2. OVERVIEW OF NATIONAL RURAL HEALTH MISSION

3. National Rural Health Mission (NRHM) was launched on 12 th April 2005 in India. It is one of the biggest–ever integrated health initiatives in the health sector in the last 50 years. NRHM is not a project but an over arching umbrella integrating the on going vertical programmes and addressing issues related to the determinants of health like sanitation, Nutrition, and safe drinking water. Cont… NATIONAL RURAL HEALTH MISSION

4. The National Rural Health Mission seeks to adopt a sector wide approach and aims at systematic reforms to enable efficiency in health services delivery. NRHM subsumes key national programmes namely the RCH II, General Curative Care, National disease control programmes and the integrated disease surveillance project. NRHM will also enable the mainstreaming of Ayurvedic, Yoga, Unani, Siddha and Homeopathy system of medicine (AYUSH). Cont…

5. The Goal of Mission is to improve the availability of and access to quality health care by people especially for those residing in rural areas, the poor, women and children. Mission adopt a synergistic approach by relating Health to determinants of good health viz. of Cont… - nutrition, - sanitation, - hygiene and - safe drinking water

6. The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. The Mission is an articulation of the commitment of the Government to raise public spending on health from 0.9% of GDP to 2-3% of GDP. THE NRHM VISION

7. EXPECTED OUTCOMES AT NATIONAL LEVEL  Infant Mortality Rate (IMR) reduced to 30/1000 live births by 2012.  Maternal Mortality Ratio (MMR) reduced to 100/100,000 by 2012.  Total Fertility Rate (TFR) reduced to 2.1 by 2010.  Malaria Mortality Reduction Rate : 50% upto 2010, additional 10% by 2012.  Leprosy Prevalence Rate : Reduce from 1.8/10,000 in 2005 to less than 1/10,000 thereafter.  Infant Mortality Rate (IMR) reduced to 30/1000 live births by 2012.  Maternal Mortality Ratio (MMR) reduced to 100/100,000 by 2012.  Total Fertility Rate (TFR) reduced to 2.1 by 2010.  Malaria Mortality Reduction Rate : 50% upto 2010, additional 10% by 2012.  Leprosy Prevalence Rate : Reduce from 1.8/10,000 in 2005 to less than 1/10,000 thereafter.

8. EXPECTED OUTCOMES AT NATIONAL LEVEL  Tuberculosis DOTS Services : Maintain 85% cure rate through entire Mission period.  Increase Utilisation of first Referral Units from less than 20 to 75%.  Upgrading Community Health Centres to Indian Public Health Standards.  Japanese Encephalitis Mortality Reduction Rate : 50% by 2010 and sustaining at the level until 2012.  Cataract Operation : Increasing to 46 lakhs per year until 2012.

9. INTER SECTORAL CONVERGENCE PPP Initiatives, Departmental Coordination for programs Like VHND, Pustikar Diwas DISEASE CONTROL PROGRAMME  RNTCP,NLEP,  Blindness Control,  National Iodine Deficiency  Disaster Control Programe NRHM – 5 COMPONENTS NRHM Initiatives ASHA,GKS, Untied Funds RKS, MHUs, School Health Programs, Other NRHM additionalities RCH-II Maternal/Child Health Family Planning/Tribal RCH/BCC Adoloscent Health/ Training/ Institutional strengthening IMMUNISATION  Routine Immunization  Pulse Polio Campaign  Special Immunization

10. Rural AreasTotalUrban AreaTotal Mother’s Package ASHA’s Package Rs.Mother’s Package ASHA’s Package Rs. 1400600200010002001200 COMPENSATION PACKAGE Motivation for Vasectomy @ Rs. 200 (Per case) Tubectomy @ Rs. 100 (Per case) Immunization @ Rs. 150 (Per session) DOTs Provider@ Rs. 250 (on completion of treatment in six months) Motivation for Vasectomy @ Rs. 200 (Per case) Tubectomy @ Rs. 100 (Per case) Immunization @ Rs. 150 (Per session) DOTs Provider@ Rs. 250 (on completion of treatment in six months) 1. Institutional Delivery

