No. No. Introduction 1-4 1. Organization & Infrastructure 5-17 2. NRHM, Health & Population Policies 19-49 3. Funding For The Programme 51-61 4. Maternal Health Programme 63-69 5. Child Health Programme 71-74 6. National Programmes Under NRHM 75-112 7. Information, Education And Communication 113-118 8. Partnership With Non-Government Organisations 119-121 9. Family Planning 123-138 10. Training Programme 139-146 11. Other National Health Programmes 147-160 12. International Co-Operation For Health & Family Welfare 161-164 13. Medical Relief And Supplies 165-187 14. Quality Control in Food & Drugs Sector, Medical Stores 189-201 15. Medical Education, Training & Research 203-303 16. Facilities For Scheduled Castes And Scheduled Tribes 305-308 17. Use of Hindi In Official Work 309-310 18. Activities In North East Region 311-322 19. Gender Issues 323-331 Annexure Organisation Chart of Department of Health & Family Welfare, 333 Organization Chart of DGHS & Audit Observation. Annual Report 2010-11 1 The Ministry of Health and Family Welfare oversees the implementation of policies and programmes for health care around the country, within the framework set by the National Health Policy of 2002 and the priorities set in successive Five Year Plans. While the responsibility for the delivery of health care rests largely with the State Governments, the Government of India plays a role in setting policy and providing resources for the implementation of National Programmes. Despite substantial progress made on many fronts there are still areas of concern. Maternal and Infant Mortality are still unacceptably high in several areas, infectious disease continues to remain a threat to public health. Non- Communicable Diseases including cancers, cardio- vascular disease, diabetes and mental illnesses affect sizeable numbers of our population. India does not as yet have an adequate number of all categories of health professionals, whether of doctors, specialist doctors, nurses, nurse practitioners, para-medics and health workers. The National Health Policy (NHP) was formulated in 2002 to provide prophylactic and curative health care services towards building a healthy nation. The NHP- 2002 aims to achieve an acceptable standard of good health amongst the general population of the country. This is sought to be done by increasing access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing areas and institutions. The challenge has been to provide the country more equitable access to health services across the social and geographical expanse of the country. Thus, keeping in line with this broad objective, several health programmes/ schemes have been launched from time to time. There has been a steady increase in the aggregate public health investment, in the country. The contribution of Central Government towards public investment for provision of health care services has also been enhanced over the Introduction Introduction Introduction Introduction Introduction years. Expenditure in Health Sector on Public Health is about 1% of the GDP. National Rural Health Mission (NRHM) The country has a well structured multi-tiered public health infrastructure, comprising District Hospitals, Community Health Centres, Primary Health Centres and Sub-Centres spread across rural and semi-urban areas and tertiary medical care providing multi-Speciality hospitals and medical colleges. Improvements in health indicators can be attributed, in part to this network of health infrastructure. However, the progress has been quite uneven across the regions with large scale inter-State variations. Despite the consistent effort in scaling up infrastructure and manpower, the rural and remote areas continue to be deficit in health facility and manpower. Conscious and vigorous efforts continue to be made during the current year to step up funding in the health sector and to increase spending in the public domain, at least to raise it to the level of 3 per cent of the GDP by 2012. The major thrust in the National Rural Health Mission (NRHM) has been towards achieving qualitative improvements in standards of public health and health care in the rural areas through strengthening of institutions, community participation, decentralization and creating a workforce of health workers viz. ASHAs. While the Mission was formally launched in 2005 and has taken a while to effectively find a firm footing, early indications reflect its positive impact. Reliable estimate based on surveys show an appreciable decline in infant mortality (50 per 1000 live births in 2009 as against 60 in 2003), decline in total Fertility Rate (from 3.0 children per women in 2003 to 2.6 in 2008) and improvement in the percentage of safe deliveries etc. (from 48.0 in 2004 to 52.7 in 2007-08). A new initiative under NRHM has been taken to identify backward districts for ensuring differential financing. Based on health indicators 264 backward districts across Annual Report 2010-11 2 the country have been identified for providing focused attention. Similarly, after many years the agenda of family planning is back in mainstream health discourse and has been repositioned for better maternal and child health apart from population stabilization. The Reproductive and Child Health (RCH) Programme is a key element of National Rural Health Mission(NRHM). The system strengthening being undertaken under the Mission has lent support to the Programme towards reducing MMR, IMR and TFR. Janani Suraksha Yojana(JSY) has resulted in a steep rise in demand for services in public health institutions with the institutional deliveries registering a substantial increase. The number of JSY beneficiaries has risen from 7.3 lakhs in 2005-06 to about 1 crore in 2009-10. Facility upgradation on a large scale has been undertaken to strengthen health care services for mothers and the neonates. Establishment of new born corners, new born stabilization units and special care units for new born has received a special thrust. In addition, capacity building initiatives such as IMNCI, FIMNCI SBA, NSSK, EMOC and LSAS have been upscaled. SBA trainings have started showing positive results with percentage of skilled attendants at birth registering an increase. Multi skilling of doctors in EMOC and LSAS has led to operationalization of First Referral Units providing C- Section services. Referral Transport for pregnant women has seen considerable progress across States and has emerged as a key intervention to improve timely access of pregnant women to public health facilities. Family Planning has again come back to centre stage after several decades. Wide political support for voluntary family planning has given a new impetus to the Ministrys initiatives. A name-based tracking of mother and children has been launched whereby pregnant women and children can be tracked for their Ante-natal Care and immunisation along with a feedback system for the ANM, ASHA etc to ensure that all pregnant women receive their Ante-Natal Care Check-ups (ANCs) and post-natal care (PNCs); and further children receive their full immunisation. All new pregnancies detected are being registered from 1st April, 2010. The states are putting in place systems to capture such information on a regular basis. In pursuance of the commitment made by the Government in the address of Honble President of India to the Joint Session of Parliament on 4 th June 2009 an Annual Report to the People on Health was published in September 2010 to generate a debate on the issues presented in the Report. National Council of Human Resources in Health (NCHRH) The President in her address to the Joint Session of Parliament on 26 th June 2009, announced the Governments intention to set up a National Council of Human Resources in Health (NCHRH) as an overarching regulatory body for health sector to reform the current regulatory framework and enhance supply of skilled personnel. Consequently, a Task Force under the Chairmanship of former Union Secretary (Health & Family Welfare) was constituted to deliberate upon the issue of setting up of the proposed National Council. The National Commission, which will coordinate all aspects of medical, dental, nursing, pharmacy & paramedical education, will in itself consist of senior professionals and experts of known integrity and social commitment, selected/ nominated by the most stringent standard. Accordingly, the following three bodies have been proposed to be formed under the ambit of NCHRH National Board for Health Education, National Evaluation, Assessment & Accreditation Committee and National Councils. Non Communicable Disease: The Ministry of MoHFW has launched two new programmes namely (i) The National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke(NPCDCS) and (ii) The National Programme for Health Care of Elderly(NPHCE) to address the menace of Non-Communicable Diseases(NCDs) such as cancer, diabetes, cardiovascular diseases and stroke that are major factors reducing potentially productive years of human life and resulting in huge economic loss. Initially, these two new programmes will be implemented in 100 districts of 21 selected states of the country. The country is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases which are emerging as the leading cause of death in India accounting for over 42% of all deaths with considerable loss in potentially productive years of life. The Government of India initiated National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. During the Annual Report 2010-11 3 remaining part of the 11 th Plan, 100 districts across 21 States will be supported under this programme. Main activities would include health promotion, opportunistic screening of 30+ population and management of common NCDs. District Hospitals will be upgraded by setting up NCD Clinic, District Cancer Facility and Cardiac care Units. Besides, 65 Tertiary Cancer Centres will be set up to provide comprehensive treatment to common cancers across the country. A provision of Rs. 1230 crores has been made for this programme during 2011-12. In addition, with increasing life expectancy, there is a growing geriatric population who require special health care. National Programme for Health Care of the Elderly has also been initiated this year in the same districts. The programme will provide services to the elderly population at various levels. Geriatric Clinic and 10 bedded Geriatric wards will be set up in District Hospitals. In addition, 8 Regional Geriatric Centres will be set up in selected medical colleges for tertiary care, training and research activities. A provision of Rs 288 crores has been made during 2010-12. The Ministry of Health Family Welfare, Government of India has launched National Programme for Prevention and Control of Deafness (NPPCD) on the pilot phase basis in the year 2006-07(January 2007) covering 25 districts which was extended to another 35 districts, 41 districts and 75 districts in the year 2008-09, 2009-10 and 2010-11 respectively, covering total of 176 districts of 16 States and 3 UTs. The launch of the dedicated National Tobacco Control Programme (NTCP) in the 11 th Five Year Plan has been the major milestone to facilitate the implementation of the tobacco control laws to bring about greater awareness about the harmful effects of Tobacco and to fulfil the obligation(s) under the WHO-FCTC. The programme at present is under implementation in 42 districts in 21 states in the country. The Global Adult Tobacco Survey (GATS) Report was released by Honble HFM on 19 th October, 2010. An out lay of Rupees 30.00 Crore has been earmarked for the NTCP in the current financial year 2010-11, out of which an amount of Rs. 17.17 Crores has been spent till date. Central Government Health Scheme The Central Government Health Scheme has been in existence since 1954, when it started functioning in Delhi. The Central Government Health Scheme has since come a long way and presently Central Government Health Scheme covers 25 cities. In order to make the CGHS user friendly, its functioning has been streamlined and revamped. Important actions in this direction have been the computerisation of the functioning of the CGHS and its dispensaries, delegation of enhanced financial powers to CGHS functionaries and to Ministries / Departments, issue of plastic cards to beneficiaries enabling them to take treatment in any dispensary, introduction of direct indenting of commonly prescribed medicines by CMOs in charge of dispensaries, empanelment of private hospitals and diagnostic centres to provide options, in addition to the facilities available in Government hospitals, polyclinics and laboratories, outsourcing of sanitary work in dispensaries, outsourcing of dental services, opening of stand-alone dialysis unit in Delhi, appointment of the Bill Clearing Agency (BCA) of settlement of bills of hospitals of pensioner beneficiaries treated in hospitals, etc. These measures have resulted in increased satisfaction level of CGHS beneficiaries. Control of Infectious Disease The upgradation of National Centre for Disease Control (NCDC) is being taken up to enhance the capabilities of the Central and State Governments in disease surveillance outbreak investigation and rapid response to disease outbreaks. The proposal has been approved by the Cabinet. During the year 2010, about 1000 disease outbreaks were reported and responded to under Integrated Disease Surveillance Programme (IDSP). Under Externally Aided Projects, scaling up of Long Lasting Insecticidal Nets (LLINs), Rapid Diagnostic Tests (RDTs) and Artemisnin Based Combination Therapies (ACTs) in high malaria endemic states has been taken up. Similarly, for Kala-Azar elimination, RDTs and oral drugs are also being scaled up. In view of growing threats of other vector-borne diseases like dengue and chikungunya, institutional surveillance has been strengthened and source reduction measures have been taken. In spite of the widespread prevalence of dengue infection in Delhi before and during Common-wealth Games (CWG), members of foreign delegations and other participants in the CWG were not affected by dengue due to sustained source reduction measures at CWG sites. The Revised National Tuberculosis Control Programme (RNTCP) has moved beyond the case detection rate of 70% and cure rate of 85% in India and efforts are being Annual Report 2010-11 4 made to further improve the rates. With a view to meeting the challenge of Multi-Drug Resistant Tuberculosis (MDR-TB), 43 Culture and Drug Sensitivity Laboratories are being set up and MDR-TB care and management services scaled up. The Ministry of Health & Family Welfare is giving financial assistance to the poor patients for treatment at different hospitals in all over the country under the following two schemes namely: (i) Rashtriya Arogya Nidhi and (ii) Health Minister s Discretionary Grants. Rashtriya Arogya Nidhi is providing financial assistance to patients, living below poverty line, who are suffering from major life threatening diseases to receive medical treatment in Government Hospitals. Financial Assistance up to a maximum of Rs.50,000/- is available to the poor indigent patients from the Health Minsters Discretionary Grant to defray a part of the expenditure on Hospitalization/treatment in Government Hospitals in cases where free medical facilities are not available. K. Chandramouli Secretary (H&FW) Ministry of Health & Family Welfare March 14, 2011 New Delhi Annual Report 2010-11 5 Chapter 1 1.1 INTRODUCTION In view of the federal nature of the Constitution, areas of operation have been divided between Union Government and State Governments. Seventh Schedule of Constitution describes three exhaustive lists of items, namely, Union list, State list and Concurrent list. Though some items like Public Health, Hospitals, Sanitation, etc. fall in the State list, the items having wider ramification at the national level like family welfare and population control, medical education, prevention of food adulteration, quality control in manufacture of drugs etc. have been included in the Concurrent list. The Union Ministry of Health & Family Welfare is instrumental and responsible for implementation of various programmes on a national scale in the areas of Health and Family Welfare, prevention and control of major communicable diseases and promotion of traditional and indigenous systems of medicines. In addition, the Ministry also assists States in preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance. Expenditure is incurred by Ministry of Health & Family Welfare either directly under Central Schemes or by way of grantsinaids to the autonomous/statutory bodies etc. and NGOs. In addition to the 100% centrally sponsored family welfare programme, the Ministry is implementing several World Bank assisted programmes for control of AIDS, Malaria, Leprosy, Tuberculosis and Blindness in designated areas. Besides, State Health Systems Development Projects with World Bank assistance are under implementation in various states. The projects are implemented by the respective State Governments and Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure the Department of Health & Family Welfare only facilitates the States in availing of external assistance. All these schemes aim at fulfilling the national commitment to improve access to Primary Health Care facilities keeping in view the needs of rural areas and where the incidence of disease is high. The Ministry of Health & Family Welfare comprises the following four departments, each of which is headed by a Secretary to the Government of India:- Department of Health & Family Welfare Department of AYUSH Department of Health Research Department of AIDS Control Organograms of the Department of Health & Family Welfare are at Annexure at the end of the Annual Report. Directorate General of Health Services (DGHS) is an attached office of the Department of Health & Family Welfare and has subordinate offices spread all over the country. The DGHS renders technical advice on all medical and public health matters and is involved in the implementation of various health schemes. 1.2 MINISTER IN CHARGE The Ministry of Health and Family Welfare is headed by Union Minister of Health and Family Welfare, Shri Ghulam Nabi Azad since 29 th May 2009. He is assisted by the Ministers of State for Health and Family Welfare Shri Dinesh Trivedi and Shri S Gandhiselvan. Shri S. Gandhiselvan Minister of State for Health and Family Welfare Shri Dinesh Trivedi Minister of State for Health and Family Welfare Shri Ghulam Nabi Azad Union Minister of Health and Family Welfare Annual Report 2010-11 6 1.3 ADMINISTRATION The Department has taken new initiatives and steps to ensure that the Government policies and programmes are implemented in a time-bound and efficient manner, as part of Governments commitment to provide better healthcare facilities. It has enforced discipline and accountability amongst its officers and staff. Director (Administration) attends to service related grievances of the staff in the Department of Health and Family Welfare. Secretary (Health and Family Welfare) also gives personal hearing to staff grievances. Director (Welfare & PG) in the Department is functioning as nodal officer for redressal of public grievances. Under Secretary (Welfare and PG) assists him in the matter. 1.4 HEALTHY LIFESTYLE CENTRE (YOGA & GYM) A Healthy Lifestyle Centre (Yoga & Gym) duly funded by WHO has been functioning in the Ministry since 28 th November, 2005. Two well-trained (one male and one female) Yoga instructors from Morarji Desai National Institute of Yoga have been deployed to take yoga classes for male and female employees of the Ministry. 1.5 CENTRAL HEALTH SERVICE The Central Health Service was restructured in 1982 to provide medical manpower to various participating units like Directorate General of Health Services (DGHS), Central Government Health Service (CGHS), Government of National Capital Territory (GNCT) of Delhi, Ministry of Labour, Department of Posts, Assam Rifles, etc. Since inception a number of participating units like ESIC, NDMC, MCD, Himachal Pradesh, Manipur, Tripura, Goa, etc. have formed their own cadres. JIPMER, Puducherry which has become an autonomous body w.e.f. 14 th July, 2008 has gone out of CHS cadre. The latest in the list of institutions which has gone out of CHS cadre is Govt. of NCT of Delhi. Consequent upon the formation of Delhi Health Service 906 posts ( 14 SAG, 150-Non-Teaching, 742-GDMO ) belonging to Govt. of NCT of Delhi have been decadred from CHS. At the same time units like CGHS have also expanded. The Central Health Service now consists of the following four Sub-cadres and the present strength of each Sub-cadre is as under: (i) General Duty Medical Officer sub-cadre - 2155 (ii) Teaching Specialists sub-cadre - 850 (iii) Non-Teaching Specialists sub-cadre - 772 (iv) Public Health Specialists sub-cadre - 078 In addition to the above there are 19 posts in the Higher Administrative Grade, which are common to all the four sub cadres. 1.5.1. Recruitment: (a) Recruitment of GDMOs: -Dossier of 450 candidates has been received from UPSC on the basis of Combined Medical Service Examination-2009 including 16 physically handicapped candidates and they were allocated to different Ministries/Departments as below: i) Ministry of Railoways - 248 (including 8 PH) ii) Ministry of Defence - 005 (including 1 PH) iii) MCD - 026 (including 1 PH) iv) NDMC - 019 v) Central Health Service - 152 (including 6 PH) Governments policy on reservation for SC, ST, OBC & Physically Handicapped is being followed strictly in the recruitment of Medical Officers of CHS. In order to avoid inordinate delays in issuing offers, provisional offer of appointment are being issued to the CMSE candidates pending verification of their character and antecedents from the authorities concerned as per decision of Committee of Secretaries. 1.5.2. Promotions: During the year, the following numbers of promotions were effected/under process in various sub-cadres of the Central Health Service: Annual Report 2010-11 7 I. Review of CHS-Rules, 1996: Recruitment Rules, 1996 for Central Health Service has been revised in consultation with DOP&T and sent to UPSC for approval. II. Posting of doctors to Andaman & Nicobar Islands: Despite best efforts on the part of this Ministry, the vacancies of Specialists (Non-Teaching) Sub-Cadre in Sub- Sr. Designation of posts No. cadre No. G 1. Senior Medical Officers to (Grade Pay Rs. 6600/- in PB-3) to Chief Medical Officers. 01 D (Grade Pay Rs. 7600/- in PB-3) M 2. Chief Medical Officer (Grade Pay Rs. 7600/- in PB-3) to Chief Medical Officer (NFSG)(Regular) O (Grade Pay Rs. 8700/- in PB-4) 89 3. Chief Medical Officer (NFSG) (Grade Pay Rs. 8700/- in PB-4) to Senior Administrative Grade (Grade Pay of Rs. 10000/- in PB-4) 586 T 1. Assistant Professor (Grade Pay Rs. 6600/- in PB-3) to Associate Professor (Grade Pay Rs. 7600/- in PB-3) 55 E A C 2. Associate Professors (Grade Pay Rs. 7600/- in PB-3) to the post of Professor (Grade pay 8700 in PB-4). 34 H I N 3. Professor (Grade Pay Rs. 8700/- in PB-4) Director-Professor(SAG) (Grade Pay Rs. 10000/- in PB-4) 160 G N 1. Specialist Grade-II (Junior scale) (Grade Pay Rs. 6600/- in PB-3) to Specialist Grade I 57 O (Grade Pay Rs. 7600/- in PB-3) N 2 Specialist Grade-II (Senior scale) (Grade Pay Rs. 7600/- in PB-3) to Specialist Grade I T (Grade Pay Rs. 8700/- in PB-4) 17 E 3. Specialist Grade-I officers (Grade Pay Rs. 8700/- in PB-4) promoted to the post of SAG A (Grade Pay Rs. 10000/- in PB-4) under DACP Scheme 219 C 4. A proposal for holding DPC for one post of HAG for 2008- 09 and 5 posts for 2009-10 and 2 H posts for 2010-11 is being sent to UPSC. I 5. Proposal for holding DPC for 1 post of Special DGHS sent to UPSC N G P 1 Specialists Gr. I officers (Grade Pay Rs. 8700/- in PB-4) to SAG (Grade Pay Rs. 10000/- in PB-4) 14 U B L I C H E L T H A & N Islands could not be filled. Accordingly, from August 2008 onwards, General Duty Medical Officers with requisite PG qualification as well as Specialists are being deputed to the A & N Islands for a period of 90 days in Specialities of Paediatrics, Medicine, Radiology, ENT, and Obstetrics & Gynaecology, Anaesthesia and Ophthalmology. Requisition for all vacant Non-teaching Specialist CHS posts in A&N Islands have been sent to UPSC with a request to fill up these posts urgently. Annual Report 2010-11 8 1.5.3. Other Service related matters (i) RTI: The number of RTI cases received in this Division is 548. (ii) Court Cases: There were 79 Court cases pending in various CAT/Courts in the beginning of financial year 2010-11. But due to vigorous efforts by the CHS Division, 14 cases have been disposed off by the courts and only 65 cases are pending in courts. 1.5.4. Constitution of a Committee for considering the representations of CHS Officers for Upgradation of below bench Mark Grading in the ACRs: Consequent to the instructions contained in Department of Personnel and Trainings O.M. No. 21011/1/ 2010-Estt.A dated 13.4.2010 , a Committee under the Chairmanship of Shri Keshav Desiraju , Additional Secretary has been constituted for considering the representations of hundreds of CHS officers for upgradation of the below bench mark grading in their ACRs. 1.5.5. Non Medical Scientists 2010-11. A proposal has been mooted to amend the ISP Rules, 1990 to incorporate provisions for inclusion of more posts within its ambit. Participating Units/Institutes have been asked to submit proposals in this regard. A proposal for amendment of UPSC (Exemption from Consultation) Regulations, 1958 under Ministry of Health and Family Welfare with the view to do away with the requirement of consultation with the UPSC in the matter of in-situ promotions upto S.IV level has been sent to Department of Personnel and Training. Action has been taken to fill up Seven posts as S-V level with UPSC. Pending ACRs and Bio-data are being collected. 1.5.6. Dental Side - 2010-11 During the year six posts of Dental Surgeons under Ministry of Health and Family Welfare have been filled up on regular basis. For one post, administrative formalities are being completed before offer of appointment to be issued to recommended candidate by UPSC. 13 officers had been considered for promotion to SAG level. 7 were promoted and 6 were not found fit, as having below bench mark of ACRs, formalities for upgradation of ACRs as per DOP&Ts guidelines are being completed. The process has also been initiated to amend the Dental Posts Recruitments Rules, 1997 to bring them in conformity with the changes that have since taken place. 1.6 E-Governance Initiatives of the Ministry of Health & FW Health Informatics Division of National Informatics Centre provides MIS and Computerization support to Ministry of Health & Family Welfare. More than 1300 PCs of the Ministry are connected to the Local Area Network (LAN), which in turn, connected to NICNET through RF Link and leased line circuits. Salient features of the some of the projects handled by NIC are as follows: 1.6.1. Web Page The updation of Website of the Ministry of Health & Family Welfare http://mohfw.nic.in and various other websites under the Ministry are done on a regular basis, as and when the information is provided by the users. Critical information such as notifications of the CGHS, Tenders and Advertisements under the Ministry, sanction details of the Principal Accounts Office & PublicExpenditure Management, etcare such areas where regular updation takes place. In addition a no. of websites under the MoHFW are being maintained by the respective users on their own. 1.6.2. Network Maintenance and email, internet usage NIC provides new LAN connections; network based Anti- virus solution in addition to maintaining existing network users. At present over 1300 LAN nodes have been provided in the Department of Health & Family Welfare, Directorate General of Health Services and about 100 LAN nodes at IRCS Building at Dept of AYUSH. The email and internet usage has grown significantly and officials prefer email communication over other means. The network maintenance and desktops require constant updation from the operating system service providers and hence the un-authorized access is controlled effectively. 1.6.3. Computerization of Mother and Child Tracking System (MCTS) It has been decided to have a name-based tracking whereby pregnant women and children can be tracked for their ANCs and immunisation along with a feedback system for the ANM, ASHA etc to ensure that all pregnant Annual Report 2010-11 9 women receive their Ante-Natal Care Check-ups (ANCs) and post-natal care (PNCs); and further children receive their full immunisation. All new pregnancies detected/ being registered from 1 st December 2009 at the first point of contact of the pregnant mother with the health facility/ health provider would be captured as also all Births occurring from 1 st December, 2009. The states are putting in place systems to capture such information on a regular basis. The National Informatics Centre is rolling out their software application to other States based on the Gujarat model of e-Mamta. The master data entry of health facilities is almost complete and now states will start entering the names of the mothers and children in the online system. The system will help in developing work plan for the ANMs and ASHAs so as to deliver the health services to all the mothers and children. An offline version of the MCTS system has also been developed for facilities where the internet connectivity is not there and this can be linked to the online system on a periodic basis. The first cycle of the system is expected to be completed by March 2011. The URL is http://nrhm-mcts.nic.in . 1.6.4. Computerization of Central Govt. Health Scheme (CGHS) CGHS is high on the agenda of the Government with the ultimate objective to provide effective, timely and hassle free healthcare to the CGHS beneficiaries. The computerized system is aimed at computerizing all functions of the dispensary such as Registration, Doctors prescription, Pharmacy Counter, Stores, Laboratory & Indent etc. The system has been successfully implemented in all the 24 cities of CGHS including Delhi/ NCR covering 248 allopathic wellness Centres (WCs). The introduction of plastic cards for every individual CGHS beneficiary with the barcoded number has been implemented successfully in Delhi/NCR. Now all the new CGHS beneficiary has to have a plastic card in all CGHS cities. Bulk procurement of commonly indented medicines from manufacturers / suppliers has been successfully operational in Delhi/NCR and in 6 cities outside Delhi/ NCR. The implementation of online MRC Claims module is under implementation in Delhi/NCR. The AYUSH WCs are being computerized in Delhi/NCR and are expected to be completed by March 2011. The URL of the site is http://cghs.nic.in. The implementation of the CompDDO package for the DDOs of CGHS in Delhi/NCR and 6 cities outside Delhi/ NCR is underway. The telephone number for the CGHS HELPLINE 011- 66667777 is operational during office hours on all working days and it provides information to the CGHS beneficiaries. 1.6.5. Intra-Health Portal for the Ministry: Intrahealth portal is a G2G and G2E application and caters to the needs of employees and Divisions of MoHFW / DteGHS. It has the following facilities: 1. Notice Board consisting of circulars/orders issued by various Divisions of MoHFW and DteGHS. 2. Payslips for the employees under Department of Health & FW, AYUSH, DGHS are available online 3. Office Procedure Automation (OPA) for tracking of file movements 4. Bulletin Board for exchange of views and comments. 5. Links to various Govt. web-sites. 6. Photo gallery relating to important events in Health and FW sector. The portal URL is http://intrahealth.nic.in. 1.6.6.Computerisation of Medical Stores Organization (MSO) and General Medical Stores Depots (GMSDs) The MSO is a premier organization of the MoHFW, which is involved in procurement and supply of medicines to the Central Govt. hospitals across India, CGHS, Para- military forces. MSO does it through its 7 GMSDs located across India. Inventory management is therefore, very vital for the MSO so that the medicines are supplied to the indenters in time after proper quality check. The web based Inventory management system for the MSO & GMSD has been implemented on a full scale now. All the stakeholders such as MSO, GMSDs, indenters, suppliers; Labs etc are using the online system. The suppliers have been providing the medicine supplies with the barcodes (1D) at the tertiary level packaging and secondary level packaging. http:// msotransparent.nic.in Annual Report 2010-11 10 1.6.7. Usage of NIC CompDDO package by various DDOs under the MoHFW Composite DDO Package (CompDDO) has been in regular usage by Cash(Health) Section, Cash(FW) Section, MoHFW, and Cash Section, DteGHS, Nirman Bhawan, New Delhi, with the technical support from NIC. The same package has been in use by PPAO, PAO(Sectt.), PAO(DteGHS), attached with MoHFW/ DteGHS, Airport Health Office,New Delhi, Rural Health Training Centre(RHTC),Najafgarh,New Delhi, and National Centre for Disease Control(NCDC). Recently,the package has also been installed and made operational at FSSAI,National Institute of Biologicals,Central Pharmacopia Commission and National Institute of Health and FW. The package automates functions of Cash Sections as regards preparation of pay bills, payments of employees salaries through their bank accounts/ECS, GPF, income tax, etc. The staff at all these organizations/sites has been trained to operate the package, and issues that arise from time to time are taken care of by NIC.. 1.6.8. CPGRAMS and E-Service Book Centralised Public Grievance and Redressal & Monitoring System (CPGRAMS) is under implementation in the Ministry and DteGHS. It provides for on-line monitoring, processing and disposal of Public Grievances. E-service Book project has provision for updation and maintenance of service books of employees electronically. The project is under implementation in the Ministry and DteGHS. 1.6.9. Usage of PAO Package of NIC under MoHFW PAO-2000 is a software package developed by NIC, and it monitors details of expenditure by MoHFW, DteGHS and sub-ordinate organizations through on-line transfer of data from various PAOs to PPAO, MoHFW, Nirman Bhawan, New Delhi. The PPAO then transmits the compiled data to CGA through the NETWORK for on-line updation of database at their end. Provision is also there for various reports and queries at different levels. The package is in continued usage by PAOs and PPAO attached with MoHFW / DteGHS and sub- ordinate organizations. All the 11 PAOs attached with MoHFW / DteGHS and sub-ordinate Organizations have been using the package: 1.PAO(Secretariat) 2.PAO(DteGHS) 3. PAO(Safdarjung Hospital). 4. PAO(Dr RML Hospital) 5. PAO(LHMC) 6. PAO(NCDC) 7. PAO(CGHS) 8. PAO(Mumbai) 9. PAO (Kolkata) 10. PAO(Puducherry) 11. PAO(Chennai). 1.6.10. OncoNET India Project: This project envisages connecting of 27 Regional Cancer Centres with associated Peripheral Cancer Centres to provide early cancer diagnosis/detection, treatment and follow up for cancer patients. The project has been implemented successfully in 4 RCCs and 4 PCCs at present and 3 more sites are under implementation. 1.6.11. Implementation of e-Hospital Solution at the Sports Injury Centre, Safdarjang Hospital, New Delhi: The e-Hospital @NIC - consists of more than 14 core modules that cover major functional areas of the Hospital viz. Out Patient Department, In Patient Department, Casualty, Ward Management, Operation Theatre Management, Clinic Information, Path Laboratories, Radiology, Blood Bank, MRD, Stores & Inventory control Management, Accounts, Personnel Management have been planned for implementation during this year. Implementation support is being provided by NICSI from Sep, 2010. 1.6.12. Online allotment and Display System of Central Quota of UG/PG Medical/Dental seats: DGHS, Ministry of Health & Family Welfare allots 15% of M.B.B.S/B.D.S and 50% M.D/M.S/M.D.S and Post- graduate Diploma seats of recognised Medical Colleges to the merit holders as provided by CBSE/AIIMS who conduct competitive examinations on All India basis. The Computerized Allotment and Display System software of NIC fully complies with guidelines and orders given by Honble Supreme Court of India and various other High Courts on various occasions over the period of last 15 years or so. Salient features of the Scheme are as follows: 1.6.13. Under-Graduate Counselling More than 2250 MBBS and around 200 BDS seats are available in 127 colleges across India. Allotment is done in two or more rounds as per court orders. Annual Report 2010-11 11 SC, ST, OBC and PH reservations done through roster system approved for this purpose. This system does VC based on-line allotment at Delhi, Kolkata, Chennai and Mumbai, through NICNET. 1.6.14. Post-Graduate Counselling More than 4250 MD/MS/Diploma in 106 disciplines and 154 PG Dental seats in 28 Dental Colleges across India. Allotment is done in two or more rounds as per court orders. SC, ST, OBC and PH reservations done thro roster system devised for this purpose. This system does VC based on-line allotment at Delhi, Kolkata, Chennai and Mumbai through NICNET. 1.6.15. Technical Support to AYUSH NIC AYUSH wing provides necessary IT support including LAN, WAN, web security, anti-virus etc to all the users of AYUSH at IRCS Building, New Delhi. 1.6.16.Integrated Disease Surveillance Project (IDSP) NIC has completed establishment of IT centers at all 796 IDSP sites across the country and handed over the same to the IDSP wing of NCDC. The URL of the site is http:/ /idsp.nic.in. 1.7 ACCOUNTING ORGANIZATION As provided in Article 150 of the Constitution, the Accounts of the Union Government, shall be kept in such form as the President of India, may on the advice of Comptroller & Auditor General of India prescribe. The Controller General of Accounts (CGA) in the M/o Finance shall be responsible to prepare and compile the Annual Accounts of the Union Government to be laid in Parliament. The CGA performs this function through the Accounts Wing in each Civil Ministry. The Officials of Indian Civil Accounts Organization are responsible for maintenance of Accounts in Ministry of Health & Family Welfare. They have dual responsibility of reporting to the Chief Accounting Authority of the Ministry/Department through the Financial Adviser for administrative and accounting matters within the Ministry, as well as to the Controller General of Accounts, on whose behalf they function in this Ministry to carry out its designated functions under the Allocation of Business Rules. The administration of Accounts Officials in Ministry of Health & Family Welfare is under the control of the office of the CGA. The Secretary of each Ministry/Department is the Chief Accounting Authority in Ministry of Health & Family Welfare. This responsibility is to be discharged by him through and with the help of the Chief Controller of Accounts (CCA) and on the advice of the Financial Advisor of the Ministry. The Secretary is responsible for certification of Appropriation Accounts and is answerable to Public Accounts Committee and Standing Parliamentary Committee on any observations of the accounts. Accounting Set Up In the Ministry: The Ministry of H&FW has four Departments viz. Department of Health & Family Welfare, Department of Ayush (Ayurveda, Yoga, Unani, Sidha & Homeopathy), Department of Health Research & Department of AIDS Control (NACO). There is a common Accounting Wing for all the Departments. The Accounting Wing is functioning under the supervision of a Chief Controller of Accounts supported by a Controller of Accounts (CA), Dy. CA and eleven Pay & Accounts Officers (PAOs) and Drawing & Disbursing Officers (DDOs) in the field. The CCA is submitting internal audit observations and matter related to financial discipline directly to the Secretary in respect of each Department and its subordinate organizations. The Annual Review Report of the Internal Audit is also subject to scrutiny by the CGA and Ministry of Finance. The CCA is also entrusted with the responsibility of Budget Division & Official Language Division of the Ministry. In addition, there are fourteen encadred posts of the Accounts Officers located at various places. There is a common Internal Audit Wing for all the Departments, which carry out the inspection of all the Cheque Drawing and Non-Cheque Drawing Offices, Pr. Accounts Office and all the PAOs. There are 5 Field Inspection Parties located at Delhi, Chandigarh, Mumbai, Kolkata and Bangaluru. Accounting Functions in the Ministry: The Accounting function of the Ministry comprises of various kinds of daily payments and receipts, compiling Annual Report 2010-11 12 of daily challans, vouchers, preparation of daily Expenditures Control Register etc. Monthly expenditure accounts, monthly receipts and monthly net cash flow statements are being prepared for submission to Ministry of Finance through the CGAs office. The entire work of payment and accounts has been computerized. The Pr. Accounts Office prepares Annual Finance Accounts, Annual Appropriation Accounts, Statement of Central Transactions, Annual Receipts Budget, Actual Receipts and Recovery Statement for each grant of the Ministry. The head wise Appropriation Accounts are submitted to the Parliament by the CGA along with the C&AGs report. In addition, the Pr. Accounts Office issues orders of placement of funds to other civil Ministries, issues advices to Reserve Bank of India (RBI) for release of loans/ grants to State Governments and LOC to the accredited Bank of the Ministry for placing funds with DDOs. Apart from general accounting functions, the Accounts Wing gives technical advices on various Budgetary, Financial and Accounting matters. The Accounting Wing also functions as a coordinating agency on all accounts matters between Ministry and the Office of the Controller General Accounts & the Comptroller and Auditor General. Similarly it coordinates on all budget matters between Ministry and the Budget Division of the Ministry of Finance. Internal Audit Wing The Internal Audit Wing of the Department of Health and Family is handling the internal audit work of all the four Departments. There are more than 600 audit units of the Department of Health and Family Welfare, 24 units of Department of AYUSH and 25 units of Department of Health Research. The Internal Audit plays a significant role in assisting the Departments to achieve their aims and objectives. The role of Internal Audit is growing and shifting from Compliance audit confined to examining the transaction with reference to Government Rules and Regulations to complex auditing techniques of examining the performance and risk factors of an entity. In 2009-10, 97 audit paras have been raised which include observations to the tune of Rs. 1368.47 crores. A total No. of 851 paras have been settled during 2009-10. 1.8 IMPLEMENTATION OF RTI ACT, 2005 The Right to Information Act, 2005, enacted with a view to promote transparency and accountability in the functioning of the Government by securing to the citizens the right to access the information under the control of public authorities, have already come into effect w.e.f. 12.10.2005. Under the Right to information Act, 2005, 32 Central Public Information Officers( CPIOs) and 17 Appellate Authorities( A/As) have been appointed in the Ministry of Health & Family Welfare (Department of Health & Family Welfare). All CPIOs including autonomous organizations/PSUs have placed all obligatory information pertaining to their Division/programme, under Section 4(i) of the RTI Act, 2005 in the Website of Ministry. Now RTI Request/ Appeal Management System (RRAMS) is under implementing stage. Under this system CPIOs and Appellate Authorities (including autonomous organizations) would create computer Based management of RTI requests and appeal. Applications under the Act for seeking information are accepted at Facilitation Centre, near Gate No.5, Nirman Bhavan & at Coordination-II ( CDN-II) Section, Room No. 215A, D Wing, Nirman Bhawan, New Delhi. Applications are also accepted by post through Receipt & Issue (R&I) Section. During 2009-2010, 1541 applications and 250 RTI Appeals were received under RTI Act, 2005. Annual return for the year 2009-2010 has already been sent to CIC. During 2010-11, 2419 applications and 389 appeals till 31.12.10 have been received. 1.9 VIGILANCE Vigilance Wing of the Department of Health and Family Welfare functions under the overall control of an officer of the rank of Joint Secretary to the Government of India who also works as part time Chief Vigilance Officer (CVO) of the Ministry . The CVO is assisted by a part time Director(Vig.), an Under Secretary(Vig.) and the supporting staff of Vigilance Section. The Vigilance Division of the Ministry deals with vigilance and disciplinary cases of the Department of Health and Family Welfare and vigilance cases involving officers of Dte.GHS and CGHS. The Vigilance wing monitors vigilance enquiries, disciplinary proceedings in respect of Doctors and non-medical/technical personnel borne on the Central Health Service (CHS), P&T Dt.GHS Annual Report 2010-11 13 dispensaries and other institutions like Medical Stores Organizations, Port Health Organizations, Labour Welfare Organization etc. During 2010-11(till ending December,2010), one charge sheet each for major penalty and minor penalty for alleged irregularities were issued. Penalties were imposed in 7 cases and charges were dropped in 6 cases. Sanction for prosecution was granted in one case and 2 appeal cases were received/processed. One official was placed under suspension. Suspension was revoked in 2 cases and ongoing cases of suspension were reviewed by the Committee. More than 115 complaints were received from CVC, 45 miscellaneous complaints were forwarded by CBI and 75 complaints were received from other sources. 29 references were sent to CVC, 6 to UPSC, 3 references to DOP&T and 6 references were sent to Ministry of Law & Justice for advice. Presently there are 2 court cases being dealt with in the Division. Central Vigilance Commission guidelines of use Information Technology for vigilance administration are being implemented vigorously and major initiatives have been taken regarding use of technology in e-governance for minimising the need of interfacing officials with beneficiaries. The entire process of registration of patients, maintenance of personal records, prescription, investigation advices, distribution of medicines etc. have been computerised in the CGHS to make the entire process transparent. In Central Drugs Standard and Control Organization, standard operating procedures and e-submission has been introduced. The official web-site has also been launched giving all details. Vigilance Division, MOHFW Organization and Functions The Vigilance Division of the Ministry functions under the overall control of the Chief Vigilance Officer (CVO), an officer of the rank of Joint Secretary to Government of India, assisted by a Director, an Under Secretary and a Vigilance Section with supporting staff. The CVO is appointed by the Department with the concurrence of Chief Vigilance Commission. The CVO is responsible for keeping an eye on the integrity and conduct of public servants of the Ministry and also for implementation of anti corruption measures. He deals with all vigilance cases and act as a link between the Ministry and agencies like CBI, CVC, UPSC, DOP&T, etc. The CVOs of the autonomous organizations and VOs in attached/ sub- ordinate offices under the Ministry are appointed in consultation with CVO. The main function of the Division is to implement the preventive and punitive measures to combat the corruption. Preventive measures adopted are Examination of Rules and procedure of the organization to eliminate or minimize scope for corruption, identification of sensitive issues, surprise inspections, surveillance on officers and doubtful integrity, scrutiny of property returns etc. The Division follows rules, regulations and guidelines issued from time to time in respect of vigilance cases of different types and appropriate action is taken in consultation with CVC, UPSC, and DOP&T etc. wherever necessary. 