KERALA PIP PRESENTATION 2008 09 NPCC MEETING 180308

KERALA PIP PRESENTATION 2008 -09 NPCC MEETING 18/03/08

STANDARDISATION OF INSTITUTIONS Sub Centres : For every 5 wards, one sub centre which will have one ANM, one JHI and 5 ASHAs. (Urban Health Centres in Urban areas to be set up. ) PHC : For every Panchayat, one PHC. There are 999 Panchayats and we have 829 PHCs and 115 Block PHCs. Plus Rural Dispensaries and Government Dispensaries. CHCs: One Block Panchayat should have a CHC (30 -100 beds) with FRU facilities. One Taluk / Government Hospital (100 – 150 beds) District / General Hospital (500 – 700 beds)

ESSENCE OF OUR PIP • Promoting preventive and promotive aspects of Primary Health care in the community • Strengthening Training program and Capacity Building • Establishing Health Management Information System • Establishing referral system of protocol – Strengthening the 3 rd tier and activating the 2 nd tier • Strengthening Nursing Education Department • Improving Health Indicators • Putting up a system of referral transport • Launching special programs for NCDs linked with ASHA / LW

ESSENCE OF OUR PIP • Piloting remedial measures for 2 nd Generation problems like • Pain & Palliation. • Malignancies. • Geriatric care. • Suicides. • Mental Health Programs etc. • Tackling Re-emergence of Infectious Diseases • Combined BCC strategy • Optimizing use of all systems of medicine • Convergence of activities of Health Determinants

RCH II Program Objectives and Strategies Activity Current level Target 2008 -09 IMR 15 12 MMR 110 75 TFR 1. 7 Leprosy Prevalence Rate 0. 29 0. 25 Upgradation of CHCs 34 118 Engaging ASHA / LW 8469 20661 Neo natal Mortality Rate 8. 5 8

RCH II Program Objectives and Strategies Activity Current level Target 2008 -09 MNGO program in districts 10 14 Full Vaccination coverage 75 80 Contraceptive Use 69 72 Male Sterilization(%) ~1 1. 5 Annual Parasite Index 0. 062 0. 05 Annual Falciparam Index 0. 009 0. 008 24 20 Container Index (Mosquito) %

RCH II Objectives achieved by the State Activity Mothers who had at least 3 antenatal visit (%) Deliveries assisted by a health professional (%) Universal coverage of all eligible pregnant women under JSY Birth assisted by a doctor / nurse / JPHN/Other health professional Mothers who recd. Postnatal care within 2 days of delivery Vaccination coverage (complete) Children 12 -23 months who recd. BCG% Current level 94 Target 2008 -09 100 99. 7 99. 8 60 85 99. 7 100 87. 7 90 75 80 94. 6 99

RCH II Objectives achieved by the State Activity Children age 12 -35 months who recd. A vitamin A dose in last 6 months Children with diarrhoea in last 2 weeks who recd. ORS Children with diarrhoea in last 2 weeks taken to a health facility Children with acute respiratory infection or fever in last 2 weeks taken to health inst. Children age 0 -5 months breastfed Children age 6 -9 months receiving solid or semi-solid food and breast milk Pregnant women age 15 -49 anemic Current level 38. 2 Target 2008 -09 45 34. 6 45 67. 4 80 81. 4 90 56. 2 60 93. 6 95 33. 3 25

RCH II Objectives achieved by the State Activity No. of HMS registered Current Target level 2008 -09 100% have 0 bank accounts under PR act WH & SC Committees 16009 17287 No. of CHCs upgradation 50 118 Dist. Trg. Plan developed and implemented 0 14 Dist. BCC plan developed and implemented 14 14 AYUSH inst. Included in NRHM NIL 100% Urban RCH in Municipalities No. of Block PHCs functioning as 24 X 7 No. of CHCs functioning as 24 X 7 NIL 67 101 53% 105 115

RCH II Objectives achieved by the State Activity Dental Units in CHCs and Higher instns. Current Target level 2008 -09 74 190 Though approved in PIP 07. 08, funds not released till date 5568 Adolescent Clinics 1 84 HMIS in Health Care Institutions 17 1048 Mobile Psychiatry team Blood Storage System 4 6 14 60 Communication facilities to Sub Centre Comm. facilities to Emergency Ambulance Comm. Facilities to PHC / Block PHC 132 545

RCH II Objectives achieved by the State Activity Special Program for Infection Control in Institutions Malaria Death Total Current Target level 2008 -09 59 178 8 0 0. 062 0. 05 Container Index (Mosquito) Average 24 20 Breteau Index (Average %) 38 20 Annual Parasite Index

