Doda - National Rural Health Mission

184 Pages·2008·1.36 MB·English

GOVERNMENT OF JAMMU & KASHMIR

NATIONAL RURAL HEALTH MISSION

DISTRICT HEALTH ACTION PLAN

District Doda

September 2007

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Map of the District

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PREFACE

The Hon’ble Prime Minister launched the NRHM on 12th April 2005 throughout the country with
the basic objective of providing accessible, affordable and accountable health care in rural
areas. Its primary focus is on making the public health system fully functional at all levels. While
detailing the functioning of the NRHM, the present planning process initiated in the State
provides the entire framework for making the Public Health System fully functional and
standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes
the need for communitisation of the Public Health System, improved financing and management
of public health, human resource innovations, and a long-term financial commitment to enable
the state and districts to undertake programmes aimed at achieving the Mission goals.

National Rural Health Mission envisages the planning process to be participatory and
decentralized starting with the Village. It seeks to empower the community by placing the health
of the people in their own hands and determine the ways they would like to improve their health.
This is the only way to ensure that health plans are local specific and need based. The State
should facilitate the processes by providing enabling environment and required financial and
technical support. NRHM was launched in April 2005 and is being implemented by the
Department of Health and Medical Education, Government of Jammu & Kashmir.

In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has
constituted the District Health Mission and significant progress has been made since it’s
beginning. As per the NRHM guidelines, it has merged multiple societies at the district level.
The District Action Plan was the most important aspect of the NRHM and to make District Plan
more meaningful and address local health problems, preparation of Block Health Plans was
considered essential. The decentralized planning process involved village consultations and
preparation of Village Health Plans by the Village Health Water and Sanitation committees;
followed by development of Block Action Plans through integration of Health Facility Surveys
and block specific needs. The Block Action Plans were then integrated to form District Action
Plan.

As result of this exercise, the district now has developed capacity for preparing the need based
health action plans following participatory processes. A District Planning Team (DPT) was set
up for this purpose in the month of July 2007 with representation from various sectors
concerned with NRHM. This group was responsible for management of the entire planning
process in the district and also for provision of the technical support. The DPT is the standing
body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns
the plan but will also be responsible for monitoring the progress of implementation to achieve
the objectives of the plan. The members of the DPT are:

# Name Designation Department
1. Sourav Bhagat DC Doda DC Office
2. A A Malik Chief planning officer DC Office
3. I A Shapu CMO Doda Health
4. Dr M I Zargar Dy. CMO Health
5. Kamlesha Kumar TSWO SWO
6. Shayesta Sultana CDPO Social welfare
7. Dr Kuldeep Kumar MO (ISM) ADMO
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8. J M Tharmta DEPO Education
9. Dr M S Wani DHO Health
10. Waseem Raja District program manager Health
11. Ashok kumar District account manager Health
12. Surnnder Singh PMA Health
13. Tariq Hussan Data assistant Health

The orientation of DPT, facilitated by EPOS Health India, was held on 12th July 2007. This
enabled the DPT members to not only understand NRHM approach, key components and
strategies of NRHM, but also manage the planning process and develop the District Action Plan.
The DPT met a number of times and the individual members reviewed the situation of their
respective sectors/areas and collectively developed the strategic vision for improving the health
status of the district population.

We the members of the DPT on behalf of the entire Planning Team reiterate and certify that this
District Action Plan has been prepared through participatory processes. It has been developed
by integrating the Block Action Plans prepared by integrating health facility surveys and village
health plans in each block of the District. This plan also incorporates the needs and plans from -
108 Sub health centres, 32 PHCs, 3 CHCs and 1 District Hospital in the District.

