NRHM Jammu Kashmir 2008 09 PIP Presentation to

NRHM Jammu & Kashmir 2008 -09 PIP Presentation to NPCC 27 th March, 2008 Secretary to Government Health & Medical Education Department Govt. of J&K 1

Jammu & Kashmir PROGRESS 2

6000 Year Wise Expenditure 5556. 85 5000 4000 3000 1407, 66 2000 158, 91 0 2005 -06 2006 -07 2007 -08 (Upto Feburary )

Progress of Expenditure 7000 7123. 42 6000 5000 4000 3000 2000 1566, 7 1000 158, 91 0 2005 -06 2006 -07 2007 -08 (Upto Feburary )

Financial Progress Rs in lacs Year Allocation Expenditure % 2005 -06 2652. 57 158. 91 5. 99 2006 -07 4274. 61 1407. 66 32. 93 2007 -08 (up to Dec) 1083. 37 5556. 85 69. 36 (in Jan) 11625. 00 Total Expenditure (excluding Jan release) 8010. 55 7123. 45 88. 92 Total ( with Jan. release) 19635. 55 7123. 45 36. 27 5

Approval 2007 -08 RCH Flexipool 2007 -08 Unspent Balance as on 1 st April 2007 Mission Flexipool Unspent Balance as on 1 st April 2007 Immunization Disease Control Programs Total Rs. 13. 49 cr Rs. 8. 11 cr Rs. 168. 40 cr Rs. 43. 65 cr Rs. 3. 44 cr Rs. 41. 81 cr Rs. 278. 90 cr Total Release by Go. I under NRHM Rs. 127. 08 cr State Contribution Rs 5. 06 cr 6

REQUST FOR ADDITIONAL FUNDS 7

REQUST FOR ADDITIONAL FUNDS Infrastructure Development Plan HCM, J&K had projected the demand of building up proper Health infrastructure to Hon’ble Prime Minister and on his directions, the Planning Commission provided to J & K Rs. 60. 00 crore as ACA in the last quarter of 2006 -07. MOHFW also released Rs. 20 crore for upgradation of District Hospitals. (Contd)

REQUST FOR ADDITIONAL FUNDS Infrastructure Development Plan Hon’ble Prime Minister set up a Task Force on Development of Jammu and Kashmir. It recommends: “It will be erroneous to use the same norm for health coverage uniformly across the country. In J&K, the low density of population, difficult terrain, militancy, poor road infrastructure and lack of public transport all add to the costs and accessibility of health care, and these variables should be factored in evaluating the adequacy of coverage. ” It recommends as follows: Increased outlays under National Rural Health Mission (NRHM) from Rs. 65 cr to Rs. 100 cr per annum ; (Contd)

REQUST FOR ADDITIONAL FUNDS Report also recommends construction of health centre buildings with external assistance (Rs 1000 cr) for PHCs/HSCs Report advises J&K "to capitalize on the funds, programme mode and expertise available under the NRHM. Any further programmes and projects in the health sector need to build on the foundation to be laid by NRHM. If J&K makes a success of NRHM, it will have put its heath sector on a virtuous circle of higher efficiency, lower costs to the poor and better outcomes…” Rs. 1057 Cr IDP was prepared & submitted for EAP 10

REQUST FOR ADDITIONAL FUNDS Accordingly J&K formulated & presented an Infrastructure Development Plan (IDP), NPCC approved in principle & Rs 95. 50 Cr allotted in 2007 -08; DPRs in progress and likely to be completed in 2 months. (contd)

Infrastructure Development Plan (NRHM) appd. Jammu & Kashmir DISTRICT HOSPITALS (22) 200 beds IPHS Norm SUB-DISTRICT HOSPITALS (61) at Tehsil level 50 beds IPHS Norm CHCs FRUs (57) at Block level 30 beds IPHS Norm PHCs (Strengthening of Existing PHCs (374) & upgradation of AD (287) - 6 beds IPHS Norm SUBCENTRES (1907 existing SC) & upgradation of MACs (346) – IPHS Norm 12 12