1.10 ACTIVITIES OF THE COMPLAINT COMMITTEE ON SEXUAL HARASSMENT OF WOMEN EMPLOYEES In pursuance of the directions of Honble supreme Court in their judgement in the case of Vishakha and other vs. State of Rajasthan and others, a Complaint Committee has been constituted in the Department of Health & Family Welfare to look into the complaints of sexual harassment of women employees in the Department. The SHC is chaired by Smt. Shalini Prasad, Joint Secretary and has three members Smt. Aparna Sachin Sharma, Smt. Rekha Chauhan and Sh. J. P. Pandey. No new case is received for hearing during the period 2010-11. 1.11 PUBLIC GRIEVANCE CELL Public Grievance Redressal Mechanism is functioning in the Ministry of Health & Family Welfare as well as in the attached offices of the Directorate of Health Services and the other Subordinate offices of CGHS (both in Delhi and other Regions), Central Government Hospitals and PSUs falling under the Ministry for implementation of the various guidelines issued from time to time by the Government of India through the Department of Administrative Reforms & Public Grievances. Shri B. Nayak, Joint Secretary in the Department of Health & Family Welfare has been designated as Nodal Officer for Public Grievances relating to the Department. Shri R. D. Indora,Under Secretary in the Department of Health & Family Welfare is functioning as Public Grievance Officer. Similarly other organizations under the Ministry have also senior level officials functioning as Public Grievances Officers. Annual Report 2010-11 14 No. of Disposal Pendency Grievances received 2259 1006 1253 Pursuant to the instructions of the Govt. for creation of Sevottam Compliant system to redress and monitor public grievances under Results Framework Documents for 2010-11 and implementation of Centralised Public Grievance Redress and Monitoring System (CPGRAMS) in the Ministries/Departments, CPGRAMS has been implemented in the Department, Attached Office, i.e., Directorate General of Health Services,(DteGHS), Central Govt. Health Scheme, and extended to Autonomous Bodies/PSUs. It is being extended to other Subordinate Offices of Dte.GHS It is a web based portal and a citizen can lodge grievance through this system directly with the concerned Departments. A link of CPGRAMS has also been provided on the website of the Ministry, i.e., www.mohfw.nic.in. The number of written Grievance petitions received/ disposed of and pending during 2009 & 2010 are as follows: The position in regard to grievance received through CPGRAMS is as under (as on 24.01.2011): 1.12 INFORMATION & FACILITATION CENTRE To strengthen the Public Redressal Mechanism in the Ministry of Health & Family Welfare, an Information & Facilitation Centre is functioning adjacent to Gate No.5, Nirman Bhawan. The Facilitation Center provides the following information to public: 1. Circulars/ Booklets/ Pamphlets/ Posters/ NGO Guidelines and forms for public use. 2. Information and Guidelines to avail of financial assistance from Rashtriya Arogya Nidhi and Health Ministers Discretionary Grant. 3. Guidelines and instructions regarding issue of NOC to Indian Doctors to pursue higher medical studies abroad. 4. Information and guidelines relating to CGHS and Queries relating to the work of the Ministry. 5. Receiving Petitions/Suggestions on Public Grievances. 6. General queries regarding the work of the Ministry received at the Information and Facilitation Centre on telephone and personally were disposed of to the satisfaction of all concerned. 1.13. NATIONAL URBAN HEALTH MISSION (NUHM) The launch of National Rural Health Mission (NRHM) for providing accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions has changed the health services delivery scenario remarkably in the rural areas of the country, particularly in the high focus/backward States. However, while there is somewhat a uniform public health infrastructure in the rural areas, it is largely non-existent in urban areas except in some large urban centres and metropolitan cities that too mostly focused on reproductive and child health services. Approximately three-quarters of urban healthcare is accounted for by private health facilities and therefore, result in substantial out of pocket expenses. The health indicators for the urban poor are as bad as their rural counterparts and much worse than the urban average. Poor environmental condition in the slums along with high population density makes them vulnerable to various communicable and vector borne diseases. Although, the government has been active in initiating improvements in the living conditions in slums, unsatisfactory living conditions continue to prevail in most of the slums. The poor health outcomes can partially be traced to the inadequate services, like water supply and sanitation, and housing facilities. The unenviable health indicators of the urban poor along with not so effective health care service delivery mechanism clearly articulate the need to address the Year Opening Grievance Grievance Pending Balance petitions petitions received disposed during of during the year the year 2009 102 165 117 150 2010 150 249 225 174 Annual Report 2010-11 15 growing challenges of urban health in a concerted way. Ministry of Health & Family Welfare proposes to launch National Urban Health Mission (NUHM) to address these issues with a focus on the slum dwellers and other disadvantaged sections. The proposed NUHM, presently at consultation stage, aims to improve the health status of the urban population by facilitating equitable access to quality healthcare with active involvement of the Urban Local Bodies (ULBs) in cities with population of one lakh and above and State Capitals. The NUHM would encourage the participation of the community in planning and management of health care services. It would promote community leadership in urban settlements; ensure the participation by creation of community based institutions under the local bodies. It would proactively reach out to urban poor settlements by way of regular outreach sessions and monthly health and nutrition day. It would mandate special attention for reaching out to other vulnerable sections like construction workers, rag pickers, sex workers, brick kiln workers, rickshaw pullers, etc. This could be done through the public healthcare systems or through PPP or other innovative models deemed suitable by the states. Discussions with various stakeholders including the States and Union Territories, Ministry of Urban Development, Ministry of Housing and Urban Poverty Alleviation have been undertaken, to finalise the contours of the Mission and formulation of the framework of its implementation. NHUM would also leverage the reform component of JnNURM for promoting public health component among Urban Local Bodies. With a view to improving convergence and synergy among various stakeholders, NUHM would envisage the active participation of these stakeholders in Mission Steering Group, Coordination Committees at the national, state and municipal levels. NUHM would also utilize the infrastructure and skill- sets of other programmes like JnNURM, SJSRY and ICDS etc. to improve the urban health care service delivery system. 1.14 RURAL HEALTH SERVICES The health and family welfare programme in the country is being implemented through primary health care system. In rural areas, primary health care services are provided through a network of 145894 Sub-centres, 23391 Primary Health Centres and 4510 Community Health Centres as Item Amount Salary of ANM and LHVAs per State Govt. pay scale Rent Rs. 3000 Medicine To be supplied under RCH Programme Contingency Rs. 3200 Voluntary Worker Rs.1200/- as honorarium on March 2009 based on the following norms of population case load/work load and distance. The population norms for SC/PHC/CHC is as follows : Sub-Centre Sub-centre is the first peripheral contact point between Primary Health Care system and the community. It is manned by one Female (ANM) and one Male Health Worker and one LHV for six such Sub-Centres. Sub- centres are assigned task relating to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programmes and provided with basic drugs for minor ailments needed for taking care for essential health need for women and children. The number of sub-centres functioning in the country present as on March, 2009 is annexed. Govt. of India bears the salary of ANM and LHV besides rent liability and contingency whereas, the salary of the Male Health Worker is borne by the State Governments. Expenditure per annum for the existing Sub-centres Under NRHM, Sub-centres are being strengthened by provision of untied funds of Rs.10,000/- per year which is operated by the ANM and the Sarpanch, supply of allopathic and indigenous medicines and provision of an additional worker (male multipurpose worker or additional ANM), Annual maintenance grant of Rs.10,000/- is also made available to every Sub-centre to undertake and supervise improvement and maintenance of the facility. Centre Plain Area Population NormsHilly/ Tribal area Sub-Centre 5000 3000 Primary Health Centre (PHC) 30,000 20,000 Community Health Centre (CHC) 1,20,000 80,000 Annual Report 2010-11 16 Upgradation of existing Sub-centres, including building for Sub-centres functioning in rented premises and setting them up as per 2001 census has also been envisaged under NRHM. Primary Health Centre (PHC) PHC is the first contact point between village community and the Medical Officer. It is manned by a Medical Officer and 14 other staff. It acts as a referral Unit for 6 Sub-Centres and has 4-6 beds for patients. It performs curative, preventive, promotive and Family Welfare services. There are 23391 PHCs functioning in the country. The PHCs are being strengthened under NRHM to provide a package of essential public health programmes and support for outreach services to ensure regular supplies of essential drugs and equipment, round the clock services in all PHCs across the country, upgrading single doctor PHC to 2 doctors PHC by posting AYUSH practitioners at PHC level, provision of 3 Staff Nurses in a phased manner. The States/UTs have to incorporate their proposals and requirement of funds in their Annual Programme Implementation Plans under NRHM. Untied Grant of Rs.25,000/- per PHC for local health action and Annual Maintenance Grant of Rs.50,000/- per PHC through PHC level Panchayat Committee/Rogi Kalyan Samiti to undertake and supervise improvement and maintenance of physical infrastructure have been provided. Community Health Centre (CHC) CHC is established and maintained by the State Governments and as per standards it is supposed to be manned by four Medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, and Labour Room and Laboratory facilities and serves as a referral centre for 4 PHCs. It provides facilities for emergency obstaetrics care and specialist consultations. Indian Public Health standards lays down that this CHC is to be manned by 6 Medical Specialists including Anaesthetics and an eye surgeon (for 5 CHCs) supported by 24 paramedical and other staff with inclusion of two nurse midwives in the present system of seven nurse midwives. At present 4510 CHCs are functioning in the country. For Upgradation of CHCs as per the Indian Pubic Health Standards (IPHS). State/UTs have been requested to carry out the facility survey of all CHCs so as to gauge the exact requirement of funds in terms of upgrdation of the facility as far as manpower, building, equipments etc. Funds are being provided every year as requested by the States in their annual Programme Implementation Plan under NRHM. Strengthening of the Sub-Divisional /Sub-District and District Hospitals Strengthening of sub-divisional /sub-district and district hospitals is an approved activity under NRHM. The funds are released to States/UTs Governments as per their requirement reflected in their annual PIP. The same is examined in this Ministry and funds are released the recommendations of NPCC. Indian Public Health Standards (IPHS) Indian Public Health Standards (IPHS), which detail the specifications of standards to which institutions of primary health care would have to be raised to so that the citizen is confident of getting public health services in the hospital that can be measured to be of acceptable standards. Indian Public Health Standards (IPHS for Sub-centres, PHCs, CHCs, Sub-divisional/Sub-district Hospitals and District Hospitals lay down Standards not only for personnel and physical infrastructure, but also for delivery of services, and management. A system of performance bench marks will be introduced to concurrently assess the adherence of public hospitals to IPHS, in a transparent manner. Each Hospital would, as part of IPHS, be required to set up a Rogi Kalyan Samitti (RKS)/Hospital Management Committee), which will bring in community control into the management of public hospitals. Guidelines for setting up of Rogi Kalyan Samiti have been circulated to all States/UTs. Based on the registration details of RKSs set up by various States/UTs, funds @ Rs. one lakh per PHC, CHC, Sub-divisional/Sub-district Hospitals and @ Rs.5.00 lakhs per District Hospital have been released for RKSs to these States/UTs. The objective is to provide sustainable quality care with accountability and peoples participation alongwith total transparency. Mobile Medical Units/Health Camps With the objective to take health care to the door step of the public in the rural areas, especially in under-served areas, Mobile Medical Units (MMUs), have been provided, one per district under NRHM. The States are however, expected to address the diversity and ensure the adoption of more suitable and sustainable model for Annual Report 2010-11 17 the MMU to suit their local requirements. They are also required to plan for long-term sustainability of the intervention. Two kinds of MMUs are envisaged, one with diagnostic facility for the States other than North-East States, Himachal Pradesh and J&K. In addition, for the North- Eastern States, Himachal Pradesh and J&K, specialized facilities and services such as X-ray, ECG and ultrasound are proposed to be provided in MMUs due to their difficult hilly terrain, non-approachability by public transport, long distances to be covered etc. The States are needed to involve District Health Society/ Rogi Kalyan Samiti/NGOs in deciding the appropriate modality for operationalization of the MMUs. The provision of staff will be considered only for the States who will run the vehicles with support of NGOs/RKSs and in case of States out-sourcing the vehicles. States are needed to work out numbers of mobile dispensaries/ health camps as a means of mobilizing local communities of health action and for creating demand Tackling the problem of lack of manpower in Rural Areas: The Government is seized of the problem of lack of skilled manpower in rural health infrastructure. A number of new and innovative steps have been taken by various State/UT Governments to bridge the gap between the available and required manpower especially for ensuring the availability of Doctors in rural areas. A Task Group constituted under the National Rural Health Mission under the chairmanship of Director General of Health Services has recommended the following measures to ensure the services of doctors in rural areas : Increase in the age of retirement of doctors to 65 years preferably with posting near hometown; Decentralization of recruitment at district level; Walk-in-interview and contractual appointment of doctors; Enhancing the salary for posting in rural areas by one-third; Increasing the admission capacity in medical colleges for Anaesthesia; Reviving the Diploma Course in Anaesthesia; To start one year Certificate Course in Anaesthesia for Medical Officers working in the system at present to be given by National Board of Examination. Recognition of five hundred bedded Hospitals to provide the facility for conducting the above course; Hiring of private practitioners on case-to-case basis. The above recommendation were circulated to All the State /UT Governments. State/UT Governments have taken a number of initiatives to ensure presence of doctors in rural areas such as : Compulsory rural/difficult area posting for admission to post-graduate courses and as a pre-requisite for promotion, foreign assignment or training abroad ; Compulsory rotation of doctors on completion of prescribed tenure as per classification of locations; Contractual appointment of doctors; Option to forgo non practicing allowance and undertake practice without compromising on assigned duties, as per the service rules; offering incentive in form of allowance etc. Manning of PHCs by NGOs/ Non Government Stakeholders; Involvement of Medical colleges. Apart from doctors, steps have been taken to deploy contractual manpower in all other cadres ie. ANM, MPWs, Pharmacists etc. The funds are being released to all States/UTs under NRHM as per their demand reflected in their NRHM PIPs. There has been significant improvement in manpower after engaging contractual staff under NRHM. Annual Report 2010-11 19 Chapter 2 2.1 NATIONAL RURAL HEALTH MISSION (NRHM) The National Rural Health Mission was launched by the Honble Prime Minister on 12 th April 2005, to provide accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions. The detailed Framework for Implementation that facilitated a large range of interventions under NRHM was approved by the Union Cabinet in July 2006. Under the NRHM, the difficult areas with unsatisfactory health indicators were classified as special focus States to ensure greatest attention where needed. The thrust of the Mission is on establishing a fully functional, community owned, decentralized health delivery system with inter sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health like water, sanitation, education, nutrition, social and gender equality. Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities. From narrowly defined schemes, the NRHM is shifting the focus to a functional health system at all levels, from the village to the district. The NRHM is about increasing public expenditure on health care from the current 0.9% of the GDP to 2 to 3% of the GDP. The corollaries of such a policy directive are not only has increased Central Government budgetary outlay for health, but States are also make a matching increase at least 10% of the budget annually including a 15% contribution into the NRHM plan, and that the center state financing ratio shifts from the current 80:20 to at least a 60:40 ratio in this plan period. Another important corollary is that the state health sector develops the capacities to absorb such fund flows. There are currently many constraints, especially in the High Focus states to absorb these funds and the poorest performing states which require the largest infusion of resources have NRHM, Health & NRHM, Health & NRHM, Health & NRHM, Health & NRHM, Health & Population Policies Population Policies Population Policies Population Policies Population Policies some of the greatest problems to spend the funds already with them. This is one of the main reasons why a process of reforming and strengthening the state health systems needs to go hand in hand with the increase of fund flows. The NRHM is thus also about health sector reform. The architectural correction envisaged under NRHM is organized around five pillars, each of which is made up of a number of overlapping core strategies. a) Increasing Participation and Ownership by the Community: This is sought to be achieved through an increased role for PRIs, the ASHA programme, the village health and sanitation committee, increased public participation in hospital development committees, district health societies in the district and village health planning efforts and by a special community monitoring initiative and also through a greater space for NGO participation. b) Improved Management Capacity: The core of this is professionalising management by building up management and public health skills in the existing workforce, supplemented by inculcation of skilled management personnel into the system. c) Flexible Financing: The central strategy of this pillar is the provision of untied funds to every village health and sanitation committee, to the sub-center, to the PHC, to the CHC including district hospital. d) Innovations in human resources development for the health sector: The central challenge of the NRHM is to find definitive answers to the old questions about ensuring adequate recruitment for the public health system and adequate functionality of those recruited. Contractual appointment route to immediately fill gaps as well as ensure local residency, incentives and innovation to find staff to work in hitherto underserved areas and the use of Annual Report 2010-11 20 multi-skilling and multi-tasking options are examples of other innovations that seek to find new solutions to old problems. e) Setting of standards and norms with monitoring: The prescription of the IPHS norms marks one of the most important core strategies of the mission. This has been followed up by a facility survey to identify gaps and funding is directed to close the gaps so identified. The NRHM approach is summed up in the figures below: Many path breaking initiatives operationalised under the NRHM 2.1.1. More than 8.3 lakh Accredited Social Health Activists (ASHAs) are connecting households to health facilities. The presence of community volunteers on this unprecedented scale has resulted in peoples growing pressure on utilization of services from the public sector health system. States across the country are reporting significantly higher utilization of outpatient services, diagnostic facilities, institutional deliveries and inpatient care. Large scale demand side financing under the Janani Suraksha Yojana (JSY) has brought poor households to public sector health facilities on a scale never witnessed before. Over 348.94 lakh women have been covered under JSY so far since its introduction in 2005. 2.1.2. A second ANM in Sub Centres, 3 Nurses in PHCs for 24X7 services along with diagnostic services, co-location of AYUSH doctor at PHC and availability of Specialist Doctors and Nurses on a much larger scale has been attempted under the NRHM to take accountability to the people. States are recruiting Nurses and other Para Medic Staff on contract based on local criteria. Even Doctors and Specialists are recruited at the district level on contract and based on local criteria. Various form of performance based incentives have been attempted to make money follow the patient and to keep the motivation of public health workers in remote areas high. A lot more needs to be done in the sphere for performance based incentives in remote and difficult areas in order to ensure availability of skilled human resources where needed. 2.1.3. Through formation of registered Societies (Rogi Kalyan Samitis) at PHCs, CHCs and District Hospitals, legal entities are created that have far greater flexibility in discharge of their functions. NRHM has provided an opportunity to provide cashless hospitalised services to the poor through the Rogi Kalyan Samiti resources. It has also provided an opportunity to charge a modest fee from those who can afford to pay. The Rogi Kalyan Samitis have adequate resources for local health action and for ensuring a well maintained hospital. Wherever Medical Officers, in-charge of PHCs and CHCs and their RKSs, have taken interest, the face of government hospital has been transformed with the untied funds available to every institution under NRHM. NRHM is an opportunity for States to display to the people that fully functional quality health care is possible within the existing public system. 2.1.4. The untied grants to sub-centres has given a new confidence to our ANMs in the field who are far better equipped now with Blood Pressure measuring equipment, stethoscope, the weighing machine etc. They can actually undertake a proper ante-natal care and other health care services. Sub Centres are now functioning as sub-centres Annual Report 2010-11 21 providing services of which, many of them were absent on account of lack of regular resources. The constitution of the Village Health and Sanitation Committees is taking a little time in many States as the effort is to set up these Committees within the umbrella of Panchayati Raj Institutions. The intention of NRHM is inter-sector convergence and the effort in all the States is to bring Health, Sanitation, Nutrition, Water and Education together on a common platform within the framework of PRIs, at the village level. The untied funds to Village Committees are a great boon for public health action as was demonstrated in Kerala in Alleppey District where large scale vector control measures could be taken up with untied funds. 2.1.5. Human Resources is a key issue in the health sector and, specially, resident health workers in remote areas. Some excellent innovations have been attempted in the States to train local women as ANM. West Bengals efforts in this direction has been path breaking where educated women from the 100 most difficult blocks of West Bengal are being trained to become ANMs on condition that they go back to the village for performing duties. The efforts to provide opportunities for ASHAs and Aanganwadi Workers to become ANMs has also been emphasised as ultimately the quest for better health care must realize that a locally resident person is the best bet to secure a resident health worker. The problems of absenteeism can be tackled through emphasis on the local criteria in such recruitments. 2.1.6. Many un-served areas have been covered through Mobile Medical Units. The efforts in Gujarat in this direction have been commendable. Andhra Pradeshs EMRI system enables people to access well equipped ambulances within no time anywhere in the State. Such successful models are worthy of replication and NRHMs efforts have been to encourage emulation. Sincere efforts to promote good practices have been made by providing opportunities of all State level teams to visit such regions that have done good work. There is a lot to learn from each other and NRHM promotes the bonding of States through regular inter-State visits to see good practices. 2.1.7. While in some regions government health facilities have geared up by utilizing flexible finances under NRHM to cope with the increased workload, in many other regions there is a long way to go before health facilities fully gear themselves to meet the growing need of peoples health care. Poor households have voted with their feet by coming to the public system as never before. The challenge of NRHM now is to provide quality health care to the growing number of households whose faith in the government system has been restored. NRHM cannot afford to let down poor households who have come to the public system with so much hope and aspiration. There is a sense of urgency in improving the facilities for quality health care. 2.1.8. The journey of NRHM has been crafted by the responses of the States. It is for the States to decide on what their priorities are. District and State Programme Implementation Plans form the basis of approvals. Never before has there been so much flexibility in a programme to suit the diverse needs of States and regions. NRHM has set a new standard of partnership with States where it is the States that determine what is needed to resolve the crisis of the public sector health system. Human Resources, physical infrastructure, equipment, capacity building, resources, skill up-gradation resources etc. are available on an unprecedented scale. The philosophy of NRHM is to move from distrust to trust. Within the umbrella of Panchayati Raj Institutions, NRHM has tried to formulate an accountability framework that makes every health facility responsible to the people whose needs it caters to. Starting from the Village Health and Sanitation Committees, NRHM has crafted facility specific public institutions within the framework of PRI to ensure that Health Institutions have the flexibility to deliver in partnership with the community. 2.1.9. From the village to the district level all requirements of the health system can be met through the NRHM and States have come up with innovative plans to suit their needs. Realizing the need for improved management of the Public Sector Health System, NRHM has extended management support to States at all levels and for all institutions. The thrust on Nursing Institutions, Nurses and ANMs has been its foremost message to the States considering the need for public sector facilities to provide round the clock services. 2.1.10. Improved Financial Management: In order to ensure that enhanced fund allocations to States/UTs and other institutions under the NRHM are fully coordinated, managed, and utilized, the Financial Management Group for NRHM (FMG-NRHM) has been set up to operationalize the following financial management arrangements and funds flow processes for release, monitoring and utilization of funds under NRHM as per Annual Report 2010-11 22 recommendations of the Empowered Programme Committee (EPC). Organizational Set up 1. Joint Secretary (Policy) heads the NRHM Division, under him Director, NRHM (Policy) looks after the policy, infrastructure Development, Coordination & Human Resource Development functions. 2. NRHM Finance Division under the Director (NRHM-Finance) is functioning under the direct control of Special Secretary & Mission Director (NRHM) and coordinates the financial management activities of all NRHM Programmes such as RCH-II, NRHM Additionalities, Routine Immunization and the National Disease Control Programmes. 3. NRHM Finance Division is functional since 21.12. 2006 with ministerial staff i.e Director, Under Secretary, Accounts Officer, Section Officer and other financial management staff. The reorganized FMG-NRHM isstaffed also by financial management personnel on contract basis such as Finance Controllers, Finance Analysts, Financial Assistants. All sanction orders for release of funds under all programmes and pools under NRHM are processed through the FMG. Objectives of FMG-NRHM Bring about integration in the financial management of the National Health Programs subsumed under the NRHM. Improve Financial Management Systems at the Centre, State and District levels under the NRHM. Systematize the funds flow, monitoring utilization, accounting and audit of all programmes under NRHM. Functions of FMG-NRHM Release of funds under RCH Flexible Pool and Mission Flexible Pool and clearance of release proposals of all other programmes under NRHM. Centrally transfer funds electronically to State Health Societies for all programmes under NRHM and maintain a centralized data base for all releases and utilization under all components of NRHM viz. (a) RCH, (b) Additionalities under NRHM, (c) Routine Immunization and (d) National Disease Control Programs. Monitoring and compilation of Financial Monitoring Reports (FMRs) on quarterly basis. Claim refund of eligible expenditure from Development Partners like World Bank, UNFPA, DFID etc. Statutory Audit arrangements and submission of Audit Reports to Development Partners. Provide Financial Management Formats, monitor financial performance indicators and update state- wise profiles. Capacity building of finance and accounts personnel of States/UTs. Obtaining UCs for various programs under NRHM. Generating MIS reports on the basis of FMRs received. System for Funds Release Obtaining approval of National Programme Coordination Committee (NPCC) and communicating approved amounts to States/UTs. Release of funds is made on the basis of BEs/REs approved by the Ministry of Finance, communicated separately to States. As per GFRs, up to 75% of the approved BEs are released to States on receipt of provisional UCs/ FMRs for the previous year. Balance 25% is released after receipt of satisfactory audited accounts with final UCs. Concurrence of IF is obtained in all cases. Training/capacity building of Finance & Accounts Personnel FMG-NRHM periodically conducts the training of Finance and Accounts personnel of State/District Health Societies. State-wise workshops with State Finance and Accounts Managers were organized in August, 2010 to discuss various issues to prepare and update the state-wise profiles on financial management. NRHM Finance Division is actively engaged in preparing E-training Modules, Hand Books for Annual Report 2010-11 23 State, District and Block level finance personnel under NRHM. While e-transfers through the accredited bank of the Ministry are taking place to all States, e-banking has been introduced on a pilot basis in Karnataka Stae which uses the Core Banking System (CBS) for generation of MIS report to provide information on funds movement, utilization and unspent balances to the management. The Ministry is awaiting the results of the pilot initiated in Karnataka to further implement e-banking in other States/UTs. Detailed Operational Guidelines on Financial Management are also being prepared for adoption and implementation at State, District and Block and Village levels under the NRHM to being about efficiency, accuracy and accountability in financial processes. 2.1.11. Under NRHM, electronic Transfer of Funds (ETF) has been started from GoI to States and also States to Districts. This has reduced the time lag in transfer of funds from 1-2 months to a few hours. E-banking is being operationalized for real time financial reporting and monitoring. Financial Monitoring Reports are now being received from all States. Detailed guidelines for Delegation of Administrative & Financial Powers under NRHM have been given to States. State Finance and Accounts Managers and accounts personnel have been recruited at State, district and block levels under NRHM. A system for Concurrent Audit has been set up in the SHSs and DHSs. The National Rural Health Mission represents a major departure from the past, in that central government health financing is now directed to the development of state health systems rather than being confined to a select number of national health programmes. NRHM is therefore, an effort at building a partnership with States to ensure meaningful reforms with more resources. Ultimately, success of NRHM will depend on ability of the Mission interventions to galvanize State Governments into action, pursuing innovations and flexibility in all spheres of public health action. The progress on several key indicators on NRHM has been noticed. 2.1.12. Progress under National Rural Health Mission (NRHM) ASHAs Selection of 8,33243 ASHAs have been done in the entire country, out of which 7,82807 up to 1 st Module and 6,75693 up to 2nd Module 6,59037up to 3 rd Module, 641421 up to 4 th Module and 3,19429 up to 5 th Module. 5.70 lakhs ASHAs have been provided with drug kit as well. Infrastructure 1.46 lakhs Sub-centres in the country are provided with untied funds of Rs. 10,000 each. 4,82219 Sub- centres & VHSC have operational joint accounts of ANMs and Pradhans for utilization of annual untied funds. 50,728 Sub-centres are functional with second ANM. Out of 4510 Community Health Centres(CHCs), 2921 CHCs have been selected for upgradation to IPHS and facility survey has been completed in 2864 CHCs (includes other also). 29904 Rogi Kalyan Samitis have been registered at different level of facilities. Manpower 9856 Doctors and Specialist, 53552 ANMs, 26734 Staff Nurses,18272 Paramedics have been appointed on contract by States to fill in critical gaps. Management Support 1784 professionals (CA/MBA/MCA) have been appointed in the State and 635 District level Program Management Units (PMU) and 3529 Block level Program Management Units (BPMU) have been established to support NRHM. Mobile Medical Units In 381 districts, the Mobile Medical Units has been operationalised till September,2010. Immunization Intense monitoring of Polio Progress Services of ASHA useful. JE vaccination completed in 11 districts in 4 states 93 lakh children immunized during 2006-07. JE vaccination has been implemented in 26 districts of 10 states in 2007. The 11 districts of 4 states where JE vaccination was carried out in 2006 have introduced JE vaccine in Routine Immunization to vaccinate new cohort between 1-2 years of age with booster dose of DPT. Annual Report 2010-11 24 House tracking of polio cases and intense monitoring. Neonatal Tetanus declared eliminated from 7 states in the country. Full immunization coverage evaluated at 43.5% at the national level.(NFHS-III) Accelerated Immunization Programme taken up for EAG and NE State. Institutional Delivery Janani Suraksha Yojana (JSY) is operationalised in all the States, 7.38 lakh women are benefited in the year 2005-06, 31.58 lakh in 2006-07, 73.28 lakh in 2007-08, 90.36 lakh in 2008-2009, 100.78 in the year 2009-2010. Neo Natal Care Integrated Management of Neonatal and Childhood Illnesses (IMNCI) started in 323 districts and 3,13,783 health personnel trained in IMNCI. Convergence Over 35 lakhs in 2006-07, 49 lakhs in 2007-08, 58 lakhs in 2008-2009, 58 lakhs in year 2009-2010, and 34 lakhs in 2010-11 so far. Monthly Health and Nutrition Days being organized at the village in various States. The States have constituted 4,98378 Village Health and Sanitation Committees. They are being involved in dealing with disease outbreak. Convergence with ICDS/Drinking Water/ Sanitation/NACO/PRIs ground work completed. School health programmes have been initiated in over 26 States. Health Action Plans State PIPs have been received from 35 States/UTs during the Plans have been apprised and funds are being released for the year 2010-11. The first cut of Integrated District Health Action Plans (IDHAP) has been finalized for 642 districts. Mainstreaming of AYUSH Mainstreaming of AYUSH has been taken up in the State.14766 AYUSH facilities are available at District and below district level health institutions. AYUSH person are part of State Health Mission / Society / RKS / ASHA training as members. Trainings Trainings in critical areas including Anesthesia, Skilled Birth Attendance (SBA) taken up for MOs/ ANMs. Integrated Skill Development Training for ANMs/ LMV/MOs, Training on Emergency Obstetrics care and No Scalpel Vasectomy (NSV) for MOs, Professional Development Programme for CMOs is on full swing. ANM Schools being upgraded in all States. New nursing schools taken up. Health Resource Centres National Health Systems Resource Centre (NHSRC) set up at the National level. Regional Resource Centre set up for NE. State Resource Centre being set up by States. Monitoring and Evaluation Independent evaluation of ASHAs / JSY by UNFPA / UNICEF / GTZ in 8 States. Immunization coverage evaluated by UNICEF. Independent monitoring by identified institutions like Institute of Public Auditors of India. Phase I of community monitoring in 9 states namely Rajasthan, Orissa, Maharashtra, Madhya Pradesh, Tamil Nadu, Chhattisgarh, Jharkhand, Karnataka and Assam has been completed. Concurrent evaluation by several independent agencies is in progress. District wise Annual Health Survey for high focus states are in pipeline. Cabinet approved. Surveys NFHS III and DLHS III completed. Financial Management:- Financial Management Group set up under NRHM in the Ministry. During the FY 2005-06, out of total allocation of Annual Report 2010-11 25 Rs. 6,731.16 crore for the ministry, an amount of Rs. 5,862.57 crore was released as part of NRHM. Against Rs. 9065 crore for NRHM activities during 2006-07, Rs. 7,361.08 crore released. During the FY 2007-08, out of total allocation of Rs. 11,010 crore for the ministry, an amount of Rs. 10,189.03 crore was released as part of NRHM. During the FY 2008-09, out of total allocation of Rs. 12,050 crore for the ministry, an amount of Rs. 11,229.47 crore was released as part of NRHM. During the FY 2009-10, out of total allocation of Rs. 14,050 crore for the ministry, an amount of Rs. 11631.39 crore was released as part of NRHM. For the FY 2010-11, the total allocation for NRHM is Rs. 15,440 crore for the ministry, an amount of Rs. 4300.13 crore is released so far. 2.1.13. Interventions under NRHM to Address the Issues Relating to Left Wing Extremism From the directions of the Union Home Minister, 33 High Focus District have been identified by the Planning Commission in order to address the critical gaps in these districts in respect of the certain key parameters of the concerned Ministries through Integrated Action Plan (IAP) with the support of the respective State Governments, District Administration, Elected Representative and the respective State Holders. An Interministrial Committee has been set up for providing necessary recommendations and suggests possible interventions for the purpose of addressing the focused need of the affected blocks. The necessary steps have been initiated in the Ministry of Health and Family Welfare to fill up the corresponding critical gaps in health infrastructure, human resources, training, immunization, supply of drugs and equipments etc. The necessary preventive steps have been formulated to incentivize the difficult areas. The following are some of the Measure taken under NRHM: A Cadre of supportive and caring ASHAs created to stem alienation. Bridging infrastructure and human resource gaps. Appointment of Resident Health workers through local criteria. Organizing of outreach camps. Incentivizing health workers and pooling of resources. Cluster based development through Community Health Workers. Creation of separate cadre of Rural Medical Assistance to serve in the conflict prone areas, like Chhattisgarh. Providing reservation of seats in Post Graduation for Medical Studies as an incentive for serving in rural areas. Performance based incentives for difficult areas, hard areas, allowances etc. for encouraging doctors and specialists to serve in these areas. Short term courses for Medical Officers posted in CHCs for comprehensive obstretrics care, anesthesis for emergency obstetrics and neo-natal care. Providing health care service to inaccessible areas through Mobile Medical Units. To increase awareness among women and local communities about their health rights and their public service entitlements. 2.1.14. Supportive Supervision of High Focus Districts In order to provide emphasis on evidence based planning, using data triangulation methods in order to include some non-negotiable elements and targeted health outcomes, an attempt has been made to undertake Supportive Supervision in 264 pre-identified backward districts for high focus planning, based on the following criteria:- 140 backward districts based on ranking of 13 indicators from the DLHS III data prepared by the Statistics Division of the Ministry. The indicators inter alia include female literacy, households with low standard of living, percentage of girls married below 18 years, use of contraceptives, institutional births, full Immunization, proximity to health facilities, road connectivity etc, among others. Those districts with SC/ST population above 35%. It is desirable that a certain percentage of allocation is earmarked in the District Plans for these pockets in the non SC/ST majority districts to minimize Annual Report 2010-11 26 disparities. Some of the North Eastern States have been excluded in this criterion, as they already have a high percentage of tribal population and this earmarking may not be essential. 33 highly left wing affected districts as prepared by the Ministry of Home Affairs. The Supportive Supervision intervention consistently engages in refinement of the tools and techniques used for reporting. It also serves as a channel for horizontal communication of ideas and innovations to the state through sharing of experiences between consultants. For the purpose, the Ministry of Health & Family Welfare has developed an action oriented monitoring plan in which joint teams have been formed to visit the high focus districts, in which the Consultants are visiting the states in the identified districts and providing assistance to them for improving the measurable health indicators with the objective to bring desired improvements in health indicators. The visits of consultants to the health facilities, viz. Sub-centers, PHCs/CHCs and DH are relating to monitoring of the progress, status and functioning of health facilities in terms of infrastructure, human resources, training etc. together with the quality of health care service delivery by interaction with ASHAs, PRIs, Civil Society Group etc. Consultants interact at various levels such as village, block, district, state and the center. Real time feedback is given to the facility in charge. A detailed report so prepared is shared with district and state authorities and submitted at respective Programme Directors level for necessary action. 2.1.15. Meeting of International Advisory panel on NRHM A meeting of the International Advisory Panel on NRHM under the chairmanship of the Honble Minister for Health & Family Welfare held was on 7 th August, 2009. In this meeting several important issues relating to rural health were discussed in detail. The last meeting of the Forum held on 4 th February, 2010 had recommended certain issues for implementation. Among the various recommendations of IAP meeting held on 7.9.2009 one recommendation was regarding possibilities to explore the partnership with IAP in developing model districts across the country, and adopt the same practices in respect of districts of other States. 2.1.16. Meeting of Inter-Sectoral convergence under NRHM with the other departments of the Government of India. A meeting of the Inter-Sectoral convergence under NRHM was held on 7 th September, 2010 with the departments of HRD, Rural Development, Human and Child Development, Panchayati Raj and the Department of AYUSH. Among the various recommendations of the meetings, one of the recommendations was for better implementations of School Health Programme and Joint Review of the Programme by the two Ministers. The other important recommendations include, preparation of Health Education Module for National Literacy Mission; preparation of Integrated Training Module with inputs from the Ministers of Health (including NACO & AYUSH), Education, Women and Child Development (WCD), Water and Sanitation; preparation of common IEC booklets with inputs from (including NACO & AYUSH) and preparation of training module for Emergency Medicine for AYUSH doctors at public health facilities; Joint Review of the programmes of Health and the Ministry of Education. 2.2. HEALTH POLICY The National Health Policy-2002 (NHP-2002) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. The policy outlines the need for improvement in the health status of the people as one of the major thrust areas in the social sector. It focuses on the need for enhanced funding and organizational restructuring of the public health initiatives at national level in order to facilitate more equitable access to the health facilities. An acceptable standard of good health amongst the general population of the country is sought to be achieved by increasing access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions. Emphasis has been given to increase the aggregate public health investment through a substantially increased contribution by the Central Government. Priority would be given to preventive and curative initiatives at the primary health level through increased sectoral share of allocation. 