Financials of Reproductive and Child Health Program – II Base Flexible Pool Funds FY 2005 -06 (Rs. in Crores) Inflow of Base Outflow of Base Flexible Funds for under RCH - II RCH -II 21. 43 6. 69 2006 -07 31. 03 10. 15 2007 -08 (as on close of 29 th February 2008) 14. 94 46. 54 Balance in Bank committed for expenditure Total 4. 02 67. 4 * Rs 4. 32 crores received recently on 22/2/2008 for procurement of identified drugs and equipment under utilization

MNGO Funds under RCH – II FY Inflow Outflow 2005 -06 0. 63 0. 05 2006 -07 1. 65 0. 90 2007 -08 (as on close of 29 th February 2008) Balance in Bank committed for expenditure Total 6. 39 1. 39 6. 33 8. 67 (Rs. in Crores)

Financials of Additionalities under NRHM/Mission Flexible Pool Funds (Rs. in Crores) FY 2005 -06 Inflow of Outflow of Mission Flexible Pool Funds 10. 69 0 2006 -07 41. 93 30. 06 2007 -08 (as on close of 29 th February 2008) 68. 31 88. 49 Balance in Bank committed for expenditure 0 2. 39 Total 120. 94

Financials of Immunization (including PPI) (Rupees in crores) FY Inflow of Funds Outflow Funds 2005 -06 1. 85 1. 50 2006 -07 4. 29 3. 16 2007 -08 (as on close of 29 th February 2008) Balance in Bank committed for expenditure Total 3. 33 2. 75 9. 47 7. 41

Financials of funds received from Department of AYUSH (Rupees in crores) Particulars Supply of essential Drugs to 797 AYUSH Dispensaries (790 Ayurveda, 6 Siddha & 1 Unani) situated in Remote and backward areas Through Director ISM Inflow Outflow Balance 1. 99 1. 29 Through Oushadhi 0. 60 Supply of essential drugs for Homeopathy Through Homeopathy 1. 31 Total 3. 30 0. 10 1. 31 3. 20 0. 10

Financials of funds received from Department of AYUSH for Ayurveda Medical Education (Rupees in crores) Particulars PG Ayurveda Medical Education Inflow 1. 94 List of Institutions Vaidyarathnam PS Varier Ayurveda College, Kottakkal Ayurveda College TVM Ayurveda College Thripunithura Ayurveda College Kannur Padiar memorial Homeopathic medical College, Chottanikkara Total Outflow 0. 45 0. 40 0. 38 0. 71 0. 47 2. 41

Financials of funds received control of Chickungunya Particulars Fund for control of Chickungunya control activities Inflo Outflo w w 6. 24 6. 21 Committed Total 0. 03 6. 24

Statement of Expenditure Activity /Compo nent Inflo w of funds Part A – RCH –II 67. 40 Part BAddition al 120. 9 4 Part CImmuniz ati Total Funds Cumulati Devol ve ved Expenditu re up to 31. 03. 2007 Expendi ture up to 3 rd Quarter of FY 2007 -08 Gran d total SOE Percen tage of SOE furnis hed 11. 13 32. 19 43. 32 64 % 120. 9 4 2. 10 48. 26 50. 36 42 % 9. 47 7. 41 2. 19 2. 49 4. 68 63 % 197. 8 1 195. 7 2 15. 42 82. 94 98. 36 50 % Expected SOE by 31 st March 2008 150 crores 76 %

Value of Utilization Certificates furnished for core activities § Base Flexible Funds under RCH – II: Out of Rs 67. 40 Crores from 2005 -06 to 2007 -08, UC for Rs 32. 19 Crores has been furnished § Mission Flexible Pool: Out of Rs 69. 40 Crores from 2005 -06 to 2007 -08, UC for Rs 40. 18 Crores has been furnished § Total Value Rs 72. 37 Crores § For tied releases such as Drugs etc separate UCs are furnished

PIP – 2008 -09 Base Flexible Pool – RCH II

ALLOCATION DETAILS( in crores) Activity Proposed Allocation ( in the Sub 2008 -09) Group Meeting Unspent Proposed in the final PIP after remarks Base Flexible funds 56. 66 133. 30 18. 38* 84. 05** JSY 21. 00 21. 18 0 17. 02** Comp. for Ster. 5. 22 0 5. 22 Routine Immun. 2. 40 8. 66 2. 09 4. 50 85. 28 159. 71 99. 08 295. 99 Total RCH pool Mission Flexi pool 2. 09 110. 81 90. 00 (expected 188. 08 + to be received from GOI)