Name of Chief Medical Officer Signature Date

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CONTENTS
PREFACE..........................................................................................................................4
CRITICAL ISSSUES AND PRIORITY ACTIONS...............................................................7
EXCECUTIVE SUMMARY..............................................................................................13
PLAN AT A GLANCE......................................................................................................14
1. SITUATION ANALYSIS...............................................................................................36
SOCIO-ECONOMIC INDICATORS..................................................................................46
2. PLANNING PROCESS................................................................................................64
3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS.........................68
4. GOALS........................................................................................................................70
5. TECHNICAL COMPONENTS......................................................................................71
PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) II..................................................71
PART B: NEW NRHM INITIATIVES.................................................................................91
PART C: IMMUNIZATION.............................................................................................108
PART D: NATIONAL DISEASE CONTROL PROGRAMME.................................................111
6. INTER SECTORAL CONVERGENCE......................................................................124
7. COMMUNITY ACTION PLAN....................................................................................135
8. PUBLIC PRIVATE PARTNERSHIP...........................................................................137
9. GENDER AND EQUITY.............................................................................................140
10. CAPACITY BUILDING.............................................................................................143
11. HUMAN RESOURCE PLAN....................................................................................151
12. PROCUREMENT AND LOGISTICS........................................................................155
13. DEMAND GENERATION - IEC................................................................................157
14. FINANCING OF HEALTH CARE.............................................................................160
15. PROGRAMME MANAGEMENT..............................................................................162
16. BIO MEDICAL WASTE MANAGEMENT.................................................................167
17. MONITORING & INFORMATION SYSTEM.............................................................168
BUDGET AT A GLANCE..............................................................................................174

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CRITICAL ISSSUES AND PRIORITY ACTIONS

# Thematic Critical Issues of the District Specific Priorities
Area
1. District (cid:1) Functional integration of (cid:1) Societies need functional integration
Health vertical societies like and strengthening.
Management: Blindness Control Society, (cid:1) Capacity building of the DHS
TB Control Society, District members regarding the programme,
Malaria Society etc. their roles, various schemes and
mechanisms for monitoring and
(cid:1) Monitoring and evaluation. regular reviews and also operational
guidelines for running the District
Health Society.
(cid:1) Monitoring of health activities by
health personnel only. Members
from other departments and also
from the elected representatives
need to become members for better
monitoring and implementation.
(cid:1) Strengthening the functioning of the
DHS.
2. District & (cid:1) Need for providing more (cid:1) Development of total clarity at the
Block technical support to the district and the block levels amongst
Programme CMO office for better all the officials and Consultants
Management implementation especially about NRHM activities
in light of the increased (cid:1) Training of district officials and
volume of work in NRHM. Block SMOs for programme
(cid:1) Strengthening the management
monitoring and reporting (cid:1) Streamlining Financial management
especially in the areas of and systems
Maternal and Child Health, (cid:1) Strengthening the CMO office with
Civil works Behaviour DPMU with extra computers,
change and accounting telephone system and human
right from the level of the resources.
Subcentre. (cid:1) Capacity building of the DPMU
personnel for monitoring
(cid:1) Strengthening the Block
Management Units by establishing
BPMUs.
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3. Reducing (cid:1) Lack of 24X7 facilities for (cid:1) Increase coverage of full ANC and
maternal and safe deliveries in Postpartum Care to pregnant
child deaths subcentres and PHCs. women
and (cid:1) Lack of authentic data (cid:1) Increase in Institutional deliveries by
Population regarding the maternal and operationalsing 24X7 PHCs.
stabilization infant deaths in the district. (cid:1) Strengthen FRUs for Emergency
(cid:1) Equipments are not Obstetric Care services along with
working properly or not minimum basic infrastructure, Blood
available as per the need in Storage facilities, Facilities for
subcentres, PHCs & CHCs Neonatal Care, drugs and
to provide quality services. equipments.
(cid:1) Lack of facilities with for (cid:1) Increase availability of safe abortion
emergency obstetric care. services at all block level CHCs/
(cid:1) Non-availability of PHCs.
Specialists for an (cid:1) Increased coverage under JSY
aesthesia, obstetric care, (cid:1) Strengthening the Village Health
paediatric etc. Day
(cid:1) Lack of referral transport (cid:1) To increase awareness among
systems. mothers and communities about the
(cid:1) Lack of Blood Storage importance of institutional deliveries
facilities at FRUs (cid:1) Improved behaviour practices in the
(cid:1) Lack of Neonatal care community
facilities at FRUs (cid:1) Operationalization of all the
sanctioned Anganwadis
4. Family Low level of FP acceptance (cid:1) Increased awareness for
Planning due to lack of awareness or Emergency Contraception and 10 yr
motivation and low male Copper T
participation (cid:1) Decreasing the Unmet Need for
Family Planning
(cid:1) Ensure availability of all FP
methods at block level facilities.
(cid:1) Train more MOs for NSV and
promote the same.
(cid:1) Partner with private doctors for FP
and RCH services
(cid:1) Increasing Access to Emergency
Contraception and spacing methods
through Social marketing
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(cid:1) Building alliances with other
departments, PRIs, Private sector
providers and NGOs
5. Adolescent (cid:1) Adolescents especially the (cid:1) Implement ASRH programme to
Health boys are exposed to increase the knowledge levels of
smoking, addictions, peer Adolescents on RH and Life skills
pressure and there is no (cid:1) Implement of Kishori Shakti Yojana
one to counsel them. in coordination with ICDS and
(cid:1) Teenage pregnancies also NGOs.
emerging as a problem and (cid:1) Operationalise Adolescent Friendly
unsafe abortion & Health services at the health
premarital sex trend are on facilities
rise.
6. Mobile (cid:1) Remote population is not (cid:1) Coverage of the tribal populations
Medical Units covered due to lack of which are migratory in blocks
(MMUs) required staff, Gandooh, Bhaderwah.
infrastructure. (cid:1) Provide one-MMU equipped with
(cid:1) Communications system is GPRS for services.
poor. (cid:1) Contract MOs and staff nurses for
MMUs
7. Upgrading (cid:1) None of the CHCs are as Following CHCs needs to be upgraded
CHCs to per the IPHS standards; as per IPHS Standards in the first year:-
IPHS however the condition of all (cid:1) CHC Bhaderwah
existing CHCs is deplorable (cid:1) CHC Thathri
and needs to be upgraded (cid:1) CHC Gandooh
as per IPHS standard.