2.3. NATIONAL COMMISSION ON POPULATION In pursuance of the objectives of the National Population Policy 2000, the National Commission on Population was Annual Report 2010-11 27 constituted in May 2000 to review, monitor and give directions for the implementation of the National Population Policy (NPP), 2000 with a view to meeting the goals set out in the Policy, to promote inter-sectoral co-ordination, involve the civil society in planning and implementation, facilitate initiatives to improve performance in the demographically weaker States in the country and to explore the possibilities of international cooperation in support of the goals set out in the National Population Policy. The first meeting of the Commission was held on 22.07.2000 and the then Prime Minister had announced the formation of an Empowered Action Group within the Ministry of Health and Family Welfare for paying focused attention to States with deficient national socio- demographic indices and establishment of National Population Stabilization Fund [Jansankhya Sthirata Kosh] to provide a window for canalizing monies from national voluntary sources to specifically aid projects designed to contribute to population stabilization. The National Commission of Population has since been reconstituted in April 2005 with 40 members under the Chairmanship of the Prime Minster. Minister of Health & FW and the Deputy Chairman of the Planning Commission are Vice Chairmen of the Commission. The present membership also includes the Chief Ministers of the States of Uttar Pradesh, Madhya Pradesh, Rajasthan, Bihar, Jharkhand, Kerala and Tamil Nadu. The reconstituted National Commission on Population had decided on the following. There should be Annual Health Survey of all districts which could be published annually so that health indicators at district level are periodically published, monitored and compared against benchmarks. Setting up of five groups of experts for studying the population profile of the States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Orissa to identify weaknesses in the health delivery systems and to suggest measures that would be taken to improve the health and demographic status of the States. Annual Health Survey: The Ministry is in the process of conducting an Annual Health Survey (AHS) to prepare the District Health Profile of all Districts in pursuance to the decisions of the National Commission on Population. The Registrar General of India (RGI) has been designated as the Nodal agency. The Mission Steering Group (MSG) of NRHM, in its third meeting had approved the proposal for AHS in 284 EAG districts including Assam. The Survey is being conducted by RGI at an estimated annual cost of Rs.110 crores. The current status of the Survey is that the field units have been identified, the sample units selected and the survey schedules/questionnaire finalized in consultation with various stake holders. The survey would be spread over 20252 sampling units in the 9 States and shall cover about 36 lakh households. It is expected that the first set of results would be available in early 2011. Expert Groups: Five groups of experts were constituted for studying the population profile of the States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Orissa. The draft reports of the expert groups was examined in the Commission for correctness of the demographic data and then sent to the concerned five States for the following: - o Commenting on the report of the expert group. o Provide an update on what they are doing for stabilization of population under NRHM. o Prepare a presentation on their work on Population Stabilization for the next meeting of the NCP. The Commission has been providing policy support to the population stabilization efforts under overall framework of implementation of NRHM by the states. The Commission has come out with a number of publications in collaboration with Registrar General of India and Institute of Economic Growth, which provides valuable inputs on future demographic trends, challenges and suggestive measures for achieving population stabilization as envisaged in NPP 2000 and NRHM goals. The second meeting of the Commission was held on 21 st October 2010 under the Chairmanship of Prime Minister. The Commission deliberated upon population stabilization issue amongst other issues and after deliberation, the Commission adopted the following resolution with broad consensus recommending the key points for the stakeholders as follows: According Priority o Population Stabilization should be accorded high priority. Annual Report 2010-11 28 o Chief Ministers should provide leadership to the promotion of small family norm. o Social experts, social scientists and communication experts should be involved. o A safe motherhood campaign should be carried out on the lines of pulse polio programme, with focus on population issues. Programmatic Interventions o IEC Campaign should be revitalized vigorously. o Undertake strategy to meet the unmet need for family planning services. o Strengthen Public Health services and facilities like clean toilets, water, electricity, etc. o Strengthen Post Partum family planning services at all centres where deliveries takes place. o Focus to be on Delay of age at marriage, delay in birth of first child and promotion of birth spacing between children. o Availability of medicines at all Public Health Facilities. o Involve AYUSH Doctors in family planning programmes. Inter-Sectoral Co-ordination o Ministries of HRD, WCD and Panchayati Raj should be actively involved in population stabilization programme. o Utmost attention to be given for education, particularly of girls. o Education regarding family life including reproductive and sexual health issues at a younger age be given to adolescents to further empowerment of women. o Interventions to improve nutritional status, particularly pregnant mothers to be strengthened. o Institutions and Hospitals run by institutions like ESI, Railways and Defence Services should be involved in family planning services. Other Interventions o Raising of legal age at marriage of girls to be considered. o Gender to be included in medical education. o NGOs working among members of Muslim Community may be actively involved in enhancing awareness regarding small family norms. o Emphasis on research to develop more innovative contraceptives to expand available contraceptive choices. o Availability of funds for heath sector, as well as for family planning should be increased. 2.4. JANSANKHYA STHIRATA KOSH The National Population Stabilisation Fund was constituted under the National Commission on Population in July 2000. Subsequently it was transferred to the Department of Health and Family Welfare in April 2002. It was renamed and reconstituted as Jansankhya Sthirata Kosh (JSK) under the Societies Registration Act (1860) in June 2003. The General Body of JSK is chaired by the Minister for Health and Family Welfare, while the Governing Board is chaired by Secretary (H & FW). The Executive Director is the Chief Executive Officer of the Kosh. JSK has undertaken a number of initiatives for population stabilization which in brief are as follows: GIS Mapping: JSK has taken up the mapping of 485 districts and its sub divisions in the country through a unique amalgamation of GIS maps and Census data. The maps identify the basic health infrastructure available and accessibility in terms of availability of roads. The density of population in each district has now been added as another layer, to provide an in - depth view of the health services availability in relation to the density of population in the area. Call Centre: JSK runs a Call Centre (1800-11-6555) to provide reliable and authentic information on issues related to reproductive and child health. It specifically cater to adolescents, newly married and about to be married persons from the High Focus states of UP, Bihar, MP, Rajasthan, Jharkhand and Chhattisgarh. Till 31 st October 2010, the Call Centres have received approximately 2,00,000 calls and more than 3,00,000 enquiries. The maximum numbers of queries being received are on issues related to contraception, pregnancy, sexual health and infertility. Strict quality checks are in place to ensure high quality service. Extensive publicity has been taken up to promote the Call Centre number. Annual Report 2010-11 29 Prerna Strategy: This strategy identifies and recognizes young married couples from backward districts who have adopted Responsible Parenthood Criteria as role models for other young couples in the district. JSK has instituted Prerna Awards for couples who fulfil basic criteria, which are girls marrying at the age of 19; having first child two years after marriage; and keeping a gap of 3 years between first and second child followed by sterilisation of either parent. The couples are awarded with a certificate and Kisan Vikas Patras at a widely publicized and well attended function in the district. JSK has worked in tandem with Union Ministries/ Departments, district administration, civil society, the community, and corporate houses and has identified 378 couples till 31 st October 2010 to award them with the Prerna Award. Santushti: The Santushti strategy provides private sector gynaecologists and vasectomy surgeons an opportunity to conduct sterilisation operations in Public Private Partnership (PPP) mode under the scheme already announced by Ministry of Health and Family Welfare in September 2007. It offers accredited health facilities a start up advance for 100 sterilization surgeries and an additional Rs 500 per case to accredited nursing homes for conducting 30 sterilization cases in camp mode in a single day. Under this Scheme, 3331 sterilizations have been performed during the period April 2010 to October 2010. IUCD 380A: JSK has taken up the promotion of the IUCD 380 A as a contraceptive device offering long term highly effective, reversible protection against pregnancy. Till dated about 400 senior Obstetricians and Gynaecologists have been trained on NTT for IUCD 380A insertion in different training sessions organized by JSK. Presently JSK is pursuing training of more doctors, ANMs in target States to increase utilization rates of this device. Celebration of World Population Day 2010: MoHFW, JSK and Govt. of NCT, Delhi jointly organized a run for population stabilization on Raj Path, New Delhi on the Population Day in which 3000 adolescents from schools of Delhi participated. The event was flagged up by the Union Minister for Health & Family Welfare, Shri Ghulam Nabi Azad and Chief Minister of Delhi, Smt. Shiela Dikshit in presence of Union Minister of State for Health & Family Welfare and important dignitaries of Govt. of NCT, Delhi. The event was marked with participation of Kumari Saina Nehwal, the World acclaimed Badminton star in the run. Emphasizing the need of population stabilization Shri Azad reiterated Governments commitment to promote population stabilization by making people aware about the benefit of small families and on the need to educate girls. He ruled out coercion completely in the efforts for population stabilization. Speaking on the occasion, Smt Sheila Dikshit stressed the need for empowerment of girls and women to control population growth. The event was widely covered in both print and electronic media. JSK collaborated with NDTV to highlight Population Stabilisation efforts of Union Government before a large audience through some of its popular shows preceded with week long promos and factoids on the issues. Activities in states having high population growth: In partnership with Kendriya Vidyalaya Sangathan and DPS society, JSK organized debate, painting and photography competition on Population Stabilisation themes in schools managed by KVS and DPS Societies in states of UP, Bihar, MP, Rajasthan, Jharkhand, Orissa, Delhi and Chhattisgarh in which approximately 3.5 lakh children participated. A national level quiz and debate competition was organized in Delhi on Population Stabilization for schools from the 6 states. Shri Dinesh Trivedi, the Minister of State for Health and Family Welfare gave away the prizes to the winning teams and participants. In Bihar, competitions were organized in all higher secondary schools in partnership with the State Education Department thereby reaching out to almost 25 lakh students. At university/ higher level institutions, JSK organized various competitive events on Population Stabilisation in medical colleges of Bihar and Kalinga Institute of Medical Sciences (KIMS) Orissa. Annual Report 2010-11 30 Mid-Media Campaign JSK in participation with the Song & Drama Division of GOI organized 2000 shows in selected high fertility districts on issues of Population Stabilisation. Advertisement panels highlighting population issues were printed and distributed in high fertility states for its display in schools to make the adolescent aware about the impending need of population stabilization. 2.5. FAMILY PLANNING INSURANCE SCHEME 2.5.1. India is the first country that launched a National Family Planning Programme in 1952, emphasizing fertility regulation for reducing birth rates to the extent necessary to stabilize the population at a level consistent with the socio-economic development and environment protection. Since then the demographic and health profiles of India have steadily improved. 2.5.2. Government of India Scheme to Compensate Acceptors of Sterilization for Loss of Wages: With a view to encourage people to adopt permanent method of Family Planning, Government has been implementing a Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages for the day on which he/she attended the medical facility for undergoing sterilization. Apart from providing for cash compensation to the acceptor of sterilization for loss of wages, transportation, diet, drugs, dressing etc. out of the funds released to States/UTs under this scheme, some States/UTs were apportioning some amount for creating a miscellaneous purpose fund. This fund was utilized for payment of ex- gratia to the acceptor of sterilization or his/her nominee in the unlikely event of his/her death or incapacitation or for treatment of post operative complications attributable to the procedure of sterilization, as under:- i) Rs. 50,000/- per case of death. ii) Rs. 30,000/- per case of incapacitation. iii) Rs.20,000/- per case of cost of treatment of serious post operation complication. Any liability in excess of the above limit was to be borne by the State/UT/NGO/ Voluntary Organization concerned from their own resources. The Honble Supreme Court of India in its Order dated 1.3.2005 in Civil Writ Petition No. 209/2003 (Ramakant Rai V/s Union of India) has, inter alia, directed the Union of India and States/UTs for ensuring enforcement of Union Governments Guidelines for conducting sterilization procedures and norms for bringing out uniformity with regard of sterilization procedures by - I. Creation of panel of Doctors/health facilities for conducting sterilization procedures and laying down of criteria for empanelment of doctors for conducting sterilization procedures. II. Laying down of checklist to be followed by every doctor before carrying out sterilization procedure. III. Laying down of uniform proforma for obtaining of consent of person undergoing sterilization. IV. Setting up of Quality Assurance Committee for ensuring enforcement of pre and postoperative guidelines regarding sterilization procedures. V. Bringing into effect an Insurance Policy uniformly in all States for acceptors of sterilizations etc. The above directions have all been taken into consideration and consolidated in the updated manuals on Standards and Quality Assurance in Sterilization Services available on the Ministrys website (www.mohfw.nic.in). The Family Planning Insurance Scheme is one of the initiatives launched under direction from the Honble Supreme Court w.e.f 29 th November, 2005. Under the existing Government Scheme no compensation was payable for failure of sterilization, and no indemnity cover was provided to Doctors/Health Facilities providing professional services for conducting sterilization procedures etc. There was a great demand in the States for indemnity insurance cover to Doctors/Health Facilities, since many Govt Doctors are currently facing litigation due to claims of clients for compensation due to failure of sterilization. This has led to reluctance among the Doctors/Health Facilities to conduct sterilization operations. 2.5.3. First Year of Scheme : With a view to do away with the complicated process of payment of ex-gratia to the acceptors of Sterilisation for treatment of post operative Complications, or Death attributable to the procedure of sterilization, the Family Planning Insurance Scheme (FPIS) was introduced w.e.f 29 th Annual Report 2010-11 31 November, 2005 with Oriental Insurance Company, to take care of the cases of Failure of Sterilization, Medical Complications or Death resulting from Sterilization, and also provide Indemnity Cover to the Doctor / Health Facility performing Sterilization procedure, as follows:- Section I: a) Death due to Sterilization in hospital: Rs.1,00,000/- b) Death due to Sterilization within 30 days of discharge from hospital Rs.30,000/- c) Failure of sterilization (including first instance of conception after sterilization). Rs.20,000/- d) Expenses for treatment of medical complications due to sterilization operation (within 60 days of operations Rs.20, 000/-* Total liability of the Insurance Company shall not exceed Rs. 9 crore in a year under each Section. (*To be reimbursed on the basis of actual expenditure incurred, not exceeding Rs.20, 000.) Section II: All the doctors/health facilities including doctors/health facilities of Central, State, Local-Self Governments, other public sectors and all the accredited doctors/health facilities of non-government and private sectors rendering Family Planning Services conducting such operations shall stand indemnified against the claims arising out of failure of sterilization, death or medical complication resulting therefrom upto a maximum amount of Rs. 2 lakh per doctor/health facility per case, maximum upto 4 cases per year. The cover would also include the legal costs and actual modality of defending the prosecuted doctor/health facility in Court, which would be borne by the Insurance Company within certain limits. 2.5.4. Second Year of Scheme : This scheme was renewed with Oriental Insurance Company w.e.f. 29-11-06 with modification in the limits and payment procedure. 2.5.5. Third Year of Scheme : This scheme was renewed with ICICI Lombard Insurance Company and improved w.e.f. 01-01-08 with modification in the limits and payment procedure based on 50 lakh sterilization accepters. The revised packages are as follows: Section Coverage Limits I A Death due to Sterilization in hospital or within 7 days from the date of discharge from the hospital. Rs. 2 lakh. B Death due to Sterilization within 8 -30 days from the date of discharge from the hospital. Rs. 50,000 C Failure of Sterilization Rs 30,000 D Cost of treatment upto 60 Actual not days arising out of Complication exceeding from the date of discharge. Rs 25,000/-. II Indemnity Insurance per Upto Rs.2 Doctor/facility but not more Lakh per than 4 cases in a year. claim Total liability of the insurance Company shall not exceed Rs. 9 crore in a year under each Section. The revised package and guidelines are as follows: Section Coverage Limits I IA Death due to Sterilization in hospital or within 7 days from the date of discharge from the hospital. Rs. 2 lakh. IB Death due to Sterilization within 8 - 30 days from the date of discharge from the hospital. Rs. 50,000/-. IC Failure of Sterilisation Rs 25,000/-. ID Cost of treatment upto 60 Actual not days arising out of Complication exceeding from the date of discharge. Rs 25,000/-. II Indemnity Insurance per Upto Doctor/facility but not more Rs. 2 Lakh than 4 cases in a year. per claim Total liability of the Insurance Company shall not exceed Rs. 9 crore in a year under each Section. Annual Report 2010-11 32 For the policy period of 1/1/2008 to 31/12/2008 an amount of Rs. 31741700 was paid as premium. 3786 claims, amounting to Rs. 13.63 crore was paid. Out of which Rs. 9.00 crore was paid by ICICI and Rs. 4.63 crore was paid by the Ministry for claims in excess of Insures liability of Rs. 9.00 crore upto Nov, 2010. 2.5.6. Fourth Year of Scheme : This scheme was renewed with ICICI Lombard Insurance Company based on 45 lakh sterilization accepters w.e.f. 01-01-09 with modification in procedure as follows: For the policy period of 1/1/2009 to 31/12/2009 an amount of Rs. 49297951 was paid as premium. 3821 claims, amounting to Rs. 14.40 crore was paid. Out of which Rs. 9.00 crore was paid by ICICI and Rs. 5.40 crore was paid by the Ministry for claims in excess of Insures liability of Rs. 9.00 crore upto Nov, 2010. 2.5.7. Fifth Year of Scheme : This scheme was renewed with ICICI Lombard Insurance Company w.e.f. 01-01-10 with all benefits available as mentioned under Policy-2009 above based on 50 lakh sterilization accepters; however, total Liability of the Insurance Company was amended and shall not exceed Rs. 14.00 crore in total inclusive of both under Section-I & II instead of Rs. 9.00 crore under each Section. Section Coverage Limits I A Death following Sterilization in hospital or within 7 days from the date of discharge from the hospital. Rs. 2 lakh B Death following Sterilization within 8-30 days from the date of discharge from the hospital. Rs. 50,000 C Failure of Sterilization Rs. 30,000 D Cost of treatment upto Actual not 60 days arising out of exceeding complication from the Rs 25,000/- date of discharge. II Indemnity Insurance per Upto Rs. 2 Doctor/facility but not more Lakh than 4 cases in a year. per claim Total liability of the insurance Company shall not exceed Rs. 9 crore in a year under each Section. For the policy period of 1/1/2010 to 31/12/2010 an amount of Rs. 143390000 was paid as premium. 3132 claims, amounting to Rs.10.73 crore was paid by the ICICI upto Nov, 2010. 2.5.8. Sixth Year of Scheme : This Scheme is renewed with ICICI Lombard Insurance Company w.e.f. 01.01.2011 based on 50 lakh sterilization accepters; however, total Liability of the Insurance Company is amended and shall not exceed Rs. 25.00 crore under Section-I Rs. 1.00 crore under Section-II. A Premium amounting Rs. 25,90,05,000 including service tax is paid on 31/12/2010. The benefit under the policy is as follows: 2.6. COMPENSATION FOR ACCEPTORS OF STERILIZATION With a view to encourage people to adopt permanent method of Family Planning, Government has been implementing a Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages for the day on which he/she attended the medical facility for undergoing sterilization. Section Coverage Limits I A Death following Sterilization in hospital (inclusive of death during process of sterilization operation) or within 7 days from the date of discharge from the hospital. Rs. 2 lakh B Death following Sterilization within 8-30 days from the date of discharge from the hospital Rs. 50,000 C Failure of Sterilization Rs. 30,000 D Cost of treatment upto 60 days Actual not arising out of complication exceeding following sterilization operation Rs. 25,000 (inclusive of complication during process of sterilization operation) from the date of discharge. II Indemnity Insurance per Up-to Rs. 2 Doctor/facility but not more lakh per claim than 4 cases in a year. Note: The Liability of the insurance Company shall not exceed Rs. 25.00 crore in a year under Section I and Rs. 1.00 crore under Section II. Annual Report 2010-11 33 Under the Scheme, compensation for loss of wages to acceptors of sterilization was revised with effect from 31.1-.2006 and has been further improved with effect from 7.9.07 .Revision in the compensation package to boost to male participation in family planning i.e. Vasectomy from existing Rs.800/- to Rs.1500/- and Tubectomy from Rs.800/- to Rs.1000/- in public facilities and to Rs.1500/- for both Vasectomy and Tubectomy in accredited private health facilities to all categories in High Focus States and BPL/ SC/ST in Non- High Focus States with categorization of population as BPL, SC/ST and Above Poverty Line (APL) and health facilities at public/ accredited private institutions has been approved. The details of the revised scheme are as under:- A. Public (Government) Facilities: B. Accredited Private/NGO Facilities: Category Type of operation Facility Motivator Total *High focus 18 States Vasectomy(ALL) 1300 200 1500 Tubectomy(ALL) 1350 150 1500 **Non High focus Vasectomy (ALL) 1300 200 1500 17 States/UTs. Tubectomy (BPL + SC/ST) 1350 150 1500 Category Breakage of Acceptor Motivator Drugs and Surgeon Anaesthetist Staff OT / Refresh- Camp- Total the dressings charges nurse technician ment manage Compensation helper ment package *High Vasectomy 1100 200 50 100 - 15 15 10 10 1500 focus (ALL) 18 States Tubectomy (ALL) 600 150 100 75 25 15 15 10 10 1000 **Non Vasectomy 1100 200 50 100 - 15 15 10 10 1500 High focus (ALL) 17 States/UTs Tubectomy (BPL + SC/ST only)) 600 150 100 75 25 15 15 10 10 1000 **Non Tubectomy 250 150 100 75 25 15 15 10 10 650 High (NON BPL + focus NON SC/ST 17 States/ only) i.e. APL UTs. Annual Report 2010-11 34 *High Focus States- Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand, Chattisgarh, Uttrakhand, Orissa, Jammu & Kashmir, Himachal Pradesh, Assam, Arunachal Pradesh, Manipur, Mizoram, Meghalaya, Nagaland, Tripura, Sikkim. **Non-High Focus States- Karnataka, Kerala,Tamil Nadu, Andhra Pradesh, Maharashtra, Goa, Gujarat, Punjab, Haryana, West Bengal, Delhi, Chandigarh, Puducherry, Andaman & Nicobar Islands, Lakshadweep & Minicoy Islands, Dadra & Nagar Haveli, Daman & Diu. No apportioning of the above amount is admissible for creating a miscellaneous purpose fund for payment of compensation in case of deaths, complications and failures as these are already covered under the National Family Planning Insurance Scheme. 2.7. HEALTH INSURANCE SCHEME A Task Force was established by the MOHFW to explore new health financing mechanisms. The terms of reference for this task force included review of existing mechanisms to include health financing, human resource implications to manage health financing and risk pooling schemes, extent of subsidies required, ensuring equity and non- discrimination, feasibility in various states, suggested design of pilots and sites to launch community based health insurance models, and required modifications of existing structures to introduce health financing schemes. This Ministry had advised the State/UT Governments to prepare Health Insurance models as per their local prepare Health Insurance models as per their local needs to be run on pilot basis and certain guidelines were sent to all States/UTs for preparation of pilot projects on Health Insurance. Government of India will provide support to State Governments under National Rural Health Mission. The support from Government of India, for paying premium for the Health Insurance Scheme for the BPL families has been fixed as per Universal Health Insurance Scheme of the Ministry of Finance, at Rs. 300/- for a family of five. The states which are implementing the Health Insurance scheme for BPL population within the NRHM framework, however, piloted and based on the local needs are as under: Din Dayal Antyoday Upchar Yojana - Madhya Pradesh The Government of Madhya Pradesh is providing free treatment and investigation facility on hospitalization and investigation facility on hospitalization without any exclusion up to a limit of Rs. 20,000/- per family per annum in all government health facilities to the under privileged section of the society i.e. 57 lakh BPL families and 10 lakh other families under Din Dayal Antyoday Upchar Yojana from 25 th September 2004. The benefit is provided for all disease and conditions including delivery, without any exclusion. The Department of Public Health and Family Welfare, Government of MP is the Implementing Agency for the Scheme in the state. The average benefit availed is under Rs. 1,000/- per family per annum. Mukhya Mantri Raksha Kosh for BPL Population Rajasthan Government of Rajasthan has launched the Mukhya Mantri Jeevan Raksha Kosh with effect from January 1, 2009 and is being implemented to provide free in-patient care and out-patient care to BPL families. BPL card holder will get cash less health care facilities in Medical Colleges, District hospitals and CHCs of the district for inpatient care for any ailment and OPD care. Further, if high end care facility not available in the state for such ailment, they shall be sent out of the state to AIIMS, New Delhi or PGI, Chandigarh for such treatment. 2.8. HEALTH MINISTERS DISCRETIONARY GRANT Financial assistance up to maximum of Rs.50,000/- is available to the poor indigent patients from the Health Ministers Discretionary Grant to defray a part of the expenditure on Hospitalization/treatment in Government Hospitals in cases where free medical facilities are not Annual Report 2010-11 35 available. The assistance is provided for treatment of life threatening diseases i.e. Heart, Cancer, Kidney, Brain- tumor etc.. During the year 2009-10, financial assistance totaling Rs.30.80 lakh was given to 167 patients. A provision of Rs.100.00 lakh has been made during the current financial year 2010-11. Till 3 rd 0January, 2011, a sum of Rs.71.20 lakh has been released to 198 patients. 2.9. RASHTRIYA AROGYA NIDHI (RAN) Rashtriya Arogya Nidhi was set up under Ministry of Health & Family Welfare in 1997 to provide financial assistance to patients, living below poverty line, who are suffering from major life threatening diseases to receive medical treatment in Government Hospitals. Under the scheme of Rashtriya Arogya Nidhi, grants-in-aid is also provided to State Governments for setting up State Illness Assistance Funds. Such funds have been set up by the Governments of Andhra Pradesh, Bihar, Chhattisgarh, Goa, Gujarat, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Jharkhand, Maharashtra, Mizoram, Rajasthan, Sikkim, Tamil Nadu, Tripura, West Bengal, Uttarakhand, Haryana, Punjab, Uttar Pradesh, NCT of Delhi and Puducherry. The Grants-in-aid released to these Funds are at Table-A. Other States/Union Territories have been requested to set up such Fund, as soon as possible. Applications for financial assistance up to Rs.1.5 lakh are to be processed and sanctioned by the respective State Illness Assistance Fund. Applications for assistance beyond Rs.1.50 lakh and also of those where State Illness Assistance Fund has not been set up are processed in this Department for release from the Rashtriya Arogya Nidhi. In order to provide immediate financial assistance, to the extent of Rs.1.00 lakh per case, to critically ill, poor patients, who are living below poverty line (BPL) and undergoing treatment, the Medical Superintendents of Dr. RML Hospital, Safdarjung Hospital, Smt. Sucheta Kriplani Hospital, All India Institute of Medical Sciences, New Delhi, PGIMER, Chandigarh, JIPMER, Puducherry, NIMHANS, Bangalore, CNCI, Kolkatta, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, RIMS, Imphal and NEIGRIHMS, Shillong have been provided with a revolving fund of Rs.10-40 lakhs. The revolving fund is replenished after its utilization. For cases requiring financial assistance above the Rs.1.00 lakh per case the applications are processed in the Department of Health & Family Welfare through a Technical Committee headed by Special Director General (ME), DGHS before being considered for approval by a duly constituted Managing Committee with Honble Minister for Health & Family Welfare as the Chairman. During the year 2009- 10, financial assistance totalling Rs.710.69 lakh was given directly to 228 patients under Rashtriya Arogya Nidhi (Central fund) and further, the revolving fund of amount Rs.325.00 lakhs has been given to the above Hospitals/ Institutes. A provision of Rs.700.00 lakh has been made during the current financial year 2010-11. Till 3 rd January, 2011, a sum of Rs.599.63 lakh has been released to 200 patients, and further, revolving fund of amount Rs.130.00 lakh has been released to the above Hospitals/ Institutes. 2.10. HEALTH MINISTERS CANCER PATIENT FUND Health Ministers Cancer Patient Fund (HMCPF) within the Rashtriya Arogya Nidhi (RAN) has also been set up in 2009. In order to utilize the HMCPF, the revolving fund as under RAN, has been established in the various Regional Cancer Centre(s) (RCCs). Such step would ensure and speed up financial assistance to needy cancer patients and would help to fulfill the objective of HMCPF. The financial assistance to the cancer patient up to Rs.1.00 lakh would be processed by the concerned Institute on whose disposal the revolving fund has been placed. Individual cases which require assistance more than Rs.1.00 lakh but not exceeding Rs.1.50 lakh is to be sent to the concerned State Illness Assistance Fund of the State/UT to which the applicant belongs or to this Ministry in case no such scheme is in existence in the respective State or the amount is more than Rs.1.50 lakh. Initially, 27 Regional Cancer Centres (RCC) were proposed at whose on proposal revolving fund of Rs.10.00 lakh was placed (List of RCCs is at Table B & C). During the current financial year 2010-11 i.e. till 3rd January, 2011, a sum of Rs.270.00 lakh have also been released to 14 Regional Cancer Centres. Annual Report 2010-11 36 TABLE-A Year-wise Budget Estimate State/UT amount to which grant was released (Rs. in crore) Year Budget State/ UTs. Amount Estimate (to which (Rs. in (B.E) grant crore) (Rs. in released) crore) 1996-97 25.00 Karnataka 5.00 Madhya Pradesh 5.00 Tripura 2.00 NCT of Delhi 0.50 1997-98 25.00 Andhra Pradesh 5.00 Tamil Nadu 5.00 Himachal Pradesh 0.25 Jammu & Kashmir 0.25 NCT of Delhi 0.25 1998-99 25.00 Maharashtra 2.00 West Bengal 0.50 Kerala 1.00 Mizoram 0.50 Rajasthan 1.00 NCT of Delhi 0.50 1999-2000 25.00 Goa 0.15 Gujarat 1.00 Rajasthan 1.00 2000-01 6.50 Sikkim 0.25 Rajasthan 0.50 J & K 0.125 Bihar 1.25 Goa 0.15 2001-02 4.00 Chhattisgarh 0.50 Andhra Pradesh 2.50 2002-03 2.80 NCT of Delhi 0.40 Jharkhand 1.50 Rajasthan 1.00 2003-04 3.50 Uttaranchal 0.25 2003-04 3.50 Uttaranchal 0.25 Jharkhand 0.50 Jammu & Kashmir 0.24 Kerala 1.00 Rajasthan 1.01 NCT of Delhi 0.50 2004-05 3.20 Chhattisgarh 2.05 Karnataka 1.00 Goa 0.90 NCT of Delhi 0.25 Pondicherry 0.25 2005-06 3.00 Rajasthan 1.00 Mizoram 0.15 Tamil Nadu 1.05 Haryana 0.50 NCT of Delhi 0.30 2006-07 3.00 Andhra Pradesh 0.65 Jammu & Kashmir 0.125 Kerala 0.275 Tamil Nadu 0.95 Rajasthan 1.00 NCT of Delhi 0.25 2007-08 5.00 West Bengal 1.1025 Goa 0.30 Himachal Pradesh 0.27 Madhya Pradesh 0.8750 Rajasthan 1.00 Punjab 0.4525 NCT of Delhi 0.70 Puducherry 0.25 2008-09 5.00 Punjab 0.0475 Kerala 2.00 Uttar Pradesh 2.50 Goa 0.30 Sikkim 0.4750 2009-10 5.00 West Bengal 2.156 Chhattisgarh 1.8750 Haryana 0.25 2010-11 5.00 Tamil Nadu 2.50 Goa 0.25 West Bengal 1.25 Haryana 0.25 Annual Report 2010-11 37 TABLE-B List of 27 Regional Cancer Centre and Financial Assistance provided to them during the year 2009-2010 from Health Minister Cancer Patient Fund (HMCPF) within Rashtriya Arogya Nidhi (RAN) Scheme are given below. List of 27 Regional Cancer Centre(s) Sl. Name of Institute Rs. in No lakh 1. Chittaranjan National Cancer Institute, Kolkata, West Bengal 30.00 2 Kidwai Memorial Institute of Oncology, Bangalore, Karnataka 10.00 3. Regional Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu 20.00 4 Acharya Harihar Regional Cancer Centre for Cancer Research & Treatment, Cuttack, Orissa. 10.00 5 Regional Cancer Control Society, Shimla, Himachal Pradesh 10.00 6 Cancer Hospital & Research Centre, Gwalior, Madhya Pradesh 10.00 7 Indian Rotary Cancer Institute, (AIIMS), New Delhi 10.00 8 R.S.T. Hospital & Research Centre, Nagpur, Maharashtra 10.00 9 Pt. J.N.M. Medical College, Raipur, Chhattisgarh. 10.00 10 Post Graduate Institute of Medical Education & Research, Chandigarh 10.00 11 Sher-I Kashmir Institute of Medical Sciences, Soura, Srinagar. 10.00 12 Regional Institute of Medical Sciences, Manipur, Imphal 10.00 13 Govt. Medical College & Associated Hospital, Bakshi Nagar,Jammu 10.00 14 Regional Cancer Centre, Thiruvananthapuram, Kerala 10.00 15 Gujarat Cancer Research Institute, Ahmedabad, Gujarat 10.00 16 MNJ Institute of Oncology, Hyderabad, Andhra Pradesh 10.00 17 Puducherry Regional Cancer Society, JIPMER, Puducherry 10.00 18 Dr. B.B. Cancer Institute, Guwahati, Assam 10.00 19 Tata Memorial Hospital, Mumbai, Maharashtra 10.00 20 Indira Gandhi Institute of Medical Sciences, Patna, Bihar 10.00 21 Acharya Tulsi Regional Cancer Trust & Research Institute (RCC), Bikaner, Rajasthan. 10.00 22 Regional Cancer Centre, Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rotan, Haryana. 10.00 23 Regional Cancer Centre, Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rotan, Haryana. 10.00 24 Civil Hospital, Aizawl, Mizoram 10.00 25 Sanjay Gandhi Post Graduate Institute of Medical Sciences,Lucknow 10.00 26 Kamala Nehru Memorial Hospital, Allahabad, Uttar Pradesh 10.00 27 Govt. Arignar Anna Memorial Cancer Hospital, Kancheepuram, Tamil Nadu. 10.00 Total = Rs.280.00 lakh released in 2009-10 *Fund is yet to be released. TABLE-C List of Regional Cancer Centres and Financial Assistance provided to them during the year 20102011 from (HMCPF within RAN) Scheme, are given below. (in Rs. lakh) 1. Director, CNCI, Kolkata Rs .60.00 2. Chief, AIIMS, New Delhi Rs. 30.00 3. Director, RCC, Kerala Rs. 40.00 4. Med. Supdt., Rogi Kalyan Samiti, Shimla Rs. 20.00 5. Med. Supdt.,Civil Hos. Aizawl, Mizoram Rs. 20.00 6. Med. Supdt., Agartala, Tripura Rs.20.00 Annual Report 2010-11 38 2.11. PRE- CONCEPTION AND PRE-NATAL DIAGNOSTIC TECHNIQUES (PROHIBITION OF SEX SELECTION) ACT, 1994. Adverse Child Sex-Ratio in India Sex ratio (number of females per thousand males) is one of the most important indicators used for study of population characteristics. The declining trend in sex ratio has been a matter of concern for all in the country. Sex ratio in India has declined over the century from 972 in 1901 to 927 in 1991. The sex ratio has since gone up to 933 in 2001. In contrast the child sex ratio for the age group of 0-6 years in 2001census was 927 girls per thousand boys as against 945 recorded in 1991 Census. The encouraging trend in the sex ratio during 1991-2001 was marred by the decline of 18 points in the sex ratio of children aged 6 years or below. The Census 2001 figures further reveal that the child sex ratio is comparatively lower in the affluent regions, i.e., Punjab (798), Haryana (819), Chandigarh (845), Delhi (868), Gujarat (883), Himachal Pradesh (896) and Rajasthan (909). (These are the seven focus States/ UTs for purposes of the PC&PNDT Act, 1994). Some of the reasons commonly put forward to explain the consistently low levels of sex ratio are son preference, neglect of the girl child resulting in higher mortality at younger age, female infanticide, female foeticide, higher maternal mortality and male bias in enumeration of population. Easy availability of the sex determination tests and abortion services may also be proving to be catalyst in the process, which may be further stimulated by pre- conception sex selection facilities. Sex determination techniques have been in use in India since 1975 primarily for the determination of genetic abnormalities. However, these techniques were widely misused to determine the sex of the foetus and subsequent abortions if the foetus was found to be female. In order to check female foeticide, the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was brought into operation from 1 st January, 1996. The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 has since been amended to make it more comprehensive. The amended Act and Rules came into force with effect from 14.2.2003 and the PNDT Act has been renamed as Pre- conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 to make it more comprehensive. The technique of pre-conception sex selection has been brought within the ambit of this Act so as to pre-empt the use of such technologies which significantly contribute to the declining sex ratio. Use of ultrasound machines has also been brought within the purview of this Act more explicitly so as to curb their misuse for detection and disclosure of sex of the foetus lest it should lead to female foeticide. The Central Supervisory Board (CSB) constituted under the Chairmanship of Minister for Health and Family Welfare has been further empowered for monitoring the implementation of the Act. State level Supervisory Boards on the line of the CSB constituted at the Centre have been introduced for monitoring and reviewing the implementation of the Act in States/UTs. The State/UT level Appropriate Authority has been made a multi member body for better implementation and monitoring of the Act in the States. More stringent punishments are prescribed under the Act so as to serve as a deterrent for minimizing violations of the Act. Appropriate Authorities are empowered with the powers of Civil Court for search, seizure and sealing the machines, equipments and records of the violators of law including sealing of premises and commissioning of witnesses. It has been made mandatory to maintain proper records in respect of the use of ultrasound machines and other equipments capable of detection of sex of foetus and also in respect of tests and procedures that may lead to pre- 7. Med.Supdt., JIPMER, Puducherry Rs.10.00 8. Director & Dean, Chennai Rs.10.00 9. Hon. Director, Ahmedabad.