12. ASHA Every one thousand population there will be a ASHA ASHA act as a bridge between the ANM and the village and be accountable to the Panchayat. She will be an honorary volunteer, receiving performance-based compensation. She will promote institutional delivery, universal immunization, referral, escort services for RCH and other health care delivery programmes. She will facilitate in preparation of village health plan along with ANM/AWW under leadership of village health & sanitation committee.

13. Rs.10000/- per SubCentre per annum to be kept in joint account of Sarpanch and ANM. To be spent on:- –Minor repair of Sub Centre. –Payments for cleaning after child birth. –Transport during emergency to appropriate referral centre. Rs.10000/- per SubCentre per annum to be kept in joint account of Sarpanch and ANM. To be spent on:- –Minor repair of Sub Centre. –Payments for cleaning after child birth. –Transport during emergency to appropriate referral centre. Untied fund at Sub Centre level Transport of samples during epidemics. Payment of wages for environmental sanitation. Payment/Reward to ASHA for certain specific activities. Should not be used for Salary, Vehicle purchase & expenses of Gram Panchayat.

14. Provision quality service round the clock referral care at CHC level is an important strategic intervention under NRHM. In order to ensure quality of services, the Indian Public Health Standards are being set up for CHCs so as to set up a yard stick to measure the services being provided. The Programme includes provision of : OT/ Labour room/ X-Ray etc. Blood transfusion facilities. LSAS doctors at each L-3 institutions Upgrading CHCs as per Indian Public Health Standard.

15. –RKS at every District, Sub-Division and Block Level Hospital. –RKS is a registered society for better management of hospitals with people’s participation. –Corpus Fund from Govt. of India –Rs. Five Lakhs per District Headquarters Hospital –Rs. One Lakh per Sub-Divisional Hospital and CHCs/ PHCs. –RKS at every District, Sub-Division and Block Level Hospital. –RKS is a registered society for better management of hospitals with people’s participation. –Corpus Fund from Govt. of India –Rs. Five Lakhs per District Headquarters Hospital –Rs. One Lakh per Sub-Divisional Hospital and CHCs/ PHCs. Rogi Kalyan Samiti

16. –Under NRHM Mobile Medical Unit to be functional in each tribal blocks to supplement existing system in remote inaccessible areas. –Each Mobile Medical Unit will have Specialist services –Under NRHM Mobile Medical Unit to be functional in each tribal blocks to supplement existing system in remote inaccessible areas. –Each Mobile Medical Unit will have Specialist services Mobile Medical Units

17.  Seeks to revitalize local health traditions and mainstream AYUSH infrastructure, manpower and drugs.  Space shall be provided for AYUSH practitioner and pharmacist in CHCs/ PHCs.  PHC(N) shall be upgraded to include two Doctors by inducting AYUSH practitioner.  Seeks to revitalize local health traditions and mainstream AYUSH infrastructure, manpower and drugs.  Space shall be provided for AYUSH practitioner and pharmacist in CHCs/ PHCs.  PHC(N) shall be upgraded to include two Doctors by inducting AYUSH practitioner. Ayurveda Homoeopathy Unani Siddha Yoga and Naturopathy Mainstreaming AYUSH

18. Intersectoral Convergence Cont… NRHM envisage that determinants of health, like sanitation, nutrition and safe drinking water influences general health to a large extent. Therefore it is considered necessary to forge linkages with department of Women & Child Development, Rural Development Department, Education, Panchayat Raj, Rural Water Supply & Sanitation Department.

