and treatment of common ailments  Responsibilities will be increased gradually with “On the Job Training”

Achievement so far  A group of NGOs and GOs Constituted as a State Advisory Committee  Work already started in 16 blocks  More than 2000 Mitanins already selected  Facilitators manual and the first two Mitanin Training manuals ready  Training of Mitanins to begin soon

Requirements under Existing RCH Programme  Training of at least 20 more surgeons in NSVT  Training of ANMs in counselling skills, and IUD insertion  Large Scale TBA training  IUD insertion kits for ANMs  Equipping of FRUs with blood storage and emergency obstetric surgery facilities

The proposal for EAG funds  Improvement of Training Infrastructure  Mobile Hospitals - to improve Outreach  Telemedicine - at Pendra  Community Midwifery Course  Training of Doctors in Anesthesia and money for their insurance coverage

Gaps in Training Infrastructure  Only 5 out of 16 Districts have DTCs  No SIHFW  RHFWTC Bilaspur not well equipped  5 AMNTCs, 3 MPW(M)TCs, 4 GNTCs - all buildings need repairs  All Centers need Training equipment  Capacity building of training faculty needed

Requirement of funds for Training Infrastructure S NItemAmount (in lakhs) 1Repair and renovation of existing buildings 70 2Construction of new buildings364 3Providing modern training aids165 4TOT (from money in the Danida Project) 0 Total599

Mobile Hospitals  Initially 3 mobile hospitals proposed  Each mobile hospital will be fully equipped and cost approximately 30 lakh  Public - Pvt -NGO partnership –Provided by Govt., managed by Pvt/NGO –Pvt/NGO to provide for recurring expen. –Govt. to give Medicines under National Programmes, and for BPL  Run on Predefined routes in Hat-Bazars

Telemedicine  To begin with Link Medical College Raipur with Pendra  Video-conferencing link through VSAT  Total Cost 40 lakh  Provide good secondary level care at remote locations

Community Midwifery Course  The "Paramedical Council Act" already passed  Affiliation and examination by Chhattisgarh Paramedical Council  Course design workshop - cost Rs 1 lakh  Equipping all ANMTCs - Rs 30 lakh  Stipend to 50% reserved category students - Rs 5.40 lakh

Aneshthesia Training of Doctors  Course design workshop - Rs 1 lakh  Equipping Medical College Raipur for Training - Rs 15 lakh  Cost of training of 40 doctors for 3 months lakh  Cost of Insurance of Anesthesia trained MBBS doctors - Rs 10 lakh

The Proposal for EAG funds S.No.SchemeCost 1Improvement in Training Infrastructure Mobile Hospitals Telemedicine Community Midwifery Anesthesia Training Total