REQUST FOR ADDITIONAL FUNDS Infrastructure development Works taken up S. N o Hospital Status 1. DH, Kathua IPD Block being Inaugurated 2. DH, Rajouri Block ‘A’ 2 nd Floor Columns raised upto roof level. Block ‘B’ G/F raised upto floor level. 3. DH , Poonch 1 st floor slab laid. 4. DH, Doda OPD Block to be inaugurated in April 5. DH , Kishtwar OPD being Inaugurated in April. 6. DH , Budgam Work in progress 7. DH, Kulgam OPD Block being Inaugurated in April. 8. Govt. Hospital, Sopore OPD Inaugurated this week. 9. DH, Baramulla OPD Block being inaugurated next month. 10. DH, Bandipora Work in progress. 11. DH, Anantnag Work in progress. 13

Jammu & Kashmir SPIP-2008 -09 14

Jammu & Kashmir District IDHAPs through decentralized & consultative planning: Village Level consultations & preparation of Village Health Plans Block Level consultations & preparation of Block Health Plans District Action Plans, through integration of Health Facility Surveys and assessments of district specific needs. State PIP : Integration of all 22 District IDHAPs form the part of the State PIP 15

RCH 2008 -09 Rs in lacs Funds Released by Go. I (2007 -08) 382. 6 Unspent balance March 2007 810. 57 Total Funds Available in 2007 -08 1193. 17 Expenditure 991. 55 Funds Available with the SHS 0. 0 Unspent with Districts/ Blocks 227. 44 Allocation incd state share 2575. 00

Activity ROP apprl 2007 -08 134. 81 118. 95 43. 39 8. 08 25. 03 3. 67 Unspent 1 st April 2007 212. 99 28. 49 75. 63 12. 84 82. 57 0. 00 Exp. 2007 -08 110. 18 8. 61 64. 28 8. 23 54. 09 0. 00 Projected Budget 2008 -09 179. 82 158. 40 57. 60 10. 80 34. 20 5. 40 Innovations / PPP / NGO 175. 47 30. 72 0. 13 234. 00 Total Technical 513. 07 443. 24 245. 52 685. 60 Infrastructure and Human Resources 462. 47 178. 38 144. 16 617. 40 Institutional Strengthening 22. 23 0. 00 28. 80 Maternal Health Child Health Family Planning Adolescent Health Urban Health Tribal Health Vulnerable Groups Funds Available 2007 -08 1081. 17 17

Activity Training ROP Unspent Funds Projected apprl 1 st April Available Exp. Budget 2007 -08 2008 -09 209. 16 15. 62 26. 46 279. 00 BCC / IEC 40. 38 4. 48 15. 13 54. 00 Procurement 20. 19 0. 00 27. 00 Programme Management 81. 50 123. 98 187. 20 108. 00 765. 70 618. 47 1800. 00 230. 94 485. 00 Total Flexipool 1349. 00 JSY 21. 22 Sterilisation Compensation 23. 65 61. 69 200. 00 Routine Immunization 0. 00 80. 43 90. 00 991. 55 2575. 00 Grand Total 1349. 00 810. 57 112. 00 1193. 17

NRHM Additionalities Rs in lacs Funds Rcvd -2007 -08 12253. 00 Unspent with SHS (March 2007) 4448. 33 Total Funds Available -2008 -09 16701. 33 Funds Available with SHS as on 25 th March 08 12110. 21 Indicated Allocation for 2008 -09 1700. 00 Total Funds Available for the year 2008 -09 14065. 21 Additional Requirement 08 -09 6964. 68

ROP apprl 2007 -08 Unspent 1 st April 2007 Funds Available 2007 -08 Exp. 2007 -08 Proposed Budget 2008 -09 Strngth. of DHs to IPHS 2000. 00 4000. 00 2000. 00 Upgradation of CHC to IPHS 0. 00 1111. 36 655. 33 0. 00 Upgd. of DHs to IPHS 0. 00 280. 00 Upgd. of 8 SDH to 200 bedded DH s 2000. 00 0 2000. 00 Upgd. of 61 T. H to 50 bedded SDH 3000. 00 3000. 00 Upgd of 57 Block. Hs into CHC 500. 00 500. 00 Construction of PHCs 1000. 00 1000. 00 Construction of SHCs 1000. 00 1000. 00 Activity