19. Stakeholders

20. 1.Reproductive & Child Health (RCH) Programme - II. Reproductive and Child Health (RCH) Programme-II is an ongoing programme under NRHM, with the objective of improving the Reproductive Health of men and women and the health of children from 2005-12 The focus of the programme is to reduce the Maternal and Child Mortality and Morbidity with emphasis on rural health care. Adolescent Health and Gender, Urban Health, Tribal Health and Public Health and Public Private Partnership are the other supporting focus areas in RCH-II. Ongoing Programmes :

21. Components of RCH II Maternal Health Quality ANC, PNC – VHND, Anemia prophylaxis, TT, early diagnosis of complication, Birth planning Institutional Delivery –Infrastructure strengthening, Incentives, referral system SBA Provision of BEmONC & CEmONC services Availability of FP services for limiting/Spacing Safe Abortion Janani Express at each health institutions

22. Components of RCH II Child Health Institutional delivery with 48 hrs stay SNCU I & II NSSK Immunization strengthening Pustikar Diwas, VHND IMNCI

23. Components of RCH II Family Planning Expanding facilities & choices –Fixed day centers –Limiting methods Minilap Laparoscopic NSV –Spacing methods IUCD –Skill enhancement –RTI/STI treatment at PHC level OP/CC – ASHA is a depot holder QAC – To provide quality services

24. 23 Village level interventions for addressing Maternal & Child Health issues. Organised monthly at Anganwadi Centres through the coordinated efforts of ANM, ASHA, AWWs. VILLAGE HEALTH& NUTRITION DAYS…MAMATA DIVAS

25. To effectively combat the problems of malnutrition and to reduce malnutrition rate in Orissa (from 44% to 35% by 2012 NRHM Goal) Pushtikar Divas has been devised. This activity is one of the strategic interventions by Health & Family Welfare and Women & Child Development departments to address malnutrition. This is to be organized once on the 15 th of every month, in the Block PHC/CHC. Children in the Grade - II, III, IV or moderate to severely malnourished shall be referred by the AWW/ANM to the Block PHC/CHC for management & treatment. The Medical Officers shall undertake the treatment as per the defined treatment protocol. At the block, PHC/CHC Medical Officers are required to undertake detailed examination, possible investigation, diagnosis and treatment of referred children, as per the treatment protocol. PUSTIKAR DIWAS

26. Address holistically the health and nutrition needs of children in a manner which fulfils the needs of today's lifestyle For preventive, promotive and curative services to the school children Around 2848 schools will be covered Around 2,80,000 children will be screened It will be an inter-sectoral effort School Health Programme

27.  Screening, health care and referral  Immunization (TT-10)  De-worming  School-based activities promoting good health  Monitoring & Evaluation Components of SHP

28. GKS Formation Processes Revenue village is the unit of GKS formation Ward member is the chairperson, Anganwadi Worker is the convener, ASHA supports the functioning of GKS Rs. 10,000/- untied fund per annum

29. Immunization : Immunization is one of the foremost Public Health Programme in the country. It is the need of the hour to reach every child and mother and deliver health services. This is an emerging process and the goal is to 100% immunization status by 2010 in the district. Immunization is a key intervention under NRHM and major activities include Routine immunisation Intensified Pulse Polio immunization. Maintenance of Cold Chain Procedure

30. National Vector Borne Disease Control Programme (Malaria) The goal of the NVBDCP programme is to reduce Malaria death by 50% by 2012. Vector control activities are parasite index and in areas with resistance to synthetic Parathyroid. Larvivorous fish and treated bed nets have been distributed. Besides BCC activities have been undertaken in the community by creating awareness. National Disease Control Programme :

31. National Programme for control of Blindness The goal of the programme is to reduce the prevalence of blindness to 0.8% by 2012. To realize the goal, cataract surgery, screening of students for refractive errors & correction, eye collection & training of workers & teaches ect are being conducted in the state.

32. Revised National Tuberculosis Control Programme (RNTCP) RNTCP is uniformly operational across the state through the strategy is directly observed treatment short course(DOTs). The chest symptomatic are subjected to sputum examination & patients positive for acid fast bacilli are provided full course of treatment under the direct supervision of DOTs provider. Success rate of new smear positive case is 85%, case detection is 54% & seamer conversion is 86%.