(Gujarat.) Rs.10.00 10. Tata Memo.Centre, Mumbai Rs.10.00 11. Director, Bangaluru Rs.10.00 12. Med. Supdt. Kamala Nehru Memorial Hospital, Allahabad. (Uttar Pradesh) Rs. 10.00 13 MS, PGIMER, Chandigarh Rs.10.00 14 Director, RCC Raipur, Chhattisgarh Rs.10.00 Total= Rs.270.00 lakh (as on 03.01.11) Annual Report 2010-11 39 conception selection of sex. The sale of ultrasound machines has been regulated through laying down the condition of sale only to the bodies registered under the Act. Punishment under the Act Imprisonment up to 3 years and fine up to Rs. 10,000/-. For any subsequent offences, imprisonment up to 5 years and fine up to Rs. 50,000 / Rs.1,00,000.The name of the registered medical practitioner is reported by the Appropriate Authority to the State Medical Council concerned for taking necessary action including suspension of the registration if the charges are framed by the court and till the case is disposed off. Status and Report from States/UTs As per the reports received from the States and UTs, 39854 bodies using ultrasound, image scanners etc. have been registered under the Act. 462 ultrasound machines have been sealed and seized for violation of the law. As on 30.06.2010, there were 706 ongoing cases in the Courts for various violations of the law. Though most of the cases (223) are for non-registration of the centre/clinic, 216 cases relate to non-maintenance of records, 155 cases relate to communication of sex of foetus, 36 cases relate to advertisement about pre-natal/conception diagnostic facilities and 76 cases relate to other violations of the Act/Rules. The concerned state governments are regularly requested to take effective measures for speedy disposal of the ongoing cases. Ministry of Health and Family Welfare has taken a number of steps for the implementation of the Act. The major steps taken are as follows: Meetings of the Central Supervisory Board (CSB) Meetings of the Central Supervisory Board (CSB) of PC & PNDT Act are being held regularly (every six months) under the Chairpersonship of Union Minister of Health and Family Welfare. So far, 16 meetings have been held. Sensitization through Members of Parliament Funds were released to the Governments of Chandigarh, Delhi, Gujarat, Haryana, Himachal Pradesh, Punjab and Rajasthan at the rate of Rs.5.00 lakh per Honble Member of Parliament (both Lok Sabha and Rajya Sabha) of these States/UTs, considered sensitive from the point of view of Child Sex Ratio, for undertaking awareness generation activities like organising exhibitions, seminars, workshops, trainings / orientations programmes for PRIs, public meetings, debates, essay competitions, nukkad nataks, stage shows etc. On 2.10.2007 on the occasion of the Birth Anniversary of the Father of the Nation, Mahatma Gandhi, a signature campaign was launched to generate awareness regarding the evils of female foeticide. H.E. the President of India appended her signature first on the scroll as the first citizen of the country. Rallies were also organised on 4.10.2007 in every district of the NCT of Delhi to generate awareness among the public. The National Level Meeting on Save the Girl Child held on 28.4.2008 at Vigyan Bhawan, New Delhi, was inaugurated by Dr. Manmohan Singh, Honble Prime Minister of India, in the presence of the Honble Union Minister of Health & F.W., Honble Union Minister of State (I/C) for Women & Child Development and Honble Minister of State for Health & F.W.. The large turn-out of Ministers, Members of Parliament and senior Health officers from the Central and State/UT Governments and representatives of various organisations active in the area of Child welfare at the day long fruitful deliberations of the National Meet lent the necessary impetus to the Save the Girl Child mission. All the State/UT Governments were requested to replicate such meeting in their respective States/UTs. The message of the above National Level Meet was disseminated through the accredited print and electronic media. Medical Audit It is proposed to conduct Medical Audit of the ultrasound clinics in the country in a phased manner to spread awareness of the Act and required procedural formalities so as to prevent violations of the Act. Scrutinizing Form F filled in respect of all pregnant women by the clinics will also help in detecting violations, if any. Changing Appropriate Authorities In place of Chief Medical Officer / District Health Officer, District Collectors / District Magistrates have been nominated as District Appropriate Authorities to strengthen the implementation of the Act at the ground level. States of Maharashtra, Tripura, Gujarat, and Chhattisgarh have informed that they have issued the necessary notification in this regard. Annual Report 2010-11 40 Proposed Amendments to PC & PNDT Act. To make the implementation of the Act more effective and stringent, it is proposed to amend certain provisions of the Act, such as changing the Appropriate Authority at the State level from Director (H&FW) to Secretary (H&FW) to facilitate the reporting of District Appropriate Authority (DAA) to State Appropriate Authority (SAA), inclusion of an officer of or above the rank of Joint Director of H&FW in the SAA, and vesting the power the search and seize records to any Group B Gazetted Officer. Funding to the State through RCH - II Funds have been provided to all States/UTs, as requested by them, in their Programme Implementation Plan under RCH II for undertaking various activities for implementation of the Act at the State level. Inclusion of the issue under NRHM Sensitization on sex ratio issue has been made a part of curriculum for ANMs. For tracking delivery of a pregnant woman, ASHAs are now provided a fixed remuneration at the village level (Keeping a track of the ante-natal check-ups and accompanying the pregnant mother to an institution for delivery). Constitution of National Inspection and Monitoring Committee (NIMC) A National Inspection and Monitoring Committee (NIMC) has been constituted at the Centre to take stock of the ground realities through field visits to the problem states. During 2006-09, the Committee visited the States of Delhi, Haryana, Maharashtra, UP, Rajasthan, Orissa, Karnataka, Kerala, H.P. and Punjab. It is proposed to strengthen the National Support and Monitoring Cell with induction of appropriate consultants to oversee the implementation of the Act. Meeting with the manufacturers of ultrasound machines A meeting with all major manufacturers of the ultrasound machines was held on 20.7.2007. It was learnt that L&T and Wipro GE have developed an effective IEC message on a sticker to put on all ultrasound machines. Wipro GE has set up a PNDT Audit Cell. All the manufacturers have since been sensitizing their engineers on this issue, who in turn, brief the medical practitioners while installing the machines. Training of Judiciary With a view to sensitize the judiciary, the National Judicial Academy, Bhopal provided training to trainers from the State Judicial Academies during 2005-06, who in turn would provide training to the judiciary in the area under their jurisdiction. The National Law School of India University, Bangalore, was provided grants for Training of lower judiciary and public prosecutors from State Judicial Academies in a phased manner, beginning with Karnataka during 2007-2008. Annual Report on implementation of the PNDT Act Implementation of the PNDT Act is being published in Annual Report since 2005 which gives complete information on the implementation of PC & PNDT Act. Frequently Asked Questions (FAQs) booklet The Ministry of Health and Family Welfare, in collaboration with the United Nations Population Fund (UNFPA), have developed a Frequently Asked Questions booklet about the PNDT Act which has proved to be quite useful to the lay persons, medical community and to the Appropriate Authorities in understanding the provisions of the Act for better implementation. Website on PNDT In addition to the Union Health & F.W. Ministrys Website, (www.mohfw.nic.in), an independent website, pndt.gov.in for PNDT Division was launched by the Honble Union Minister of Health & F.W. on 28.4.2008. This website, in addition to containing all the relevant information relating to PNDT Act, Rules, Regulations and activities, enables online filing of data right from Clinics (including submission of From-F online by the Clinics) in the field to the District and State level and their retrieval at the District, State and National levels. An exercise is on to impart training to the user groups on the use of the website in a phased manner beginning with the focused states of Punjab, Haryana, Rajasthan, Gujarat, Himachal Pradesh, Maharashtra and Delhi This training programme will be conducted by the experts from National Informatics Centre. Toll Free Telephone: Similarly, the Honble Union Minister of Health & F.W. launched a Toll Free Telephone (1800 110 500) on the same day under the PNDT Division of the Ministry to facilitate the public to lodge complaints anonymously Annual Report 2010-11 41 against any violation of the provisions of the Act by any authority or individual and to seek PNDT related general information. (The service is presently suspended, pending resolution of certain operational issues; mainly unauthorized advertising by the outsourced service provider). Awareness Generation The problem has its roots in social behaviour and prejudices and along with the legislation various activities have been undertaken to create awareness against the practice of pre-natal determination of sex and female foeticide through Radio, Television, and Print Media. Workshops and seminars are also organized through voluntary organizations at state/regional/district/block levels to create awareness against this social evil. Cooperation has also been sought from religious / spiritual leaders, as well as medical fraternity to curb this practice. The Government of India has launched Save the Girl Child Campaign with a view to lessen son preference by highlighting achievements of young girls. Shri Kapil Dev, former Captain of the Indian national Cricket Team, has been nominated as the Brand Ambassador for the campaign. Advt. over the Internet regarding Gender Testing Kits: A new factor which is threatening to adversely impact the PNDT efforts of the Government, i.e. the advertisements placed on the websites regarding the Gender Testing Kits. The Honble High Court of Punjab and Haryana Suo Motu took congnisance of the above report and issued notices to the State Governments of Haryana and Punjab and also to the Central Government. Affidavit on behalf of UOI has been filed. On 29.11.2007, the Customs Department was requested by this Ministry to examine the possibility of intercepting such Gender Determination Kits when imported into the country under the Customs Act. They were also requested to furnish details of such importers to facilitate the Ministry to take appropriate action against them under the PC & PNDT Act. This was followed up at the Secretary level, vide the letter dated 5.1.2007. In response to the above request of this Ministry, the Customs Department informed that it has suitably alerted its field formations to seize the Gender Testing Kits imported from abroad. Subsequently, the Central Board of Excise & Customs on 1.4.2008 made certain suggestions for consideration of this Ministry for interception of the Gender Testing Kits effectively. In the light of CBECs letter dated 1.4.2008 cited above, two rounds of Inter-Ministerial Meetings were held on 7.5.2008 and 16.5.2008 under the Chairmanship of Joint Secretary (PK), where the representatives of the Customs Department, DGFT, DGHS and DCG (I) were invited to find a solution to the problem posed by the import of Gender Testing/Sex-Determination Kits. It was, inter alia, decided to amend the PC & PNDT Act, 1994 and the Rules/Regulations framed thereunder suitably to provide for establishment of a registration mechanism in the matter of import of Gender Testing Kits and other similar medical kits. On the request of the Customs authorities, DCG (I) and DDG (M) have been requested to frame the required parameters for identification of the Gender Testing Kits from among the similar kits imported into the Country. Sting operation carried out of BBC in Delhi and NOIDA: The sting operation conducted recently by BBC at NOIDA and New Delhi revealed that illegal sex determination tests were carried out at Dr. Mangala Telang clinics on an NRI couple from the U.K. This was reported in the website of BBC News.The Appropriate Authorities of Uttar Pradesh and NCT of Delhi were requested to inquire into the matter and furnish their respective reports thereon. In their respective reports, the State Governments indicated that inspection of the facilities of Dr. Mangala Telang at NOIDA and Delhi were carried out, the Premises and sealed and her registration suspended. In addition to the above, the Government of U.P. has filed a court case against Dr. Mangala Telang at NOIDA. 2.12 IMPROVEMENT IN THE QUALITY OF HEALTHCARE The improvement in the quality of healthcare over the years is reflected in respect of some basic demographic indicators (Table given below). The Crude Birth Rate (CBR) has declined from 40.8 in 1951 to 29.5 in 1991 and further to 22.8 in 2008. Similarly there was a sharp decline in Crude Death Rate (CDR) which has decreased from 25.1 in 1951 to 9.8 in 1991 and further to 7.4 in 2008. Also, the Total Fertility Rate (average number of Annual Report 2010-11 42 children likely to be born to a woman between 15-44 years of age) has decreased from 6.0 in 1951 to 2.6 in the year 2008 as per the estimates from the Sample Registration System (SRS) of Registrar General India (RGI), Ministry of Home Affairs. The Maternal Mortality Rate has also declined from 437 per one lakh live births in 1992 93 to 254 in 2004-06, according to the SRS Report brought out by RGI. Infant Mortality Rate, which was 110 in 1981, has declined to 53 per 1000 live births in 2008. Child Mortality Rate has also decreased from 57.3 in 1972 to 15.2 in 2008. Table 1 Achievements of Family WelfareProgramme Family Planning Methods: The total number of acceptors of different Family Planning methods enrolled in the country during the year 2009-10 was 36.29 million. Table 2 below summarizes Sl. Parameter 1951 1981 1991 Current level No. 1 Crude Birth Rate (Per 1000 Population) 40.8 33.9 29.5 22.8 (2008) 2 Crude Death Rate (Per 1000 Population) 25.1 12.5 9.8 7.4 (2008) 3 Total Fertility Rate (Per woman) 6.0 4.5 3.6 2.6 (2008) 4 Maternal Mortality Rate NA NA 437 (1992-93) 254(2004-06) (Per 100,000 live births) NFHS S.R.S. 5 Infant Mortality Rate 146(1951-61) 110 80 53 (2008) (Per 1000 live births) 6 Child (0-4 years) 57.3(1972) 41.2 26.5 15.2 (2008) Mortality Rate per 1000 children 7 Couple protection 10.4(1971) 22.8 44.1 46.5 (2008) Rate (%) $ Source: 1 Office of Registrar General, Ministry of Home Affairs, India. $ (2) Deptt of Health & FW. the position in regard to family planning achievements during 2009-10 and 2010-11 (up to September 2010) at All India Level. Annual Report 2010-11 43 Table 2 Family Planning Acceptors by methods (Figures in million) Sl.No. Methods Achievement * Achievement *
2009-2010 2010-11 2009-10 (April 2010- (April 2009- Sep 2010) Sep.2009) 1. Sterilisation 5.02 1.60 1.72 2. IUD Insertions 5.79 2.46 2.87 3. Condom Users (Eq.) 17.36 6.49 8.71 i. Under Free Distribution 8.33 6.49 8.71 Scheme (Eq.) ii. Under Commercial 9.03** NA NA Distribution scheme(Eq.) 4. Oral Pill Users 8.11$ 3.55 4.69 i. Under Free distributionScheme (Eq.) 4.65 3.55 4.69 ii. Under Commercial Distribution 3.47** NA NA Scheme(Eq.) Total Acceptors 36.29 14.1 17.99 *: Provisional figures Source: HMIS Portal Eq -Equivalent ** Branded full cost commercial sales figures are not included. The data is still awaited from SSM Division of the Ministry. $:- Total does not match due to round off. Annual Report 2010-11 44 Table 3 Assessed Need of Immunisation vis--vis Achievement during 2009-10 under RCH Programme (All India) Sl.No. Activity Assessed Achievement* % Change. % Achvt.of Need for Assessed 2009-10 2009-10 2008-09 Need 1 2 3 4 5 6 7 A. Immunisation i. Tetanus Immunisation for 29264 24717 24348 (+) 1.5 84.5 Expectant mothers ii. DPT Immunisation 25187 25070 23345 (+) 7.4 99.5 For Children iii. Polio 25187 24964 23916 (+) 4.4 99.1 iv. B.C.G. 25187 25809 26013 (-) 0.8 102.5 v. Measles 25187 24007 23443 (+)2.4 95.3 vi. DT Immunisation 24748 18171 14204 (+) 27.9 73.4 For Children vii. T.T. (10 Years) 25706 16675 13523 (+) 23.3 64.9 viii. T.T. (16 Years) 25660 14636 11815 (+) 23.9 57.0 B. Prophylaxis against nutritional anaemia among women 29264 25568 22663 (+)12.8 87.4 C. Prophylaxis against Blindness due to Vit. A deficiency $ i. 1 st dose (below 1 year + above 1 year) 25187 24058 18292 (+) 31.5 95.5 ii. 5 th dose 24364 20378 11480 (+) 77.5 83.6 iii 9 th dose 24748 13504 9603 (+) 40.6 54.6 * Provisional figures received through HMIS Portal as on 22 nd Oct., 2010. (Figures in 000s) Immunization Performance for the year 2009-10 vis--vis 2008-09 is given in Table 3. Table-4 gives the comparative performance during 2010-11 and 2009-10 for the period April-September of the respective years. Annual Report 2010-11 45 Table 4 Assessed Need of Immunisation Vis--vis Achievement During 2010-11 (April,10 to Sept, 10) under RCH Programme (All India) Sl.No. Activity Assessed Achievement* % Change. % Achvt.of Need for Assessed 2010-11 2010-11 2009-10 Need (Apr.2010 to April 2009to Sept.2010) Sept.2009) 1 2 3 4 5 6 7 A. Immunisation i Tetanus Immunisation for 29678 10846 12212 (-) 11.2 36.5 Expectant mothers ii DPT Immunisation 25540 10360 12184 (-) 15.0 40.6 For Children iii. Polio 25540 10285 12210 (-) 15.8 40.3 iv. B.C.G. 25540 11260 12498 (-) 9.9 44.1 v. Measles 25540 10169 11740 (-) 13.4 39.8 vi. DT Immunisation 25092 4665 10484 (-)55.5 18.6 For Children vii T.T. (10 years) 26065 6801 8427 (-)19.3 26.1 viii. T.T. (16 Years) 26013 6132 7296 (-) 16.0 23.6 B. Prophylaxis against Nutritional Anaemia among Total Women 29678 16629 11436 (+) 45.4 56.0 C. Prophylaxis against blindness due to Vit. A deficiency i. 1 st dose (below 1 year+ 25540 11155 12131 (-) 8.0 43.7 above 1 year) ii. 5 th dose 24706 9056 9643 (-) 6.1 36.7 iii 9 th dose 25092 5991 6242 (-) 4.0 23.9 * Figures are provisional. Source: HMIS Portal (Figures in 000s) Annual Report 2010-11 46 2.13 HEALTH MANAGEMENT INFORMATION SYSTEM For capturing information on the service statistics from the peripheral institutions, an exercise was undertaken to rationalize the data capturing format by removing redundant information, reducing the number of forms and focused on facility based reporting. The revised forms were finalized in September 2008 and disseminated to the States. A web based Health MIS (HMIS) portal was also launched in October, 2008 to facilitate data capturing at District level. The HMIS portal has led to faster flow of information from the district level and about 98% of the districts reported monthly data for the fiscal year 2009-10. The Provisional Report for the performance of the States for the year 2009-10 (up to March, 2010) as reported by the States was brought and shared with the stakeholders. Soft copy is also available on the HMIS Portal in public domain. The HMIS portal is now being rolled out to capture information at the facility level. Now that data has started flowing regularly on the HMIS portal, a workshop on improving the quality of data was organized in May 2010. Core M&E teams have been formed in the States to look at the consistency of the HMIS data in finding the gap and providing solutions for strengthening the Health MIS system in States. 2.13.1. Tracking of Mothers and Children It has been decided to have a name-based tracking whereby pregnant women and children can be tracked for their ANCs and immunisation along with a feedback system for the ANM, ASHA etc to ensure that all pregnant women receive their Ante-Natal Care Check- ups (ANCs) and post-natal care (PNCs); and further children receive their full immunisation. All new pregnancies detected/being registered from 1st April, 2010 at the first point of contact of the pregnant mother would be captured as also all births occurring from 1st December, 2009. The states are putting in place systems to capture such information on a regular basis. Mother and Child Tracking System require intense capacity building at various levels primarily at the Block and Sub- Centre levels. The National Informatics Centre (NIC) has been requested to modify and adapt the Gujarat model of e-Mamta software application to other States. This application is being hosted on servers that are to be procured for the purpose and customisation will be carried out by NIC. The roll-out is being monitored centrally for which dashboards are being prepared for the purpose and it is proposed to integrate the application for a Help Desk that is proposed to be put in place for the health sector. 2.14 SURVEYS AND EVALUATION ACTIVITIES District level Household Surveys: The Ministry also coordinated the activities of the District Level Household Survey (DLHS)-3 during 2007-08 for assessing the impact of the health programmes and generating various health related indicators at the District and State level. All India, State and District Fact Sheets for the results of the survey have been released and hosted on the HMIS Portal for use by the health officials and other stakeholders. The detailed All India and State Reports have also been released. Concurrent evaluation of NRHM: In pursuant to a decision taken by the Empowered Programme Committee (EPC) of NRHM, Concurrent evaluation of NRHM has been undertaken by the Ministry in 197 districts of all States/UTs covering activities and programmes initiated under the NRHM through the International Institute of Population Science (IIPS), Mumbai. IIPS acted as the nodal agency for conducting the Concurrent Evaluation and outsourced the field work to independent agencies having experience in conducting surveys / research studies. The Fact sheet for 187 districts have been disseminated in the Ministry in October 2010. National and State reports are being finalised and expected to be released by March, 2011. Regional Evaluation Teams(RETs): There are 7 Regional Evaluation Teams (RETs) located in the Regional Offices of the Ministry which undertake evaluation of the NRHM activities including Reproductive and Child Health Programme (RCH) on a sample basis by visiting the selected districts and interviewing the beneficiaries. These teams generally visit two adjoining districts in a state every month and see the functioning of health facilities and carry out sample check of the beneficiaries to ascertain whether they have actually received the services. Reports of the RETs are sent to the States for taking corrective measures on issues highlighted in the reports. During 2009-10, 114 districts were visited by the RETs. Annual Health Survey: The Annual Health Survey (AHS) launched by the Ministry aims to prepare District Health Profile of the 284 districts in the EAG States and Annual Report 2010-11 47 Assam on an annual basis. The AHS is being conducting through the Registrar General of India (RGI), Ministry of Home Affairs. The AHS is a hybrid model where the field work has been outsourced to external agencies and supervision being done by the RGI staff. The Annual Health Survey aims to provide feedback on the impact of the schemes under NRHM in reduction of Total Fertility Rate (TFR), Infant Mortality Rate (IMR) at the district level and the Maternal Mortality Ratio (MMR) at the regional level. These are important indicators of health which are currently being estimated at the national/state level through the Sample Registration System (SRS) by Registrar General of India. The fieldwork of the Survey is in progress and reports likely to be available in early 2011. 2.15 POPULATION RESEARCH CENTRES (PRCs) The Ministry has established 18 Population Research Centres (PRCs) in various institutions in the country with a view to carry out research on various topics pertaining to population stabilization, demographic and other health related programs. While 12 of these PRCs are located in universities, the remaining six are located in institute of national repute. The Ministry of Health & Family Welfare provide 100% financial grant-in-aid to all PRCs as on a year to year basis towards salaries of staff, books and journals, TA/DA, data processing/stationary/contingency etc., and other infrastructure requirement. As a statutory requirement, under Rule 212 (2) of the General Financial Rules 2005, the Annual Reports of 17 PRCs for 2009-10 which received Rs. 25 lakhs or above as Recurring Grant during 2009-10, alongwith the audited statement of accounts were laid on the table of both the houses of parliament. The performance of PRC Sagar, which received less than 25 lakhs as Recurring Grant for 2009-10, was also found to be satisfactory. During the year 2009-10, the studies completed by the Population Research Centres (PRCs) on some of the important topics of research including the studies assigned by the Ministry are given below: 1) Male Involvement in Reproductive Health :Evidence from NFHS-3 and DLHS-2 2) Rapid Appraisal of Critical components of National Rural Health Mission (NRHM) in Karnataka 3) Reproductive Health Status of Adolescent Married girls in Karnataka 4) Convergence of Demographic Indicators in Karnataka :An Exploration 5) Orientation for Senior-level officials on use of Demographic Data for Local Level Planning and Monitoring of Development Programmes. 6) Study on Rapid Appraisal of National Rural Health Mission(NRHM) Implementation in Sambalpur and Kendrapara districts of Orissa 7) Monitoring of Coverage Evaluation Survey (CES) 2009 8) District Human Development Report Hoshiarpur, Punjab 9) Rapid appraisal of NRHM Ambala District Haryana 10) An Annotated Bibliography and Abstracts of Research (2002-2007) 11) Rapid Appraisal of National Rural Health Mission (NRHM) in the State of Punjab: Patiala district 12) A Study of Out-of-pocket Expenditure on Medial Services and Drugs: An Exploratory Analysis of U.P.,Rajasthan and Delhi. 13) Gender and forest conservation: The Impact of womens participation in community forest governance, Ecological Economics, 14) Does womens Proportional Strength affect their Participation: Governing local forests in south Asia 15) Exploring Gender Differences in functional disabilities among the Old: Are Women at a Disadvantageous Position 16) Changing Demographic Landscape of South Asia and Emerging Issues of Employment, Ageing and Old Age Security. 17) Challenges for the NRHM: Study of Recent Demographic and Health Profile in NRHM States. 18) Shortages and surpluses: changing Female-male Ratios in Younger and Older Ages: Policy Implications in south Asia. Annual Report 2010-11 48 19) Development, Demographic change and Migration: A study of Two Hilly States of India. 20) Women, Empowerment and the State: Enhancing Capabilities Through Employment Generation Schemes. 21) Sex Differentials in Child Health and Nutritional Status in Punjab. 22) Education in MDGs: Is India Expected to Achieve its Targeted Goal and How? 23) Rapid Assessment of NRHM in Uttar Pradesh 24) Rapid appraisal of National Rural Health Mission (NRHM) implementation in Koppal district, Karnataka. 25) Facility Assessment of Secondary Level Public Hospitals in Tamil Nadu Phase I 26) Facility Assessment of Medical college Hospitals and Allied Hospitals in Tamil Nadu Phase I 27) Rapid Appraisal of NRHM Implementation in Bankura District of West Bengal 28) Rapid Appraisal of NRHM Implementation in Jorhat District of Assam 29) Rapid Appraisal of NRHM Implementation in Sonitpur District of Assam 30) Impact of Literacy in infant Mortality Rate in Assam 31) A study on the Role of Assamese Radio Programme Sanjog in Promoting UEE with Special reference to Alternative Schooling 32) Rapid Appraisal of National Rural Health Mission Implementation on Udham Singh Nagar District of Uttarakhand. 33) Maternal Mortality in districts of Uttar Pradesh: An Illustration through indirect estimation 34) Utilisation of Maternal and Child health (MCH) Care services in India with special reference to EAG states. 35) Improving womens Health in Bihar 36) A Critical Review of Community Participation in Family Welfare Programmes. 37) Trends in contraceptive prevalence and fertility across the different districts of Bihar 38) The Demographic Impact of the Partition of India With Special Reference to Eastern India 39) Can Beautiful be Backward? Tribes of India in a Long Term Demographic Perspective 40) Employment differentials by Social Groups of India 41) Distributional Pattern of Social Groups in Higher Education: An Analysis of Census Data for Maharashtra, 1991-2001. 42) Disparities in Higher Education Between and Within Social Groups: Analysis by Major States of India, 1999-2000. 43) Rapid Appraisal of National Rural Health Mission: Gadchiroli District,Maharashtra . 44) Rapid Appraisal of NRHM Implementation in Madhya Pradesh district Anuppur 45) Rapid Appraisal of NRHM Implementation in Madhya Pradesh: District Indore 46) Rapid Appraisal of National Rural Health Mission in Rajouri District of Jammu and Kashmir. 47) Rapid Appraisal of National Rural Health Mission in Baramulla District of Jammu and Kashmir. 48) Role of Men in Reproductive Health in Jammu & Kashmir. 49) Disability Burden and the Need for Social Action: The Role of the Family, Community and the NGOs. 50) National Rural Health Mission Initiatives and Reproductive Child Health Phase-II: An Evaluation. 51) Organisation and Functioning of Health Services in Himachal Pradesh. 52) Reducing Maternal and Child Mortality in Himachal Pradesh 53) Unmet Reproductive Health Needs of the Couples and the Role of the Male Partner in Meeting the Needs. 54) National Rural Health Mission: An appraisal of its rationale, structure and Prospects. Annual Report 2010-11 49 55) Rapid Appraisal of National Rural Health Mission Implementation in Kozhikode district, Kerala 2008-2009. 56) Infertility in India: A Comparative Study by State 57) Suicides in Kerala : What do Trends reveal! 58) A Profile of Adolescence and youth in India . 59) Morbidity among Men and women in India: State wise analysis based on NFHS-III data. 60) Immunization coverage in EAG states and Assam: A comparative study with Kerala based on NFHS-III data. 61) The use of temporary contraception and Discontinuation in Kerala . 62) Household headship and nutritional status of women and children in Kerala 63) People living with HIV/AIDS in India, Inference from NFHS-III. 64) Reproductive Health Status of Tribal Women in Rajasthan. 65) Knowledge and Satisfaction of Patients about NRHM Interventions at Dungarpur district Hospital . 66) Impact Assessment of Institutional Delivery Care Services in Tribal Areas of Rajasthan. 67) Rapid Appraisal of National Rural Health Mission (NRHM) Implementation Banaskantha district, Gujarat 68) Rapid Appraisal of National rural Heath Mission (NRHM) implementation, Surat district, Gujarat. 69) District Level Household Survey (DLHS-3) in Andaman and Nicobar Islands 70) Important RCH Indicators of DLHS-3 of Andaman & Nicobar Islands. Annual Report 2010-11 51 Chapter 3 The Ministry of Health & Family Welfare consists of four departments viz. the Department of Health & Fam- ily Welfare, Department of AYUSH, Department of Health Research and Department of AIDS Control. Achieving an acceptable standard of health for general population has been the objective over the plan era in the Health sector. In line with this objective, there has been a steady increase in the allocations made for this sector Funding For The Programme Funding For The Programme Funding For The Programme Funding For The Programme Funding For The Programme since from the 1st Plan. The allocation for this sector has been substantially enhanced from Rs. 36378.00 crores in the 10th plan to Rs.1,36,147.00 crores in the 11th Plan. The table below is captured the financial outlays and expenditure for Health & Family Welfare for the 10th Plan (2002-07) and Health, Family Welfare and Health Research for the 11th Plan (2007-12). Approved Outlay Expenditure Plan Period Health F.W. $ Health Total Health F.W. Health Total Research Research 10 th Plan 10252.00 26126.00 X 36378.00 X Outlay Actual 10521.00 31064.00 X 41585.00 8694.15 26349.23 X 35048.87 Status 2002-03 1550.00 4930.00 X 6480.00 1359.82 3916.63 X 5276.45 2003-04 1550.00 4930.00 X 6480.00 1325.81 4409.27 X 5735.08 2004-05 2208.00 5780.00 X 7988.00 1772.36 4864.21 X 6636.57 2005-06 2908.00 6424.00 X 9332.00 2259.21 5672.53 X 7931.74 2006-07 2305.00 9000.00 X 11305.00 1982.44 7486.59 X 9469.03 11 th Plan 41092.92 90558.00 4496.08 136147.00 (2007-12) Outlay 2007-08 2985.00 10890.00 X 13875.00 2183.71 10380.25 X 12563.96 2008-09 3650.00 11930.00 420.00 16000.00 3008.82 11260.18 390.56 14659.56 2009-10 4450.00 13930.00 420.00 18800.00 3260.40 13304.51 399.90 16964.86 (Prov.) (Prov.) (Prov.) 2010-11 5560.00 15440.00 500.00 21500.00 (Rupees in Crores) $ :- Figures shown as NRHM from 2006-07 onwards. Prov.:- Provisional F.W. :- Family Welfare. The scheme-wise break up of plan and non plan expenditure during 2009-10 and outlays 2010-11 for Health, NRHM and Health Research is given at statement I and II. Annual Report 2010-11 52 DEPARTMENT OF HEALTH AND FAMILY WELFARE HEALTH SECTOR Scheme- wise Break- up of Actule Expenditure during 2009-10 and Outlay for 2010-11 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 A. CENTRALLY SPONSORED PROGRAMMES 23202.50 1202.38 25.09 1227.47 2734.75 22.05 2756.80 1 National AIDS Control Programme and National S.T.D. Control Programme 5728.00 938.06 0.00 938.06 1435.00 0.00 1435.00 2 Cancer 2871.92 69.65 25.09 94.74 225.00 22.05 247.05 (i) National Cancer Control Programme 2400.00 28.25 11.59 39.84 180.00 9.05 189.05 (ii) Tobacco Control Programm 471.92 16.40 0.00 16.40 45.00 0.00 45.00 (iii) Rastriya Arogya Nidhi 0.00 25.00 13.50 38.50 0.00 13.00 13.00 3 National Mental Health Programme 1000.00 51.60 0.00 51.60 120.00 0.00 120.00 4 Assistance to State for Capacity Building(Truma Care) 732.95 52.66 0.00 52.66 115.00 0.00 115.00 (i) Truma Care 0.00 52.66 113.00 0.00 113.00 (ii) Prevention of Burn Injury 0.00 0.00 2.00 0.00 2.00 5 Assistance to States for Drug & PFA Control 260.00 0.00 0.00 0.00 0.00 0.00 0.00 New initiatives under CSS (Others) 12609.63 90.41 0.00 90.41 839.75 0.00 839.75 6 Telemedicine (E- Health) 183.00 0.00 0.00 0.00 17.00 0.00 17.00 7 National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke 1660.50 3.44 0.00 3.44 100.00 0.00 100.00 8 National Programme for Health for the Elderly 400.00 0.00 0.00 0.00 60.00 0.00 60.00 9 District Hospitals 1500.00 16.00 0.00 16.00 225.00 0.00 225.00 (i) Strengthening of MCH wing/Hospitals and other wing in District Hospitals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (ii) Upgradation of States Govt. Medical Colleges(NE) 1500.00 16.00 0.00 16.00 225.00 0.00 225.00 10 Human Resource for Health 4000.00 17.22 0.00 17.22 351.00 0.00 351.00 (i) Upgradation/Strengthening of Nursing Services 2900.00 17.22 0.00 17.22 250.00 0.00 250.00 (ii) Strengthening/Creation of Paramedical Institutes 1000.00 0.00 0.00 0.00 100.00 0.00 100.00 (iii) Strengthening/ Upgradation of Pharmacy Schools 100.00 0.00 0.00 0.00 1.00 0.00 1.00 Statement-I Annual Report 2010-11 53 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 11 Health Insurance (National Urban Health Mission) 4495.00 0.00 0.00 0.00 10.00 0.00 10.00 12 Pilot Projects 371.13 53.75 0.00 53.75 76.75 0.00 76.75 Sport Medicines/Sport Injiry 90.00 40.23 0.00 40.23 30.00 0.00 30.00 Deafness 100.00 7.36 0.00 7.36 11.50 0.00 11.50 Leptospirosis Control 4.48 0.52 0.00 0.52 0.85 0.00 0.85 Control of Human Rabies 8.65 0.67 0.00 0.67 1.60 0.00 1.60 Medical Rehabilitation 50.00 1.12 0.00 1.12 13.30 0.00 13.30 Ogran Transplant 25.00 0.30 0.00 0.30 11.00 0.00 11.00 Oral Health 25.00 0.00 0.00 0.00 3.50 0.00 3.50 Fluorosis 68.00 3.55 0.00 3.55 5.00 0.00 5.00 B. CENTRAL SECTOR SCHEMES 17890.42 2058.02 3055.77 5113.79 2825.25 2438.50 5263.75 1 Oversight Committee 1827.00 30.00 0.00 30.00 300.00 0.00 300.00 Strengthening of the Institutes for Control of Communicable Diseases 531.23 63.21 57.69 120.90 77.48 64.06 141.54 2 National Institute of Communicable Diseases 60.00 16.88 20.49 37.37 18.05 22.48 40.53 National Tuberculosis Institute, Bangalore 9.48 1.16 6.36 7.52 1.95 5.66 7.61 3 Others Research Institutes 461.75 45.17 30.84 76.01 57.48 35.92 93.40 i B.C.G. Vaccine Laboratory, Guindy, Chennai 80.00 0.39 4.35 4.74 5.75 12.50 18.25 ii Pasteur Institute of India, Coonoor 280.00 11.26 0.00 11.26 16.27 0.00 16.27 iii Lala Ram Sarup Institute of T.B. and allied diseases, Mehrauli, Delhi 78.75 30.37 14.41 44.78 30.00 11.00 41.00 iv Central Leprosy Training & Research Institute Chengalpattu (including Integrated Vaccine complex & Media Park) (Tamil Nadu) 10.00 0.48 7.07 7.55 2.73 6.65 9.38 Statement-I Annual Report 2010-11 54 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Regional Institute of Training, Research & Treatment under Leprosy Control Programme 13.00 2.67 5.01 7.68 2.73 5.77 8.50 (a) R.L.T.R.I., Aska (Orissa) 3.00 0.03 1.88 1.91 0.50 2.35 2.85 (b) R.L.T.R.I., Raipur (M.P.) 2.00 0.18 3.13 3.31 0.50 3.42 3.92 (c) R.L.T.R.I., Gauripur (W.B.) 8.00 2.46 0.00 2.46 1.73 0.00 1.73 4 Strengthening of Hospitals & Dispensaries: 1162.34 202.68 1231.69 1434.37 241.75 1027.05 1268.80 i Central Government Health Scheme (including Health Insurance) 565.80 57.93 608.89 666.82 67.65 500.00 567.65 ii Medical Treatment of CGHS Pensioners 0.00 0.00 449.74 449.74 1.00 377.87 378.87 iii Central Institute of Psychiatry, Ranchi 100.00 20.73 27.28 48.01 27.25 24.18 51.43 iv All India Institute of Physical Medicine & Rehabilitation, Mumbai 56.00 4.11 7.91 12.02 5.00 8.00 13.00 v Dr. R.M.L. Hospital, New Delhi 351.00 103.07 127.39 230.46 118.00 107.00 225.00 vi Others 89.54 16.84 10.48 27.32 22.85 10.00 32.85 Institute for Human Behaviour & Allied Sciences, Shahdara, Delhi 8.00 0.00 0.00 0.00 1.00 0.00 1.00 Grant to New Delhi TB Centre 0.00 0.00 2.48 2.48 0.00 2.00 2.00 All India Institute of Speech & Hearing, Mysore 81.54 16.84 8.00 24.84 21.85 8.00 29.85 5 Strengthening of Institutions for Medical Education, Training & Research: 2350.95 209.58 140.52 350.10 224.62 132.28 356.90 (a) Medical Education: 1749.67 166.19 75.52 241.71 171.40 59.15 230.55 i Indira Gandhi Institute of Health & Medical Sciences for NorthEast Region at Shilong* 1266.38 65.00 0.00 65.00 67.85 0.00 67.85 ii N.I.M.H.A.N.S., Bangalore 266.38 54.38 71.31 125.69 58.35 55.03 113.38 iii Kasturba Health Society, Wardha 106.91 28.60 0.00 28.60 27.00 0.00 27.00 Statement-I Annual Report 2010-11 55 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 iv National Medical Library, New Delhi 100.00 18.21 4.21 22.42 17.70 4.12 21.82 v National Board of Examinations, New Delhi 10.00 0.00 0.00 0.00 0.50 0.00 0.50 (b) Training: 288.65 18.56 6.32 24.88 22.38 6.77 29.15 i Upgradation/ Development of Nursing Services 280.65 17.55 0.00 17.55 21.00 21.00 ii Nursing Colleges 8.00 1.01 6.32 7.33 1.38 6.77 8.15 (i) R.A.K. College of Nursing, New Delhi 5.00 0.71 4.82 5.53 0.82 4.77 5.59 (ii) Lady Reading Health School 3.00 0.30 1.50 1.80 0.56 2.00 2.56 (c) Research: 10.00 3.12 11.60 14.72 5.00 16.44 21.44 (i) Indian Council of Medical Research, New Delhi # Membership for International Organization 10.00 3.12 11.60 14.72 5.00 16.44 21.44 #- ICMR merged with department of Health Research from 2008-09 (d) Public Health 108.81 7.78 29.30 37.08 10.72 35.19 45.91 i Institute of Public Health (PHFI) 22.00 0.00 0.00 0.00 1.00 1.00 ii All India Institute of Hygiene & Public Health, Calcutta (AIIH&PH) and Serologist and Chemical Examiner, Calcutta 86.81 7.78 29.30 37.08 9.72 35.19 44.91 a. AIIH&PH, Calcutta 85.81 7.59 25.88 33.47 9.22 30.98 40.20 b. Serologist & Chemical Examiner, Calcutta 1.00 0.19 3.42 3.61 0.50 4.21 4.71 (e) Others 193.82 13.93 17.78 31.71 15.12 14.73 29.85 i Indian Nursing Council 10.00 0.15 0.12 0.27 0.25 0.12 0.37 ii V.P. Chest Institute, Delhi 158.00 12.00 17.00 29.00 12.00 13.00 25.00 iii National Academy of Medical Sciences, New Delhi 7.72 0.78 0.37 1.15 0.87 0.42 1.29 iv Medical Council of India, New Delhi 10.00 1.00 0.00 1.00 1.00 0.80 1.80 Statement-I Annual Report 2010-11 56 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Medical Grants Commission 8.10 0.00 0.00 0.00 1.00 0.00 1.00 vi Dental Council of India 0.00 0.00 0.19 0.19 0.00 0.19 0.19 viiPharmacy Council of India 0.00 0.00 0.10 0.10 0.00 0.20 0.20 6 System Strengthening including Emergency Medical Relief/ Disaster Management 1106.58 273.36 137.66 411.02 198.71 148.32 347.03 i (a) Health Education, Research & Accounts 32.33 0.56 2.42 2.98 3.28 3.55 6.83 Health Education Bureau, New Delhi 11.65 0.12 2.42 2.54 1.00 2.20 3.20 Health Intelligence and Health Accounts 20.68 0.44 0.00 0.44 2.28 1.35 3.63 a. Intelligence 10.68 0.44 0.00 0.44 1.68 1.35 3.03 b. Accounts 10.00 0.00 0.00 0.00 0.60 0.60 ii Strengthening of D.G.H.S./ Ministry: 25.00 2.84 77.12 79.96 4.23 78.80 83.03 a. Strengthening of Deptts under the Ministry 15.00 2.24 39.76 42.00 2.60 42.05 44.65 b. Strengthening of DGHS 10.00 0.60 37.05 37.65 1.63 35.75 37.38 Other( Discretionary Grant) 0.00 0.31 0.31 0.00 1.00 1.00 iii Emergency Medical Relief 564.82 207.20 0.00 207.20 100.00 0.00 100.00 Health Sector Disaster Preparedness and Management 447.25 2.03 0.00 2.03 38.40 0.00 38.40 Emergency Medical Relief (including Avian Flu) 117.57 205.17 0.00 205.17 61.60 0.00 61.60 iv (d) Others 484.43 62.76 58.12 120.88 91.20 65.97 157.17 i Central Research Institute, Kasauli 292.92 6.51 22.57 29.08 30.00 28.12 58.12 ii National Institute of Biological, NOIDA (U.P.) 62.65 11.00 0.00 11.00 17.25 0.00 17.25 iii Prevention of Food Adulteration (including project of Feasibilities Testing sheme of Vitamins and Mineral ) 25.36 iv Food Safety & Standards Authority of India 21.00 2.80 23.80 12.65 2.54 15.19 Statement-I Annual Report 2010-11 57 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Central Drug Standard & Control Organization (CDSCO) 88.50 14.59 11.00 25.59 10.00 13.68 23.68 vi Indian Pharmacopeia Commission 8.82 3.56 12.38 20.00 2.75 22.75 vii National Pharmaccopoeia 0.00 0.00 0.00 0.35 0.35 viii Port Health Authority 15.00 0.84 18.19 19.03 0.95 18.88 19.83 i) Jawaharlal Nehru Port Sheva 8.20 0.55 0.00 0.55 0.60 0.00 0.60 ii) Setting up of offices at 8 newly created international Airports 6.80 0.29 18.19 18.48 0.35 18.88 19.23 7 Pradhan Mantri Swasthya Suraksha Yojana 3955.00 474.49 0.00 474.49 750.00 0.00 750.00 8 New Initiatives under CS 6957.32 804.70 1487.80 2291.64 1032.69 1066.26 2098.95 i Forward Linkages to NRHM (New Initiatives in NE) 900.00 0.86 0.00 0.86 60.00 0.00 60.00 ii National Centre for Disease Control 450.00 0.97 0.00 0.97 18.69 0.00 18.69 iii Advisory Board for Standards 22.00 0.00 0.00 0.00 2.00 0.00 2.00 iv Programme for Blood and Blood Products 450.00 0.00 0.00 0.00 20.00 0.00 20.00 v Medical Store Organisation 0.00 0.00 39.11 39.11 0.00 40.00 40.00 vi Procurement of Meningitis Vaccine for Inoculation of Haj Pilgrims 0.00 0.00 3.76 3.76 0.00 6.00 6.00 9 Redevelopment of Hospitals / Institutions 6035.32 802.87 1444.93 2247.80 992.00 1020.26 2012.26 i All India Institute of Medical Sciences & its Allied Departments, New Delhi 1461.00 250.51 636.00 886.51 400.00 400.00 800.00 ii P.G.I.M.E.R., Chandigarh 625.00 75.00 317.00 392.00 90.00 220.00 310.00 iii J.I.P.M.E.R., Pudicherry 564.00 115.00 160.00 275.00 132.00 120.00 252.00 iv Lady Harding Medical College & Smt. S.K. Hospital, New Delhi 383.83 44.19 114.07 158.26 79.00 97.00 176.00 v Kalawati Saran Children Hospital, New Delhi 74.88 20.29 25.57 45.86 24.00 23.26 47.26 Statement-I Annual Report 2010-11 58 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 vi RIMS, Imphal, Manipur 589.92 109.70 0.00 109.70 80.50 0.00 80.50 vii LGBRIMH, Tejpur, Assam 267.07 36.00 0.00 36.00 41.40 0.00 41.40 viii RIPANS, Aizwal, Mizoram 69.62 17.00 0.00 17.00 19.50 0.00 19.50 ix Safdarjung Hospital and College, New Delhi 2000.00 135.18 192.29 327.47 125.60 160.00 285.60 10 Other Schemes (Award of Prizes in Hindi, Treatment of Ex-VIPs, Grants to Indiam Red Cross Society & Johns Ambulance 0.00 0.00 0.41 0.41 0.00 0.53 0.53 TOTAL(HEALTH) 41092.92 3260.40 3080.86 6341.26 5560.00 2460.55 8020.55 III Depart of Health Research 4296.08 399.90 184.07 583.97 500.00 160.00 660.00 Indian Council of Medical Recearch (ICMR) 4296.08 399.90 184.07 583.97 500.00 160.00 660.00 GRAND TOTAL 45389.00 3660.30 3264.93 6925.23 6060.00 2620.55 8680.55 Statement-I Annual Report 2010-11 59 DEPARTMENT OF HEALTH AND FAMILY WELFARE NRHM AND MEDICAL RESEARCH INSTITUTE Scheme- wise Break- up of Actul Expenditure during 2009-10 and Outlay for 2010-11 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 I CENTRALLY SPONSORED SCHEMES 88451.22 13120.72 9.96 10231.41 15127.64 13.16 15140.80 A. Disease Control Programmes 6645.63 971.40 7.53 978.93 1132.32 6.95 1139.27 1 National Vector Borne Disease Control Programme 3190.00 338.20 7.53 345.73 418.00 6.95 424.95 2 National T.B Control Programme 1447.00 311.56 0.00 311.56 350.00 0.00 350.00 3 National Leprosy Eradication Programme 268.70 34.83 0.00 34.83 45.32 0.00 45.32 4 Iodine Deficience Disorder Control Programme (IDDCP) 155.40 21.20 0.00 21.20 45.00 0.00 45.00 5 National Programme for Control of Blindness 1550.00 252.60 0.00 252.60 260.00 0.00 260.00 6 National Drug De-Addiction Control Programme(NDDPC) 34.53 13.01 0.00 13.01 14.00 0.00 14.00 B. Free Distribution & Social Marketing of Condoms for NACO 2200.00 222.85 0.00 222.85 304.00 0.00 304.00 C. Family Welfare 79605.59 11926.47 2.43 9029.63 13691.32 6.21 13697.53 Infrastructure Maintenance 20448.70 3149.98 0.00 3149.98 3781.63 0.00 3781.63 i Direction & Administration 1955.28 281.31 0.00 281.31 375.00 0.00 375.00 (i) Maintenance of State & Distt.FW Bureaus 1955.28 281.31 0.00 281.31 375.00 0.00 375.00 ii Rural Family Welfare Services (Sub Centres) 16865.00 2649.24 0.00 2649.24 3108.06 0.00 3108.06 iii Urban Familiy Welfare Services 958.84 138.17 0.00 138.17 182.00 0.00 182.00 iv Grants to State Training Institutions 669.58 81.26 0.00 81.26 116.57 0.00 116.57 (a) Basic Training for ANM/LHVs 520.48 59.40 0.00 59.40 85.18 0.00 85.18 (b) Maintenance & Strengthening of HFWTCs 93.01 13.61 0.00 13.61 19.05 0.00 19.05 (c) Basic Training for MPWs Worker (Male) 56.09 8.25 0.00 8.25 12.34 0.00 12.34 Statement-II Annual Report 2010-11 60 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 2 Free distribution of Contraceptives 330.00 35.39 0.00 35.20 55.00 0.00 55.00 3 RCH Programme (Procurement of Supplies & Materials) 1500.00 159.44 0.00 159.44 200.00 0.00 200.00 4 Routine Immunization (Supply of vaccine etc) 2457.16 350.31 0.00 350.31 450.00 0.00 450.00 5 Pulse Polio Immunization 3994.18 1198.47 0.00 1198.47 1067.08 0.00 1067.08 (a) Procurement of Vaccines 1964.48 605.02 0.00 605.02 581.51 0.00 581.51 (b) Operating cost 2029.70 593.45 0.00 593.45 485.57 0.00 485.57 6 IEC (Inf., Edu. and Communication) 1001.50 155.13 2.43 157.56 204.94 6.21 211.15 7 Area Projects 463.51 17.87 0.00 17.87 31.67 0.00 31.67 (a) USAID assisted Projects 463.50 11.96 0.00 11.96 25.00 0.00 25.00 (b) EC assisted Projects 0.01 0.00 0.00 0.00 0.00 0.00 0.00 (c.) Projects through Vol.Orgns/ Sociaties/Autonomous 0.00 5.91 0.00 5.91 6.67 0.00 6.67 8 Flexible Pool for State PIPs 49410.54 6859.88 0.00 6859.88 7901.00 0.00 7901.00 (i) RCH Flexible Pool 16229.47 3479.11 0.00 3479.11 3850.00 0.00 3850.00 (ii) Mission Flexible Pool 33181.07 3380.77 0.00 3380.77 4051.00 0.00 4051.00 II CENTRAL SECTOR SCHEMES 2106.78 183.79 56.63 240.42 312.36 61.29 373.65 A. DISEASE CONTROL PROGRAMME 300.45 40.02 0.00 40.02 35.00 0.00 35.00 1 Integrated Disease Survillance Project 300.45 40.02 0.00 40.02 35.00 0.00 35.00 B. FAMILY WELFARE 1806.33 143.77 56.63 200.40 277.36 61.29 338.65 1 Social Marketing Area Project 50.00 0.00 0.00 0.00 0.50 0.00 0.50 2 Social Marketing of Contraceptives 450.00 21.86 0.00 21.86 40.00 0.00 40.00 3 F.W Training and Res. Centre, Mumbai 18.80 2.04 1.93 3.97 5.50 2.43 7.93 4 NIHFW, New Delhi 34.00 14.82 19.03 33.85 15.30 20.40 35.70 5 IIPS, Mumbai 24.00 3.00 11.30 14.30 20.00 9.90 29.90 6 RHTC, Najafgarh 23.65 0.00 7.61 7.61 0.02 9.35 9.37 7 Population Research Centres 53.50 9.73 0.00 9.73 14.20 0.00 14.20 8 CDRI, Lucknow 23.15 4.58 0.00 4.58 4.90 0.00 4.90 Statement-II Annual Report 2010-11 61 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non-Plan Total 1 2 3 4 5 6 7 8 9 9 Travel of Exp./Conf/Meetings etc. 6.00 0.11 0.00 0.11 1.00 0.00 1.00 10 International Cooperation 8.95 2.62 0.00 2.62 3.50 0.00 3.50 11 NPSF/National Commission on Population 30.00 0.59 0.00 0.59 4.00 0.00 4.00 12 NGOs (PPP) 100.00 1.74 0.00 1.74 2.65 0.00 2.65 13 FW Linked Health Insurance Plan 40.00 18.33 0.00 18.33 15.00 0.00 15.00 14 RCH Training 51.62 4.58 0.00 4.58 7.00 0.00 7.00 15 Management Information System (MIS) 750.00 34.49 0.00 34.49 100.00 0.00 100.00 16 Central Procurement Agency 5.00 5.00 17 Other Schemes 142.66 25.28 16.76 42.04 38.79 19.21 58.00 (a) Research & Study 30.00 0.58 0.00 0.58 2.20 0.00 2.20 (b) Role of Men in Planned Parenthood 16.05 0.45 0.00 0.45 3.92 0.00 3.92 (c ) Training in Recanalisation 4.20 0.00 0.00 0.00 0.40 0.00 0.40 ( d) Assistance to I.M.A. 1.00 0.35 0.00 0.35 0.50 0.00 0.50 (e) Testing Facilities for IUD and Fallopian 4.50 1.10 0.00 1.10 1.20 0.00 1.20 (f) Expenditure at HQs (RCH) 30.00 5.19 0.00 5.19 6.22 0.00 6.22 (g) Regional Offices 24.00 14.86 5.87 20.73 20.00 8.75 28.75 (h) Information Technology 20.00 1.17 0.00 1.17 1.30 0.00 1.30 (i) FW Programme in Other Ministries 7.00 0.27 0.00 0.27 1.20 0.00 1.20 (j) Gandhigram Institute 5.91 1.31 0.00 1.31 1.85 0.00 1.85 (k) Technical Wing (HQ) 0.00 10.89 10.89 10.46 10.46 Total (NRHM) 90558.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45 III Depart of Health Research 200.00 0.00 0.00 0.00 ICMR & IRR 200.00 0.00 0.00 0.00 GRAND TOTAL 90758.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45 Statement-II Annual Report 2010-11 63 Chapter 4 4.1. INTRODUCTION Promotion of maternal and child health has been one of the most important objectives of the Family Welfare Programme in India. Under the NRHM (2005-2012) and the Reproductive and Child Health( RCH) Programme Phase-II (2005-10) the Government of India is actively pursuing the goals of reduction in Maternal Mortality by focusing on the 4 major strategies of essential obstetric and new born care for all, skilled attendance at every birth, emergency obstetric care for those having complications and referral services. The other major interventions are provision of Safe Abortion Services and services for RTIs and STIs. This policy recommends a holistic strategy for bringing about total intersectoral coordination at the grass root level and involving the NGOs, Civil Societies, Panchayati Raj Institutions and Women's Group in bringing down Maternal Mortality Ratio and Infant Mortality Rate. The National Rural Health Mission and the 11th Five Year Plan have set the goal of reducing MMR to less than 100 per 100,000 live births by the year 2010. Accordingly, schemes and programmes have been developed for various interventions focused on reducing maternal deaths. The Maternal Mortality Ratio in India is 254 per 100,000 live births (SRS, RGI: 2004-06 Maternal Mortality Report). 4.2. MATERNAL MORTALITY RATIO (MMR) MMR is defined as the number of maternal deaths per 100,000 live births due to causes related to pregnancy or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy. MMR India: The national average of MMR is 254 per 100,000 live births ( SRS-2004-06), which in itself is very high compared to the international scenario like Sweden (5), USA (24), Brazil (58) and even in neighbouring countries like Bangladesh (340), Pakistan (260), Sri Lanka (39) and Thailand (48) (Source- 'Trends in Maternal Mortality; 1990-2008 -Estimates developed by WHO, UNICEF, UNFPA and the World Bank'). Some of the States with high Maternal Mortality as per the RGI-SRS report of 2004-06 are: States MMR Uttar Pradesh/Uttarakhand 440 Rajasthan 388 Madhya Pradesh/Chhattisgarh 335 Bihar/Jharkhand 312 Assam 480 Causes of Maternal Mortality: The major causes of Maternal Mortality have been identified as haemorrhage (both ante and post partum), toxemia (Hypertension during pregnancy), anemia, obstructed labour, puerperal sepsis (infections after delivery) and unsafe abortion as given below: Heamorrhage accounts for more than one- third of all deaths followed by puerperal sepsis and abortion. Anaemia which has been included in other conditions is a major contributory factor. Most of these deaths are preventable with good ante natal care, timely identification and referral of pregnant women with complications of pregnancy and timely provision of emergency obstetric care. Moreover Maternal Health Programme Maternal Health Programme Maternal Health Programme Maternal Health Programme Maternal Health Programme Annual Report 2010-11 64 social factors like Illiteracy, low socio-economic conditions, poor access to health facilities are also contributing factors leading to higher maternal mortality. 