AP PIP final

360 Pages·2010·2.61 MB·English

CHAPTER
I
SUMMARY

1. Executive Summary

By addressing all the components like maternal health, child health, family
planning, adolescent health including urban health, vulnerable group, gender equity,
logistics management, program management and financial management, the overall
aim is to provide equitable quality services to all the rural population.
The state of Arunachal Pradesh during RCH-II envisages achieving Maternal
Mortality Rate (MMR) from the present level of 306 to less than 100, Infant Mortality
Rate (IMR) of less than 30 by 2010 from the present level of 61 and a Total Fertility
Rate (TFR) of 2.1 at the end of 2010 from current level of 3(NFHS 3).
The Program Goals and Objective of the State is to reduce IMR to 30/1000 LB
by 2012, MMR to 100/1 lakh by 2012, TFR to 2.1 by 2012, Malaria Mortality
Reduction Rate 50% by 2010, Cataract operation increase to 46 lakhs by 2012,
Leprosy prevalent rate -<1/1000 and DOTS 85% cure rate.

The total budget for all the activities under NRHM is as below:
Sl. Components Budget
No. (in lakh)
A. RCH-II 1608.99
B. NRHM Additionalities 2018.58
C. Routine Immunization 475.46
D. VERTICAL PROGRAMME
1. Revised National TB Control Programme 70.97
2. National Programme For Control Of Blindness 422.07
3. National Vector Borne Disease Control Programme 1137.94
4. National Leprosy Eradication Programme 325.14
5. Integrated Diseases Surveillance Programme 346.10
6. Iodine Deficiency Disorder 79.6
E. Intersectoral Convergence 3.24
GRAND TOTAL:- 6488.09

The plan preparation started with design team at state level with an initial
workshop on December 2008 and also at district level. All the components under
RCH are covered which include MH, CH, FP, ARSH, Urban health, PPP etc. To
improve the accessibility and quality of the RCH services are envisaged. Other
important aspects which are covered are program management, financial
management, logistic management etc. With all these input, it is hoped that all the
indicated goals under RCH would be met. The 3rd year of the 5 year proposal has
already been completed with fair amount of activities implemented. The
implementation would be more vigorous during the 3rd year onward.
With additional inputs from NRHM, the proposed target will be met. Need
based funding rather than population based funding is of utmost importance to the
state.
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CHAPTER
II
Process of Plan Preparation

The National Rural Health Mission (NRHM) was launched in the State of
Arunachal Pradesh in the financial year 2005-06 with the objective of providing
integrated quality health care services to the people, with special emphasis on the
rural poor. The cornerstone of the Mission is to bring about synergy in the inputs and
interventions of various vertical national health and family welfare programs in order
to ensure holistic approach in plans, policies, strategies and implementation of the
health department in the State. It is envisaged under NRHM to bring all vertical
programs of the Department of Health & Family Welfare under a single and unified
umbrella.
Components of NRHM
The components of NRHM are as follows:
A RCH II
B NRHM Additionalities
C Routine Immunization
D National Disease Control Programs
- RNTCP
- NVBDCP
- NLEP
- IDSP
- IDD
- NPCB
E Inter-sectoral Convergence
State level workshop called for Participatory Planning for Health for preparing
District/Block Health Action Plan for RCH II, NHRM & RI was convened in the month
of September 2008 at Naharlagun which was attended by concerned officers of the
Health Department from the districts and state, representatives of the Women and
Child Departments, and the PHED. The workshop deliberated on vital points like
facility survey, household survey and plans to address the major areas of health with
technical inputs from RRC -NE. These were the issues to be addressed in the Block
and District Health Action Plan. Further, Workshop for 6 days on District Health
Management was also organized at Naharlagun with the help of NHSRC, Delhi &
GoI. Further, 3 days workshop on modification/correction of BHAP / DHAP was held
wef 18th February with technical inputs from state planning team/ RRC-NE.
The issues like integration of organizational structures, decentralization and
district management of health programs, community participation and ownership,
merger of societies into one Health Society, preparation of District/Block Health
Action Plans covering health, FW, nutrition, water, sanitation and involvement of
PRIs were also discussed in the workshop. Meetings at the district level with stake
holders for BHAP/DHAPs, involvement of the district machinery on sustainable basis
was imperative; in the preparation of the DHAPs, interaction with the officers /
officials and community was necessary when bottom-up approach is adopted.
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Incorporating all the data received through DHAPs from 16 districts, the state
PIP has been framed. Depending upon the absorptive capacity of the districts, and
JRM V findings, a implementation plan is made for 09-10.