33. National Leprosy Elimination Programme (NLEP) The objective of the programme is to eliminate leprosy by bringing all the cases of leprosy under Multi Drug Therapy (MDT). As of now 20 districts have achieved leprosy elimination status. This has been possible, as a result of intense BCC activities, training integrated of vertical infrastructure of leprosy into general health.

34. Areas of the Project Area of operation 13 Blocks of this district 286 GPs of this district 2060 villages of this district HEALTH INSTITUTIONS OF KEONJHAR DISTRICT District Head Quarter Hospital: 01 Sub-Divisional Hospital: 02 Community Health Centre: 17 Single Doctor PHC (PHC New): 66 Sub-center: 351 Total:437

35. Scope for private participation Handing of PHC (N)/SC to Corporate houses /NGOs for management purposes where health service providers are not available Collaboration with the corporate houses organising different health camps and Mega Swasthya Mela. Vulnerable group sensitisation and mobilisation. Adoption of different wards in DHH/SDH for management purposes and beautification of hospitals

36. Strengthening the local government (PRIs & Communities) Through GKS capacity building the PRIs and the communities can be sensitised and ownership can be developed for health seeking behaviour. Capacity building of RKS members

37. Practical problem/issues Delay in constructional activities Vacancy of Medical Officers and other paramedical staff in rural health institutions. Delay in referral by the community. Fill up the paramedical persons immediately in the drive mode. Promotion of 2 nd referral system in all the Block CHC by providing hired ambulances

38. Specific problem Banspal: 1.Posting of Doctors (5 Nos), staff nurses (6 Nos), HW(F) & Addl. HW(F), HW(M) in all the health institution of Banspal Block 2.Ambulance provision at CHC 3.Adoption of few institutions under PPP mode by NGO/NYK/Corporate houses where the service providers are not available (4-5 sub-centers) 4.Sensitisation among the service providers about the service delivery system 5.Infrastructure development at PHC (N),SC- 1 No. SC constru. 6.IEC/BCC activities at community and service providers level 7.Incentive packages for HW(F) and ASHA for service delivery

39. Telkoi 1.Posting of Doctors, staff nurses (6 Nos.), HW(F) (5Nos)& Addl. HW(F), HW(M) 2.Adoption of few institutions under PPP mode where the service providers are not available 5 PHC(N) ( Kaliahata, Raisuan, Krushnapur, Jagamohanpur, Sirigida) & SC-5 (Talapada, L.N.. Pur, Kaliahata, Raisuan, Karadangi) 3.Sensitisation among the service providers about the service delivery system 4.Infrastructure development at PHC (N),SC 5.IEC/BCC activities at community and service providers 6.Incentive packages for HW(F) and ASHA for service delivery

40. Harichandanpur 1.Posting of Doctors, staff nurses, HW(F) & Addl. HW(F), HW(M) 2.Adoption of few institutions under PPP mode where the service providers are not available 2 PHC(N) ( Kalapata, Rebenapalaspal, 3.Posting doctors and other paramedical staff at Bhagamunda 4.Sensitisation among the service providers about the service delivery system 5.Infrastructure development at PHC (N),SC- 6 Nos. 6.IEC/BCC activities at community and service providers 7.Incentive packages for HW(F) and ASHA for service delivery

41. Basudevpur 1.Posting of Doctors, staff nurses, HW(F) & Addl. HW(F), HW(M) 2.Adoption of few institutions under PPP mode where the service providers are not available 2 PHC(N) ( Kalimati, Guali) to corporate houses 3.Sensitisation among the service providers about the service delivery system 4.Infrastructure development at PHC (N),SC- 15 Nos. 5.IEC/BCC activities at community and service providers 6.Incentive packages for HW(F) and ASHA for service delivery