4.3. MATERNAL HEALTH INDICATORS The estimates of maternal mortality at State/UTs levels not being very robust, MMR can only be used as a rough indicator of the maternal health situation in any given country. Hence, other indicators of maternal health status like antenatal checkup, institutional delivery and delivery by trained personnel etc. are used for this purpose. These reflect the status of the ongoing programme interventions as well as give a reflection on the situation of Maternal Health. All India figure for these indicators as per the District Level Household Survey (DLHS II and III) are tabled below: DLHS II DLHS III (2002-04) (%) (2007-08) (%) Any Antenatal Checkup 73.6 75.2 Three or more Antenatal check-up 50.4 49.8 Total Institutional Delivery 40.9 47.0 Safe Delivery 48 52.7 IFA tablets Consumed for 100 days 20.5 46.6 PNC within 2 weeks of delivery N.A 49.7 From November, 2009 - January, 2010 a nationwide survey called the Coverage Evaluation Survey (CES) was conducted by the United Nations Children Emergency Fund (UNICEF) & ORG- Centre for Social Research. This study was monitored independently by the National Institute of Health and Family Welfare (NIHFW) and Population Resource Centre. According to the CES report, the maternal health indicators are showing significant improvement as given in table below: 4.4. SCHEMES FOR IMPROVING OBSTETRIC CARE 4.4.1 Services: Under the NRHM, several initiatives are under implementation to achieve the goal of reduction in Maternal Mortality. These interventions are as follows: 4.4.1.a.Essential Obstetric Care: This includes quality ante-natal care including prevention and treatment of anaemia, institutional/safe delivery services and post natal care. To provide essential obstetric care services Government of India is operationalizing the PHCs for 24 X 7 services and also training the Staff Nurses (SNs)/ Lady Health Visitors (LHVs)/ Auxiliary Nurse Midwives (ANMs) in Skilled Attendance at Birth. 4.4.1.b. Quality Ante-natal care: Quality ANC includes minimum of at least 4 ANCs including early registration and 1st ANC in first trimester along with physical and abdominal examinations, Hb estimation and urine investigation, 2 doses of T.T Immunization and consumption of Iron Folic Acid (IFA) tablets for 100 days. 4.4.1.c.Prophylaxis and treatment of Nutritional Anemia: As per NFHS III (2005-06), 55.3% of women aged 15- 49 years are anaemic in the country. The problem is more severe during pregnancy, with 58.7% of pregnant women (15-49 years) being anemic and 63.2 % of lactating women. Under the NRHM /RCH II Programme all pregnant and lactating women are provided with one tablet (containing 100 mg of elemental iron and 0.5 mg of Folic Acid) daily for 100 days. Those who have severe anaemia are provided with double dose of these tablets. IFA in the form of tablets and liquid formulations are currently being supplied by the Government of India in RCH Kit A and are distributed through the Sub-Centres and through outreach activities at Village Health and Nutrition Days (VHNDs) to women and children. These are also available at other health facilities like PHCs, CHCs, District Hospitals throughout the country. Details Major Indicators Achievement (%) CES 2009-10 3+ ANC is reported 68.7% Institutional delivery 73% Skilled Birth Attendance (Institutional+ Home) 76.2% Annual Report 2010-11 65 regarding interventions for anemia are given below: 4.4.1.d Provision of 24 Hrs Delivery Services at PHC: Under RCH II, all the CHCs and 50% of the PHCs are being operationalized for providing round the clock delivery services by placing at least 3 -5 Staff Nurses and 1 Medical Officer in these facilities. 4.4.1.e.Post natal care for Mother and Newborn: Ensuring post natal care within first 24 hours of delivery and subsequent home visits on 3rd, 7th and 42nd day are Pregnant and lactating women 100 mg of elemental iron and 0.5 mg of folic acid for at least 100 days for prevention of Anaemia. Those who have anaemia are provided with double dose of these tablets Health & N u t r i t i o n education to p r o m o t e d i e t a r y diversification, inclusion of iron-folate rich food and food items that promote iron absorption. 6mths -5 years 20 mg elemental iron and 100 mcg folic acid per ml of liquid formulation. 6-10 years 30 mg elemental iron and 250 mcg folic acid per child per day IFA supple- mentation. Children Interventions for Anemia under NRHM Long Lasting Insecticide Nets (LLINs)/Insecticide Treated Bed Nets (ITBNs) to households in endemic areas particularly to pregnant women and children important components for identification and management of emergencies occurring during post natal period. The ANMs, LHVs and staff nurses are being oriented and trained for tackling emergencies identified during these visits. 4.4.2 Skilled Attendance at Birth: Government of India is commited to provide skilled attendance at every birth both at community and institution level. SNs/ANMs/LHVs are trained in Skilled Attendance at Birth for a period of 3 weeks. For this curriculum and technical guidelines have been revised and training is being implemented accordingly in all the States and UTs. 4.4.3. Provision of Emergency Obstetric and Neonatal Care at First Referral Units (FRUs): Provision of Emergency Obstetric and Neonatal Care at FRUs is being done by operationalizing all FRUs in the country. While operationalization the thrust is on the critical components such as manpower, blood storage units and referral linkages etc. Availability of trained manpower (Skill Based Training for MBBS doctors) is linked with operationalization of FRUs. The initiatives being undertaken are: 4.4.3.a Training of MBBS Doctors in Life Saving Anaesthetics Skills for Emergency Obstetric Care: Provision of adequate and timely Emergency Obstetric Care (EmOC) has been recognized globally as the most important intervention for saving lives of pregnant women who may develop complications during pregnancy or childbirth. The operationalization of FRUs, at sub- district i.e. CHC level for providing EmOC to pregnant women is a critical strategy of RCH-II, which needs focused attention. It has not been possible to operationalize these FRUs till now due to various factors most pertinent being shortage of specialist manpower, i.e. Gynaecologist and Anaesthetist, particularly at district and sub district level. For effective and better management of Emergency Obstetric needs at the grass root level, Government of India has taken a policy decision and is implementing 18 weeks programme for training of MBBS doctors in life saving anaesthetic skills for Emergency Obstetric care at FRU. The training programme is being implemented in nearly 100 medical colleges across all the major States including NE Region. Annual Report 2010-11 66 4.4.3.b Training in Obstetric Management Skills: Government of India has introduced training of MBBS doctors in Obstetric Management & Skills in collaboration with Federation of Obstetric and Gynaecological Society of India (FOGSI). A 16 weeks training programme in obstetric management & skills including Caesarian Section operation is being implemented at the level of Medical Colleges and District Hospitals in nearly 25 medical colleges of the States. 4.4.3.c Referral Services at both Community and Institutional level: Establishing referral linkages between the community and FRUs is an essential component for access of services particularly during emergencies. Since emergencies during the process of birth cannot be predicted, it is essential to place effective referral linkages which can be accessed by all pregnant women in case of emergency. States have been given the flexibility to establish assured referral systems. 4.4.4. Other Major Interventions are: 4.4.4.a.Safe Abortion Services/ Medical Termination of Pregnancy (MTP): Abortion is a significant medical and social problem in India. An ICMR study (1989) documented that the rates of safe (legal) and unsafe (Illegal) abortions were 6.1 and 13.5 per 1000 pregnancies, respectively. It is evident that perhaps two-thirds of all abortions take place outside the authorized health services by unauthorized, often unskilled providers. The Medical Termination of Pregnancy (MTP) Act was passed by the Indian Parliament in 1971 and came into force from April 1, 1972. The aim of this Act was to reduce maternal mortality and morbidity due to unsafe abortions. The MTP Act, 1971 lays down the conditions under which a pregnancy can be terminated and the place where such terminations can be performed. A recent amendment to the Act (2003) includes decentralization of power for approval of places, as MTP centers, from the states to the district level with the aim of enlarging the network of safe MTP service providers. The amendment also provides for specific punitive measures for performing MTPs by unqualified persons and in places not approved by the government. Whether spontaneous or induced, abortion has been a matter of concern over many decades now, particularly because of sepsis and other complications associated with it. Eight percent of maternal deaths are attributed to complicated abortions. This is a preventable tragedy. This is also an indication of the unmet need for safe abortions. The National Population Policy 2000 underlines the provision of safe abortions as one of the important operational strategies. Provision of MTP services at 24 X 7 PHCs, CHCs and FRUs are being strengthened by training of medical manpower in techniques of MTP by the States. The following are the strategies to promote safe abortions: Community level: Spread awareness regarding safe MTP in the community and the availability of services thereof. Enhance access to confidential counseling for safe MTP; train ANMs, AWWs and link workers/ ASHAs to provide such counseling. Promote post-abortion care through ANMs, link workers/ASHAs and AWWs while maintaining confidentiality. Facility level: Provide quality MVA (Manual Vacuum Aspiration) facilities at all CHCs and at least 50% of PHCs that are being strengthened for 24-hour deliveries. Provide comprehensive and high quality MTP services at all FRUs. Encourage private and NGO sectors to establish quality MTP services. Guidelines for Manual Vacuum Aspiration (MVA) upto 8 weeks of pregnancy for Medical Officers for performing safe abortions at primary health care facilities have been disseminated to the states for implementation. Comprehensive safe abortion guidelines including medical abortion and providing services for medical abortion through the peripheral health care infrastructure have also been disseminated. 4.4.4.b. RTI/STI Services Reproductive Tract and Sexually Transmitted Infections (RTI/STI) were not recognized as a public health problem until recently. Research conducted in India to document the magnitude of reproductive morbidity, has made the Annual Report 2010-11 67 incidence of these infections more visible and brought them into the reproductive health agenda. Several studies conducted in India during the past decade suggest high prevalence of reproductive morbidity among women. As per DLHS-III (2007-2008), about one-fifth (18.3%) of women reported some symptoms of RTI/ STI, however there is no data regarding the percentage who sought treatment. The spread of HIV infection and the role that RTI/STI plays in the transmission of HIV have also brought urgency to the problem. The identification and management of reproductive tract infections is an important objective of the RCH programme. The following are the strategies under RCH II programme. The prevention, early detection and effective management of common lower reproductive tract infections have been included as a component of essential care through the existing primary health care infrastructure. Convergence with the National AIDS Control Programme (NACP) is being sought for the provision of these services, in terms of utilization of services for case management, laboratory services, counseling services, drugs, equipments, blood safety etc. Under RCH - II RTI/STI services are being implemented at sub-district level i.e. in at least 50% of the PHCs and all FRUs, including drugs, training, disposable equipment, and provision for laboratory technicians. National Guidelines for Management of RTIs/ STIs have been developed in coordination with National Institute for Research in Reproductive Health, Mumbai (under ICMR) and have been disseminated to States. 4.4.4.c.Setting up of Blood Storage Centers (BSC) at FRUs: Timely treatment of complications associated with pregnancy is sometimes hampered due to non-availability of Blood Transfusion services at FRUs. The Drugs and Cosmetics Act has been amended to facilitate establishment of Blood Storage Centers at such FRUs. 4.5. JANANI SURAKSHA YOJANA (JSY) 4.5.1. Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health * In HPS Tribal area (Notified by Ministry of Tribal Affairs), the ASHA package is Rs. 600 in Rural Area w.e.f. 15.6.2010. & in North East States the ASHA package is Rs. 600 in Rural Area w.e.f. September, 2006. Category Rural Area Urban Area Mothers ASHA Mothers ASHA package package In LPS 1400 600 1000 200 In HPS 700 200* 600 200 State Eligibility Category LPS States In All births, delivered in a health centre Government or Accredited Private Health Institutions. HPS States In Up to 02 live births Mission (NRHM) being implemented with the objective of promoting institutional delivery among the poor pregnant women. Launched on 12th April 2005, JSY is being implemented in all States and UTs and integrates JSY benefits with delivery and post-delivery care. The scheme focuses on poor pregnant woman with special dispensation for states having low institutional delivery rate namely, the States of Uttar Pradesh, Uttrakhand, Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Assam, Orissa, Rajasthan and Jammu & Kashmir. While these states have been classified as Low Performing States (LPS), the remaining states have been named as High Performing States (HPS). Besides the maternal care, the scheme provides cash assistance to all eligible mothers for delivery care. ASHA, the Accredited Social Health Activist acts as an effective link between the Government and the poor pregnant women. Her role is to facilitate pregnant women to avail services of maternal care and arrange referral transport. In Low performing States, all women including those from SC and ST families, delivering in Government health centres like Sub-centre, PHC/ CHC/FRU/general wards of District and State Hospitals or accredited private institutions are eligible to receive the cash assistance. In High Performing States, BPL pregnant women, aged 19 years and above and the SC and ST pregnant women are eligible to receive the cash assistance under the Yojana. The scale of Cash Assistance (in Rs.) for Institutional Delivery is as under:- Annual Report 2010-11 68 ASHA package of Rs. 600/- available in LPS, NE States and in Tribal Districts of all States/UTs in the rural areas includes the following three components:- Cash assistance, over and above the mothers package, for referral transport to go to the nearest health centre for delivery. The state will determine the amount of assistance (should not be less than Rs.250/- per delivery) depending on the topography and the infrastructure available in their state. It would, however, be the duty of the ASHA and the ANM to organize or facilitate in organizing referral transport, in conjunction with Gram Pradhan, Gram Sabha etc. Cash incentive to ASHA should not be less than Rs.200/- per delivery in lieu of her work relating to facilitating institutional delivery. Generally, ASHA should get this money after her post-natal visit to the beneficiary and that the child has been immunized for BCG. Transactional cost (balance out of Rs. 600/-) is to be paid to ASHA in lieu of her stay with the pregnant woman in the health centre for delivery to meet her cost of boarding and lodging etc. Therefore, this payment should be made at the hospital/ heath institution itself. The Yojana subsidizes the cost of Caesarean Section or for the management of obstetric complications, up to Rs. 1500/- per delivery to the Government Institutions, where Government specialists are not in position. LPS and HPS States, all such BPL pregnant women, aged 19 years and above, preferring to deliver at home is entitled to cash assistance of Rs.500/-per delivery, up to two live births. The progress on implementation of JSY during the last five years is as reflected in the chart below:- JSY Physical and Financial progress in past 5 years 4.5.2. Village Health and Nutrition Day Village Health & Nutrition Day (VHNDs) is organized at the Anganwadi Centre at least once every month to provide ante natal/ post-partum care for pregnant women. Promotion of institutional delivery, immunization, family planning & nutrition are the other various services being provided during VHNDs. 4.5.3. Other simultaneous steps being undertaken are: Funds are provided to States to hire staff including doctors and nurses, on a contractual basis wherever necessary. SBA skills have been incorporated in the pre-service curriculum of SNs/ANMs/LHVs. Bed strength of health facilities are being increased to cope up with the demand of services. All Districts and selected high focus blocks have been strengthened with persons with expertise in managerial skills, data management and financial management so that planning and implementation of services can be ensured. States have identified difficult, most difficult and inaccessible areas as per geographical location, tribal population, underserved area, left wing affected areas etc. or in terms of difficulty in finding human resource for these areas and special incentives for specialists and MOs for such areas have been proposed by the States to overcome the shortage of medical officers and specialists in these areas. Category Rural Area Urban Area Mothers ASHA Mothers ASHA package package In LPS & HPS ** 500 Nil 500 Nil ** In LPS and HPS States, all BPL pregnant women, aged 19 years and above, delivery at home are entitled to cash assistance of Rs.500/ -per delivery, up to two live births. The scale of Cash Assistance (in Rs.) for Home Delivery is as under:- Annual Report 2010-11 69 Flexibility funding to states and districts through untied funds, AMGs and corpus funds. 4.5.4. Involvement of professional associations for skill based training under PPP The services of private health facilities for providing reproductive health services are being mobilized under various demand side financing schemes through the mode of Public Private Partnership (PPP). Many states such as Gujarat (Chiranjeevi Yojana), Jharkhand (Mukhya Mantri Janani Shishu Swasthya Abhiyan), West Bengal (Ayushmati Scheme) are being implemented under Public Private Partnership. For better implementation of this, GOI guidelines have been issued to the states. GOI Guidelines to the States for engaging the services of private health facilities for up-scaling SBA training for ANMs/ SNs/LHVs have also been issued. 4.6. NEW INITIATIVES 4.6.1. Maternal Death Review(MDR): It has been decided to review every maternal death both at the health facilities and in the community through formation of MDR Committees at district level and a task force at State Level. The purpose of the review is to find gaps in the service delivery which leads to maternal deaths and take corrective action to improve the quality of service provision. The process of Maternal Death Review has been initiated by the states for which guidelines and tools have been disseminated to the states by the Ministry. 4.6.2 Maternal & Child Health (MCH) Centres: The Government of India is facilitating the States in identifying the delivery points /MCH centres (for basic and emergency obstetric management) for quality care during pregnancy, child birth and in post-natal period and commensurate family planning services, operationalization of these facilities along-with rational deployment of existing manpower, training of doctors and specialists in these identified MCH centres/ delivery points and providing funds for strengthening and up gradation of these centres. 4.6.3 Name Based Tracking of Pregnant Women: Government of India has taken a policy decision to track every pregnant woman by name for provision of timely ANC, institutional delivery, and PNC along-with immunization of the new- born. 4.6.4 Monitoring and Evaluation of Service Delivery: To monitor the performance and quality of the health services being provided for maternal and child health under the NRHM/RCH II program, several mechanisms like performance statistics, surveys, community monitoring, quality assurance, field visits etc have been placed to strengthen the monitoring and evaluation of the key indicators and strategies under these programs. 4.6.5. Health Management Information System (HMIS): A web-based system has been established by the M&E Division of the Ministry for flow of information of both physical and financial progress from District to State and there in up to the national level. Comprehensive set of formats for reporting by health facilities i.e. SCs/PHCs/ CHCs/DHs are available for monthly/quarterly and annual reporting. Mode of e-governance is being used for quick data sharing and evaluation of key indicators. 4.7. CHALLENGES/CONSTRAINTS: 4.7.1. Human resources for health: There is a huge shortfall in the number of human resources required and currently in position. 4.7.2. Governance issues:Tenure of key officers, including Principal Secretaries, State NRHM Mission Directors, Directorate officials at the state levels, Chief District Medical Officers and Block Medical Officers, is not assured. This affects programme ownership and continuity of interventions. 4.7.3. Decentralized Planning: Decentralized planning capacities are inadequate, including capacity to utilize locally available data for district planning. Facility surveys have been carried out by most states; however these have not been systematically analyzed by the states to map out the resources and gaps, and prepare facility-wise micro plans for operationalization/strengthening. 4.7.4. Village Health and Sanitation Committees:These need to be strengthened and activated for improved outcomes. 4.7.5. Monitoring & Supervision:Supervisory structures at the state and district level are weak. At many places, there is no mechanism for monitoring and supervision. 4.7.6. Public Private Partnership (PPP): PPP in RCH services are not up to the expected levels and needs to be scaled up. Annual Report 2010-11 71 Chapter 5 5.1. INTRODUCTION 5.1.1 Under the National Rural Health Mission (NRHM), Child Health Programme comprehensively integrates interventions that improve child health and addresses factors contributing to infant and underfive mortality. The major components of child health programme are: i) Establishment of New Born Care facilities and Facility Based Integrated Management of Neonatal and Childhood Illnesses (F-IMNCI), ii) Navjaat Shishu Suraksha Karyakram iii) Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and Pre- Service IMNCI iv) Home Based Care of Newborns v) Universal Immunization vi) Early detection and appropriate management of Acute Respiratory Infections, Diarrhoea and other infections vii) Infant and young child feeding including promotion of breast feeding viii) Management of children with malnutrition ix) Vitamin A supplementation and Iron and Folic Acid supplementation x) School Health Programme 5.1.2 Child Health Goal under RCH II/NRHM: Child HealthCurrent StatusRCH II/NRHM: MDG indicator SRS (2008) 2010-2012 2015 IMR (infant mortality rate) 53 < 30 28 Neonatal mortality rate 36 < 20 < 20 Under 5 mortality rate 69 - < 39 The strategies for child health intervention focus on improving skills of the health care workers, strengthening the health care infrastructure and involvement of the community through behavior change communication. 5.2. THE PROGRESS OF VARIOUS COMPONENTS OF CHILD HEALTH PROGRAMME ARE AS FOLLOWS 5.2.1 Integrated Management of Neonatal & Childhood Illnesses (IMNCI) is being implemented in 323 districts and 3.13 lakh personnel have been trained. F IMNCI launched to multi skill doctors and staff nurses with special skills required to manage new born and child hood illnesses at facilities. Moreover IMNCI has been introduced in the curriculum of 79 Medical colleges and more than 4000 medical students have been trained on various aspects of IMNCI. 5.2.2 A total of 192 Sick New Born Care Units (SNCUs), 366 stabilization units and 1524 new born care corners has been established. 5.2.3 Under the Navajat Shishu Suraksha Karyakram (NSSK), 14490 health personnel have been trained. This scheme launched to address issues of care at birth and to reduce neonatal mortality. 5.2.4 Totally, 1898 Nutritional Rehabilitation Centres (NRCs) have been set up across States for treatment of acute malnutrition. 5.2.5 School Health Programme (SHP) has been launched nationwide and is currently being implemented in 33 States/UTs. Health check-up, treatment of minor ailments, health education, micronutrient supplementation and immunization services are being offered in close conjunction with the ministry of HRD. 5.2.6 Vitamin A supplementation is being implemented for all children of 9 months to 5 years of age with the objective of decreasing the prevalence of Vitamin A deficiency to levels below 0.5%. During 2009- 10 the coverage of 1st, 5th and 9th dose of vitamin A was 80.8%, 71% and 45.9% respectively. 5.3 UNIVERSAL IMMUNIZATION PROGRAMME 5.3.1 Immunization Programme is one of the key interventions for protection of children from life threatening conditions, which are preventable. Under the Universal Immunization Programme, vaccination is carried out to prevent seven vaccine preventable diseases i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B. Since Child Health Programme Child Health Programme Child Health Programme Child Health Programme Child Health Programme Annual Report 2010-11 72 2006, 1 dose of SA-14-14-2 JE vaccine has been introduced under routine immunization in the high burden districts in phased manner. 5.3.2 The immunization coverage has seen an improvement over the years. However, there is further need for improvement especially in DPT3 & OPV3 coverage and reducing drop outs. Following table outlines under the programme: Source Coverage Evaluation Survey (CES) District Level Household Survey (DLHS) Time Period 2006 2009 DLHS 2 (2002-04) DLHS 3 (2007-08) Full Immunization 62.4 61.0 45.9 53.5 BCG 87.4 86.9 75.0 86.7 OPV3 67.5 70.4 57.3 65.6 DPT3 68.4 71.5 58.3 63.4 Measles 70.9 74.1 56.1 69.1 No Immunization - 7.6 19.8 4.6 (Figures in %) 5.3.3 To strengthen routine immunization, some newer initiatives have been introduced as part of the State Programme Implementation Plan (PIP). These initiatives are provision of Auto Disable (AD) Syringe to ensure injection safety, support for alternate vaccine delivery from PHC to Sub-Centres and outreach sessions, provision for deploying additional manpower to carryout Immunization activities in urban slums and underserved areas where services are deficient and support for mobilization of children to immunization session sites by Accredited Social Health Activist (ASHA), Women Self Help Groups etc. 5.3.4 Expansion of Hepatitis B Vaccine: Hepatitis B vaccination was introduced in UIP in the financial year 2002-03 as a pilot in 33 districts and 15 cities and was further expanded to all the districts of 10 states namely Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Punjab, Tamil Nadu and West Bengal. Following the recommendation of National Technical Advisory Group on Immunization (NTAGI), it has been decided to provide Hepatitis B vaccination all over the country. 5.3.5 Introduction of Measles Second Opportunity: Measles immunization directly contributes to the reduction of under-five child mortality and hence to the achievement of Millennium Development Goal number 4. In order to accelerate the reduction of measles related morbidity and mortality, second opportunity for measles vaccination is being implemented. The NTAGI has recommended the introduction of another dose of measles vaccine through measles Supplementary Immunization Activity (SIA) for States where evaluated coverage for measles vaccine is less than 80% while for the remaining States where coverage is more than 80%, NTAGI recommended a second dose through routine immunization. The 14 states with measles coverage of less than or equal to 80%, viz. Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Madhya Pradesh, Manipur, Meghalaya, Nagaland, Rajasthan, Tripura and Uttar Pradesh are being covered through Supplementary Immunization Activity, in a phased manner followed by introduction of second dose at 16-24 months in routine immunization. 5.3.6 Introduction of Japanese Encephalitis (JE) Vaccine: JE vaccination was started in 2006 to cover 109 endemic districts in phased manner, using SA 14-14 -2 vaccine, imported from China. Single dose of JE vaccine was given to all children between 1 to 15 years of age through campaigns followed by one dose at 16-24 months under routine immunization to cover the newer cohort. By the end of 2009-10, 90 districts have been covered under the JE vaccination programme; and remaining 19 districts are being covered in 2010-11. In Annual Report 2010-11 73 addition, in 2010-11 re campaign has been planned in 9 districts; 7 in Uttar Pradesh and two in Assam, in view of their low coverage as per the coverage evaluation survey conducted in 2008. The JE vaccine is being integrated into routine immunization in the districts where campaign had already been conducted to immunize the new cohort of children by vaccinating with single doses at 16 -24 months. 5.4 PULSE POLIO IMMUNIZATION(PPI) In the pursuance of the World Health Assembly resolution of 1988, the Pulse Polio Immunization (PPI) Programme was started nation-wide from 1995 to eradicate polio in India covering children in the age group 0-3 years. In order to accelerate the pace of polio eradication, all children under the age of 5 years were targeted since 1996-97. The annual strategy on polio eradication is decided on the basis of recommendation of India Experts Advisory Group (IEAG) which constituted of Indian experts and international experts. The National Polio Surveillance Project (NPSP) provides technical support for high quality Acute Flaccid Paralysis (AFP) surveillance & assists the government in micro planning, training & monitoring of polio immunization campaign. Since the PPI initiative in 1995, significant success has been achieved in reducing the number of polio cases in the country & total cases decline gradually. Of the 3 types of polio causing viruses, type 2 (WPV-2) has already been eradicated in 1999. The bivalent vaccine (bOPV) was introduced in the country for the first time in 2010. In 2010, two National Immunization Days (NIDs) and six sub-national Immunization Days (SNIDs) have been conducted. The NID rounds covers approximately 170 million children and SNID rounds cover 40-80 million children. In addition, large scale multi-district mop-ups have been conducted in response to detection of the WPVs. As a result of these interventions remarkable progress has been made towards polio eradication with only 41 polio cases detected (as on 24th December 2010) compared to 650 cases detected during the same period in 2009. Details are given in the table below. The most significant progress is seen in the endemic states with no type 1 case detected in UP since November 2009 and one type 1 case detected in 2010 in Bihar with onset of July 2010. The major risks to eradication of type 1 polio are transmission in West Bengal and Jharkhand areas and re-introduction of type 1 polio from neighboring Nepal or West Bengal through extensive migration and population movements. 5.5 INFANT AND YOUNG CHILD FEEDING (IYCF) 5.5.1 Promotion of infant and young child feeding (IYCF) practices. The following are emphasized under IYCF: Early initiation of breastfeeding within one hour of delivery Exclusive breastfeeding of the first six months of life Timely and adequate complementary feeding along with continuation of breast feeding up to two years of life Comparison of indicators of child feeding practices: Table: State-wise details of polio cases in 2010 (as on 24th December 2010) S. State WPV-1 WPV-3 Total No 1 Uttar Pradesh 0 10 10 2 Bihar 3 6 9 3 West Bengal 5 2 7 4 Jharkhand 3 5 8 5 Maharashtra 5 0 5 6 Haryana 0 1 1 7 Jammu & Kashmir 1 0 1 Total 17 24 41 NFHS I NFHS II NFHS III (1992-93) (1998-99) (2005-06) Indicators Rural Urban Total Children under 3 years breastfeeding within one hour of birth (%) 9.5 16.0 21.5 28.9 23.4 Children aged 0-5 months exclusively breastfeeding (%) N.A N.A 40.7 31.1 38.4 Annual Report 2010-11 74 5.6 IRON AND FOLIC ACID SUPPLEMENTATION 5.6.1 To manage the widespread prevalence of anaemia in the country, Iron and Folic Acid supplementation is provided for at least hundred days in a year for all age groups, i.e infants above six months of age up to adolescence and pregnant and lactating mothers as well as IUD users. 5.6.2 Infant from the age of 6 months onwards up to the age of five years shall receive iron supplements in liquid formulation in doses of 20 mg elemental iron and 100 mcg folic acid (per day) for 100 days in a year. Children 6-10 years of age shall receive iron in the dosage of 30 mg elemental iron and 250 mcg folic acid for 100 days in a year and adolescents 11-18 years shall receive supplements at the same dosage and durations as adults. 5.7 COLD CHAIN SYSTEM VACCINE STORAGE AT PHC/CHC LEVEL 5.7.1 The cold chain system consists of a series of transportation & storage facilities for vaccines from the manufacturers to the beneficiaries at a recommended temperature. Now this year nearly 15000 equipments were procured and are being supplied to states for upgradation of cold chain system in the country. More than 87000 units consisting of the following equipments are there in the states for storing the vaccines at various levels. I. Walk in Coolers and Walk-in - Freezers Rooms: These are supplied at State/Regional Level to maintain a vaccine stock required for 3 months in its catchment area. There are at present 161 walk in coolers and 36 walk in freezers installed at various location of the states in the country. II. Ice Lined Refrigerators (Large) and Deep Freezers (Large) at the district Level: 8700 number ILRs (L) and Deep Freezers (L) have been supplied. At the district stores Deep Freezers are also used for storing Polio Vaccine at below (-) 15 Centigrade. III. A Twin Set of ILR/Deep Freezers: These have been supplied in pairs to all PHCs, where a stock of one months requirement of vaccines is maintained. 79000 such units have been supplied to different health institutions. IV. Skill based training to cold chain technicians was provided to equip with repair management skills on CFC free equipments. Cold chain stores renovation has also been initiated in the States as per their requirements. Annual Report 2010-11 75 Chapter 6 6.1 INTRODUCTION Several National Health Programmes such as the National Vector Borne Diseases Control, Leprosy Eradication, TB Control, Blindness Control and Iodine Deficiency Disorder Control have now come under the umbrella of National Rural Health Mission. 6.2. NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMME (NVBDCP) The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of vector borne diseases namely Malaria, Filaria, Kala- azar, Japanese Encephalitis (JE), Dengue and Chikungunya which is covered under the overall umbrella of NRHM. The States are responsible for implementation of programme whereas the Directorate of NVBDCP, Delhi provides technical assistance, policies and assistance to the States in the form of cash & commodity, as per approved pattern. Malaria, Filaria, Japanese Encephalitis, Dengue and Chikungunya are transmitted by mosquitoes whereas Kala-azar is transmitted by sand- flies. The transmission of vector borne diseases in any area is dependent on frequency of man-vector contact, which is further influenced by various factors including vector density, biting time, etc. The general strategy for prevention and control of vector borne diseases under NVBDCP is described below: (i) Disease Management including early case detection and complete treatment, strengthening of referral services, epidemic preparedness and rapid response. (ii) Integrated Vector Management including Indoor Residual Spraying (IRS) in selected high risk areas, use of Insecticide Treated Bed Nets (ITNs), Long Lasting Insecticidal Nets (LLINs), use of larvivorous fish, anti larval measures in urban areas including bio-larvicides and minor and environmental engineering. National Programmes National Programmes National Programmes National Programmes National Programmes Under NRHM Under NRHM Under NRHM Under NRHM Under NRHM (iii) Supportive Interventions including Behaviour Change Communication (BCC), Public Private Partnership (PPP) & Inter-sectoral Convergence, Human Resource Development through capacity building, Operational Research including studies on drug resistance and insecticide susceptibility and Monitoring & Evaluation. 6.2.1. Malaria a. Malaria is an acute parasitic illness caused by Plasmodium falciparum or Plasmodium vivax in India. Nine major species of anopheline mosquitoes transmit malaria in India. The main clinical presentation is with fever with chills; however, nausea and headache can also occur. The diagnosis is confirmed by microscopic examination of a blood smear and Rapid Diagnostic Tests for Pf cases. Majority of the patients recover from the acute episode within a week. Malaria continues to pose a major public health threat in different parts of the country, particularly due to Plasmodium falciparum as it is sometimes prone to complications and death, if not treated early. b. There are 9 species of Malaria vectors in India, out of which the major vector mosquito for rural malaria viz. Anopheles culicifacies, is distributed all over the country and breeds in clean ground water collections. Other important Anopheline species namely An.minimus and An.fluviatilis breed in running channels, streams with clean water. Some of the vector species also breed in forest areas, mangroves, lagoons, etc, even in those with organic pollutants. c. In urban areas, malaria is mainly transmitted by Anopheles stephensi which breeds in man-made water containers in domestic and peri-domestic situations such as tanks, wells, cisterns, which are more or less of permanent nature and hence can Annual Report 2010-11 76 maintain density for malaria transmission throughout the year. Increasing human activities, such as urbanization, industrialization and construction projects with consequent migration, deficient water and solid waste management and indiscriminate disposal of articles (tyres, containers, junk materials, cups, etc.) create mosquitogenic conditions and thus contribute to the spread of vector borne diseases. The National Health Policy (2002) has set the goal of reduction in mortality on account of malaria by 50% by 2010. Reduction of malaria morbidity and mortality is also important to meet the overall objectives of reducing poverty and is included in the Millennium Development Goals (Goal 6 and target 8). Epidemiological Situation: The status of total cases, Pf cases, deaths and API from 1996 to 2010 (up to September) is given in the table and the Graph as follows. The state-wise data on malaria cases & deaths since 2007 is at Appendix- 1. Pre-independence estimates of Malaria were about 75 million cases and 0.8 million deaths annually. The problem was virtually eliminated in the mid sixties but resurgence led to an annual incidence of 6.47 million cases in 1976. Modified Plan of Operation was launched in 1977 and annual malaria incidence started declining. The cases were contained between 2 to 3 million cases annually till 2001 afterwards the cases have further started declining. During 2009, the malaria incidence was around 1.56 million cases, 0.84 million Pf cases and 1144 deaths. About 92% of malaria cases and 97% of deaths due to malaria are reported from high disease burden states namely, north eastern (NE) States, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Andhra Pradesh, Maharashtra, Gujarat and Rajasthan, West Bengal and Karnataka. However, other States are also vulnerable and have local and focal outbreaks. Resistance in Plasmodium falciparum to Chloroquine is being detected from more areas and Artesunate Combination Therapy has been introduced in such areas as first line treatment. For strengthening surveillance, Rapid Diagnostic Test (RDT) for diagnosis of P.falciparum malaria has also been introduced in high endemic areas. In these areas, ASHAs have been trained in diagnosis and treatment of malaria cases and are thus involved in early case detection and treatment. The Government of India provides technical assistance and logistics support including anti malaria drugs, DDT, larvicides, etc. under the National Vector Borne Disease Control Programme. State Governments have to meet other requirements of the programme and operational costs and to ensure the implementation of programme. North-eastern states are provided 100 per cent central assistance for programme implementation that includes operational cost. Malaria Situation in the country during 1996-2010* Year Cases (in million) Deaths API Total Pf 1996 3.03 1.18 1010 3.48 1997 2.66 1.01 879 3.01 1998 2.22 1.03 664 2.44 1999 2.28 1.14 1048 2.41 2000 2.03 1.04 932 2.09 2001 2.09 1.01 1005 2.12 2002 1.84 0.90 973 1.82 2003 1.87 0.86 1006 1.82 2004 1.92 0.89 949 1.84 2005 1.82 0.81 963 1.68 2006 1.79 0.84 1707 1.66 2007 1.50 0.74 1311 1.39 2008 1.53 0.78 1055 1.36 2009 1.56 0.84 1144 1.36 2010* 1.04 0.53 547 * Data for 2010 up to September Annual Report 2010-11 77 The major externally supported projects: Additional support for combating malaria is provided through external assistance in high malaria risk areas. There are two such externally funded projects which are currently being implemented for malaria control: (i) Global Fund Supported Intensified Malaria Control Project (IMCP) (ii) World Bank Supported Project on Malaria Control & Kala-azar Elimination. The areas covered under these projects are as under: TWO PROJECTS WITH EXTERNAL ASSISTANCE The Global Fund supported Intensified Malaria Control Project (IMCP) This project is for a period of 5 years starting from July, 05 to June, 2010. The total financial outlay of this project is Rs. 277.20 crores. The project is being implemented in 106 districts in 10 States namely, 7 North-Eastern States and in selected high risk areas of Orissa, Jharkhand and West Bengal covering a population of about 100 million. The goal of the project is to reduce malaria morbidity and mortality in 100 million populations in 10 States by 30% in 5 years. Additional Support provided in project area is listed below: Human resource such as Consultants and support staff for project monitoring units. Capacity building of Medical Officers/Lab. Technicians/ Fever Treatment Depots/Volunteers etc. Commodities such as Synthetic Pyrethroid liquid formulation insecticide for treatment of bednets, Long-Lasting Insecticidal Nets (LLINs), Rapid Diagnostic tests for quick diagnosis of Malaria, alternate drugs (Artesunate Combination Therapy, Inj. Arteether) for treating malaria cases resistant to Chloroquine. Planning & administration including mobility support, monitoring, evaluation and operational research (studies on drug resistance and entomological aspects). This project has ended in June 2010. This Intensified Malaria Control ProjectII (IMCP-II) will be implemented for a period of five years (2010-2015). Achievements of IMCP: (Project end): Under this project in five years followings have been achieved: (i) Provision of 5145475 ITNs (including 6,75,004 LLINs) to targeted population in project areas (ii) 2,16,42,050 bed nets treated with insecticides in project area during the project period Annual Report 2010-11 78 (iii) Treatment with SP-ACT in 970450 uncomplicated Pf cases (iv) Treatment with artemisinin injections in 343930 severe malaria cases (v) 4890 medical officers of public and private healthcare sectors trained (vi) 137 recruited and trained for the supervision in project areas (vii) 3261 LTs trained in malaria microscopy (viii) 9601 service deliverers of local NGOs/CBOs identified and trained (ix) 2,13,997 community volunteers trained in malaria control strategies (x) 70860 awareness camps organized at village level for treating bed-nets. The impact in terms of epidemiological indicators for the project areas based on the data received up to July 2009 are shown in the following table: The enhanced inputs under the project ie, introduction of RDT for early diagnosis and complete treatment with ACT (SP + Artesunate) regimen and injection Artemisinine derivatives along with use of ITN/LLINs as personal protective measures have helped to achieve decline in malaria incidence by 23.4%, with overall declining trend in SPR, SfR with improvement in process indicator ABER indicating improved surveillance. The World Bank Supported Project on Malaria Control & Kala-azar Elimination This project has been approved for 5 years effective from March 2009 to December 2013. The total financial outlay for this project is Rs.1000 crore. This project is being implemented in 93 malarious districts of eight (8) states namely Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa & Karnataka and 46 Kala-azar districts in three states namely Bihar, Jharkhand and West Bengal. The project will be implemented in two phases. Phase one is covering 50 most malaria endemic districts in five States namely Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Orissa and Jharkhand and 46 kala-azar districts in Bihar, Jharkhand & West Bengal. From 3 rd year, phase two shall be implemented in remaining (43) malaria districts. Additional support provided in this project are: i) Provision of Human Resource like Consultants & Support staff at National, State, District & Sub District level for surveillance & monitoring. ii) Promotion & use of long lasting Insecticide Nets (LLINs) in high malaria endemic areas. Table: Status of Epidemiological Indicators of malaria In IMCP (2002-09) Indicator 2002 2003 2004 2005 2006 2007 2008 2009 % Change from 2002 Population (In,000s) Project 83838 89619 90807 93533 101887 103925 106004 105645 26.0 ABER Project 7.76 7.72 7.20 8.87 9.28 8.61 8.47 9.89 27.45 Annual Parasite Incidence (API) 5.25 5.33 4.98 4.88 4.95 4.05 3.43 4.02 - 23.42 Project Slide Positivity Rate (SPR) Project 6.77 6.90 6.79 5.51 5.33 4.70 4.05 4.07 -39.88 Slide falciparum Rate (SfR) Project 3.41 3.33 3.32 2.55 2.79 2.52 2.41 2.63 -22.87 Malaria Mortality Project 478 484 395 426 1124 ** 691 389 563 +17.78 ** Due to epidemic situation in Assam Annual Report 2010-11 79 Year Population Total P.f P.F %SPR SFR Deaths cases 2008 113334073 113810 18963 13.42 1.66 0.22 102 2009 114699850 166065 31134 18.75 2.98 0.56 213 *2010115159555 111486 15332 13.75 2.81 0.39 118 *Provisional up to October, 2010 iii) Social mobilization and vulnerable community plan to address the issues of marginalized sections. iv) Strong BCC/IEC activities at Sub district level through identified agencies. v) The project also envisaged the safe guard policies by undertaking Environmental Management Plan (EMP) on safe disposal & environmental hazards. vi) Capacity building of Medical Officers /Lab Technicians/Fever Treatment Depots/Volunteers etc. vii) Supply of rapid kits for Malaria and drug Artesunate combination therapy (ACT) for treatment of PF cases. 