BASE FLEXIBLE POOL BUDGET ESTIMATE FOR 2008 -09 (Rs in lakhs) COMPONENT Proposed Approved Remarks Maternal Health 3373. 50 Includes JSY, Referral Transport Child Health 1475. 25 Includes School Health Programme Family Planning Adolescent Health 522. 00 Compensation, NSV Acceptance 89. 31 Pilot Project Urban Health 675. 00 1500. 00 Tribal Health 151. 81 Urban Health Centre Camps, Sickle Cell Anemia

BASE FLEXIBLE POOL BUDGET ESTIMATE FOR 2008 -09 (Rs in lakhs) COMPONENT Proposed Approved Remarks Vulnerable Groups 52. 30 Innovations / PPP / Gender 108. 47 Female Foetocide Prevention, NGO Program Infrastructure & HR 2141. 13 Includes Link Workers Institutional Strengthening Training 287. 5 167. 27 52. 30 Includes HMIS Includes Infection Management Trainings

BASE FLEXIBLE POOL BUDGET ESTIMATE FOR 2008 -09 (Rs in lakhs) COMPONENT BCC Procurement Proposed Approved Remarks 602. 45 22. 50* Procurement to be done by GOI Program Management 6% of budget Total 11081 8288 (56. 66 cr for Base Fle. pool + 21 cr for JSY + 5. 22 cr for Com for Sterl + 25% increase in case we perform well

PIP 2008 -09 Mission Flexible Pool

MISSION FLEXIBLE POOL BUDGET ESTIMATE FOR 2008 -09 (Rs in lakhs) COMPONENT Proposed(in Approved & proposed in SG Meet) Remarks NPCC Hospital 3446. 00 Management Society (RKS) 1214. 00 All RKS Operationalized. AYUSH not approved. Only 1 lakhs For Taluk / W&C Annual Maintenance 1612. 80 Grant 993. 80 50% Ucs submitted. Money for previous year was released in Jan 2008 Untied funds 674. 30 Previous UCs submitted. 1600. 90 Approval required for 1278 wards also 1194. 30 Ward Health & 1728. 70 Sanitation Committee Drug Kits 2000. 00 1000. 00 Required Especially for NCD component. Remaining carry over 1000 from previous year.

BUDGET ESTIMATE FOR 2008 -09 (Rs in lakhs) COMPONENT Proposed Approved Remarks Renovation of Basic Trg. Schools 170. 00 Renovation of Dist. Warehouse, Ktym 100. 00 Upgradation of CHC to IPHS 380. 00 Total requirement is Rs. 59. 50 Crores for 115 CHCs. Balance carry over from previous year 3450 crores. Upgradation of 52 Govt. Hospitals 1875. 00 All in rural areas Strengthening of Dist. /Gen Hospitals 3700. 00 900. 00 Carry over from previous year 900 lakhs Upgradation of IMCH, Kozhikode 1000. 00 Sanctioned as a special project. TOTAL 17205. 00 9908. 00 + remaining carry over of 3650 + good performance margin.

Activities required to be supported through NRHM COMPONENT Proposed during SG Revised proposal for NPCC Remarks Request for approval as given during 07 -08. Mental Health Programs (approved in 07 -08) 152. 16 State Level Resource Centre 50. 00 Research Studies / Surveys 100. 00 To strengthen M&E activities Geriatric Health Care 1060. 30 New initiative. Government of India proposed Institute of Aging Community Based Care of Bed ridden, elderly, chronically ill 453. 72 Strengthening Nursing Education 1500. 00 SLRC started. Requesting funds for sustaining. Flag ship project for Kerala through NRHM. On going initiative New initiative. Priority of Government of India too.

Activities required to be supported through NRHM COMPONENT Comprehensive Mgmt & Prev. of Mental Health Problems Proposed Approved 800. 00 Remarks Ongoing pilot project being expanded. Upgradation of Block PHC to 1000. 00 IPHS. Construction of holistic PHCs, sub centers To be done after standardization of institutions. Setting up of EMRI in the State 1147. 67 5. 12 from previous year. 500. 00 Community based linkage with cancer for northern Kerala. Malabar Cancer Centre TOTAL 6763. 55 State may be 3650 carry over allowed to from the previous spend as per year + good priority performance including incentive AYUSH.