NRHM Strategies
De-centralized village, district & State level planning.

One of the core strategies of the NRHM is to empower local governments to
manage, control and be accountable for public health services at various levels. The
Village Health and Sanitation Committee (VHSC), the standing committee of the
Gram Panchayat will provide oversight of all NRHM activities at the village level and
will also be responsible for developing the Village Health Plan with the support of the
ANM, ASHA, AWW and self-help groups. Since PRI and ICDS field functionaries are
not fully functional and not having much capacity for carry forward the health
activities in the villages, the state could not do much and realized to find out new
strong strategy for it.
At the Block Level, Panchayat Samitis will coordinate the work of the GP in
their jurisdiction and will serve as link to the DHM. The DHM will be led by the Zila
Parishad and will control, guide and manage all public health institutions in the
districts. Few districts had orientation training for the members of the PRIs so as to
get their due participation in effective implementation of NRHM and it is going on in
other districts. In one district, there is no elected PRI but in absence of them, the
local leaders have been included in this category.
De-centralized planning is the key to success of the NRHM program. The
NRHM programme planning strongly advocates for “Bottom up Approach”, where
the needs and aspiration of the masses is taken care of and on priority basis the plan
is designed at the district level, which is again apprised at state level and at state
again after prioritizing the district plans the state plan is prepared. So, in the course
of preparation of DAP, majority of the districts had house hold survey, followed by
SC level meeting (where ANM is posted) and also PHC level meeting in presence of
officers from other line department. Based on the discussion of the series of PHC
level meeting, the District Health Action Plan (DHAP) is prepared. The inputs given
during the capacity building workshop of I & II was also used while assessing
the need need of the community and why a particular activity could not be
properly implemented. FGD was also conducted with ASHAs, PRIs and
preganant mothers in few seleted areas with the help fo health officials. DHAP
of all districts are assessed and asked to make necessary changes. For assessing
the DHAPs, 3 days workshop was organized at state level. Finally, after assessing
the DHAPs of all the districts, the State Health Action Plan (SPIP) is prepared.
Overall, the involvement of PRI has been very encouraging and able to
break the sackle of lack of knowledge about NRHM etc been improved during the
year. However, it is hoped that during the coming years, their participation would be
immense for more active involvement in NRHM implementation.

3
CHAPTER
III
BACKGROUND AND CURRENT STATUS

3.1 Demographic features:
The state is situated in the northeastern part of India, bounded by
international boundaries with China in the north, Myanmar in the southeast and
Bhutan in the west. The state is situated at latitude of 90.360E to 97.30 E and
longitude of 26.420N to 29.300N covering a total land area of 83,743 sq. km. The
population of Arunachal Pradesh is 10, 91,117 (Census 2001).Density of population
is 13 persons per square kilometer. Sex ratio of the state is 901 females per 1000
males as per census 2001. The total literacy rate of the state is 54.74% with a male
literacy rate of 64.07% and female literacy rate of 44.24%. The per capita income
(97-98) of the state is Rs. 13424. [Source: Provisional Census of India 2001].
The state has a total population of 10,91,117 (Census 2001) with male
constituting 573951 and 517166 females. The percentage of population below
poverty line in 1999-2000 is 33.47 (SRS Bulletin, April 2001) with a percentage
decadal growth of 26.21 and Average Annual Exponential Growth Rate of 2.33. The
rural population constitutes 79.59% and the urban only 20.41 %. The decadal growth
rate of urban population is a staggering 101.29 %.
3.2 Administrative divisions
The administrative set up of Arunachal Pradesh and its changing district
boundaries correspond broadly to natural boundaries of river basin. Even the
boundaries of Sub-Divisions, Community Development Blocks and Administrative
Circles within the districts have also been directly affected by the terrain features,
though there is no cadastral survey conducted till date for clear cut demarcation of
administrative boundaries.
There are 16 Districts, 37 sub-divisions, 155 circles, 17 towns, 84 blocks and
3862 villages constituting an elaborate administrative structure for diffusing
developmental activities in the state.