6.2.2. Urban Malaria Scheme The Urban Malaria Scheme (UMS) under NVBDCP is being implemented in 131 towns in 19 States and Union Territories protecting 115.1 million population. Objectives: The main objectives were reduction of the disease to a tolerable level in which the human population in urban areas can be protected from malaria transmission with the available means. The Urban Malaria Scheme aims at: a). To prevent deaths due to malaria. b). Reduction in transmission and morbidity. Epidemiological Situation About 10% of the total cases of malaria are reported from urban areas. Maximum numbers of malaria cases are reported from Ahmedabad, Chennai, Kolkata, Mumbai, Vadodara, Vishakapatnam, Vijayawada etc. The comparative epidemiological profile of malaria during 2008-2010 in all urban towns of the country is given below: Control Strategy: Under UMS, Malaria Control strategies are for: (i) Parasite control & (ii) Vector control (i) Parasite control: Treatment is done through passive agencies viz. hospitals, dispensaries both in private & public sectors. In mega cities malaria clinics are established by each health sector/ malaria control agencies viz. Municipal Corporations, Railways, Defence services (ii) Vector control comprises of source reduction, use of larvicides, use of larvivorous fish, space spray, minor engineering and Legislative measures. The control of urban malaria depends primarily on the implementation of urban bye-laws to prevent mosquito breeding in domestic and peri-domestic areas or residential blocks and government/commercial buildings, construction sites. Use of larvivorous fish in the water bodies such as natural water bodies, slow moving streams, lakes, ornamental ponds/fountains etc. is also recommended. Larvicides are used for water bodies, which are unsuitable for use of larvivorous fish. Awareness campaigns are also undertaken by Municipal Bodies/Urban area authorities.The Bye-laws have been enacted and implemented in Delhi, Mumbai, Chandigarh, Ahmedabad, Bhavnagar, Surat, Rajkot, Bhopal, Agartala and Goa. Central Cross Checking Organization (CCCO): The Central Cross Checking Organization of the Directorate of National Vector Borne Disease Control Programme regularly cross check of anti-larval operations in Municipal Corporation of Delhi (MCD), New Delhi Municipal Council (NDMC), Northern Railways, Cantonment Areas as well as Zoological Park, Indian Institute of Technology Delhi, All India Radio, Jawahar Lal Nehru University and Presidents Estate in NCT Delhi and near by townships /localities of National Capital Region namely Ghaziabad and Noida in Uttar Pradesh, Faridabad, Gurgaon and Sonepat in Haryana to provide feedback about the larval density/ breeding indices and remedial measures to be undertaken by them. The monthly Annual Report 2010-11 80 entomological indices of National capital territory of Delhi for Aedes aegypti are as below from 2009 & 2010. Followings are the vector control strategies for NCT Delhi: Weekly recurrent application of larvicides like temephos and mosquito larvicides oil in different breeding habitats. Use of Larvivorous fish Gambusia affinis, and Poecila reticulate (Guppy) in ornamental tanks, ponds and other water collections. Filling up of unused well and water pools, desilting and deweeding of the margins of the drains. Use of legislative measures and prosecution of defaulters; for creating mosquitogenic conditions in domestic places. S.No. Month 2008 2009 2010* HI CI BI HI CI BI HI CI BI 1. January 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1 2. February 0.04 0.03 0.04 0.02 0.03 0.03 0.03 0.02 0.03 3. March 0.11 0.13 0.14 0.09 0.07 0.0 90.1 0.1 0.2 4. April 0.54 0.48 0.56 0.16 0.13 0.16 0.5 1.00.2 0.6 5. May 1.2 1.1 1.3 0.5 0.4 0.5 1.2 0.81.0 1.6 6. June 4.8 5.0 5.8 1.0 1.1 1.3 0.9 2.80.8 1.2 7. July 4.4 5.2 7.7 1.1 1.1 1.3 1.9 9.82.8 4.6 8. August 4.5 5.2 7.8 3.1 4.1 6.2 6.4 9.79.8 25.0 9. September 4.1 4.4 5.8 3.2 4.9 8.5 7.6 2.9.7 23.9 10. October 2.3 2.3 2.1 1.6 1.7 2.3 2.5 2.1 3.1 11. November 0.5 0.6 0.06 1.1 1.0 1.3 12. December 0.04 0.03 0.04 0.4 0.4 0.6 HI= HOUSE INDEX, CI= CONTAINER INDEX, BI= BRETEAU INDEX *Provisional up to October 2010 Vector Control Strategy Table showing breeding indices of Aedes aegypti in NCT Delhi 2008, 2009 and 2010 Spray with pyrethrum in and around 50 house of a positive malaria case. Use of fogging in case of very high density of vector mosquitoes (Aedes aegypti and An. Stephensi). 6.2.3. El i mi nat i on of Lymphat i cFilariasis 6.2.3.a.Lymphatic Filariasis is transmitted mainly by mosquito Culex quinquefasciatus which breeds in polluted water in drains, cesspits etc., in areas with inadequate drainage, sanitation.However, in some parts of Kerala Mansonia annulifera / M.uniformis also transmits the disease and the vector mosquitoes breed in water pools with aquatic vegetation. The disease is reported to be endemic in 250 districts in 20 States and UTs. The population of about 600 million in these districts Annual Report 2010-11 81 is at risk of lymphatic filariasis. This disease causes personal trauma to the affected persons and is associated with social stigma, even though it is not fatal. 6.2.3.b. The target year for Global elimination of this disease is by the year 2020. Government of India is signatory to the World Health Assembly Resolution in 1997 for Global Elimination of Lymphatic Filariasis. The National Health Policy (2002) has envisaged elimination of lymphatic fialriasis in India by 2015. The Elimination is defined as Lymphatic Filariasis ceases to be a public health problem, when the number of microfilaria carriers is less than 1% and the children born after initiation of ELF are free from circulating antigenaemia (presence of adult filaria worm in human body). 6.2.3.c.The strategy of lymphatic filariasis elimination is through: Annual Mass Drug Admi ni st r at i on (MDA) of single dose of antifilarial tablets i.e. DEC + Albendazole for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease. Home based management of lymphoedema cases and up-scaling of hydrocele operations in identified CHCs/ District Hospitals /Medical Colleges. States/UTs): 20 Districts: 250 Pop.: 600 million 6.2.3.d. To achieve elimination of Lymphatic Filariasis, the Government of India during 2004 launched annual Mass Drug Administration (MDA) with annual single recommended dose of DEC tablets in addition to scaling up home based foot care and Hydrocele operation. The co-administration of DEC+ Albendazole has been upscaled to cover the population at risk. However, Mass Drug Administration (MDA) - 2009 round was observed in 18 States/UTs except Assam and Uttar Pradesh with co-administration of DEC with Albendazole. The coverage achieved in these states for MDA is 88.6% against the targeted population. The MDA coverage was 72.4% in 2004, 76% in 2005, 82% in 2006, 83% in 2007 and 86% in 2008. The state wise coverage is indicated in Appendix-2. The MDA 2010 round has started from 11 th November, 2010. 6.2.3.e. The line listing of lymphoedema and Hydrocele cases were initiated since 2004 by door to door survey in these filaria endemic districts. The enlisted cases are regularly being updated by state health authorities and more cases are being r e c o r d e d . T h i s increase is mainly due t o incomplete s u r v e y s during initial years and rel uct ance on part of Annual Report 2010-11 82 community to reveal their manifestations of lymphoedema and Hydrocele. The updated figure till 2009 revealed that 7.62 lakhs lymphoedema and 3.93 lakhs Hydrocele cases have been enlisted. The initiatives have also been taken to demonstrate the simple washing of foot to maintain hygiene for prevention of secondary bacterial and fungal infection in chronic lymphoedema cases so that the patients get relief from frequent acute attacks. The states regularly update the list and intensify the hydrocele operations in their respective states. 6.2.3.f. The microfilaria survey in all the implementation units (districts) is being done through night blood survey before MDA. The survey is done in 4 sentinel and 4 random sites collecting total 4000 slides (500 from each site). There is definite evidence of microfilaria reduction in the MDA districts. However, the coverage of population with MDA should be above 80% persistently for 5-6 year which would reduce microfilaria load in community and thereby, interrupting the transmission. 6.2.4. Kala-Azar 6.2.4.a.Kala-azar is caused by a protozoan parasite Leishmania donovani and spread by sandfly, which breeds in shady, damp and warm places in cracks and crevices in the soft soil, in masonry and rubble heaps, etc. Proper sanitation and hygiene are critical to prevent sand fly breeding. The National Health Policy (2002) of GoI has set the goal for elimination of Kala-azar from the country by 2010. In pursuance to achieve the elimination goal, case detection and treatment compliance has been strengthened and Rapid Diagnostic Test for Kala-azar and oral drug miltefosine have been introduced. World Bank is providing assistance in 46 districts in 3 states namely Bihar, Jharkhand and West Bengal. Kala-azar is endemic in 52 districts (31 in Bihar, 4 in Jharkhand, 11 in West Bengal and 6 in UP). The Kala- azar Control Programme was launched in 1990-91. The annual incidence of disease came down from 77,099 cases in 1992 to 33598 cases in 2008 and deaths from 1419 to 151 in 2008 respectively. In the year 2009, 24212 cases and 93 deaths were reported, whereas in 2010 upto October, 23375 cases and 78 deaths have been reported - Appendix 3. 6.2.4.b. To realize the goal of elimination of Kala-azar, the Govt. of India is providing 100% support to endemic states since 2003-04. 6.2.4.c. Initiatives undertaken for Kala-azar elimination are as follows: Active Case Search: The frequency of case searches has been increased, from a single annual case search to quarterly case searches. The active case searches are carried out during a fortnight designated as the Kala-azar Fortnight, during which the peripheral health workers and volunteers are engaged to make door-to-door search and refer the cases conforming to case definition of kala- azar and PKDL to the treatment centres for definitive diagnosis and treatment. Institutional Surveillance through passive case detection: Majority of the Kala-azar cases are reported from PHCs and district hospitals. Annual Report 2010-11 83 Many private practitioner, NGO, FBOs have also been advised to report cases to the district health authorities. Treatment: To ensure complete treatment compliance a patient coding scheme has been put in place in all the treatment cetnres. Vector Control: Two rounds of DDT spray are undertaken in affected villages of the endemic district, at a dosage of 1g/m 2 . A health education programme with personal contacts as well as through mass media has been initiated to create awareness of the disease amongst the public, emphasizing the need for early case detection, acceptance of a full course of treatment and other control measures. Intensive training programme for all levels of health staff has been undertaken including one inter- country training and one inter-country training on Standard Operation Procedures (SOP). Introduction of rapid diagnosis test for Kala-azar and oral drug miltefosine in 10 pilot districts of 3 endemic states. An incentive for an amount of Rs.200/- is being provided to the Health Workers/ASHAs for referring a susceptive case of kala-azar and to ensure complete treatment after confirmation. The kala-azar activist/ Accredited Social Health Activist (ASHA) under the National Rural Health Mission (NRHM) will be provided incentives to involve them in the various activities for control of kala-azar. 6.2.5. Japanese Encephalitis (JE) 6.2.5.a.Japanese Encephalitis is a zoonotic disease which is transmitted by vector mosquito mainly belonging to Culex vishnui group. The transmission cycle is maintained in the nature by animal reservoirs of JE virus like pigs and water birds. Man is the dead end host, i.e. JE is not transmitted from one infected person to other. Outbreaks are common in those areas where there is close interaction between animals/birds and human beings. The vectors of JE breed in large water bodies such as paddy fields. The population at risk is about 300 million. 6.2.5.b. Case definition of AES: Clinically, a case of AES is defined as a person of any age, at any time of the year with the acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, coma or inability to talk), and/or new onset of seizures (excluding/simple febrile seizures). Other early clinical findings may include an increase in irritability, somnolence or abnormal behaviour greater than that seem with usual febrile illness. A simple febrile seizure is defined as a seizure that occurs in a child aged 6 months to less than six years old, whose only findings is fever and a single generalized convulsion lasting less than 15 minutes and who recovers consciousness within 60 minutes of the seizure. (Reference Guidelines for surveillance of Acute Encephalitis Syndrome with special reference to Japanese Encephalitis, Dte. of NVBDCP, Dte. General of Health Services, MOH&FW, November, 2006). 6.2.5.c. Epidemiological Situation: JE has been reported from different parts of the country. The disease is endemic in 14 states of which Assam, Bihar, Haryana, and Uttar Pradesh have been reporting outbreaks. During the year 2008, the reported AES figures indicated 3839 cases and 684 deaths. In the year 2009, 4482 cases and 774 deaths were reported. In 2010 (upto November, 2010) 4686 cases and 645 death were reported. State-wise JE cases and deaths are given in Appendix - 4. Annual Report 2010-11 84 6.2.5.d. There is no specific cure for this disease. Symptomatic and early case management is very important to minimize risk of death and complications. Govt. of India launched JE vaccination programme as an integral component of Universal Immunization Programme (UIP) with single dose live attenuated JE (SA- 14-14-2) in 11 endemic districts of 4 States namely Uttar Pradesh, Assam, West Bengal and Karnataka for children between 1 and 15 years of age and 88.39% coverage was achieved. During 2007, 28 more districts were covered with 84.28% coverage and during 2008 and 2009 children between 1-15 years in 21 and 70 districts respectively vaccinated bringing the total number vaccinated districts to 90. During 2010 out of 19 districts, 5 districts in Manipur, 2 districts in Assam and 1 district in uttarakhand have been covered under vaccination campaign. In addition 7 districts in Uttar Pradesh under special JE vaccination campaign during 2010-11. 6.2.5.e.In addition, implementation of public health measures such as, Health Education through different media like radio, TV including cable network, miking, inter- personal communication, etc for disseminating appropriate messages in the community is crucial. The emphasis is given on keeping pigs away from human dwellings or in pigsties particularly during dusk to dawn which is the biting time of vector mosquitoes. Sensitization of the community regarding avoidance of man-mosquito contact by using bet nets and fully covering the body are also advocated. Since early reporting of cases is crucial to avoid any complication and mortality, community is given full information about the signs and symptoms as well as availability of health services at health centres/hospitals. Besides, the states are advised fogging with malathion (technical) as an outbreak control measure in the affected areas. 6.2.6. Dengue Fever/Dengue Haemorrhagic Fever 6.2.6.a.Dengue Fever is an outbreak prone viral disease, transmitted by Aedes aegypti mosquitoes. Aedes aegypti mosquitoes prefer to breed in manmade containers, viz., cement tanks, overhead tanks, underground tanks, tyres, desert coolers, pitchers, discarded containers, junk materials etc, in which water stagnates for more than a week. This is a day biting mosquito and prefers to rest in hard to find dark areas inside the houses. The risk of dengue has shown an increase in recent years due to rapid urbanization, life style changes and deficient water management including improper water storage practices in urban, peri-urban and rural areas, leading to proliferation of mosquito breeding sites. The disease has a seasonal pattern i.e., the cases peak after monsoon and it is not uniformly distributed throughout the year. Dengue is a self limiting acute disease characterized by fever, headache, muscle & joint pains, rash, nausea and vomiting. Some infections results in Dengue Haemorrhagic Fever (DHF) and in its severe form Dengue Shock Syndrome (DSS) can threaten the patients life primarily through increased vascular permeability and shock due to bleeding from internal organs. Though during last 2 years numbers of cases are increasing the deaths are declining. The case fatality rate which was 3.3 % in 1996 had come down to 0.6 in 2009 and 0.4 till November 2010 because of better Annual Report 2010-11 85 management of Dengue cases in the country following National guidelines. The risk of Dengue has been increased in recent year. 6.2.6.b. Epidemiological Situation: Dengue is endemic in 29 States/UTs. After 1996, Outbreak with a total number of 16517 cases and 545 deaths upsurge of cases were recorded in 2003, 2005 and 2008. In 2009 total 15535 cases and 99 deaths have been reported. During 2010, till November 25725 cases and 99 deaths have been reported (Appendix-5). Maximum cases were reported by Delhi (6221) followed by Punjab (4022), Kerala (2501), Gujarat (2269) and Karnataka (2177). 6.2.6.c. There is no specific anti-viral drug or vaccine against dengue infection. Mortality can only be minimized by early diagnosis and prompt symptomatic management of the cases. A strategic action plan has been developed for prevention and control of Dengue and issued to the endemic States for implementation. Guidelines for clinical management of dengue fever/ dengue haemorrhagic fever and dengue shock syndrome cases have been developed and sent to the states for wider circulation. Advisories have been sent to the endemic areas for effective vector control through inter-sectoral collaboration and active community involvement, regular monitoring of Dengue cases as well as entomological parameters to forecast likely outbreaks and to take timely remedial measures. The States have been communicated to undertake widespread campaigns for community awareness and mobilization through different media like mass media, miking, inter-personal communication, etc. The emphasis is on elimination of mosquito breeding sources like avoidance of water collection in and around houses, removal of all discarded and disposed/junk materials, keeping all water containers/storage facilities tightly covered and cleaning the water coolers at least once a week before re-filling. Since early reporting of cases is crucial to avoid any complication and mortality, the community is given full information about the signs and symptoms as well as availability of health services at health centres/ hospitals. Alerting the Hospitals for making adequate arrangements for management of Dengue/ Dengue Haemorrhagic Fever cases have also been advised. The Directorate of National Vector Borne Disease Control has provided detailed guidelines for the prevention and control of dengue to the affected states. Intensive health education activities through print, electronic and inter- personnel media, outdoor publicity as well as an inter- sectoral collaboration with civil society organization (NGOs/CBOs/Self-Help Groups), PRIs and Municipal bodies have been emphasized. Regular supervision and monitoring is conducted. The Government of India in consultation with States has identified 182 sentinel surveillance hospitals with laboratory support for augmentation of diagnostic facilities in the endemic states. Further, for advanced diagnosis and backup support 13 Apex Referral Laboratories (Appendix-7) have been identified and linked with sentinel surveillance hospitals. To make these functional, test kits are provided through National Institute of Virology, Pune free of cost. Contingency grant is also provided to meet the operational costs. 6.2.7. Chikungunya Chikungunya is a debilitating non-fatal viral illness caused by Chikungunya virus. The disease re-emerged in the country after a gap of three decades. In India a major epidemic of Chikungunya fever was reported during earlier 60s & 70s; 1963 Kolkata; 1965 (Pondicherry and Chennai in Tamil Nadu, Rajahmundry, Vishakapatnam and Kakinada in Andhra Pradesh; Sagar in Madhya Pradesh and Nagpur in Maharashtra) and 1973, (Barsi in Maharashtra). This disease is also transmitted by Aedes mosquito. Both Ae. aegypti and Ae.albopictus can transmit the disease. Humans are considered to be the major source or reservoir of Chikungunya virus. Therefore, the mosquitoes usually transmit the disease by biting infected persons and then biting others. The infected person cannot spread the infection directly to other person (i.e. it is not contagious disease). Symptoms of Chikungunya fever are most often clinically indistinguishable from those observed in dengue fever. Annual Report 2010-11 86 However, unlike dengue, hemmorrhagic manifestations are rare and shock is not observed in Chikungunya virus infection. It is characterized by fever with severe joint pain (arthralgia) and rash. Chikungunya outbreaks typically result in large number of cases but deaths are rarely encountered. Joint pains sometimes persist for a long time even after the disease is cured. Deaths already occur in Chikungunya infection?(plz. check it) 6.2.7.a.During 2006, total 1.39 million clinically suspected Chikungunya cases reported in the country. Out of 35 States/UTs 16 were affected: Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Madhya Pradesh, Gujarat, Kerala, Andaman & Nicobar Islands, Delhi, Rajasthan, Puducherry, Goa, Orissa, West Bengal, Lakshadweep and Uttar Pradesh. There are no reported deaths directly related to Chikungunya. In 2007, total 14 states were affected and reported 59535 suspected Chikungunya fever cases with nil death. Subsequently in 2008, 95091 suspected Chikungunya fever cases and nil deaths have been reported. In 2009 73288 Suspected Chikungunya fever cases and Nil death have been reported. During 2010, 24364 Suspected Chikungunya fever cases have been reported. Maximum cases were reported from Karnataka (35.01%) followed by Maharashtra (24.26) (Appendix-6). 6.2.7.b. As already mentioned, Aedes mosquitoes bite during the day and breed in a wide variety of man-made containers which are common around human dwellings. These containers such as discarded tyres, flower pots, old water drums, family water trough, water storage vessels and plastic food containers collect rain water and become the source of breeding of Aedes mosquitoes. Ae.aegypti played the major role in transmitting the disease in all the states except Kerala, where Ae. albopictus played the major role. Ae. albopictus breeding was detected in latex collecting cups of rubber plantations, shoot-off leaves of areca palm, fruit shells, leaf axils, tree holes etc. There is neither any vaccine nor drugs available to cure the Chikungunya infection. Supportive therapy that helps to ease symptoms, such as administration of non-steroidal anti-inflammatory drugs and getting plenty of rest are found to be beneficial. 6.2.7.c.Government of India is continuously monitoring the situation, sending guidelines and advisories for prevention and control of Chikungunya fever to the states. Since same vector is involved in the transmission of Dengue and Chikungunya strategies for transmission, risk reduction by vector control are also same. A comprehensive Long Term Action Plan for prevention & control of Chikungunya and Dengue/Dengue Haemorrhagic Fever has been prepared and disseminated for guidance to the states. Support in the form of logistics and funds are provided to the states. The central teams are deputed to the affected states for technical guidance of the state health authorities. As most transmission occurs at home, therefore, community participation and co-operation is of paramount importance for successful implementation of programme strategies for prevention and control of Chikungunya. Therefore, considerable efforts have been made through advocacy and social mobilization for community education and awareness. For effective community participation, people are informed about Chikungunya and the fact that major epidemics can be prevented by taking effective preventive measures by community itself. For carrying out proactive surveillance and enhancing diagnostic facilities for Chikungunya, the 182 Sentinel Surveillance hospitals involved in dengue (Appendix-8) in the affected states also carries Chikungunya tests. Both Dengue and Chikungunya Diagnostic kits to these institutes are provided through National Institute of Virology, Pune and cost is borne by GOI. Further, rapid response by the concerned health Annual Report 2010-11 87 authorities has been envisaged on report of any suspected case from the Sentinel Surveillance Hospitals to prevent further spread of the disease. 6.2.7.d. The overall strategies for prevention and control are same as in Dengue such as symptomatic management of cases, reduction of breeding sources, personal protection and intensive IEC and capacity building. Initiatives undertaken by Govt. of India for prevention and control of Dengue/Chikungunya are as follows: 1. Continuous monitoring of Chikungunya and Dengue situation in states. 2. Circulation of guidelines and advisories for prevention and control of diseases to affected states. 3. Launch of intensive IEC and Behaviour Change Communication activities through print, electronic media, interpersonal communication, outdoor publicity as well as inter sectoral collaboration with civil society organizations (NGOs/CBOs/ Self Help Groups), PRIs. 4. Provision of larvicides and adulticides to affected states. 5. Identification and strengthening of Apex Referral Laboratories and sentinel surveillance hospitals for diagnosis and regular surveillance. 6. NIV, Pune has been entrusted for supply of test kits to the identified institutions free of cost. 7. Contingency grant provided to the Apex Referral Laboratories and sentinel surveillance hospitals to meet the operational cost. 8. Training is imparted on various aspects of prevention and control of Dengue and Chikungunya to programme personnel, Medical Officers on Case Management and laboratory personnel on case diagnosis. Annual Report 2010-11 88 STATEs/UTs. 2007 2008 2009 2010(till September) updated on 28.08.10) Cases Deaths Cases Deaths Cases Deaths Cases Death Andhra Prd. 27803 2 26424 0 25152 3 25511 20 Arunachal Prd. 32072 36 29146 27 22066 15 12818 0 Assam 94853 152 83939 86 91413 63 52004 30 Bihar 1595 1 2541 0 3255 21 916 1 Chhattisgarh 147525 0 123495 4 129397 11 77553 10 Goa 9755 11 9822 21 5056 10 1753 1 Gujarat 71121 73 51161 43 45902 34 36603 6 Haryana 30895 0 35683 0 30168 0 7286 0 Himachal Prd. 104 0 146 0 192 0 139 0 J&K 240 1 217 1 346 0 504 0 Jharkhand 184878 31 214299 25 230683 28 128452 9 Karnataka 49355 18 47344 8 36859 0 31298 4 Kerala 1927 6 1804 4 2046 5 1756 4 Madhya Pradesh 90829 41 105312 53 87628 26 52828 0 Maharashtra 67850 182 67333 148 93818 227 102822 149 Manipur 1194 4 708 2 1069 1 770 4 Meghalaya 36337 237 39616 73 76759 192 34866 66 Mizoram 6081 75 7361 91 9399 119 12049 18 Nagaland 4976 26 5078 19 8489 35 3744 4 Orissa 371879 221 375430 239 380904 198 279519 161 Punjab 2017 0 2494 0 2955 0 2990 0 Rajasthan 55043 46 57482 54 32709 18 29007 26 Sikkim 48 0 38 0 42 1 32 0 Tamil Nadu 22389 1 21046 2 14988 1 11308 1 Tripura 18474 51 25894 51 24430 62 19941 4 Uttarakhand 953 0 1059 0 1264 0 1097 0 Uttar Pradesh 82538 0 93383 0 55437 0 36155 0 West Bengal 87754 96 89443 104 141211 74 67920 29 A&N Islands 3973 0 4688 0 5760 0 2089 0 Chandigarh 340 0 347 0 430 0 290 0 D & N Haveli 3780 0 3037 0 3408 0 4307 0 Daman & Diu 99 0 115 0 97 0 132 0 Delhi 182 0 253 0 169 0 191 0 Lakshadweep 0 0 0 0 8 0 6 0 Puducherry 68 0 72 0 65 0 97 0 All India Total 1508927 1311 1526210 1055 1563574 1144 1038753 547 Appendix-1 State-wise Malaria situation in the Country Annual Report 2010-11 89 Appendix-2 Population Coverage (%) during Mass Drug Administration (MDA) Sl. No. States/UTs 2004 2005 2006 2007 2008 2009 1 Andhra Pradesh 84.78 81.05 89.66 89.13 91.96 91.85 2 Assam 25.42 42.94 67.33 78.32 81.34 ND 3 Bihar 81.64 77.82 79.77 77.23 ND 85.17 (partial) 4 Chhattisgarh 84.17 82.80 ND 89.53 91.30 91.53 5 Goa 97.92 95.33 97.17 97.83 97.46 96.32 6 Gujarat 45.47 98.23 69.60 92.11 93.25 97.63 7 Jharkhand 42.25 74.16 72.75 79.03 84.64 84.32 8 Karnataka 85.22 89.31 90.20 89.67 90.53 89.30 9 Kerala 86.10 90.15 ND 92.19 93.67 77.81 10 Madhya Pradesh 73.74 79.29 88.01 88.48 90.14 87.59 11 Maharashtra 78.68 86.48 87.80 88.39 89.71 89.51 12 Orissa 90.11 90.60 87.40 88.47 85.43 89.81 13 Tamil Nadu 95.18 ND ND 77.22 87.61 94.1 14 Uttar Pradesh 66.40 71.03 75.97 79.87 81.67 ND 15 West Bengal 39.58 51.24 ND 76.63 77.79 86.93 16 A&N Islands 85.85 88.31 93.17 98.73 94.10 91.40 17 D & N Haveli 91.13 98.26 94.93 94.16 96.67 95.84 18 Daman & Diu 94.96 73.23 87.17 93.27 91.85 91.56 19 Lakshadweep 64.53 88.23 80.00 86.83 86.32 89.00 20 Puducherry 94.76 96.63 ND 96.30 97.01 96.02 Total 72.41 75.99 81.61 82.75 86.03 88.57 ND: - Not Done YD: - Yet to do RN: - Report not received Annual Report 2010-11 90 Appendix-3 State-wise Kala-azar Cases & Deaths Sl. No State 2007 2008 2009 2010 (upto Oct. updated on 29.11.10) C D C D C D C D 1 Bihar 37819 172 28489 142 20519 80 18738 69 2 W. Bengal 1817 9 1256 3 756 0 1146 4 3 UP 69 1 26 0 17 1 12 0 4 Jharkhand 4803 20 3690 5 2875 12 3426 4 5 Delhi* 19 0 34 0 12 0 33 0 6 Assam 0 0 98 0 26 0 12 0 7 Uttarakhand 2 0 0 0 2 0 0 0 8 Sikkim 0 0 4 1 5 0 3 0 9 Gujarat* 4 1 0 0 0 0 0 0 10 M.P 0 0 1 0 0 0 0 0 11. Himachal Prd. 0 0 0 0 0 0 5 1 INDIA 44533 203 33598 151 24212 93 23375 78 C: Cases D: Deaths *Imported Annual Report 2010-11 91 Appendix-4 STATE-WISE CASES AND DEATHS DUE TO SUSPECTED AES/JE Sl. Affected 2007 2008 2009 2010 No. States/UTs (till 30.11.10) C D C D C D C D 1 Andhra Pradesh 22 0 6 0 14 0 132 5 2 Assam 424 133 319 99 462 92 562 125 3 Bihar 336 164 203 45 325 95 50 7 4 Goa 70 0 39 0 66 3 58 0 5 Haryana 85 46 13 3 12 10 0 0 6 Karnataka 15 3 3 0 246 8 82 1 7 Kerala 2 0 2 0 3 0 19 5 8 Maharashtra 2 0 24 0 1 0 34 17 9 Manipur 65 0 4 0 6 0 116 14 10 Tamil Nadu 42 1 144 0 265 8 290 5 11 Uttarakhand 0 0 12 0 0 0 0 0 12 Uttar Pradesh 3024 645 3012 537 3073 556 3331 460 13 West Bengal 16 2 58 0 0 0 1 0 14 Nagaland 7 1 0 0 9 2 11 6 Grand Total 410 995 3839 684 4482 774 4686 645 C : Cases D : Deaths Annual Report 2010-11 92 Sl. No. State 2007 2008 2009 2010* Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1 Andhra Pd. 587 2 313 2 1190 11 728 3 2 Assam 0 0 0 0 0 0 158 2 3 Bihar 0 0 1 0 1 0 287 0 4 Chhattisgarh 0 0 0 0 26 7 1 0 5 Goa 36 0 43 0 277 5 219 0 6 Gujarat 570 2 1065 2 2461 2 2269 0 7 Haryana 365 11 1137 9 125 1 1079 20 8 J & K 0 0 0 0 2 0 0 0 9 Jharkhand 0 0 0 0 0 0 11 0 10 Karnataka 230 0 339 3 1764 8 2177 6 11 Kerala 603 11 733 3 1425 6 2501 17 12 Madhya Pd. 51 2 3 0 1467 5 171 1 13 Meghalaya 0 0 0 0 0 0 1 0 14 Maharashtra 614 21 743 22 2255 20 1116 6 15 Manipur 51 1 0 0 0 0 5 0 16 Nagaland 0 0 0 0 25 0 0 0 17 Orissa 4 0 0 0 0 0 19 0 18 Punjab 28 0 4349 21 245 1 4022 13 19 Rajasthan 540 10 682 4 1389 18 1253 6 20 Sikkim 0 0 0 0 0 0 0 0 21 Tamil Nadu 707 2 530 3 1072 7 1662 8 22 Uttar Pradesh 132 2 51 2 168 2 941 8 23 Uttrakhand 0 0 20 0 0 0 21 0 24 West Bengal 95 4 1038 7 399 0 612 1 25 A&N Island 0 0 0 0 0 0 25 0 26 Chandigarh 99 0 167 0 25 0 163 0 27 Delhi 548 1 1312 2 1153 3 6221 8 28 D&N Haveli 0 0 0 0 0 0 25 0 29 Puducherry 274 0 35 0 66 0 38 0 TOTAL 5534 69 12561 80 15535 96 25725 99 Appendix-5 State-Wise Dengue Cases And Deaths *provisional upto November Annual Report 2010-11 93 2009 2010* Sl.No Name of Total No. of No. of No. of Total No. of No. of the State Suspected Samples confirmed deaths Suspected Samples confirmed No. of Chikungunya tested cases Chikungunya tested cases deaths fever cases fever cases 1 Andhra Pd. 591 297 117 0 107 107 41 0 2 Goa 1839 1525 685 0 1312 1312 595 0 3 Gujarat 1740 453 169 0 1353 586 248 0 4 Haryana 2 2 0 0 26 26 1 0 5 Karnataka 41230 7714 3164 0 8550 3460 1359 0 6 Kerala 13349 2761 711 0 1521 460 209 0 7 Madhya Pd. 30 30 5 0 31 31 14 0 8 Meghalaya 0 0 0 0 16 16 8 0 9 Maharashtra 1594 766 443 0 5913 1569 768 0 10 Orissa 2306 41 2 0 425 10 4 0 11 Rajasthan 256 256 106 0 365 365 110 0 12 Tamil Nadu 5063 2873 1053 0 4299 3478 736 0 13 Uttar Pradesh 0 0 0 0 1 1 1 0 14 West Bengal 5270 816 338 0 305 305 69 0 15 A&N Island 0 0 0 0 59 0 0 16 Delhi 18 18 18 0 70 70 70 0 17 Lakshadweep 0 0 0 0 0 0 0 0 18 Puducherry 0 0 0 0 11 11 3 0 Total 73288 17552 6811 0 24364 11807 4236 0 *provisional upto November Appendix-6 Epidemiological Profile Of Chikungunya Fever In The Country Annual Report 2010-11 94 Appendix - 7 APEX REFERRAL LABORATORIES (i) All India Institute of Medical Sciences, New Delhi, (ii) National Institute of Communicable Diseases, Delhi (iii) National Institute of Virology, Pune, (iv) National Institute of Mental Health and Neuro-Sceinces, Bangaluru, (v) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, (vi) Postgraduate Institute of Medical Sciences, Chandigarh, (vii) ICMR Virus Unit (NICED), Kolkata, (viii) Kings Institute of Preventive Medicines, Chennai, (ix) Institute of Preventive Medicine, Hyderabad, (x) B.J. Medical College, Ahmedabad, (xi) Kerala State Institute of Virology and infectious diseases, Alleppey, (xii) Defence Research Development and Establishment, Gwalior. (xiii) Regional Medical Research Centre (ICMR), Dibrugarh, Assam. Annual Report 2010-11 95 Name of the State Sentinel Hospitals/Institutes Andhra Pradesh 1. MGM Hospital, Warangal, 2. Ruya Hospital,Tirupathi, 3. Govt.Hospital,Guntur, 4. Govt.Hospital,Vijayawada, 5. Govt. Hospital,Karimnagar, 6. Govt. Hospital,Nizamabad, 7. Govt.Hospital,Annanthpur. 8. VBRI,Hyderabad. 9. Medical College, Kurnool 10. Medical College, Mahboobnagar Goa 1. Hospicio Hospital, Margoa, South Goa. 2. Goa Medical College, Goa 3. Asilo Hospital (North Goa), Mapusa Maharashtra 1. Govt. Medical Vollege, Nagpur, 2. B.J. Medical College, Pune, 3. Govt. Medical College, Aurangabad 4. District Hospital, Akola 5. District Hospital, Nashik 6. Govt. Medical College, Nanded 7. J.J.Hospital, Mumbai 8. District Hospital, Chandrapur 9. Govt. Medical College, Yavatmal 10. District Hospital, Beed 11. Govt. Medical College, Kolhapur 12. Govt. Medical College, Dhule 13. K.E.M. Hospital, Mumbai Name of the State Sentinel Hospitals/Institutes 14. Sion Hospital, Mumbai 15. District Hospital, Thane Gujarat 1. N.H.L. Municipal Med. College, Ahmedabad. 2. Govt. Medical College, Vadodara, 3. Govt. Medical College,Surat, 4. Municipal Med. College,Surat, 5. M.P. Shah Med. College, Jamnagar, 6. Govt. Med. College, Rajkot, 7. Govt. Medical College, Bhavnagar. 8. General Hospital, Palanpur 9. General Hospital, Dahod 10. General Hospital, Bhuj Madhya Pradesh 1. Gandhi Medical College, Bhopal, 2. G.R.Medical College,Gwalior 3. S.S. Medical College, Rewa, 4. N. S.C.B Medical college, Jabalpur 5. M.G.M. Medical College, Indore 6. Khandwa district hospital 7. Betul district hospital 8. Sagar district hospital 9. Guna district hospital 10. Chhindwara district hospital 11.Satna district hospital 12. District Malaria Office, Bhopal Haryana 1. B.K. Hospital, Faridabad. 2. General Hospital, Ambala Appendix-8 List of the Sentinel Hospitals for Dengue and Chikungunya Annual Report 2010-11 96 Name of the State Sentinel Hospitals/Institutes 3. State Bacteriological Laboratory, Karnal 4. General Hospital, Gurgaon 5. General Hospital, Panchkula 6. Medical College, Agroha Delhi 1. Swami Daya Nand Hospital, Shahadra, Delhi 2. Raja Harish Chand Hospital, Narela, Delhi 3. Hindu Rao Hospital , Delhi 4. Sanjay Gandhi Memorial Hospital, Mangol Puri, Delhi 5. Baba Sahib Ambedkar Hospital, Rohini, Delhi 6. Safdarjung Hospital, New Delhi 7. Malviya Nagar Hospital, Malviya Nagar, Delhi 8. SVB Patel Hospital Patel Nagar 9. ABG Hospital, Moti Nagar, Delhi, 10.Ram Manohar Lohia Hospital, New Delhi 11.Lok Nayak Hospital, Jawahar Lal Nehru Marg, Delhi 12.Deen Dayal Upadhyay Hospital, Hari Nagar, Delhi 13.GTB Hospital, Dilshad Garden, Delhi 14.Chacha Nehru Children Hospital, Geeta Colony, Delhi 15.Lal Bahadur Shastri Hospital, Khichirpur, Delhi 16.Maharishi Balmiki Hospital, Pooth Khurd, Delhi 17. Dr. Hedgewar Arogya Sansthan, Karkardooma, Delhi Name of the State Sentinel Hospitals/Institutes 18.Lady Hardinge Medical College and its associated hospital Sucheeta Kriplani Hospital 19.Army Hospital R & R Dhaula Kaun 20.Central Hospital, Northern Railway 21.Guru Govind Singh Govt. Hospital, Raghuvir Nagar, Delhi 22.Babu Jagjivan Ram Memorial Hospital, Jahangirpuri, Delhi 23.Bhagwan Mahavir Hospital, Pitampura, Delhi 24.Jag Parvesh Chander Hospital, (JPC) , Shastri Park Hospital 25.NC.Joshi Memorial Hospital, Karolbagh, Delhi 26.Kasturba Hospital, Near Jama Masjid, Delhi 27.Aruna Asaf Ali Hospital, Rajpur Road, Delhi 28.NDMC Charak Palika Hospital, Moti Bagh, New Delhi 29.Rao Tula Ram Memorial Hospital,Jaffarpur, Delhi 30.G.B.Pant Hospital, Jawahar Lal Nehru Marg, Delhi 31.Base Hospital Delhi Cant., 32.Kalawati Saran Children Hospital 33. ESI Hospital, Basai Darapur Punjab 1. Civil Hospital, Ludhiana 2. Govt. Medical College, Amritsar 3. Govt. Medical Colelge, Patiala 4. Civil Hospital, Bathinda 5. Civil Hospital, Jalandhar Annual Report 2010-11 97 Name of the State Sentinel Hospitals/Institutes 6. Civil Hospital, S.A.S.Nagar (Mohali) Rajasthan 1. SMS Hospital, Jaipur 2. J.K. Lone Hospital 3. Umaid Hospital,Jodhpur 4. SMDM, Jaipur 5. M.B. Hospital, Kota, 6. S.P. Medical College, Bikaner 7. RNT Medical College, Udaipur 8. JLN Medical College, Ajmer 9. General Hospital Bharatpur Kerala 1. Govt. Medical College, Kozhikode 2. Medical College, Kottayam 3.Medical College, Thiruvanthapuram 4.Public Health Lab, Thiruvanthapuram 5. District Hospital, Kollam 6. THQHThodupuzha, Dist. Idukki 7. Regional Public Health Laboratory, Ernakulam 8. District Hospital, Palakkad 9. District Hospital, Manjeri, Malappuram 10. District Hospital, Mananthavady, Dist. Wyanad West Bengal 1. Burdwan Medical College Hospital. 2. School of Tropical Medicine, Kalkata 3. Medical College, Kolkata 4. Nil Ratan Sircar Medical College & Hospital, Kolkata 5. SSKM Medical College & Hospital, Kolkata Name of the State Sentinel Hospitals/Institutes 6. R.G.Kar Medical College & Hospital, Kolkata 7. National MCH, Kolkata 8. Midnapore Medical College & Hospital, Midnapur 9. Bankura Sammilani Medical College & Hospital, Bankura 10.North Bengal Medical College & Hospital, Siliguri Karnataka 1. Central Lab. (Hqrs), Bangaluru 2. Virus Diagnostic Lab, Shimoga 3. Vijay Nagar Institute of Medical Science, Bellary 4. District Surveillance Unit, SNR hospital, Kollar 5. District Surveillance Unit, Belgaum 6. District Surveillance Unit, Mangalore, D Kanada 7. Medical College, Hubli 8. District surveillance Unit Chitradurga 9. District Surveillance Unit Hassan 10. District Surveillance Unit Mysore11. D i s t r i c t Surveillance Unit Bidar 12. District Surveillance Unit Raichur 13. District Surveillance Unit Bijapur 14. District Surveillance Unit Tumkur 15. NIV Field Station, Bangaluru 16. Indira Gandhi Institute of Child Health (IGICH) 17.National Center for Disease Control (NCDC) Annual Report 2010-11 98 Name of the State Sentinel Hospitals/Institutes Tamil Nadu 1. Kanniyakumari Medical College 2. Tirunelveli Medical College 3. Thoothukudi Medical College 4. Thanjavur Medical College 5. Mohan Kumaramangalam Medical College, Salem 6. Coimbatore Medical College 7. K.A.P.Viswanathan Medical College, Trichy 8. Theni Medical College 9. Chengalpattu Medical College 10. Madurai Medical College 11.Vellore Medical College 12. Madras Medical College 13.Institute of Vector Control and Zoonoses, Hosur Bihar 1.Patna Medical college & Hospital Uttar Pradesh 1. Regional Lab. Swasthya Bhawan, Lucknow. 2. District Hospital, Ghaziabad, 3. L.L.R.M., Medical College, Meerut, 4. M.L.B. Medical College, Jhansi, 5. M.L.N.,Medical College, Allahabad. 6. Institute of Medical Sciences, B.H.U., Varanasi. 7. S.N., Medical College, Agra. 8. G.S.B.M., Medical College, Kanpur. Name of the State Sentinel Hospitals/Institutes 9. K.G.M.U., Lucknow. 10. Authority Hospital, Noida Orissa 1. S.C.B. Medical College, Cuttak 2. VSS Medical College, Burla, Sambalpur 3. MKCG, Medical College, Berhampur, Ganjam A&N Islands 1.GB Pant Hospital, Port Blair Lakshadweep 1.Indira Gandhi Hospital, Kavaratti Manipur 1. Regional Institute of Medical Sciences, IMPHAL Puducherry 1. JIPMER, Puduchery 2. General Hospital, Puduchery Jammu & Kashmir 1.Govt. Medical College, Jammu Chattishgarh 1. Pt. J.N.M Medical College, Raipur, 2. Sardar Vallabh Bhai Patel District Hospital, Bilaspur Jharkhand 1.Rajendra Institute of Medical Science (RIMS), Ranchi 2. MGM Medical College, Jamsedpur Assam 1. Gauhati Medical College, Guwahati 2. Assam Medical College, Dibrugarh Uttarakhand 1. Doon Hospital, Dehradun 2. Susheela Tiwari Medical College, Haldwani, Nainital Total 182 Annual Report 2010-11 99 6.3. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP) The National Leprosy Control Programme was launched by the Govt. of India in 1955. Multi Drug Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population, at the National level in the month of December 2005 as set by the National Health Policy, 2002. The National Leprosy Eradication Programme is 100% centrally sponsored scheme. MDT is supplied free of cost by WHO. Following are the programme components (i) Decentralized integrated Leprosy services through General Health Care System. (ii) Training in Leprosy to all General Health Services functionaries. (iii) Intensified Information, Education & Communication (IEC). (iv) Renewed emphasis on Prevention of Disability and Medical Rehabilitation and (v) Monitoring and supervision. 6.3.1. Epidemiological Situation 32 States/UTs have achieved leprosy elimination status. Only 3 States/UT viz. Bihar, Chhattisgarh and Dadra & Nagar Haveli are yet to achieve elimination. Further, out of 633 districts, 510 (80.57%) have also achieved elimination level. At the end of March 2010, there were 87,190 leprosy cases on record (under treatment). In 2009-10, total 1,33,717 new leprosy cases were detected and put under treatment as compared to 1,34184 leprosy cases detected during corresponding period of previous year giving Annual New Case Detection Rate (ANCDR) of 10.93 per 1,00,000 population. Among the new cases detected in 2009-10, the proportions were- MB cases (54.43%), female (35.42%), children (9.97%) and grade II disability (3.08%). Out of 1,47,642 leprosy cases discharged during the year, 1,33,822 cases (90.6%) were released as cured after completing treatment. 2856 reconstructive surgeries were conducted in 2009-10 for correction of disability in leprosy affected persons. The declining trend of Prevalence and Annual New Case Detection Rate per 10,000 population since 1991-1992 is shown in the diagram below: 6.3.1. Activities under NLEP: 6.3.2.a.Diagnosis and treatment of leprosy- Services for diagnosis and treatment (Multi Drug Therapy) are provided by all primary health centres and govt. dispensaries throughout the country free of cost. Difficult to diagnose and complicated cases and cases requiring reconstructive surgery are referred to district hospital for further management. ASHAs under NRHM are being involved to bring out leprosy cases from villages for diagnosis at PHC and follow up cases for treatment completion. ASHAs are being paid incentive for this activity from the programme budget. 6.3.2.b. Training: Training of general health staff like medical officer, health workers, health supervisors, laboratory technicians and ASHAs are conducted every year to develop adequate skill in diagnosis and management of leprosy cases. Training of State & District Leprosy Officers organized at schieffline Institute of Health Research & Leprosy Centre Vellore, Tamil Nadu and RLTRI Raipur. 6.3.2.c.Urban Leprosy Control: To address the complex problems in urban areas, the Urban Leprosy Control activities are being implemented in 422 urban areas having population size of more than 1 lakh. These activities include MDT delivery services & follow up of Annual Report 2010-11 100 patient for treatment completion, providing supportive medicines & dressing material and monitoring & supervision. 6.3.3. Involvement of NGOs Non Governmental Organizations (NGOs) have been involved in the programme for many decades and have provided valuable contribution in reducing the burden of leprosy. NGOs serve in remote, inaccessible, uncovered, urban slums, industrial / labour population and other marginalized population groups. IEC, Prevention of impairments and disabilities, Case Detection & referral and follow-up for treatment completion are some important activities undertaken by NGOs. Under SET scheme, Rs. 2.10 crores have been allocated to NGOs in 2010-11 and Grant-in-Aid to NGOs is routed through State Leprosy Societies. 6.3.4. ILEP Agencies The International Federation of Anti-leprosy Associations (ILEP) is actively involved as partner in NLEP. In India, ILEP is constituted by 10 Agencies viz. The Leprosy Mission, Damien Foundation of India Trust, Netherland Leprosy Relief, German Leprosy Relief Association, Lepra India, ALES, AIFO, Fontilles India, AERF - India and American Leprosy Mission. ILEP is providing support in the form of planning, monitoring & supervision of the programme, capacity building of GHC staff, IEC, providing re-constructive surgery services and socio economic rehabilitation of persons affected with leprosy. 36 NGOs conducting re- constructive surgeries for disability correction in leprosy affected persons are also supported by ILEP. 6.3.5 WHO Support WHO support the programme in the form of providing financial assistance for conducting annual review meetings at national level and technical support through State/Zonal NLEP Coordinators in the high endemic states. WHO continues to provide requirement of anti- leprosy MDT drugs to the country free of cost with assistance from NOVARTIS. 6.3.6 Information, Education & Communication (IEC) Intensive IEC activities are conducted for awareness generation and particularly reduction of stigma and discrimination against leprosy affected persons. These activities are carried through mass media, outdoor media, rural media and advocacy meetings. More focus is given on inter personnel communication. Intensive IEC Campaign with a theme Towards Leprosy Free India is being carried out towards further reduction of leprosy burden in the community, early reporting of cases & their treatment completion, provision of quality leprosy services and reduction of stigma & discrimination against leprosy affected persons. Mass media campaign during the period October, 2010 and January-February 2011, have been planned through the Prasar Bharati to spread awareness about leprosy in the General Public. 6.3.7 Disability Prevention and Medical Rehabilitation For prevention of disability among persons with insensitive hands and feet, they are given dressing material, supportive medicines and micro-cellular rubber (MCR) footwear. The patients are also empowered with self care procedure for taking care of themselves. More emphasis is being given on correction of disability in leprosy affected persons through reconstructive surgery (RCS). To strengthen RCS services, GOI has recognized 83 institutions for conducting RCS based on the recommendations of the state government. Out of these, 42 are Govt. institutions and 41 are NGO institutions. 6.3.8 Supervision and Monitoring Programme is being monitored at different level through analysis of monthly progress reports, through field visits by the supervisory officers and programme review meetings held at central, state and district level. For better epidemiological analysis of the disease situation, emphasis is given to assessment of New Case Detection and Treatment Completion Rate and proportion of grade II disability among new cases. Independent Programme evaluation is also been conducted through an independent agency. 