Activities required to be supported through NRHM COMPONENT BE 2008 -09 Approved Remarks RKS for Ayurveda Institutions 1322. 00 Nil RKS for Homoeo Institutions 680. 00 Starting of Homoeo Dispensaries 400. 00 Starting Rapid Action Epidemic Control Cell 283. 00 Comprehensive Training Program in Homoeopathy 10. 37 Proposals of Indian Systems of Medicine 1498. 20 Kerala has a tradition of separate AYUSH institutions. In the national Workshop for Homoeopathy held at New Delhi on 5 th & 6 th Nov. 2007, it was advised that proposals under AYUSH should be submitted to Government of India through NRHM. Support is required for these institutions. Patent Cell 24. 10

NATIONAL DISESASE CONTROL PROGRAMS AND CONVERGENCE ESTIMATE FOR 2008 -09 (Rs in lakhs) • RNTCP • IDSP • NLEP • NPCB • NIDDCP • NVBDCP • TOTAL PART E • CONVERGENCE (Mainly with NVBDCP) : 580. 61( 68% approved) : 624. 50 : 221. 25 : 798. 21 : 30. 50 (20. 00) : 813. 02 : 3068. 09 : 841. 9

RCH – II Activities proposed 2008 -09 Maternal Health § Janani Suraksha Yojana § 30 FRUs to be operationalize § 24 X 7 services in 30 Block PHCs § Strengthening the W & C Hospitals § Ward Health & Nutrition Day § RCH Camps § Non recurring cost of mobile phones at SC (proposed but not implemented during 07. 08) § Providing specialists in CHCs and selected institutions § ASHA/Link Worker – Implementing activities through ASHA, providing Drug Kits, Training for ASHA

RCH – II Activities proposed 2008 -09 Child Health § Establishment of sick new born care in selected W & C Hospitals § Providing Iron supplement, Zinc, Vitamin A supplementation § Strategy for providing ORS § BCC activities for promotion of breastfeeding mainly through ASHA, ANM etc. § IMNCI Training – facilitators trg, follow up trg, trg for MO & health workers (GOI to help State in conducting TOT) and IMNCI implementation § Providing specialists in CHCs and selected institutions

RCH – II Activities proposed 2008 -09 Family Planning § NSV camps, NSV Training for MO § Male & Female Sterilization services on fixed days § Compensation for Sterilization § Accreditation of private hospitals for FP activities – PPP approach § BCC activities for spacing methods § IUD camps, compensation for IUD, IUD training § Laparo, Minilap training § Workshops on standards & Quality Assurance § Procurement of equipments

RCH – II Activities proposed 2008 -09 Urban RCH § Providing RCH services to entire urban area with special focus on Urban Slums § Hiring ANM in Urban areas § Provision of Drugs § Revamping PP Unit § Providing specialists and para medical staff (to the bare minimum) in institutions where facilities are available, staff are not available

RCH – II Activities proposed 2008 -09 Tribal RCH § Specific Action Plan for Tribal Areas § Tribal Medical Camps, Medical Camps in CHCs § Adolescent Health Education Class § Development of Ambedkar Memorial Tribal Hospital as CHC and making it into an institutions with Education, Training and Treatment centre for chronic and incurable diseases in Wayanad dist. § Sickle Cell Anemia project for tribals in Wayanad and Palakkad Districts

RCH – II Activities proposed 2008 -09 Vulnerable Groups § Coastal Health Programs – Camps, augmentation of services in selected health institutions in coastal areas Innovations § Action Plan on Female Foeticide Prevention § NGO program § Program on Gender Equity

RCH – II Activities proposed 2008 -09 Monitoring & Evaluation § Implementation of Health Information Systems Project in remaining 13 districts (pilot in Trivandrum in 07 -08) § Collection of all Data through HISP § Training for all Health Workers on HISP (completed for Trivandrum) § Data collection through Block Coordinators § Data Analysis, Data Triangulation § Research Studies § Household surveys § Quality Assurance Committees formed in all districts

RCH – II Activities proposed 2008 -09 Monitoring & Evaluation § Logistics Management § Ensuring MIS requirement for various activities without duplication § State to report data in integrated MIES format on completion of computerisation of health institutions (State now providing Computers in all health institutions throughout Kerala now)

RCH – II Activities proposed 2008 -09 Training § State has prepared a comprehensive training with specific impetus on trainings in MH, CH & FP activities. § § Trainings to ASHA / LW Trainings to PRIs BCC Trainings to Health staff

RCH – II Activities proposed 2008 -09 BCC/IEC § Specific activities inbuilt in all interventions § Capacity building of BCC professionals § Training for Health Workers § Emphasis on quality and standards, BCC and service utilization § Intra-communication process across all channels § Integrated IEC approach

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