ROP apprl 2007 -08 Unspent 1 st April 2007 Funds Available 2007 -08 Establishment of drug warehouses 100. 00 100. 00 VHSC (Orientation Workshop for VHSC) 20. 00 7. 75 50. 00 Untied Funds to VHSC 753. 70 0. 00 753. 70 Untied Fund for SC Maintenance Grant for SCs Installation of Telephones at SHCs Village Health & Nutrition Day 190. 70 35. 36 226. 06 190. 70 0. 00 190. 70 5. 00 0. 00 25. 00 90. 44 0. 00 90. 44 Rel/comt 180. 00 337. 50 Activity Contractual Manpower for 53 CHCs Proposed Exp. Budget 2007 -08 2008 -09 Rel/comt 725. 04

Activity RKS ROP Unspent Funds apprl 1 st April Available Exp. 2007 -08 574. 00 Room and honorarium for 5. 27 AMCHI/ healer Support to Tribes training, drug kits 19. 00 and mobility support Multi-skilling of 132. 15 doctors School Health 300. 00 Programme Procurement of 400. 00 440 Ambulances Proposed Budget 2008 -09 0. 00 574. 00 541. 00 0. 00 5. 27 Rel/ comt 10. 00 19. 00 0. 00 132. 15 0. 00 300. 00 Rel/comt 300. 00 400. 00 Rel/comt 800. 00 Rel/comt 30. 00 RCH 22

Activity ROP apprl 2007 -08 Unspent Funds Proposed 1 st April Available Exp. Budget 2007 -08 2008 -09 Untied funds for CHCs 28. 50 0. 00 28. 50 42. 50 AMG to CHCs 57. 00 0. 00 57. 00 85. 00 AMG for PHC 187. 00 167. 00 354. 00 187. 00 Repair of 10 ANMTCs & 6 Nursing Schools 220. 00 220. 00 IEC & Health Mela 0. 00 54. 05 9. 33 0. 00 IDHAP 0. 00 83. 00 45. 60 100. 00 ASHA Trg 95. 00 36. 06 131. 06 76. 39 90. 00 Cost of SPMU 39. 45 0. 00 Cost of DMPU, BPMU 506. 33 0. 00 506. 33 555. 00 23

Activity ROP apprl 2007 -08 Unspent 1 st April 2007 Funds Available 2007 -08 Untied funds for PHCs 93. 50 83. 50 177. 00 93. 75 MMUs 294. 00 0. 00 600. 00 Advanced MMU for emergencies recommended by PMO 400. 00 800. 00 Proposed Exp. Budget 2007 -08 2008 -09 Maintenance of AMMU/ MMU 600. 00 Drug Supply for SHCs 204. 29 0. 00 224. 00 Drug Supply for CHC/FRU/RCH 1151. 00 0. 00 1175. 00

Activity ROP apprl 2007 -08 Unspent Funds 1 st April Available 2007 -08 Proposed Exp. Budget 2007 -08 2008 -09 Biomedical waste management 200. 00 In service promotional training of MPW (F) to LHV 3. 24 0. 00 3. 24 Strengthening SIHFW 5. 00 0. 00 6. 00 100. 00 125. 00 6. 50 0. 00 6. 50 5. 35 0. 00 5. 35 Setting up of SHSRC & ASHA Mentoring Groups Workshops for ICDS, TSC etc Block level workshops for BDOs, CDPOs, Mos 0. 00 Rel/comt 0. 00 200. 00 3. 50 10. 00

Activity ROP Unspent apprl 1 st April 2007 -08 2007 Funds Available Exp. 2007 -08 Rel/comt Proposed Budget 2008 -09 Training of AWW 13. 20 0. 00 13. 20 30. 00 Meetings of State & District Health Society 4. 60 0. 00 4. 60 Rewards for best health facilities 11. 70 0. 00 20. 00 AYUSH manpower (1 doctor & one pharmacist) at PHCs 200. 00 600. 00 5. 00 26

Activity AYUSH manpower (1 Doctor/ 1 Dawasaz) CHCs ROP Unspent Funds Proposed apprl 1 st April Available Exp. Budget 2007 -08 2008 -09 100. 00 35. 00 Orientation workshops of SHS/ DHS 3. 20 0. 00 3. 20 10. 00 TA/DA 2. 50 0. 00 2. 50 5. 00 Purchase of vehicle for BMO 216. 33 0. 00 Communication & monitoring funds to , Dy CMOs, BMOs etc 17. 79 0. 00 17. 79 Rel/comt 25. 00 Neonatal ICU at District Hospitals 50. 00 Rel/comt 50. 00 ASHA kit 0. 00 598. 00 151. 46 446. 54