8. Upgrading (cid:1) None of the PHCs are as (cid:1) Construction of 18 PHC buildings as
PHCs for 24 per the IPHS standards. per IPHS standards. Names of
hr Services Out of 32 PHCs and PHCs are enclosed as Annexure
and IPHS Allopathic Dispensaries, 12 (cid:1) Construction of staff quarters in 37
standards PHCs are housed in PHCs (Names of PHCs given in
government buildings and Annexure)
20 are still functioning from
rented accommodation with
out sufficient facilities.
(cid:1) 30 PHCs/ADs are without
staff quarters
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9. Upgrading (cid:1) None of the Subcentres are (cid:1) Need to construct 98 Subcentre
Sub Centres as per he norms of IPHS buildings (Names of SCs are
to IPHS (cid:1) Out of 108 subcentres, 88 enclosed as Annexure)
standards subcentres are running in (cid:1) Construction of staff quarters in all
rented buildings and 20 subcentres for ANM’s stay. (Names
subcentres are running of subcentres given in Annexure)
from government owned (cid:1) Construction of Labour rooms at all
buildings. Subcentres for promoting
(cid:1) There are no labour rooms institutional deliveries
in any of the Subcentres for
Institutional deliveries
(cid:1) There is no staff quarter in
any of the subcentres of the
district Doda.
(cid:1) The numbers of Subcentres
is also inadequate
10. Immunisation (cid:1) Lack of awareness to (cid:1) Strengthening the District Family
mothers Welfare Office
(cid:1) Alternate vaccine delivery (cid:1) Enhancing the coverage of
(cid:1) Lack of Cold storage Immunization
(cid:1) Efficient monitoring and (cid:1) Alternative Vaccine delivery
supervision mechanisms in place
(cid:1) Gaps in difficult, flung areas (cid:1) Effective Cold Chain Maintenance
& inaccessible areas upto sub centre level
(cid:1) Reporting and (cid:1) Zero Polio cases and quality
documentation surveillance for Polio cases
(cid:1) Large number of cold chain (cid:1) Close Monitoring and
equipment are not documentation of the progress
functional and need repair (cid:1) Repair and replacement of cold
or need to be replaced chain equipment as per the need
11. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between
Convergence and health department ICDS workers and health workers for
timely diagnosis of malnourished
children and their management
(detailed activities under thematic
heads)
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