6.3.9 Initiatives: 6.3.9.a.An amount of Rs. 5000/- is provided as incentive to leprosy affected persons from BPL family for undergoing per major reconstructive surgery in identified Govt./NGO institutions to compensate loss of wages during their stay in hospital. Support is also provided to Government institutions in the form of Rs. 5000/- per RCS Annual Report 2010-11 101 conducted, for procurement of supply & material and other ancillary expenditure required for the surgery. 6.3.9.b.Involvement of ASHA A scheme to involve ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis at PHC and follow up cases for treatment completion. To facilitate the involvement of ASHA, they are being paid an incentive as below: (i) On confirmed diagnosis of case brought by them Rs. 100/- (ii) On completion of full course of treatment of the case within specified time- PB leprosy case Rs. 200/- and MB Leprosy case Rs. 400/- 4,22,638 ASHAs have been trained in leprosy and involved in leprosy work 4572 ASHAs received incentive for the above said activity during 2009-10. 6.3.9.c. Discriminatory laws relating to leprosy There are certain provisions under laws / acts which are discriminatory in nature against leprosy affected persons. The Ministry of Health & Family Welfare has taken up the matter with concerned Ministries/Departments/State Governments for their consideration and action on various such discriminatory acts/laws. These Acts and Laws are being modified or repealed, which will help the persons affected by leprosy live a dignified life. 6.3.10 National Sample Survey The 131 st report of the Committee on Petitions of Rajya Sabha, 2008, recommended that the final survey, involving Panchayati Raj Institutions (PRI) may be undertaken, so that the Government can have realistic figures of Leprosy Affected Persons (LAPs) to devise a national policy. The Ministry of Health & Family Welfare informed the Committee that a multi centric study to assess the burden of active leprosy cases, leprosy persons with grade - I & II disability and the magnitude of stigma & discrimination prevalent in the society, will be carried out. The National JALAMA institute Agra (an ICMR instt.) has been entrusted with the above task. The house to house survey was started in States/UTs as below, which was preceded by training of the survey team member and IEC campaign in the concerned Block and Urban areas. (i) Six States/UTs viz. Arunachal Pradesh, Gujarat, Rajasthan, Manipur, Sikkim and D&N Haveli started in May 2010. Arunachal Pradesh, Sikkim & D&N Haveli reported completion of the Survey. (ii) Twenty States/UTs viz. Andhra Pradesh, Assam, Chhattisgarh, Goa, Himachal Pradesh, Jharkhand, J&K, Karnataka, Madhya Pradesh, Kerala, Meghalaya, Mizoram, Nagaland, Orissa, Punjab, Tamil Nadu, Tripura, Uttarakhand, Chandigarh and Daman & Diu started in June 2010. Goa, Chandigarh, Uttarakhand and Daman & Diu reported completion of the Survey. (iii) Six States/UTs viz. Uttar Pradesh, West Bengal, Maharashtra, Haryana, A&N Islands and Puducherry started in July 2010. Maharashtra, A&N Islands and Puducherry reported completion of the Survey. (iv) Delhi and Bihar have started survey in August 2010. The final report of National Sample Survey is expected by July 2011. 6.3.11 Budget: Budget allocation under NLEP for for 2009-10 was 44.50 crores and expenditure of 35.12 crores was incurred during the year. Budget allocation under NLEP for 2010-11 is 45.32 crores. 26.85 crores expenditure has been incurred till date. 6.4 REVISED NATIONAL TB CONTROL PROGRAMME (RNTCP) Tuberculosis is a major public health problem in India. The burden of TB in India (Prevalence) as in the year 2000 was 8.5 million total cases of which 3.8 million were bacillary pulmonary cases, 3.9 million abacillary cases and 0.8 million extra-pulmonary cases. India accounts for nearly one-fifth of the global incidence. In 2009, out of the global annual incidence of 9.4 million TB cases, 2 million were estimated to have occurred in India. In the year 2009, India reported a total case notification of 1.3 million (all forms of TB), of which 0.62 million were reported as sputum positive cases which are infectious. An infectious case if not treated on an average infects 10-15 persons in a year. Annual risk of becoming infected with TB is 1.5% and once infected there is 10% life-time Annual Report 2010-11 102 risk of developing TB disease. About one person dies from TB in India every two minutes; ~ 760 people every day and almost 2.8 lakh every year. Revised National TB Control Programme, an application in India of the WHO-recommended Directly Observed Treatment, Short Course (DOTS) strategy to control TB with the objective of curing at least 85% of new sputum positive TB patients and detecting at least 70% of such patients, was launched in the country in March 1997 and was implemented in a phased manner. By March 2006, entire population (1114 million) of the country in all 632 districts had been covered under the Programme. 6.4.1. Achievements of RNTCP HBC: High burden countries Source: WHO Geneva; WHO Report 2010: Global Tuberculosis Control; Surveillance, Planning and Financing. Since its inception, the programme has initiated nearly 1.24 million patients on treatment, thus saving more than 2.2 million additional lives. In 2009 over 1.53 million TB patients have been initiated on treatment. In 2010, 1.17 million patients have been registered for treatment till 30 th September. India has contributed to approximately 24% of the total global new cases detection during the year 2009 as per the WHO Global Report 2010. Treatment success rates have tripled from 25% in the pre-RNTCP era to 87% presently. TB death rates have been cut 7-fold from 29% in the pre-RNTCP era to 4% presently. Annual Report 2010-11 103 The programme has consistently maintained the treatment success rate >85% and new sputum positive (NSP) case detection rate more than the global target of 70%. All states are currently implementing the Supervision and Monitoring strategy detailing guidelines, tools and indicators for monitoring the performance from the PHI level to the national level. The programme is focusing on the reduction in the default rates amongst all new and re-treatment cases and is undertaking steps for the same. Quality assured Sputum Microcopy diagnostic facilities are available through more than 12,700 laboratories across the country. To ensure quality, external quality assurance of sputum microscopy is being routinely conducted throughout the country. This includes onsite evaluation, panel testing and blinded crosschecking. To improve access to tribal and other marginalized groups the programme has developed a Tribal action plan which is being implemented with the provision of additional TB Units and DMCs in tribal/difficult areas, additional staff, compensation for transportation of patient & attendant in tribal areas and higher rate of salary to contractual staff etc. The latest treatment outcome under RNTCP for the patients registered in 2009 (Jan Sept) is represented as a pie chart Involvement of other sectors: Over 3000 NGOs, 30,000 Private practitioners, and 200 corporate houses have been involved in the provision of RNTCP services. Presently, 282 medical colleges (including private colleges) have been involved in RNTCP and are estimated to contribute nearly 10-15% of case detection in the districts that have medical colleges. Health facilities in government sectors outside Health Ministry have been involved viz. ESI, Railways, Ports and the Ministries of Mines, Steel, Coal, etc. Collaboration for increased participation of all sectors in RNTCP is being strengthened through constant interaction with all stake holders, including professional bodies like the Indian Medical Association, and Faith Based Organisations such as Catholic Bishops Conference of India. Drug Resistance Surveillance: To estimate the prevalence of drug resistance amongst new cases and re-treatment cases, state wide community based surveys have been carried out in the states of Gujarat and Maharashtra. These surveys estimate the prevalence of Multi-drug resistant TB (MDR-TB) to be ~3% in new cases and 12-17% in retreatment cases. These surveys also indicate that the prevalence of MDR-TB is not increasing in the country. Two more surveys are underway in the states of AP and western UP and there is a plan to undertake a survey in Orissa in near future. Annual Report 2010-11 104 DOTS Plus for management of Multidrug Resistant TB (MDR-TB): o The programme is in the process of establishing a network of 43 accredited Culture and Drug Susceptibility testing laboratories (DST) across the country in a phased manner for diagnosis and follows up of MDR TB patients. o Currently, 14 Culture and DST Laboratories in government sector are accredited under RNTCP including- 4 National Reference Laboratories (NRLs) that includes TRC Chennai, LRS Delhi, NTI Bangalore and JALMA Agra, 10 State level Intermediate Reference Laboratories (IRLs) at Gujarat, Maharashtra, Andhra Pradesh, Kerala, Delhi, West Bengal, Tamil Nadu , Rajasthan, Orissa and Jharkhand have been accredited; and Another 11 IRLs are under the accreditation process. The remaining IRLs will be accredited in 2011. o To supplement and support the IRL network the programme is also involving Mycobacteriology laboratories of Government Medical Colleges as well as laboratories in the NGO and Private Sector. Till date, five such labs (CMC-Vellore; BPRC-Hyderabad, Hinduja Hospital- Mumbai, SMS-Jaipur and RMRCT-Jabalpur) have been accredited and another 9 are under the accreditation process. o DOTS Plus services for management of MDR TB have been rolled out in the 10 states of Gujarat, Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala, West Bengal, Tamil Nadu, Rajasthan and Orissa. Services are available in 136 districts covering a population of 281 million. Till 30 th September 2010, ~15700 MDR suspects were examined and a total of 2975 patients were initiated on treatment in these states. o The State of Jharkhand, Uttar Pradesh, Madhya Pradesh, Uttarakhand, Karnataka and Himachal Pradesh are in advanced stage of preparation and will initiate identification of MDR suspects shortly. DOTS Plus services in the remaining states will be initiated in 2010-11. Advocacy, Communication and Social Mobilization (ACSM): o RNTCP has ACSM Strategicic framework that clearly identifies:- Objectives (Communication needs) Target Groups (Communication players) i.e.(i) Patients and Communities; (ii) Health care providers, public and private; and (iii) Influencers and opinion makers Media options to reach target groups (Communication tools) o ACSM strategy has been modified for including and addressing newer thrust areas as MDR- TB, TB HIV co-infection, and Infection control. These areas has been identified as important areas to be addressed by the media agency at the national level . o ACSM is integral part of planning at national, state and district levels, and annual action plans. Format for development of ACSM Annual Action Plan has been modified to included monitoring indicators (outcome and output). Quarterly reporting of ACSM activities by the districts and states o Six national level ACSM capacity building trainings workshops organized for State TB Officers, State IEC Officers and Communication Facilitators are currently going. o Partnership developed with the other donor and bilateral agencies to strengthen Centers capacity for ACSM o Formative research for development of communication material on MDR TB, TB HIV and Infection control completed. Impact of the programme: o TB mortality in the country has reduced from over 42/lakh population in 1990 to 23/lakh population in 2009 as per the WHO global report 2010. o The prevalence of TB in the country has reduced from 586/lakh population in 1990 to 249/lakh population by the year 2009 as per the WHO global TB report, 2010 Annual Report 2010-11 105 o Programme is currently undertaking repeat ARTI survey (2007-09), disease prevalence surveys (2007-09) to additionally monitor the progress towards MDGs. 6.4.2. RNTCP Phase II The RNTCP Phase II of the World Bank project has been approved by the Government for the period Oct 2006 to Sep 2011 for a total outlay of Rs 1,156 crore (USD 256.9 million) which includes credit from World Bank of Rs 765 crore (USD 170 million) and commodity assistance of anti-TB drugs from DFID through WHO for Rs 287 crores (USD 63.7 million) with balance of RS 191 crore (USD 42.5 million) will be given by GoI. In addition, 215.81 million US dollars is available for six years (2009 2015) through GFATM RCC mechanism (Global Fund for AIDS, Tuberculosis, Malaria Rolling Continuation Channel) for 27 districts of Uttar Pradesh, and states of Bihar, Andhra Pradesh, Orrisa, Chattisgarh, Jharkhand, Uttarakhand and Haryana. GFATM RCC will also cater through CBCI (Catholic Bishop Conference of India) in 19 states and in 11 states through IMA (Indian Medical Association). The second phase of the RNTCP is consolidating, maintaining and further improving the achievements of the first phase. Phase II of the RNTCP is a step towards achieving the TB-related Millennium Development Goal (MDG) targets. DOTS remain the core strategy. In addition to the ongoing activities, the following new activities have been envisaged in the second phase. the scaling up of the State-level intermediate referral laboratories (IRL) capacity for nation-wide implementation of external quality assessment (EQA) of sputum smear microscopy services and provision of culture and drug sensitivity testing. Implementation of DOTS-Plus for multi-drug resistant TB cases will occur in a phased manner. 6.4.3. Major Initiatives 6.4.3.a.Public Private Mix in RNTCP: The RNTCP employs the Public Private Mix (PPM) which is the strategy to diagnose and treat TB patients reporting to all sectors of health care under RNTCP through a mix of different types of health care providers. 6.4.3.b. NGO/PPs: Currently, for enhancing the involvement of NGOs and PPS under RNTCP, the guidelines have been revised with enhanced financial outlays. The programme has entered into a memorandum of understanding with large NGOs/Professional Associations like RK Mission, World Vision, Christian Medical Association of India, Catholic Health Association of India, Indian Medical Association etc. In addition, many local NGOs support programme activities to improve access of RNTCP in difficult and uncovered areas. 6.4.3.c.Medical colleges/TB Hospitals and others: Medical colleges are being provided with manpower and logistic support to facilitate their participation in the programme. The involvement of medical colleges is monitored by the Task Force mechanism at the State/ Zonal and National levels. 6.4.3.d.Other sectors: - All the 16 centrally owned ESI hospitals, Zonal Railway Hospitals, Coal, Steel and Mines health facilities, Port trust hospitals, CGHS hospitals and 200 corporate hospitals are involved in RNTCP services. Four regional workshops were conducted by Confederation of Indian Industry (CII) to sensitise and promote about workplace interventions in RNTCP at Chandigarh, Mysore, Ranchi and Pune . 6.4.3.e.Urban TB for slum dwellers:- Recognizing the problem and impact of TB on urban slum population RNTCP intends to provide greater levels of access to its services to the urban slum population. In addition, a special PPM scheme for Urban Slum dwellers has been introduced under the recently revised PPM schemes. 6.4.4 Other initiatives- The IMA has formed a National Working Group for RNTCP and has selected National and State coordinators. National, State and Local workshops are being organized by the IMA to sensitize the private practitioners. The PPM project assisted by GFATM under RCC is being implemented in 16 States - Andhra Pradesh, Chandigarh, Haryana, Maharashtra, Punjab, Uttar Pradesh, Bihar, Chhattisgarh, Gujarat, Jharkhand, Kerala, Orissa, Rajasthan, Tamil Nadu, Uttaranchal, and West Bengal . There has also been a professional coalition against TB by IMA with IAP(Indian Academy of Paediatrics),NCCP (National College of Chest Physicians),ICS (Indian Chest Society),FPAI (Federation of Family Physicians Association Of India ) as its members. Annual Report 2010-11 106 The RNTCP has adopted the recently published International Standards for TB Care (ISTC) document to improve the standards of TB management across all sectors of health care in India, and to recruit and involve additional health care providers in RNTCP activities. As the RNTCP conforms to all standards laid down in the ISTC, the central government has urged all providers of health care to adopt RNTCP to ensure adherence to the internationally recognized standard of care for TB. The Revised National TB Control Programme has signed a MOU with the Catholic Bishops Conference of India, for the involvement of Catholic Health Institutions under RNTCP in 19 states - Andhra Pradesh, Assam, Bihar, Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh ,West Bengal , Kerala, Tamil Nadu, Gujarat, Maharashtra, Goa, Meghalaya, Manipur and Nagaland .The Catholic Healthcare network is the largest in the NGO sector with more than 5,500 health care facilities. Global Fund has also approved the Round 9 Grant for TB to the three Principal Recipients, namely Central TB Division , the Union and World Vision India (WVI) for a period of 5 years (starting 1 st April 2010) with the following objectives: 1. Establish and enhance capacity for quality assured rapid diagnosis of Drug Resistant-TB in 43 Culture and DST laboratories in India by 2015; 2. Scale-up care and management of DR-TB in 35 States/Union Territories of India resulting in the initiation of treatment of 55,350 additional cases of Drug Resistant TB (DR-TB) by 2015; 3. Improve the reach, visibility and effectiveness of RNTCP through civil society support in 374 districts across 23 states by 2015; and 4. Engage communities and community-based care providers in 374 districts across 23 states by 2015 to improve TB care and control, especially for marginalized and vulnerable populations including TB-HIV patients. 6.4.5 TB/HIV coordination: Globally, the HIV epidemic is worsening the TB situation, by increasing the number of tuberculosis cases and accelerating the spread of the disease. HIV increases a persons susceptibility to TB infection and Tuberculosis increases morbidity and mortality in HIV infected persons. HIV is the most potent risk factor for progression of TB infection to disease. Since 2001, Government has been implementing a joint action plan in co-ordination with National AIDS Control Programme (NACP), to counter the growing incidence of the HIV-TB co-infection, initially in the six high HIV prevalence States of Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, Manipur and Nagaland. Services for HIV infected TB patients are provided through linkages between the Integrated Counseling and Testing Centre (ICTC) supported by the HIV/AIDS Programme and Designated Microscopy Centres (DMCs) supported by RNTCP, joint IEC activities and infection control measures. In 2007, the national action plan for TB/HIV was revised. RNTCP & NACP have formulated a National framework for joint TB/HIV Collaborative activities which replaces the action plan. The document elaborates the various activities that need to be undertaken at the National, State & district level and provides the guidelines for the same. Under the National framework there is enhanced focus on the provision of HIV care including ART, for all known HIV infected TB patients in order to reduce mortality in this group of TB patients. With the formulation of National framework, the TB/HIV collaborative activities are being extended to the entire country. The framework looks to establishing mechanisms for coordination between the two programmes at all levels. Technical working groups with the key staff of both the programmes as members have been established at the National and State level which are meeting on a periodic basis. The framework was revised in 2008 and an Intensified HIV-TB Package of services which give opportunity to all TB patients to know their HIV status and linking of all HIV+TB patients to HIV care and support for ART and Cotrimoxozole prophylaxis therapy (CPT), was rolled out to offer these additional services in states with the higher burden of HIV-TB. The 2009 revision of the National Framework establishes uniform activities at ART centers and ICTCs nationwide for intensified TB case finding and reporting, and set the ground for better monitoring and evaluation jointly by the two programmes. The HIV-TB performance indicators and performance targets act as a guide to channelize the HIV-TB interventions in the right direction at all the levels. In addition to this, the revised reporting formats and mechanisms have been incorporated in the National Framework to develop a common understanding on the monitoring system. Annual Report 2010-11 107 In 2010, Intensified TB-HIV package of services has been rolled out in 11 more states totalling to 29 States &UTs in which this package of services has already been rolled out with the vision to scale up Intensified TB-HIV package in the entire country by 2012 ART- DOTS linkages are being established at all the ART centres of the AIDS control programme to ensure optimal access to TB diagnostic and treatment services to the HIV positives at advanced stage of disease. A new TB/ HIV module for ART centre staff has been created and ART staff have been trained in this module. In addition, joint training modules on TB/HIV have been formulated for various categories of staff of RNTCP and NACP and the training activities are being scaled up. TOTs have been conducted for State and District level trainers and the training of field staff is on-going and is at various stages in the different States. IEC materials regarding TB are being made available at NACP facilities. Selective IEC material on HIV is displayed at RNTCP facilities. 6.4.6 MDR-TB: Another challenge to TB control in India is the MDR-TB. The data available to date shows that levels of MDR-TB remain relatively low, at around 3% amongst new patients and 12-17% in re-treatment cases. However, these relatively low percentage figures translate into large absolute number of MDR-TB cases, which increase the magnitude and severity of TB epidemic and pose a major threat to TB control. Guidelines for management of MDR TB cases (DOTS Plus) have been formulated and published. The Programme Division has an ambitious plan to scale up services for management of MDR-TB patients in the country and is in the process of securing funding for the same. DOTS Plus services for management of MDR TB have been rolled out in the ten states presently i.e. in the states of Gujarat, Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala, West Bengal, Tamil Nadu, Rajasthan and Orissa. Till date a total of over 2975 MDR-TB patients are on treatment in these states. Information, Education and communication (IEC) or Advocacy, Communication and Social Mobilization (ACSM) continue to be an important component of the programme. In line with the stop TB strategy, replacement of the terminology with Advocacy, Communication, and Social Mobilization (ACSM) is being promoted, as the term ACSM has advantage over IEC as it clearly defines the components and initiatives. 6.4.7 The IEC strategy in RNTCP envisages that: 1. IEC is a long term commitment where in IEC is a process and not product oriented. Implementing IEC activities is based on analysis of the needs, and developing strategy to plan need based, locally appropriate activities. Communication strategies for TB control takes care of opportunities for interactive communication, such as engaging cured patients to convince and support others, group meetings to discuss all aspects of TB control, including the social aspects. 2. It focuses on decentralized planning, choice of communication channels and monitoring to ensure contextual relevance and wide reach of information. The states and districts have to take active part in this process while Centre continues to provide leadership, develop core messages, mass media and advocacy events. 3. IEC takes care to address social issues related to TB such as stigma and gender, and special communication initiatives to address the needs of the special groups and hard to reach populations RNTCP emphasizes on decentralized planning and implementation of health communication initiatives. States and districts develop need based annual action plans and implement activities using local popular media. To support the districts in planning and implementing, Communication Facilitators have been engaged who identify opportunities and network through which communication activities are undertaken to spread information about TB and availability of free diagnosis and DOTS treatment. Other important role of Communication Facilitators is to integrate communication about TB within the context of other health programmes and NRHM. RNTCP encourages states to: i) systematic planning and implementation of communication activities based on the needs, knowledge of target groups, using the local appropriate media; ii) to undertake IEC activity for maintaining desired level of awareness, motivation, support and services in patient friendly environment; and iii) monitor IEC activities regularly like other components of the programme. RNTCP is also working to increase in state and district level capacity to plan and execute IEC activities. For this purpose, each state has undertaken an IEC audit to take stock of its current capacity. This was done with a standardized format and procedure. Annual Report 2010-11 108 The objective is to assess the existing capacity in states and districts for planning and implementing IEC activities. In many case IEC planning and implementation is individual driven depending upon the leadership role taken by the programme manager or the designated person. There is need to institutionalize these processes and IEC capacity audit is a step in this direction to document that exists at this point of time. 6.4.8 Web-based Resource Centre for IEC: A web-based resource Centre for IEC is being used by the States and Districts for reproduction of material. The Resource Centre is available on the Programmes web site:www.tbcindia.org 6.4.9 Quality Control of diagnosis and drugs: A protocol for External Quality Assurance (EQA) of sputum microscopy of slides by different level of staff at the Microscopy Centres (MCs), Districts, Intermediate Reference Laboratories and National Reference Laboratories have been operationalised. Similarly, an independent agency had been contracted to test quality of RNTCP drugs at various points. 6.4.10 Research activities: The RNTCP encourages Operational Research (OR) and has provision for funding such studies. Funds have also been made available to States for inviting proposals and funding research activities in their respective States. The OR priority research areas as well as formats for the proposals are available on the RNTCP websitewww.tbcindia.org. The aim of the research is to improve DOT services to make them more patient- friendly, ensure that treatment is directly observed and increase detection of smear positive cases. A number of studies have been done in this field. Some of these have been and are being initiated/sponsored and funded by the Central TB Division, some have been undertaken by the States and National/Central institutes, and others have been carried out by the teaching and training institutes. 6.4.11 Physical Performance: Comparative statement of achievements under RNTCP during the last 8 years. Indicators 2002 2003 2004 2005 2006 2007 2008 2009 2010 (Jan-Sep) Population coverage, (millions) 530 775 947 1080 1114 1 1131 1148 1164 2 1176 Total number of cases put on DOTS 622873 906472 1187353 1293083 1397498 1475587 1517333 1533309 1173992 New smear positive patients put on treatment 245051 358496 465331 506193 553660 592635 616016 624617 485018 Cure rate (expected 85% 84% 86% 86% 84% 84% 84% 84% 85% 85% No. of NGOs involved (approx) 410 650 1011 1600 2263 2400 2524 2291 3000 1 Entire country covered under RNTCP in March 2006 2 Projected populations in 2009 Annual Report 2010-11 109 6.4.12 Financial Performance 6.5 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3% by 2020. Rapid Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07). Main causes of blindness are as follows: - Cataract (62.6%) Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical Complication (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%), Others (4.19%) Estimated National Prevalence of Childhood Blindness / Low Vision is 0.80 per thousand. The Pattern of Assistance for National Programme for Control of Blindness during the 11th Five Year Plan has been approved by the Cabinet Committee on Economic Affairs. The Pattern of Assistance for the 11th Five Year Plan is effective from 16 th October, 2008. The allocation for the 11 th Plan (2007-12) is Rs.1250.00 crore. The allocation for the current financial year (2010- 11) is Rs.260.00 crore. 6.5.1. Main objectives of the programme: a) to reduce the backlog of blindness through identification and treatment of blind; b) to develop Comprehensive Eye Care facilities in every district; c) to develop human resources for providing Eye Care Services; Year Outlay as Actual budgeted expenditure (Rs. in Crores) (Rs. in Crores) 2006-07 202.17 220.97 2007-08 267.00 262.12 2008-09 275.00 279.90 2009-10 312.25 233.43 (till 30.09.2010) d) to improve quality of service delivery; e) to secure participation of Voluntary Organizations/ Private Practitioners in eye care; f) to enhance community awareness on eye care. 6.5.2.Salient features/strategies adopted to achieve the objectives: Provision of assistance to make eye care programme comprehensive by covering diseases other than cataract like diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, treatment of childhood blindness etc. Reduction in the backlog of blind persons by active screening of population above 50 years, organizing screening eye camps and transporting operable cases to fixed eye care facilities Coverage of underserved area for eye care services through public-private partnership. Capacity building of health personnel for improving their skill, enhancing their knowledge in delivery of high quality eye services Community awareness/information education communication (IEC) activities for creating awareness on eye- care. Major events include eye donation awareness fortnight (25 th August to 8 th September) and World Sight Day (2 nd Thursday of October) each year in addition to ongoing activities. Screening of children for identification and treatment of refractive errors and provision of free glasses to those affected and belonging to poor socio-economic strata. Development of regional institute of ophthalmology and medical colleges in a phase manner to be centre of excellence in retina units/low vision units/ paediatric eye units. 6.5.3. New Initiatives introduced during 11 th Plan Construction of dedicated Eye Wards & Eye OTs in District Hospitals in North-Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttarakhand and few other States where dedicated Operation Theaters are not available as per demand. Annual Report 2010-11 110 Appointment of Ophthalmic manpower (Ophthalmic Surgeons, Ophthalmic Assistants and Eye Donation Counsellors) in States on contractual basis. Grant-in-aid to NGOs for management of other Eye diseases other than Cataract like Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of childhood blindness etc. The assistance would be upto Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye diseases. Development of Mobile Ophthalmic Units in NE States, Hilly States & difficult terrains for diagnosis and medical management of eye diseases. Involvement of Private Practitioners in Sub District, Blocks and Village level. Maintenance of Ophthalmic Equipments supplied to Regional Institutes of Ophthalmology, Medical Colleges, District/Sub-District Hospitals, PHC/ Vision Centres. 6.4.7 Major events during 2010-11: Annual review meeting of NPCB with State Programme Officers was held on 8-9 April, 2010 as a part of review of the programme at the central level. Meetings of Technical Committee to formulate revised duties of Ophthalmic Assistants under NPCB were held on 1.9.2010 and 8.11.2010. Budget Allocation and expenditure: (Rs. in crore) Year Budget Expenditure allocated (BE/FE) 2006-07 111.87 111.53 2007-08 171.87 164.95 2008-09 250.00 249.49 2009-10 250.00 252.89 20010-11 (as on 30.11.2010) 260.00 125.00 Cataract Operations: School Eye Screening Programme: Collection of donated Eyes: Year Target Cataract % surgery operations with IOL performed 2006-07 45,00,000 50,40,089 93 2007-08 50,00,000 54,04,406 94 2008-09 60,00,000 58,10,336 94 2009-10 60,00,000 59,06,016 95 2010-11(as on 30.11.2010) 60,00,000 23,11,000 95 Year No. of free spectacles provided to school age group children with refractive errors Target Achievement 2006-07 70,000 4,56,634 2007-08 3,00,000 5,12,020 2008-09 3,00,000 10,21,082 2009-10 4,73,472 5,05,843 2010-11 (as on 30.11.2010) 3,00,000 85,000 Year Collection of donated eyes Target Achievement 2006-07 45,000 30,007 2007-08 40,000 38,546 2008-09 50,000 41,780 2009-10 55,000 46,589 2010-11 (as on 30.11.2010) 60,000 14,481 Annual Report 2010-11 111 Training of Eye Surgeons: 6.6 National Iodine Deficiency disorders Control Programme (NIDDCP) 6.6.1 Iodine an essential micronutrient required daily at 100-150 micrograms for normal human growth and development. Deficiency of iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deaf mutism, squint & various types of goiter. The sample surveys conducted in 325 districts covering all the States/Union Territories have revealed that 263 districts are endemic as the prevalence of Iodine Deficiency Disorders is more than 10%. It is also estimated that in the country more than 71 million persons are suffering from goiter and other Iodine Deficiency Disorders. The objectives of the programme is to (a) survey to assess the magnitude of the Iodine Deficiency Disorders, (b) supply of iodated salt in place of common salt, (c) resurvey to asses iodine deficiency disorders and impact of iodated salt after every 5 years, (d) health education and publicity (Information, Education & Communication, IEC), (e) laboratory monitoring of iodated salt and urinary iodine excretion. 6.6.2. Initiatives and Progress 6.6.2.a.Salt Commissioner has issued licenses to 824 salt manufacturers out of which 532 units have commenced production. These units have an annual production capacity of 120 lakh metric tonnes of Iodated salt. 6.6.2.b. Production of iodated salt of 45.90 lakh metric tonnes was recorded during the period from April 2010 to August 2010 against 55.00 lakh metric tonnes target for the year 2010-11. Year Target No. of eye surgeons trained 2006-07 250 250 2007-08 400 300 2008-09 400 450 2009-10 400 400 2010-11(as on 30.11.2010) 400 300 6.6.2.c.The Ministry of Health & Family Welfare has issued notification (with effect from 17 th May, 2006 under the Prevention of Food Adulteration (PFA) Act 1954) banning the sale of non-iodized salt for direct human consumption. 6.6.2.d. For effective implementation of National Iodine Deficiency Disorders Control Programme 31 States/UTs have established Iodine Deficiency Disorders Control Cells in their State Health Directorate. 6.6.2.e. In order to monitor the quality of iodated salt and urinary iodine excretion, 28 States/UTs have already set up Iodine Deficiency Disorders monitoring laboratories while the remaining States are in the process of establishing the same. 6.6.2.f. During the year 2010-11, to ensure the quality of iodated salt at consumption level, a total of 17426 salt samples were analyzed out of which 16239 (93%) salt samples were found confirming to the standard ( as per the report - till October 2010). 6.6.2.g. Urine samples were collected and analyzed for estimation of urinary iodine excretion for bio-availability of iodine 6581, out of which 6173 samples were found confirming to the standard (94%). 6.6.2.h. Global IDD Prevention day was observed throughout the country on 21 st October, 2010. On Global IDD Prevention Day messages on benefits of consumption of iodated salt in prevention and control of IDD were published in National & Regional newspapers. A two day national workshop on National Iodine Deficiency Disorders Control Programme was also organized at New Delhi 6.6.2.i. Visible goitre and cretinism has reduced significantly in the country. 6.6.2.j. Information, Education & Communication Activities In 16 States song and drama division through their field units have been carrying out special interactive programmes/ activities. The Directorate of Field Publicity through their 207 regional units in 29 States have carried out extensive IEC campaigns in the country regarding consumption of iodated salt for prevention and control of IDDs. The activities include film shows, group discussion and other special programmes. Annual Report 2010-11 112 IDD spots containing messages on consequences of Iodine Deficiency Disorders and benefits of consuming iodated salt are being telecast through the National Network of Doordarshan daily. In Kalyani Programme the IDD messages are telecasted thrice a week in regional languages from 8 regional Kendras of Doordarshan. IDD spots containing messages on consequences of iodine deficiency disorders and benefits of consuming iodated salt are broadcast by the All India Radio through its 40 regional channels, 133 primary channels and 22 FM channels from April 2010. State Governments have also been provided grants for undertaking IEC activities at the local level in their regional languages that includes celebration of Global IDD Prevention Day in all districts. Annual Report 2010-11 113 Chapter 7 7.1. INTRODUCTION Public policy and communication strategies influence both individual and collective change. The interface between these two components provides the framework to position behavior change. In other words, the balance between communication and policy facilitates health seeking behavior. Over the years the thrust of the Department has been to place IEC as an intervention tool to generate demand for the range of services under National Rural Health Mission (NRHM) and various schemes under public health being undertaken by the Government of India. The Communication Strategy aims to facilitate awareness, disseminate information regarding availability of and access to quality health care within our Public Health System. The key objective of the strategy is to encourage a health seeking behavior that is doable in the context in Information, Education And Information, Education And Information, Education And Information, Education And Information, Education And Communication Communication Communication Communication Communication which people live. The strategy views recipients of health services as not merely users of services but key participants in generating demand for services. During the year, the communication strategy has focused on sustaining behavior change on key health issues through multimedia tools. This implies that it was not enough to just give information and raise awareness about a particular health issue. Awareness and information dissemination should be used as tools to provide tools to the community to press for changes to improve access to health service provisions. For making health care accessible to the general public and to spread awareness on health issues, norms have also been outlined for supporting IEC activities. The framework incorporates a variety of activities involving communities and also the media. Panels inside Delhi Metro T r a i n s hi ghl i ght i ng health issues as a part of the IEC campaign. Annual Report 2010-11 114 Major IEC initiatives undertaken during the year : Integration of various IEC activities MOU signed with NFDC to scale up communication interventions in NE states. A series of press advertisements released in national dailies across the country highlighting achievements of the Ministry A magazine based programme, Kalyani-1 and 2 telecast in eight states and also all NE states. Awareness campaign on Delhi Metro trains highlighting preventive and curative aspects of various health issues. Capacity building workshops organized in states to build capacities of state IEC personnels Health Pavilion at India International Trade Fair wins gold medal for best display. Close monitoring of actual media utilization and behavioral outcomes along with financial allocations Presented a tableau on Healthy Living at the Annual Republic Day Parade, 2011 National Immunization Day (NID) held in Jan.-Feb. 2011. The following tools were used during the year: Interpersonal Communication Community Channels Mass Media Folk and Traditional Media Outdoor Media Advocacy Events, Image management, PR and Publicity The target audiences included: * Citizens of India in various age groups Direct Healthcare Providers (ANM, ASHA, AWW) Healthcare Managers/Administrative functionaries Health Communicators Grass-root functionaries Other Govt. Departments, e.g. Panchayati Raj, WCD, Water & Sanitation NGOs, Civil society stake holders and Media During the year, the following issues were being highlighted through multi-media tools: Janani Suraksha Yojana ASHA Age At Marriage Routine Immunization PNDT and Girl Child Contraceptive choice and spacing Breast Feeding Use of Iodized Salt Care of New born Institutional delivery Maternal Care, Positioning of ASHA, Village and Health Nutrition Day, JSY, IMNCI and also awareness campaign on age at marriage, PNDT, spacing and contraception. Adolescent health RCH and HIV/AIDS Communicable and non communicable diseases platform for integration A Budget allocation of Rs. 204.94 Crores was provided for IEC activities for the year 2010-11. Major achievements during 2010-11 were as under: - Reinforcing the brand identity for NRHM. - Innovations at State level for NRHM advocacy. - Intra Communication strategies for implementation at State level - New content for multi-media tools. - Integrated IEC management through Kalyani Programme News Magazine format through Prasar Bharati being telecast from EAG States and Assam. Annual Report 2010-11 115 - Special publications on achievements under health programmes - Reinforced presence in Cable and Satellite TV channels and Private FM Radio. - Special theme based issues for NRHM Newsletter. The IEC strategy of the Department has undergone a strategic shift. The communication challenge today is not only demand generation, creating awareness, but at the same time initiating a comprehensive understanding of behavior change communication in the socio-cultural framework of our Public Health System. A number of initiatives were taken to professionalize IEC activities and emphasis was laid on intensive media planning and inter-personal techniques for effective rollout of programmes and messages. 7.2. ACTIVITIES THROUGH MEDIA UNITS OF I & B MINISTRY The Media Units of the Ministry of Information and Broadcasting provide communication support to the FW Programmes as per the requirements and guidelines of the IEC Division of MOHFW. The focus is on mother and child health issues, population growth, status of women, small family norms, the Community Needs Assessment Approach and also other issues related to health programmes such as Ophthalmology, Cancer, Tobacco etc. 7.3. DOORDARSHAN i. Doordarshan telecast video spots at prime time on NRHM, RCH issues through its National Network as well Regional Kendras of Doordarshan, Prasar Bharati. ii. Doordarshan has also telecast programmes including panel discussions, interviews etc. from time to time related with NRHM. iii. A half an hour Kalyani-I and II magazine based programme was also telecast in 9 States including North-Eastern-States twice a week. Kalyani also repeated on DD Bharati. The proposal for telecast of Kalyani-I and II from North-East are also in the pipeline. iv. The spots in regional languages of north-east region were also dubbed for telecast for a special campaign.Video Spots on emergency contraceptive pill, NSV and CuT-380-A were also telecast. 7.4. DAVP DAVP has produced video/ audio spots on NRHM for telecast/broadcast. The programme proposed by DAVP for broadcast through AIR was also approved by the Ministry of Health & Family Welfare to propagate the messages on maternal health, child health and family planning and other critical issues of NRHM. The agency was also engaged in putting up exhibition during IITF- 2010 at Pragati Maidan in the capital on November 14 this year which won the Gold Medal in its category. 7.5. NFDC i. An MOU has been signed between Department of Health & Family Welfare and NFDC, a public sector company under the Ministry of Information & Broadcasting for telecast of Audio/Video spots through satellite channels as well as private FM Channels in the North Eastern region. These programmes were dubbed in regional languages through NFDC for distribution in the states. ii. The approved spots were also telecast through all satellite channel as well as FM Channels in north- eastern states. Facade of the health pavilion with Population Stabilisation theme. The pavilion won the Gold Medal among Central Government pavilions for its thematic display. Annual Report 2010-11 116 iii. NFDC is also conducting radio programmes based on all issues of maternal health including Janani Suraksha Yojana. They are also producing folk music programme in local dialect in EAG States. 7.6. ALL INDIA RADIO i. The spots approved were telecast through national network at 7:59 AM before the National News at 8.00 AM and before the evening national news at 8.45 PM. ii. AIR is broadcasting 15 minutes programme based on NRHM through 189 primary channels, 42 Vivid Bharati stations once a week on every Sunday at 7.00 PM. The programme are based on true successful stories as well as questions and answers through telephone as well as e-mail. iii. A contract has also been signed with AIR, Mumbai for broadcast of the spots on NRHM 3-4 times daily in each popular programme ( film music, rural programme, womans programme) and also before and after regional news in 18 high focused stations. iv. Department of Health & Family Welfare, Govt. of India has also supported kendras like AIR, Patna for telecast of the spots in their popular programme like Munshi Prem Chand and special radio serial titled Cine Profile. v. AIR, Munbai also telecast spots on NRHM in the North-Eastern States from the fund available under RCH budget. 7.7. SONG AND DRAMA DIVISON To educate the people about Family Welfare issues, Song & Drama Division organized live entertainment programmes like puppet shows, dance, dramas, folk shows, during India International Trade Fair 2010. 7.8. PRESS INFORMATION BUREAU It provided media coverage on important occasions, events, activities, policies and programmes of the Department. PIB arranged coverage of Family Welfare Melas, World Population Day functions, Pulse Polio Programme and other important events. 