Activity PPP/EMRI Innovation ROP apprl 2007 -08 0. 00 Unspent Funds Proposed 1 st April Available Exp. Budget 2007 -08 2008 -09 0. 00 Strng of SHS 1000. 00 50. 00 Inter-sectoral Convergence 0. 00 75. 00 Incentives to Doctors/ Institutions 0. 00 25. 00 10. 00 Strengthening PNDT Cell /Advocacy Incentive for best RKS 50. 00 20. 00

ROP apprl 2007 -08 Unspent 1 st April 2007 Funds Available 2007 -08 Exp. 2007 -08 Proposed Budget 2008 -09 Concurrent Evaluation 0. 00 50. 00 Upgradation of 1 AMT School to Nursing College 0. 00 200. 00 HRD Centre 0. 00 25. 00 Telemedicine 0. 00 7. 00 Activity GIS/MIES 25. 00 Rent of SCs/PHCs 130. 00 ESTB of Handicap Centre, Leh 50. 00 Piloting HI 100. 00 TOTAL 16833. 94 4505. 83 21282. 27 4648. 50 20000. 00

Jammu & Kashmir J&K SPECIFIC CONSTRAINTS 30

Constraints –I : External Factors Topography & Inaccessibility • Most of Districts are mountainous areas with extreme climatic conditions, some of the pockets remain cut off in winter, makes even outreach session difficult, • Retention of staff a problem. On going Militancy Movement in many areas including border areas restricted. Retention & mobility of staff a problem. Poor Road Connectivity Shortfall of 6600 KMs road length, 2060 inhabitations without connectivity, Road Density 13%, amongst lowest, (Leh- 2. 6%, Kargil- 4. 8%, Doda- 5. 2%, Poonch- 7%) 31

Constraints -II: External Factors Absence of Pvt Sector Absence of private health service providers / NGOs overload Govt. Institutions, 91 % patients load on Public HIs against 41. 7 % at national level Low density of 99 per sq km against 338 at national level population Poor public Transport System Barrier in patients reaching facilities during emergencies 32

Constraints: -III INTERNAL FACTORS Specialists Shortage of specialists, specially in Kashmir Division a major constraint in operationalizing FRUs Delayed Reporting from most of the blocks is delayed, incorrect. Shortage of Suboptimal Requires rejuvenation utilization of facilities Private Practice PP leads to non commitment of doctors to services Lack of motivation for rural posting Overwhelming majority of service providers reluctant to move out of Capital cities 33

Constraints: -III INTERNAL FACTORS Specialists Shortage of specialists, specially in Kashmir Division a major constraint in operationalizing FRUs Delayed Reporting from most of the blocks is delayed, incorrect. Shortage of Suboptimal Requires rejuvenation utilization of facilities Private Practice PP leads to non commitment of doctors to services Lack of motivation for rural posting Overwhelming majority of service providers reluctant to move out of Capital cities 34

Other Problems Difficulty to engage MBBS doctors at Rs. 8000/- Per month DCs delaying engagement of staff on contractual basis. In far-flung/difficult hard to reach areas like Leh, Kargil, Kupwara and some parts of Uri, Doctors are not applying for contractual positions. 4. In some districts, “District Programme Management Support Units” got delayed due to non-availability of candidates possessing the requisite qualification as are required under the guide lines on NRHM. 5. Progress slow on purchase of equipments necessary to upgrade DHs /CHCs/PHCs –replicating TNMSC 1. 2. 3. 35

Jammu & Kashmir Activities State &`District Health Target 100% by 2008 Societies Status SHS & DHS with requisite SPMSU/ DPMSUs in 16 districts in place (for 6 new AHSA (Selection & Training). 100% by 2008 VHSC: 7537 ( 6652 villages & 885 Hamlets) 100% by 2008 districts under progress). In place 9764 Module I: Module II: 33% Constituted: 6745 Achv) (90% 36

Jammu & Kashmir Activities 2 nd ANM at SCs as per IPHS. Strengthening of PHCs for 24 x 7 days services. First Referral Units Strengthening of CHCs Target 60% by 2009 Status Under progress. MPW / Pharmacists in place. 94 by March 08 28 by March 08 85 PHCs functioning on 24 x 7, 70 by 2009 Infrastructure upgradation in 70 CHCs Taken 24 FRUs made functional besides 14 DH