3.3 CURRENT STATUS AND GOAL
3.3.1 MATERNAL HEALTH
PROCESS/ INTERMEDIATE INDICATOR CURRENT GOAL
STATUS
09-10 10-
11
1. % of all births in government and private 31.2 45 60
institutions (Overall) (NFHS – III)
2. % of deliveries by skilled birth 33.4 44 60
attendants (doctors, nurses, ANMs) (NFHS – III)
(Overall)
3. % of pregnant women getting registered 24.5 32 36
in first trimester (NFHS – II)
4. % of pregnant women receiving 3 or 36.4 50 60
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more antenatal checks (NFHS – III)
5. % of pregnant women receiving 2 doses 45.6 55 58
of Tetanus Toxoid injections (NFHS – II)
6. % of pregnant women receiving 100 56.3 65 67
tablets of IFA (NFHS – II)
7. Number of facilities operationalized to
provide 24 hours delivery (and Basic
Emergency Obstetric Care) according to
GOI norms
CHCs 30 1
PHCs 10 10 10
(DHS, AP-
2008)
8. Percentage of women visited by
ANM/AWW in post natal period within 2 23.3 30 40
months (Home deliveries)
(NFHS-III)
9. Number of facilities operationalized in a
sustained manner as per GOI norms for
providing Comprehensive Emergency
obstetric care (including provision of
Caesarean section and blood
storage/banking facilities):
GH/DHs (blood bank in 7 are being 3 6 4
functionalized) (DHS, AP-
2008)
CHCs (Blood storage being operationalized) 1 1 0
(DHS, AP-
2008)

3.3.2. CHILD / NEONATAL HEALTH

PROCESS/ INTERMEDIATE INDICATOR CURRENT GOAL
STATUS 08-09 09-10

1. Percentage of exclusively breastfed at 6 60 80 90
months of age (NFHS – III)
2. Percentage of 13 – 24 months of age 28.4 45 70
fully immunized children : (NFHS-III)
3. Percentage of children given ORS in 33.5 50 53
diarrhea (NFHS-III)
4. Percentage of children received treatment 43.6 65 80
for ARI (NFHS-III)
5. Prevalence of anemia in children 66.3 45 30
(NFHS-III)
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3.3.3 FAMILY PLANNING
PROCESS/ INTERMEDIATE INDICATOR CURRENT GOAL
STATUS
08-09 09-10
1. Unmet need for family planning among 19.3 12 9
eligible couples : (NFHS – III)
2. Unmet need for spacing methods among 8.6 5 4
eligible couples : (NFHS – III)
3. Contraceptive prevalence rate among 35.2 50 55
eligible couples : (NFHS – II)
4. Percentage of permanent female 14.5 25 30
sterilization (RHS 2002)
5. Percentage of permanent male 0.1 0.3 0.4
sterilization (NFHS-III)

3.3.4. Adolescent Reproductive and Sexual Health

Data for adolescent group is not available for the state.

3.4. Public health infrastructure

At present, Public Health facilities are the back bone of health delivery and
family welfare services in the State. Catering to the health and family welfare needs
of the people are 2 General Hospitals at Naharlagun and Pasighat, 12 District
Hospitals at Tawang, Bomdila, Seppa, Ziro, Daporijo, Along, Yingkiong, Roing, Anini,
Tezu, Changlang and Khonsa, 44 Community Health Centers (CHCs), 85 Primary
Health Centers (PHCs), 381 Sub-Centers (SCs), 45 Homeopathy Dispensaries and
9 Ayurvedic uni ts.

No. Facility Required / In Position
Sanctioned (on 31/02/08)
1 Sub-centres - 381
1.1 Sub-centres functional b 273 (162 with ANM)
2 Primary Health Centres - 85
2.1 PHCs offering 24 hour services (except 55
manpower)
3 Community Health Centres 31
3.1 CHCs functioning as FRUs d 1
4 District Hospitals 14
4.2 DHs/GH functioning as FRUs( 2 without 10
Anesthetist)

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3.5 Private and NGO health services/infrastructure

Block/Villages of NGOs
Names of NGOs operations
VHAI Lumla (Tawang)
Thrizino (W.Kameng)
Deed Neelam (L.Subansiri)
Nacho (Upper Subansiri)
Gensi (West Siang)
KARUNA TRUST Khimyong (Changlang)
Wakka (Tirap)
Mengio (Papumpare)
Walong (Anjaw)
Bameng (East Kameng)
Sangram (Kurung Kumey)
Jeying (Upper Siang)
Etalin (Dibang Valley)
Anpum (Lower Dibang Valley)
Future Generation Sille (East Siang)
Arunachal (FGA)
Alok Prayas JAC Wakro (Lohit)
Nani Sala Foundation MNGO for P/Pare
VHAAP MNGO for East Kameng, W/
Kameng.
Daying Ering UH Pasighat
Foundation
Boria Tari Memorial UH Naharlagun / Itanagar
Society

3.6. DP (donor assisted) programmes in the state

There is no DP operating in the FW / NRHM at present.