Jammu & Kashmir Target Activities Status Strengthening of District 60% by 2009 Infrastructure Upgradation taken up Hospitals. 100% by 2012 in 14 DHs (Rs 20 lacs per DH) SDHs in 8 new Districts taken up for upgradation to DHs) Rogi Kalyan Samitis 100% by 2009 474 RKS registered in the state: DHs, CHCs, PHCs, Bank account opened for 474 RKS. (list available on website) 38

Jammu & Kashmir Activities Target Status Untied & AMG for CHCs 100% by 2008 Under process for release Untied & AMG for PHCs 100% by 2008 Under process for release Untied grants SHCs 100% by 2008 Untied funds SCs: 92 % Utilized 39

Jammu & Kashmir Activities Target Support to RKS from PHC to DHs Funds released to RKS for 14 DHs 100% by 2008 System of community monitoring Status PRIs are not in place. VHSCs 100% by 2008 constituted with members from local community Nambardars, School Teachers, Local Leaders, Women's groups, NGO, SHGs, (Merger of committees of departments like TSC, ICDS, PHE, Education in the offing). 40

Jammu & Kashmir Activities Target Status Convergence, coordination and 50% by 2008 14 DHs, 70 CHCs and 71 service guarantees 70% by 2009 PHCs equipped to provide 100% by 2012 given services. IDHAPs of all 22 districts have focused on convergence issues. Placing at least one ANM at SHCs 100% by 2008 ANMs at 1755 SHCs (92%) with all basic provisions and equipment by December 2008. 41

Jammu & Kashmir Activities Target Status Facility survey 100% by 2008 Facility survey completed. District Health Action Plan 100% by 2008 IDHAPs prepared for all 2008 -2012 22 (100%) districts of the state Mobile Medical Units for 6 Districts by 2008 Tendering under process 13 Blocks by 2008 Tendering under process districts. AMMUs for blocks 42

Jammu & Kashmir Activities Audit for 2006 -07 Convergence: Website Grievance Cell/Helpline Performance based funding to Districts Status Completed Initiative taken for Inter-sectoral Convergence among TSC, ICDS, Health, PHE, Social welfare, Education etc. www. jknrhm. com Tele Helpline Established Initiated 43

Jammu & Kashmir SPMU/DPMU Staff Position Sancti oned In Position % Trained No. of persons who have resigned during Jan. Dec 07 (Nos) (%) SPM 1 1 100 Yes State Finance Manager 1 1 100 Yes 1 State Accounts Manager 1 1 100 Yes 1 State Data Officer 1 1 100 Yes 0 DPMs 14 14 100% Yes 1 DAMs 14 11 78% Yes 3 DDOs 14 11 78% Yes 0 Data Assistant 3 3 100 yes 0 44

Jammu & Kashmir DELIVERIES IN HEALTH FACILITIES 45

Institutional Deliveries from Year 2005 -06 to 2007 -08 131821 140000 132962 120000 100000 91234 80000 60000 40000 20000 0 2005 -06 2006 -07 2007 -08 (Upto Janurary )

Comparison of Institutional Deliveries in Tertiary Level Hospital Vs Others Hospitals

Comparison of Institutional Deliveries at DHs, CHCs & PHCs 45000 41774 40000 As on Dec 36272 2007 35000 28602 30000 25623 25000 22366 22311 CHCs 18665 20000 17761 DHs 15000 10000 4993 5000 0 2005 -06 PHCs 2006 -07 2007 -08

Jammu & Kashmir MAISTREAMING OF AYUSH 49

Jammu & Kashmir ISM Doctors at PHC level in first phase 2 ISM Doctors/ Dwasaz in DHs proposed in 2008 -09 Provision of AYUSH Drugs for PHCs/DHs ASHA Drug Kits having AYUSH Medicine provided 50

Jammu & Kashmir SNPSHOTS OF NRHM WEBSITE 51

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Jammu & Kashmir PROIRITIES FOR 2008 -09 54

Priorities Strategy Completion of unfinished activities in 2008 -09 Incentives for MOs/ specialists proposed. Training for MOs of FRUs in Emo. C, Anaesthesia and specially designed short course on Paediatric care planned in premier institutions like Kalavati saran Children Hospital and Lady Hardinge Medical College New Delhi. Blood Storage to be in place by March end, (activity got delayed as supplier backed out last year at the last movement). Staff posted in most of the facilities to fill the gaps 55

Priorities Strategy Focused Orientation of Selected VHSCs Orientation of 1000 identified VHSC scheduled, being completed by May 2008, (10 villages from each block) in 2008 -09 for: Up gradation of SHC. Capacity building Plan development of the village Community participation in managing facilities. Community Monitoring. Proposed to be outsourced. Ensuring all requisite equipment in 30% SHC Contact number, address and tour plan to be displayed at the facility. 56

Priorities Strategy Synergizing district Referral system being strengthened - and Block level Measures initiated to set up linkages of services in facilities District and Block level facilities with underserved/ un served areas through MMUs, AMUs being launched in 13 blocks to attend to emergencies including the aftermath of militancy related actions Ensuring availability of Residential quarters at health facilities which are staff and services in proposed to be upgraded to precede up gradation work. health facilities Incentives for Difficult area postings Effective supervision 57

Priorities Strategy Improving communication system. Provision of vehicles, telephones, mobiles and support for all MOs and also specialists. Provision of mobile phones / fixed monthly call charges to ANMs, MOs and specialists. Telephone connectivity at all health facilities upto PHCs and mobiles for ANMs. Hand holding with Successful States Gujarat Government requested to provie support to J&K to replicating best practices/trg 58

Priorities Transfer Policy Strategy Normally no Medical Officer/Specialists are shifted before 2 years except on complaints/other exigencies. Time Bound Promotion System in place; 10 yrs, 15 yrs, 20 yrs. A transfer policy formulated , linking Time Bound Promotion with posting. In 20 yrs service a doctor shall have 7 yrs rural posting, 2 yrs difficult posting covering 5 districts & then a choice posting Quicker promotion to higher scale for working in difficult/rural area more than the tenure. Additional weightage to rural served doctors for PG as incentive. Two year rural service made mandatory for in-service doctors for PG admission. Two years’ rural service being made mandatory for selection as registrars/senior residents Posting PG Asst Surgeons against specialist vacancies. PGs posted against specialists posts in FRUs, Rules being amended for appointment on specialist cadre posts on 50% by promotion. 59

Priorities Internal audit of services. Strategy Quarterly audit by MO In-charge of Health facilities planned, it to include number of monthly OPDs and IPD at the facility, monthly surgeries and / or other specialty care cases etc. Incentive for trainings budgeted. Concurrent Evaluation Procurement and logistics TNMSC model being replicated , establishment of warehouses being taken up in phased manner, DPR under preparation. CONCURRENT EVALUATION prepared, included in PIP. initiated, DPR 60

Priorities Strategy Realignment of Medical Blocks realigned to CD Blocks. (142). Medical Blocks with CD Blocks. M&E GIS mapping of health facilities including private institutes and HMIS to be put in place by 2008 -09. Data Triangulation 61

Priorities Enhancing technical & managerial capacity Strategy Selection of agency for SHRC being finalised. HRD Centre Proposed for 2008 -09. Empowering RKS G O issued to allow the RKS to retain the user charges for development of Hospital. Strengthening State & District Health Society Director Finance & Accounts posted in SHS. Hiring of experts / specialists on contract or through deputation. State Nodal Officer and two Divisional Nodal Officers deputed to the Society 62

Priorities Innovations Strategy Performance based rewards to ANMs, MOs and specialists and CMOs for increasing institutional deliveries. Performance based awards for Blocks for improving sex ratio. Incentives to Block Medical Officers / MS of FRUs/ DHs for documenting innovations/ best practices. Scheme to support / promote non-serving Nurse Mid- wives to fill up the unmet needs in MH in PPP mode on pilot basis. Support private Medical Practitioners in establishing clinics in remote areas. Outsourcing dysfunctional health institutions on pilot basis. Award for fully immunized girl child on VHND to encourage mothers to get their children fully immunized. 63

Priorities Strategy Grading of Facilities to be graded on the bases of outcome Awards for facilities on the basis of performance against prescribed criteria. Performance based cash awards for health functionaries at all levels. E -Finance Strengthening School Health Program Facilitating service guarantee plan • Introduction of E-transfer • Funds received from Go. I are parked with ICICI bank • Online Transfer to districts from State Health Society. • Dental Surgeon being posted in all districts exclusively for Dental Health. 64