3.7. Institution arrangement and organizational development:
issues and gaps
• Institutional involved in RCH

The Mission Director (NRHM) coordinated all arrangements under the
technical inputs / support from the Nodal Officer (NRHM) cum SPM and the DRCHO
in the districts were instrumental in ensuring coordination, planning and
implementation of RCH activities.
Inter departmental cooperation was received from the Department of Social
Welfare, Women and Child Development through AWW in implementing RCH
activities primarily at the grass root level. The PRIs were involved in many activities
under NRHM as detailed in NRHM PIP. Two mother NGOs for 3 districts along with
few field NGOs were assigned roles during the year. NGOs running PPP under
NRHM were a part of the team.
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Different works department of the state Government were involved in the
preparation of estimates and execution of civil works in the state as there is no
separate construction cell in the directorate.
Above all, the different branches in the health department had full cooperation
& coordination during the year for implementation of RCH / NRHM activities.

• Current organization structure

Mission Director

State Fin ance Manager State Programme Manager/ IEC Officer/Nodal
Nodal Officer (NRHM) Officer (JSY)

C onsultant Consultant Consultant Cold Chain Dy. MEIO
( Finance) (HMIS) (Training) Officer

S tate Accounts State Data Technical Assistant DEE

Manager Manager (Cold Chain)

Accountant Data Computer
Assistant Assistant

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Organogram of District Programme Management Support Unit (DPMSU)

DMO-cum-CEO (Governing Body)

DRCHO/DFWO-cum-CEO (Executive Body)

District Programme Manager

Accountant Statistical Investigator

Data Assistant
Computer Assistant

State Health &FW Department in relation toNRHM Vs Vertical
Programs.

Ministry of Health & Family Welfare

Secretary (Health & Family Welfare)

MD (NRHM)
DIRECTOR OF HEALTH SERVICES
SPMU

DPMU

JT DHS JT. DHS
JT. DHS JT. DHS JT.DHS
(EST) (P&D)
(FW) (NLEP) (NAMP)

Program Of ficer Program Officer State
DDHS DDHS DDHS DDHS
(NBCP) (DENTAL) Epidemiolo
(TB) (PH) (S&T) (GA)
gist

Asst.
Admin. Accounts Asst. Drug
Food Officer Officer Controller
Controller

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• Accountability of staff

Mission Director: The Mission Director is accountable to the Government of
Arunachal Pradesh for overall implementation of NRHM activities.

Nodal Officer (NRHM): NO(NRHM) is the main technical person accountable
to the Mission Director for advise and guide in all matters of planning and
implementation of NRHM activities. The state has no SPM as on date and the
responsibility of SPM rest with state Nodal officer (NRHM).

State Finance Manager: He is accountable to the Mission director for timely
and proper audit of annual accounts under the NRHM, timely release of fund to
implementing agencies, effective internal control system, timely submission of
financial reports and returns. He is responsible for overall monitoring and supervision
of finance and accounts.

Consultant (Finance) and State Accounts Manager: They are accountable
to the State Finance Manager for proper maintenance of books of accounts as per
Finance & accounts Manual at the Mission Directorate, timely and proper collection
and preparation of financial reports & returns, timely release of funds to the
implementing agencies.

Consultant (HMIS) and State Data Manager: They are directly responsible
to the State Nodal officer for proper maintenance of demographic/health data bank,
timely reporting of demographic and health data.

Consultant (Training): She is directly accountable to the State Nodal Officer
for timely and proper preparation of training plan and calendar, proper coordination
of training activities, timely release of training fund to districts and implementing
agencies and reporting to various agencies involved in monitoring and supervision.

• HRD including placement of staff, tenure, job descriptions, delegation of
power, performance appraisal system

- Some of the contractual staff, especially ANMs, could not be optimally
placed as per plan. It was found that several ANMs were posted at District Hospitals
and CHCs. This was on account of non-availability of SC building / residential
quarters in the sub-centres, low pay rates and high cost of living in the rural areas
and non-sanctioning of enough SNs by the state for DH / GH in the state. However,
Steps will be initiated to rationalize the manpower and work load facility wise.
- In order to streamline the staff recruitment, posting, ToR, Terms & condition
etc for staffs under NRHM, it has been decentralized upto DHS level. The
decentralization involves the following:
- The existing contractual technical staff posted and serving as on date under
NRHM at the district shall be the exclusive staff of DHS of the respective districts.
The existing staffs shall not be transferable to other districts and are transferable
within the districts as per requirement.
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