Thank you 65

Jammu & Kashmir C R M APPRAISAL: KEY FINDINGS 66

CRM Appraisal Some Key Findings Activities Observations/Comments SYSTEMS IN PLACE FOR IMMUNIZATION AND CHANGES IN THE FIELD Comments: Mechanism of segregation of waste being adopted along with creation of common biomedical waste facility. DIAGNOSTIC FACILITIES AT HEALTH FACILITIES AND THEIR EFFECTIVENESS Comments : steps being taken for necessary Correction MANPOWER POSITION IN HEALTH FACILITES Comments : Construction of staff quarter budgeted, in PIP rationalization of manpower underway, availability of professional at facility to be published UTILIZATION OF ROGI KALYAN SAMITIS AND UNTIED FUNDS AT VARIOUS LEVELS Comments : Funds released to all facilities. 67

CRM Appraisal Some Key Findings Activities INVOLVEMENT OF PANCHAYATI RAJ INSTITUTIONS IN THE FUNCTIONING OF THE HEALTH SYSTEM Observations/Comments: Not required . PROCESS OF PREPARATION Comments : Completed OF DISTRICT HEALTH ACTION PLANS AND QUALITY OF DISTRICT HEALTH MISSION MEETINGS Comments : Training planned and budgeted in SYSTEMS OF FINANCIAL PIP, Financial Management strengthened, MANAGEMENT timeline, for funds released to be followed. 68

Priorities BCC/ IEC Strategy Formulation of Integrated Communication strategy through Professional agencies/ MERC deptt, and Management Department from university. To evolve a System of education and behaviour change communication to promote healthy life style. Area specific campaigns on communicable & noncommunicable diseases (hypertension/Diabetes etc). Customised / targeted messages using traditional, , electronic, print media with special focus on vulnerable sections Gujjar Bakarwals, Paharis, Gaddis, Sansi etc. Special public health campaign on malnutrition, Anaemia, health education to launch for promoting environmental hygiene, family health, against use of Tobacco & Alcohol 69

CRM Appraisal Some Key Findings Activities Observations/Comments HMIS AND ITS EFFECTIVENESS Comments : Rationalization of manpower as per patient load and performance. RATIONAL USE OF MANPOWER AT VARIOUS LEVELS TO ENSUREAPPROPRIATE SKILLS FOR BETTER OUTCOMES Comments : rationalization already planned as per patient load and infrastructure. THRUST ON DIFFICULT AREAS AND VULNERABLE SOCIAL GROUPS Comments : Mobile Medical Units planned in phase manner for underserved and un-served areas along with thrust on VHNDs. 70

CRM Appraisal Some Key Findings Activities ASSESSMENT OF PERFORMANCE OF ASHAs, LAB TECHNICIANS, MEDICAL DOCTORS, ETC. SYSTEM OF DISEASE SURVEILLANCE AND REPORTING Observations/Comments: Liabilities cleared, payments being given through cheques, output of functionaries in each institution ordered. Comments : V-set, equipment received, not yet installed. PREVENTIVE AND Comments : steps initiated for convergence , planned PUBLIC HEALTH workshop had to be postponed due to non availability of MEASURES FOR VECTOR Go. I officers. CONTROL AND EFFORTS AT INTER SECTORAL CONVERGENCE 71

CRM Appraisal Some Key Findings Activities Observations/Comments EFFECTIVENESS OF THE Comments: Not required. DISEASE CONTROL PROGRAMMES PERFORMANCE OF MATERNAL HEALTH, CHILD HEALTH AND FAMILY PLANNING Comments: Quality assurance committees geared up, NSV shown significant improvement number increase from 386 to 1433. Deficiencies being removed. PRFORMANCE OF Comments: tendering process in progress. MOBILE MEDICAL UNITS/ SYSTEMS OF AMBULANCES 72

CRM Appraisal Some Key Findings Activities PROGRESS OF INFRASTRUCTURE AND SYSTEMS FOR IMPROVEMENT OF CIVIL WORKS SYSTEMS OF PROCUREMENT AND LOGISITICS FOR EQUIPMENT AND DRUGS AND ITS EFFECTIVENESS Observations/Comments: Work allotted to four agencies for expeditious completion, DPRs under preparation, meanwhile concerned agencies allowed to continue construction as part of DPRs to meet the current requirements and targets. Comments: TNMSC model being replicated & budgeted. ASSESSMENT OF NON GOVERNMENTAL Comments: Very few credible NGOs were available, PARTNERSHIPS FOR however, few identified & involved. 11 MNGOs PUBLIC HEALTH GOALS identified & trained by VHAI 73

CRM Appraisal Some Key Findings Activities Functioning of ANM Training Schools ASSESSMENT OF PROGRAMME MANAGEMENT STRUCTURE AT DISTRICT AND STATE LEVEL Observations/Comments: Rationalization of Man power already under consideration. Comments: Team will be sent to facilities for monitoring, already trained at NIHFW, New Delhi, Mussorie. To be deputed this year also. 74

Jammu & Kashmir Prime Minister’s Reconstruction Plan 75

Prime Minister’s Reconstruction Plan NRHM: already discussed Pradhan Mantri’s Swasthya Suraksha Special Dispensation of Rs. 60 Cr. for Yojna (PMSSY) DH/SDHs PMSSY Upgradation of Govt. Medical Colleges Jammu and Srinagar to the level of AIIMS @ Rs. 120. 00 Cr. each with State Equity of Rs. 20. 00 Cr. 15 super specialties in Jammu and Institute of Traumatology in Srinagar alongwith 9 related Specialties J&K first to start the work at Jammu, Work on Srinagar GMC to start in April. 76

Central Equity Civil Works Machinery & Equipments Jammu Srinagar Rs. 46. Cr. Rs. 40 Cr. Rs. 47 Cr Rs. 50 Cr 77

Upgradation of Govt. Medical College Jammu Central Equity Work started on 4 -storey 220 -bedded Super Specialty Hospital Block, to be completed in 18 months. State Equity (Rs. 7. 70 Cr. spent ending Jan 2008) Const. of Addl. Emergency Block Rs. 6. 10 Cr. (completion by June 2008) Const. of 30 -bedded Pediatric ward completion by June 2008) (Cost 2. 40 Cr. ) Repair /Renovation of existing Medical College complex (Taken up) (Cost Rs. 3. 50 Cr. ) 78

GOVT. MEDICAL COLLEGE SRINAGAR Central Equity Const. of Institute of Traumatalogy & upgradation of 9 Super Specialties. CPWD is finalizing tenders, work likely to start in April 2008 to be completed in 24 months State Equity Const. of Nursing College (to be completed by June 2008) Out of State Equity Rs. 11. 28 Cr. utilized ending Jan 2008 79

MACHINERY/EQUIPMENT – STATE EQUITY Machinery & equipment worth Rs. 8. 00 crores for each College being purchased. Machinery worth Rs. 1. 40 Crore purchased for Medical College Jammu last year 80

SPECIAL DISPENSATION UNDER PM’S PACKAGE S. No Name of the Hosp. Kashmir Division Funds Allocated Expdt. Ending Jan 2008 1 DH Budgam 145. 00 125. 00 2 Govt. Hospital Kulgam 300. 00 3 Govt. Hospital Sopore 400. 00 4 DH Baramulla 400. 00 5 Govt. Hosiptal Bandipora 400. 00 150. 00 6 DH Anantnag 500. 00 7 Trauma Hospital Kangan 80. 00 55. 00 8 SDH Zainapora 55. 00 9 SDH Rajpora 20. 00 81

SPECIAL DISPENSATION UNDER PM’S PACKAGE (RS. 60. 00 CRORES FOR CONSTRUCTION OF DH/SDHS S. No Name of the Hosp. Jammu Division Funds Allocated Expdt. Ending Jan 2008 10 DH Kathua 600. 00 575. 00 11 DH Rajouri 400. 00 12 DH Poonch New 400. 00 13 DH Doda 500. 00 14 Govt. Hospital Gandhi Nagar 400. 00 15 Govt, . Hospital Bhaderwah 400. 00 225. 00 16 Govt. Hospital Sarwal. 500. 00 400. 00 17 DH Kishtwar 500. 00 Grand Total (Jammu+ Kashmir) 6000. 00 4905. 00 The balance cost of completion of these hospitals is Rs. 254 Crores approx. 82