7.9. PRINT MEDIA/PRINT PUBLICITY Press Advertisement: The IEC Campaign through Press Advertisement enabled the division to highlight key initiatives in both national and regional media. A number of campaigns were launched through the national and regional press. Especially designed half page colour advertisement on the occasion of and World Population Day was released in the newspapers all over the country to generate mass awareness toward stabilization of population. Colourful advertisements highlighting various achievements on National Rural Health Mission were also released to the newspapers on the occasion of World Health Day, Independence Day, Sadbhavana Divas, Childrens Day, achievements of five years of NRHM, Immunization, Dengue, Chickungunya etc. The most intensive print media campaign was for the national/sub-national rounds of Pulse Polio Programme which was done systematically through a series of press advertisements in major newspapers all over the country. The IEC Division also released advertisements based on focused theme such as Maternal & Child Health Care, Health & Family Welfare Pavilion in IITF- 2010 etc. The Division as part of an integrated IEC campaign covered a range of issues on NRHM related themes which provided a platform for information dissemination , awareness building and advocacy through the print media. Printed Publicity Material: In order to highlight the Ministrys consistent efforts, a series of documents were published. Each document reflected critical areas of NRHM and related programmes. These documents were distributed at major advocacy meeting and programmes to all stake-holders in States/UTs. The prominent documents published during the year were: i) Book on Five years of NRHM ii) Book on Comprehensive Abortion Care iii) Booklet on Achievement of one year of New Government iv) Bulletin of Rural Health Statistics in India v) Book on Family Welfare Statistics in India vi) Training Module for ASHA on NCD vii) Operational Guidelines for promotion of Menstrual Hygiene viii) Training Module for ASHA on Menstrual Hygiene ix) Reading Material for AHSA on Menstrual Hygiene Annual Report 2010-11 117 x) Flip Book on Menstrual Hygiene xi) Book on Hospital Housekeeping Guidelines xii) Folders on Family Planning methods (multi- languages) a) Hamara Ghar an established house journal of the Department of Health & FW is being published for the last 39 year for promotion of Health and Family Welfare programmes for grass root level workers. b) Gagar Me Sagar is a selected slogans booklet in Hindi being brought out as supportive material for Health and Family Welfare workers for publicity of Health & FW programmes to grass root level. NRHM Newsletter: The NRHM Newsletter is now established as an important publication for promotion of the programmes under National Rural Health Mission. The NRHM Newsletter is being published in Hindi, English, Assamese, Urdu, Oriya, Punjabi, Marathi, Kannada, Tamil & Bengali for NGOs and health functionaries working at the Sub- Centre, PHC, CHC and District level. The Newsletter publishes view points of all development partners, viz. NGOs, donor agencies etc. A special issue of newsletter on Population Stabilization was brought out during the year. This issue highlighted the discussions in the lower house of the Parliament on Population Stabilization. Other important issue of newsletter published in the year was Operational Plan for Mother & Child Tracking System. There has been tremendous response to the Newsletter, especially from the grass root health w o r k e r s from different regions. A number of health related issues, in the form readers response have been discussed through these Newsletter editions. Annual Wall Calendar: Special efforts were made to publish the Wall Calendar 2011 of the Ministry on integrated themes with poster value. The Calendar has come out with innovative designs highlighting initiatives taken on various health and family welfare issues. Special efforts were also made through visual publicity like this years Calendar for spreading message on health issues as an integrated theme of the Ministry. The Calendar was distributed to various health set ups. Outdoor Publicity Campaign: An awareness campaign was launched in Delhi Metro trains through panels inside train compartments highlighting various issues like New born care, Spacing methods, Population Stabilization, Female feticide, Small family, Right age of marriage, Emergency Contraception, Hand washing, T.B., Anti Tobacco etc. The IEC Division also conducted an outdoor publicity campaign by installing hoarding, unipole on various health issues like Dengue, Chikungunya, Swine-flue, Maternal & Child Health, Immunization etc. The MOHFW tableau during the Republic Day Parade, 2011 Annual Report 2010-11 118 Mass Mailing Unit(Press) The Mass Mailing Units ( Direct Mail Communication) main objective is to build up an effective mailing list of opinion leaders from different parts of the country with a view to utilize their services to bring awareness and attitudinal change among common people. At present, Mass Mailing Unit, Department of Health & Family Welfare is disseminating the Ministrys regular journals, NRHM newsletter in English, Hindi and several regional languages on a quarterly basis and wall calendars on an Annual Basis. Apart from this regular dispatch, the Mass mailing Unit has mailed various types of publicity materials like posters, leaflets, pamphlets on Health and Family Welfare programmes provided by various divisions of the Ministry to the Health Functionaries at grass root level all over the country. 7.10. IEC WORKSHOP During the year, Capacity Building IEC Workshops were organised for the District IEC Officers/District Community Mobilizers in two phases in Uttar Pradesh covering all the 80 districts. The purpose of the workshop organised at Allahabad and Agra was to enhance the skills of the officers. The workshops stressed on prioritizing the health issues according to the need of the districts, budgeting exercise, preparing IEC material and stressed Inter-Personal Communication to spread Behaviour Change messages to the general public etc. 7.11. WORLD POPULATION DAY Like every year, the World Population Day was observed on 11 th July, 2010. On this occasion, a population run was organized jointly by the Ministry and Jansankya Sthirtha Kosh at New Delhi in which the Union Health & Family Welfare Minister Ghulam Nabi Azad, Chief Minister of Delhi,Smt Sheila Dikshit and Common Wealth Games Gold Medalist Saina Nehwal participated along with school children to create awareness about population stabilization. 7.12. HEALTH PAVILION AT IITF-2010 The main theme of the Annual Health & Family Welfare Pavilion at Pragati Maidan in the capital was Population Stabilization. The Ministry has renewed and stepped up its focus on this issue and used various forums to highlight the importance of the theme. The Pavilion won the Gold Medal for its display in its category. Like every year, free health check-ups, i.e. Cancer detection, Blood test, Eye Test, Height and weight measurement, Family Planning counseling and services for male with various family spacing methods, treatment for communicable and non-communicable diseases were arranged by the Deptt. of AYUSH through its Councils of Ayurveda, Unani & Homeopathy and allopathic clinic of CGHS. Folk Dance/Nukkad Natak were organized by the Song & Drama Division to spread health and social messages. A small amphitheatre was also established to educate people through showcasing documentary films. Painting Competition was organized for the Children in two age groups and first three entries were awarded with prizes and certificate. NACO, JSK, HSCC, HLL, Rajiv Gandhi Cancer Research Hospital, Heart Care Foundation & VHAI etc also participated in the exhibition. 7.13. REPUBLIC DAY TABLEAU-2011 The Ministry of Health & Family Welfare presented a tableau at the Republic Day Parade, 2011. The theme of the Tableau was HEALTHY LIVING with emphasis on preventive and curative health care including Yoga, regular exercise and healthy food. The tableau also highlighted the adverse effects of tobacco use and substance abuse. Annual Report 2010-11 119 Chapter 8 8.1 INTRODUCTION The National Rural Health Mission (NRHM) seeks to build greater ownership of the program among the community through involvement of Non-Government Organizations. Promotion of Public Private Partnership for achieving public health goals is one of the strategies initiated by the department in this regard. This partnership will reinforce the strategy of involvement of NGOs already spelt out in the National Population Policy 2000. The Government of India is committed to voluntary and informed choice in family planning, reproductive and child health care services. Towards this end, the Government, the corporate sector, voluntary and non-voluntary sector are expected to work together in partnership. The professional bodies like Indian Medical Association, Federation of Obstetrician & Gynecologist are also involved in the partnership to achieve the desired goal. 8.2 PARTNERSHIP WITH NON- GOVERNMENT ORGANIZATIONS The Government of India envisages collaboration with NGOs through enhanced participation by the State Government also. Under RCH-II, the ownership of the program has been decentralized to the State Governments. The planning process now starts from the district level. The scheme has been included in the State PIP for NRHM under RCH II. NGOs in particular, have been assigned supplementary or complementary role to that of the Government health care delivery, thus aiding them in reaching the masses meaningfully. They have a comparative advantage of flexibility in procedures, rapport building with communities and are at the cutting edge of program implementation. NGOs will be involved in ASHAs training, activities relating to National Disease Control Programmes, PNDT related activities and service delivery in addition to health education and awareness programme. Partnership With Non- Partnership With Non- Partnership With Non- Partnership With Non- Partnership With Non- Government Organisations Government Organisations Government Organisations Government Organisations Government Organisations 8.3 NEW GUIDELINES According to the guidelines of NGO Scheme, the States have been given an important role in selection/approval of the NGOs and overseeing implementation of the projects undertaken by them. An inbuilt mechanism of monitoring the working of the NGOs and various activities undertaken under the project, in addition to the mid-term appraisal, etc. by the designated evaluating agencies/ organizations has been built into the guidelines: The key features are: - Decentralization of the schemes to the State and District level. Integration with National Rural Health Mission. Training of ASHA Activities relating to various National Disease Control Programme. Awareness relating activities concerning PNDT Act. Shift from exclusive IEC and awareness generation to Service Delivery. Delivery of RCH services by NGOs in un-served and under served areas. Clearly defined eligibility criteria for Registration, Experience, Assets and jurisdiction. Rationalization of the jurisdiction area serviced by the NGO to provide in depth service and optimize resources. Mainstreaming gender issues in all intervention areas. Enhanced male participation and involvement in delivery of all RCH services. Annual Report 2010-11 120 Emphasis on measurable qualitative and quantitative performance indicators. Selection, approval, funding and monitoring of Mother NGO/Service NGO projects by State and District RCH Committees. Increased interface of NGOs with local government bodies. 8.4 MOTHER NGO (MNGO) SCHEME The underlying philosophy of the Mother NGO (MNGO) Scheme is one of nurturing and capacity building through partnership. In accordance with the National Population Policy 2000, National Health Policy (NHP) 2002 and 10th plan document that places emphasis on decentralization of program management and RCH service delivery using a gender sensitive approach, the NGO guidelines were revised in accordance with the RCH II approach. The objectives of the MNGO scheme, are to improve RCH indicators in the under served and unserved areas, with specific focus on Mother & Child Health, Family Planning, Immunization, Institutional delivery, RTI/STI and adolescent reproductive health care. It is expected that the gender concerns and male involvement will be addressed across all the interventions. The un-served areas specifically include hilly, desert and mountainous regions, SC/ST habitats, urban slums and in areas where the government infrastructures are functioning sub optimally. Under the revised mode, NGOs are expected to facilitate RCH service delivery in addition to addressing the awareness, education and advocacy requirement. The overall approach has shifted from a project to a program mode (from one-year cycle to 3-5 year cycle). Rationalization of NGO jurisdiction (reducing coverage from 5-8 districts or more to 1-2 only), and each Mother NGO to work with only 3-4 Field NGOs (FNGOs) from each district, encouraging each Mother NGO to identify the un-served and under served pockets within the districts in consultation with District Health Officials, identification of Field NGOs from the same pockets to serve populations covering 1-2 sub centers in the provision of RCH service delivery related to NRHM Family Planning, Immunization, Mother & Child Health and access to institutional delivery. RTI/STI, adolescent reproductive health care, implementation of Janani Suraksha Yojana (JSY) are some of the salient features. Currently, 310 existing Mother NGOs are working in all the States of the Country. 8.5 SERVICE NGO (SNGO) SCHEME The Service NGOs (SNGOS) are, those, who are expected to provide clinical services and other specialized aspects such as Dai training, MTP, male involvement, covering 1,00,000 populations, contributing to achieving the RCH objectives. NGOs with an established institutional and infrastructure for service delivery are encouraged to compliment the public health care delivery system in achieving the goals of RCH-II program. These SNGOs will cover an area co-terminus to that of a CHC/block PHC with approximately 1,00,000 population or around 100 villages. Service NGOs are expected to provide a range of clinical and non-clinical services directly to the community as an integrated package of RCH-II services. Some of the services expected to be provided by Service NGOs include safe deliveries, neo natal care, treatment of diarrhoea and ARI, abortion and IUD services, RTI/STI etc. 8.6 INSTITUTIONAL FRAMEWORK FOR PROGRAM MANAGEMENT The program management under the revised scheme is decentralized to the State and district Authorities. The State Government forms State RCH society, which has the responsibility for the overall management of the scheme. The State NGO Selection committee will be responsible for MNGO selection, recommendation of projects for GOI approval, fund disbursement, capacity building, monitoring and evaluation. The District RCH society is responsible for all the operational aspects of the program management at the district level. The district NGO committee holds the responsibility for recommendation of MNGO composite proposals to State RCH Society, facilitating the signing of MOU with the MNGO and passes it on for fund release to state RCH society. The State RCH society undertakes review meetings and periodic monitoring in the field for assessing Field NGO/Mother NGO performance. Role of Government of India is related to provision of policy guidelines, final approval of proposals, and technical support for capacity building of NGOs and fund release to State governments. Annual Report 2010-11 121 8.7 STATE NGO COORDINATORS (SNGOCs) The SNGOCs are responsible for monitoring the implementation, facilitating timely submission of NGO reports to the state government, providing government feed back to NGOs, communicating government policies and programs and facilitating NGO dialogue with the district health system. Presently there are 15 selected Service NGOCs are in position. 8.8 INSTITUTIONAL FRAMEWORK FOR NGO CAPACITY BUILDING The Regional Resource Centres (RRCs) is the institutional mechanism available to support this program. There are 11 RRCs covering the programme all over the country. NGOs with expertise and experience in Reproductive Child Health (RCH) and having national level stature are identified as RRCs. The RRCs are playing an important role to be a catalyst, advocacy and net working with state governments, strengthen managerial and technical competencies of the Mother NGOs, support and oversee Field NGO training, document and disseminate best practices, collect and disseminate RCH policies, laws, and program from the respective states where they work and for maintenance of database on technical and human resources related to RCH. Annual Report 2010-11 123 Chapter 9 9.1 INTRODUCTION In 1952, India launched the worlds first national programme emphasizing family planning to the extent necessary for reducing birth rates to stabilize the population at a level consistent with the requirement of national economy. Since then, the family planning programme has evolved and the program is currently being repositioned to not only achieve population stabilization but also to promote reproductive health and reduce maternal, infant & child mortality and morbidity. The objectives, strategies and activities of the Family Planning division are designed and operated towards achieving the family welfare goals and objectives stated in various policy documents (NPP: National Population Policy 2000, NHP: National Health Policy 2002, and NRHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals and others) (see Table 1). 9.2. CURRENT SCENARIO OF POPULATION AND FAMILY PLANNING IN INDIA 9.2.1 Demographic Scenario: Indias population as per 2001 census was 1.028 billion, second only to China in the world. India which accounts for 2.4% of the land area is already supporting around Family Planning Family Planning Family Planning Family Planning Family Planning 17% of the world population. Even a cursory look at following figure will give a broad idea of the demographic scenario of India, where population of each state is equivalent to one major country in the world. India has been showing a slow but steady decline in population growth. Indias annual population growth rate during 1991-2001 decade was 1.93%, a decrease of over 15% from the previous decade. Similarly, Total Fertility Rate (TFR) in the country has recorded a steady decline to the current levels of 2.6 (SRS 2008), a 42% decline from mid-1960s. 9.2.2. Family Planning Scenario: Nationwide, the small family norm is widely accepted (the wanted fertility rate for India as a whole is 1.9: NFHS-3) and the general awareness of contraception is Program/Policy X Five Year NPP NRHM MDG Current Status Goals Plan(by 2007) (by 2010) (by 2012) (by 2015) (Reference Year) Infant Mortality Rate 45 <30 30 27 53 (2008) MaternalMortality Ratio 200 <100 100 100 254(2005) Total Fertility Rate NA 2.1 2.1 NA 2.6(2008) Table.1. Stated goals in recent National Population and Health Policies related to Family Welfare and their current status Annual Report 2010-11 124 almost universal (98% among women and 98.6% among men: NFHS-3). Both NFHS and DLHS surveys showed that contraceptive use is generally rising (see adjoining figure). Contraceptive use among married women (aged 15-49 years) was 56.3% in NFHS-3 (an increase of 8.1 percentage points from NFHS-2) while corresponding increase between DLHS-2 & 3 is relatively lesser (from 52.5% to 54.0%). The proximate determinants of fertility like age at first marriage and age at first childbirth (which are societal preferences) are also showing good improvements at the national level and adjoining figure indicates the current position of social determinants of fertility in the country. 9.3 CURRENT FAMILY PLANNING EFFORTS The Family Planning (FP) Division is involved in the development, implementation and monitoring of strategic interventions for fulfilling the twin objectives of population stabilization and promoting reproductive health within the wider context of sustainable development. The interventions, activities and performance in the area of family planning over the year 2010-11 are as follows: 9.3.1. Contraceptive services under the National Family Welfare Programme: The public sector provides a wide range of contraceptive services for limiting and spacing of births at various levels of health system as described in Table 2: Table 2: Family Planning Services in Public Health Sector Family Planning Service Service Location Service Strategy* Method Provider & Promotional Schemes LIMITING METHODS Minilap Trained & certified MBBS PHC & higher levels FDS: Fixed Day Doctors & Specialist Static Approach Doctors Laparoscopic Sterilization Trained & certified Specialist CHC & Camp Approach Usually Doctors (OBG & higher levels Revised Compensation Scheme General Surgeons) NSV: No Scalpel Trained & certified MBBS PHC & National Family Planning Vasectomy Doctors & Specialist higher levels Insurance Scheme Doctors SPACING METHODS IUD 380 A Trained & certified ANMs, Sub centre & On demand LHVs, SNs and Doctors higher levels Camp Approach Revised Compensation Scheme Oral Contraceptive Trained ASHAs, ANMs, Village level Sub centre On demand Pills (OCPs) LHVs, SNs and Doctors & higher levels VHNDs: Village Health Nutrition Days Condoms Trained ASHAs, ANMs, Village level Sub centre On demand LHVs, SNs and Doctors & higher levels VHNDs EMERGENCY CONTRACEPTION Emergency Contraceptive Trained ASHAs, ANMs, Village level Sub centre On demand Pills (ECPs) LHVs, SNs and Doctors & higher levels VHNDs Legends: ANM: Auxiliary Nurse Midwife; LHV: Lady Health Visitor; SN: Staff Nurse; ASHA: Accredited Social Health Activist Note: * extensive IEC is key component of all the strategies of Family Planning Programme Annual Report 2010-11 125 The salient features of the family planning services are as follows: Counselling, access to and provision of good quality services and follow-up care. Fixed Day Static Services (FDS) approach in sterilization services to increase access. Continuation of sterilization camps in the states with high fertility till the time FDS is implemented effectively. Revised compensation scheme for sterilization acceptors. National Family Planning Insurance Scheme (NFPIS) to cover service providers in both public and accredited private facilities, where the clients are insured in the eventualities of deaths, complications and failures in sterilization and the providers/ accredited institutions are indemnified against litigations in those eventualities. Quality Assurance Committees (QACs) have been constituted at state and district levels. The division has repositioned IUD as short and long term spacing method. Guidelines have been developed and disseminated regarding use of Emergency Contraception Pills (ECPs). Achievements in 2010-11: The performances of family planning services are showing a marginal decline in all methods (refer Annex-1 for details) for the year 2010-11 compared to the corresponding period in 2009-10. This decline could be because of incomplete data uploaded by most states and it is assumed that once complete data is entered an improved performance would be reflected. However, anecdotal evidences suggest that another reason for declining performance could be attributed to better quality of data entered in HMIS web portal. 9.3.2.Increasing male participation in Planned Parenthood, including No Scalpel Vasectomy (NSV): Increasing male participation in Planned Parenthood is one of the major strategic themes of NPP-2000. Promotion of NSV acceptance is one of the most important & visible component of increasing male participation in RCH towards addressing the gender equity issues. The No Scalpel Vasectomy (NSV), a modified male sterilization technique, was introduced in 1997. Camp approach for male sterilization was adopted initially to re-popularize male sterilization method. Based on the experiential lessons from male sterilization camps in certain states a strategy on advocacy and community mobilization for increasing NSV acceptance through camps was introduced in 2005. Human resource development with a three pronged strategy for training surgical faculty from Medical colleges, district NSV trainers and service providers is in place. Achievements in 2010-11: The camp approach was continued in most states across India (http://mohfw.nic.in/NRHM/FP/ Revised_Budget_ Guidelines_CSS.pdf) Training in NSV, was continued on a priority basis. As on September 2010: o As per the latest report (HMIS) there are 9239 facilities in the country with trained NSV providers. o Most districts in the country have district NSV trainer/s. o Surgical faculty training is being continued in 2010-11 across five regional training centres and funds for the same are being disbursed. Source: Report from HMIS web portal as on 25th November 2010 Annual Report 2010-11 126 The annual National NSV Review Workshop was held in September 2009 to review states performance in NSV, and top three performing states for the year 2008-09 (West Bengal, Punjab & Maharashtra) were felicitated. NSV performance has continued its positive trend and has shown an increase in 2009-10: Male sterilization as a percentage of total sterilization had reached a low of 1.89% in 1999 and was hovering around 2.5% until 2006 without much improvement. As a result of intensive efforts to increase male participation, the proportion of male sterilization rose to 4.3% in 2007-08 and 5.5% in the year 2008-09 and it has further improved to 5.6% in 2009-10. Number of NSVs for the period ending September 2010-11 is 4.7%. From above figure, it is evident that NSV as a percentage of total sterilization is increasing across the country and more and more states are moving in the positive direction. 9.3.3. Promotion of IUDs as a short & long term spacing method: In 2006, GOI launched Repositioning IUCD in National Family Welfare Programme ( http://mohfw.nic.in/ NRHM/FP/Repositioning_IUCD.pdf) with an objective to improve the method mix in contraceptive services and has adopted diverse strategies including advocacy of IUCD at various levels; community mobilization for IUCD; capacity building of public health system staff starting from ANMs to provide quality IUCD services and intensive IEC activities to dispel myths about IUCD. Alternative Training Methodology in IUCD using anatomical, simulator pelvic models incorporating adult learning principles and humanistic training technique was started in September 2007 to train service providers in provision of quality IUCD services. It was started in twelve districts across twelve states of India on a pilot basis and based on the success of the pilot phase and lessons learned it was expanded to cover the entire country in 2008-09. Achievements in 2010-11: As on September 2010: - GOI has trained state trainers from all the states at the National level Period April March* April-September^ Contraception 2008-09 2009-10 Annual 2010-11 (lakhs) (lakhs) Change (%) (lakhs) Male Sterilizations 2.52 2.74 8.7 0.77 Male Sterilization as % of Total Sterilization 5.2 5.5 4.7 Source: * MIS for NRHM as on November 2010 ^ HMIS RCH Reports accessed on 25 th November 2010 Table 3: Achievements in Male Sterilization, Nationwide Source: 2006-2009: MIS for NRHM as on 30 th April 2009 2009-10 & 2010-11: HMIS Standard RCH Reports Annual Report 2010-11 127 - Anatomical simulator pelvic models have been distributed to all the districts - All the states have started district trainers and service providers trainings. - Approximately 35,000 service providers (MOs, SNs, LHVs, & ANMs) have been trained till date. Rapid assessment of the IUCD training is almost complete (final report awaited). In order to increase basket of contraceptives in spacing methods, decision to introduce Multi Load Copper 375 has been taken and an operations research study has been completed in 6 states. The report/ recommendations of the study is awaited. Requirement for Multi Load IUD to be launched in the programme is being worked out. 9.3.4. Addressing the unmet need in contraception through assured delivery of family planning services: 9.3.4.a Fixed Day Static Services in Sterilisation at facility level: Operationalization of FDS has following objectives ( h t t p : / / m o h f w. n i c . i n / N R H M/ F P / Fixed_Day_Static_ Guidelines.pdf): - To make a conscious shift from camp approach to a regular routine services. - To make health facilities self sufficient in provision of sterilization services. - To enable clients to avail sterilization services on any given day at their designated health facility. 9.3.4.b. Camp approach for sterilization services is continued in those states where operation of regular fixed day static services in sterilization takes longer time duration. 9.3.4.c. Training of service providers for full operationalization of FDS is continued across all the states for all sterilization services (NSV, minilap abdominal tubectomy and laparoscopic tubectomy) and IUD services. 9.3.4. d. Rational placement of trained providers at the peripheral facilities for provision of regular family planning services. Achievements in 2010-11: FDS guidelines have been disseminated to all the states. Most states have operationalized FDS in sterilization at the district level and few states like Andhra Pradesh and Tamil Nadu have opertaionalized FDS up to the PHC level. Guidelines for Standard Operating Procedures for sterilization services in camps were developed, printed and disseminated to all the states. Guidelines for Clinical Skill Building Trainings in Male and Female Sterilization Services was (http:/ /mohfw.nic.in/NRHM/FP/Scan_Clinical_Skill_ Building. pdf) developed and disseminated to all states. Analysis of the data available from HMIS under Source: Data accessed from HMIS on 25 th November, 2010 and analyzed in-house Table 4: FDS Guidelines for sterilization services Health Facility Minimum frequency of sterilization services District Hospital Weekly Sub District Hospital Weekly CHC / Block PHC Fortnightly 24 7 PHC / PHC Monthly Note: Those facilities providing more frequent services already must continue to do so Annual Report 2010-11 128 NRHM for the period April-September 2010-11 reveals that around 60% of NSV, Minilap and even laparoscopic sterilization (which requires specialist training and expensive instruments) procedures and approximately 42% of postpartum sterilizations are being conducted at PHC and CHC level, indicating that FDS approach in sterilization is taking root in the country (See figure). Expert committee meetings have been convened to standardize trainings in female and male sterilization services. 9.3.5. Quality Assurance in Family Planning: Quality assurance in family planning services is the decisive factor in acceptance and continuation of contraceptive methods and services. The guidelines for Quality Assurance and Standards in place. The Quality Assurance Committees (QACs) set up at the State and District level, following the Supreme Court directives. At the Central level, these activities are monitored through reports and field visits. Up-to-date guidelines on quality of services are now available for Male and female sterilization services: (http:// mohfw.nic.in/NRHM/FP/Quality_Assurance.pdf) Sterilization services in camps (http://mohfw.nic.in/ NRHM/FP/SOP_Book.pdf) IUCD services(http://mohfw.nic.in/NRHM/FP/ medical_ officer.pdf & http://mohfw.nic.in/NRHM/FP/nursing.pdf) ECP administration (http://mohfw.nic.in/NRHM/ FP/ECP_Book_Final.pdf), the division has developed reference manuals on: Minilap tubectomy Post partum family planning Immediate post partum insertion of IUCD Guidelines for training in female sterilisation Achievements in 2010-11: Divisional workshops (5) on Quality Assurance in Family Planning were held in the high focus state of Uttar Pradesh. Another workshop was conducted in Bihar to orient the newly appointed district nodal officers of family planning. Almost all states have reported the constitution of the SQACs and of DQACs. 9.3.6. Post-partum Family Planning (PPFP) services: Institutional deliveries in India have increased significantly since the launch of NRHM which gives an opportunity to offer family planning counselling and contraceptive services. PPFP services are not being offered uniformly at all levels of health system across different states of India resulting in missed opportunities. Achievements in 2010-11: The division has undertaken advocacy for strengthening PPFP services, at all levels; further, it was ensured that PPFP is included in PIP for 2010-11 under NRHM. Training of Trainers for immediate PPIUCD have been organised in medical colleges and district hospitals of 18 states. PPS is showing increasing trends at the National level. The proportion of PPS out of total female sterilization has recorded an impressive 8.1 percentage points increase for the period April- March 2009-10 (32.1%) compared to the period April-March 2008-09 (24%). Further, this remains static during the corresponding period of 2010-11 at 32.2%. Hand book on Post- partum family planning has been developed. 9.3.7. Promotion of Emergency Contraceptive Pills (ECPs): ECPs are effective for preventing conception due to unplanned/ unprotected sex. This helps to reduce unwanted pregnancy and associated abortions, maternal mortality and morbidity. ECPs have been included in National Family Welfare Programme and efforts are being made to utilize them at all levels of public health system. Annual Report 2010-11 129 ECP has been included in the ASHA kits to address the issue of unwanted pregnancy at the community level. 9.3.8. Assisted Reproductive Technologies (ART) for infertility: As per WHO data, the incidence of infertility in various countries including India is around 10-15% which has created demand for assisted reproduction. In order to ensure quality in ART services and for regulating and supervising the functioning of ART clinics, the National Guidelines on ART has been developed by ICMR and National Academy of Medical Sciences for GOI. Achievements in 2010-11: The Draft bill on ART has been updated by incorporating comments from various stakeholders including the Law Commission and general public. The draft Bill has been sent to the Law Ministry for examination.. 9.3.9. New contraceptive methods and contraceptive services: It has been documented worldwide that introduction of a new contraceptive method increases the CPR by approximately 3%. The division is taking proactive approach to introduce new contraceptive methods and services in family welfare programme. Achievements in 2010-11: Post- Partum IUCD (PPIUCD) has been introduced as a contraceptive technique in the programme. Training of service providers and trainers has been done in 18 states 32 Gynaecologists and 30 (as state trainers) have trained more than 100 Gynaecologists and nurses at the district level who will be further train medical officers from FRUs. 2000 anatomical pelvic models with post-partum uterus procured with the support of UNFPA and distributed to the states. Decision to introduce Multi Load Copper 375 has been taken and operation research study for the introduction of the same in National Family Welfare Programme has been completed and the final report/ recommendation is awaited. Funds have been released to ICMR for Post Marketing Surveillance study in Centchroman (a non steroidal oral contraceptive developed indigenously by CDRI, Lucknow). RISUG is an indigenously developed intra-vasal male contraceptive. It is under Phase 3 clinical trial which is funded by the ministry. A 3 year pre-introductory study on Net-EN, Cyclofem and hormonal Implants is in progress. ICMR is conducting the research study in HRRCs and Medical Colleges prior to its introduction in the National Programme. 9.3.10. Other promotional schemes: 9.3.10.a. Revised compensation scheme for acceptors of sterilization: GOI has been providing compensation to the acceptors of sterilization for their loss of wages for availing the services as per the revised rates since September 2007 and all the states are covered under this scheme. Funds in the scheme have also been earmarked for the compensation for sterilization in accredited private health facilities and empanelled private healthcare providers. The detailed scheme is available on the ministrys website at http://mohfw.nic.in/NRHM/FP/ Revised_compensation.pdf . 9.3.10.b.National Family Planning Insurance Scheme (NFPIS): GOI launched the NFPIS Scheme in November 2005 to compensate for the acceptors of sterilization or his/her nominee in the unlikely event of failure or complications or his/ her death, following a sterilization operation. The scheme also provides for indemnity insurance cover to the medical officers and the health facilities for up to four cases of litigations per year that the healthcare provider or the facility may face as a consequence of performing sterilization operations. The Insurance scheme has been renewed with the ICICI Lombard Insurance company for the year 2009-10 The manual for NFPIS is available on the ministrys website at http://mohfw.nic.in/NRHM/FP/ FP_Manual_ 2008-Final.pdf 9.3.10.c.Public Private Partnership (PPP): PPP in family planning services are intended to utilize the reach of private sector in increasing the access to family planning services. In order to promote PPP in family planning services, accredited private facilities and empanelled private Annual Report 2010-11 130 healthcare providers are covered under revised compensation scheme for sterilization and NFPIS. Accreditation and empanelment of private health facilities /healthcare providers is decentralized to districts. However, PPP in family planning has not been adequately promoted. The division is addressing this issue by increasing advocacy for PPP at all forums including Indian Medical Association (IMA). Nearly 100 workshops have been conducted for private practitioners through funding to IMA. 9.3.11. Some major activities during the year: 9.3.11.a.National consultation on Repositioning Family Planning for Maternal & Child Health in Addition to Population Stabilisation (May 05, 2010): The consultation was inaugurated by the Honble Minister of Health and the key note address was delivered by Honble Member of Parliament Shri M S Swaminathan. Various experts from across the globe & from various international organisations like UNFPA, UNICEF, DFID, USAID, WHO, World Bank and representatives from lead NGOs participated in the consultation. 9.3.11.b.Celebration of World Population Day & Week (July 11 17, 2010): World Population Day was celebrated for the first time in all districts of the high focus states (304 districts) to generate awareness about population issues. At the central level the Honble Union Minister of Health and Family Welfare Shri Ghulam Nabi Azad flagged off a Population Run from Vijay Chowk to India Gate. The gathering was also addressed by the Honble Chief Minister of Delhi Smt. Sheila Dixit. Similar functions were also held not only in all the 9 high focus states capital but also in all their districts. In all the states two days district level melas were also held where stalls were set up for RCH services including counselling, IUD services, other spacing methods and enlisting for clients for sterilisation. Key findings: During the population week over 90,000 sterilisations were performed; this was a result of concerted IEC/BCC efforts and provision of quality services. With meticulous micro planning the available service providers could be judiciously distributed to make more facilities functional and thereby provide service to the clients nearer their place of residence. Further, it was observed that those states showed better performance where top bureaucratic leadership was actively involved. 9.3.11.c.Debate on Population Stabilisation in Parliament (August 04, 2010): The Honble Minister of Health and Family Welfare, Shri Ghulam Nabi Azad, piloted a debate in Parliament That this house consider the issue of Population Stabilisation in the country It was a historic debate as the subject was debated in Parliament after 33 long years. The debate lasted almost 7 hours and more than 34 members spoke in the debate. Cutting across party lines all members appreciated the gravity of the subject and urged the government to take all necessary steps to contain the rising population. 9.3.11.d. Meeting of the National Commission on Population (October 21, 2010) : The second meeting of the National Commission on Population (NCP) chaired by Honble Prime Annual Report 2010-11 131 Minister, Shri Manmohan Singh was held on October 21, 2010. The meeting was attended by Chief Ministers of high focus states, health ministers of the states and members of the NCP. 9.4. KEY CHALLENGES & OPPORTU- NITIES 9.4.1. Demographic challenges: It has been estimated that with current trends, the population in India will increase from 1.029 billion to 1.4 billion during the period 2001-2026, an increase of 36% in twenty-five years at the rate of 1.2% annually. There are substantial differences in TFR in between and within states and the national progress must be seen in the context of these striking differences e.g. Kerala, Tamil Nadu, Andhra Pradesh & Karnataka with TFR at or below replacement levels and states like Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, Uttarakhand, Rajasthan, Jharkhand and Orissa, with an estimated combined TFR of 4.2 in 2000. Table 5 gives the estimated year by which some selected HFS will reach replacement fertility if the current trends continue and it will delay the attainment of replacement level of fertility in India until 2021: 9.4.2. Programmatic and service delivery challenges in family planning: Unavailability of regular sterilization services: The access to sterilization services at sub-district levels is restricted due to poor implementation of FDS approach, especially so in high focus states with high TFR and high unmet need due to: - lack of trained service providers specially in minilap & NSV at the CHCs and PHCs - poor facility readiness High seasonal variation in sterilisation services is evident in high focus states (84% sterilization in last 6 months and 42% in last three months) compared to a more uniform performance throughout the year in non-EAG states (see adjoining figure). This reflects the lack of regular service provision rather than the acceptors preference, as frequently claimed by many service providers. Heavy reliance on expensive, technically and logistically high-demanding laparoscopic sterilizations: As evidenced by adjoining figure, the southern states (blue bars), except Karnataka, Table 5 Projected Year to reach Replacement-level Fertility Sl. No. Name of the State Year 1 Uttar Pradesh 2027 2 Madhya Pradesh 2025 3 Chhattisgarh 2022 4 Uttarakhand 2022 5 Bihar 2021 6 Rajasthan 2021 7 Jharkhand 2018 INDIA 2021 Source: Report of the technical group on population projections commissioned by the National Commission on Population, May 2006 Source: Data accessed as on November 25, 2010 from HMIS web Source: Data accessed as on November 25, 2010 from HMIS web portal Annual Report 2010-11 132 show a high proportion of minilap sterilizations (75 to 89% out of total female sterilization). However, in most of the high focus states (green bars), with the exception of Bihar and Jharkhand, laparoscopic female sterilization remains the predominant procedure. Laparoscopic sterilization services can be provided by trained gynaecologists/surgeons only; the procedure requires expensive instruments with high maintenance and sophisticated infrastructure including basic OT. Hence, heavy reliance on it would limit service provision in these states where the availability of specialists and facility readiness is still low. Promoting the simpler, safer and easy-to-provide minilap would be a better proposition for increasing the access to sterilization services and reduce the unmet need in limiting methods in high focus states. The huge potential for post-partum contraception offered by the increasing number of institutional deliveries has not been tapped adequately due to lack of planning, lack of trained post-partum family planning service providers and lack of infrastructure in most of the high focus states. This is evident from above figure which shows that in high focus states like Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Jharkhand, Chhattisgarh, Uttarakhand and Orissa postpartum sterilization accounts for a very lowly 3-19% of total female sterilization as compared to 75-90% in non-high focus states like Kerala and Tamil Nadu. Human resource development for minilap, laparoscopic sterilization & NSV to operationalize FDS in sterilization is picking up. However, the quality of training, post-training follow-up and support for adherence to standard service delivery protocols are poor. More importantly, there is a lack of rational human resource development plan in the states where selection of trainees, post-training placement and post-training infrastructure & logistic support are not given adequate importance leading to loss of trained service providers to the system and wasted resources. Lack of regular contraceptive updates at state/ district level for all categories of service providers is limiting the service providers knowledge level and skills to provide quality contraceptive services according to the latest service delivery protocols. Inadequate attention to spacing methods is evident by consistently low use of spacing methods across most states of India, despite high unmet need in spacing. According to DLHS 3, all the spacing methods together account for just around 25.5% of the current contraceptive use compared to 74.5% by female & male sterilizations put together as evidenced in adjoining pie chart. Inter-State variation in access to and use of family planning services: The access to and use of family planning services shows wide inter-state variations. The performance of HFS in family planning services, though improving, remains much below expected levels and needs to be stepped up considerably. Adjoining chart shows the gap between the ELA (Expected Level of Achievement) and actual performance in 2009-10 in sterilization services in select HFS and the gaps range from of 3.44 lakhs in UP and 1.92 lakhs in Bihar to 8 thousands in Chhattisgarh. The data on Source: Data accessed as on November 25, 2010 from HMIS web portal Annual Report 2010-11 133 sterilizations per 10,000 unsterilized couples exposed to higher birth order of 3 and 3+ further highlights the poor performance of HFS. The sterilization rate for 10,000 unsterilized couples exposed to high birth order ranges from a lowly 35 in Uttar Pradesh, 56 in Bihar & 59 in J&K to a high of 1,399 in Tamil Nadu and 3,493 in Andhra Pradesh as shown in the figure. The demand from the states for contraceptives and survey findings on contraceptive use are in variance. To address this issue, the logistics of procurement and supply of contraceptives has to be rationalized to reflect the actual requirement and usage. Public Private Partnership (PPP) in family planning has not been adequately promoted across most states in India and there is a reluctance to accredit private providers at state/district level which is adversely affecting the widest possible access of family planning services to clients. Source: Data accessed as on November 25, 2010 from HMIS web portal Community based family planning services (including counselling, contraceptive distribution, referral services) utilizing ASHAs, VHNDs and VHSCs have not yet been opertaionalized effectively. 9.5. FUTURE STRATEGIES The ministry has set in motion new approaches to sustain the momentum gained in the sphere of family planning and population stabilization this year, some of which are as follows: Advocacy for repositioning the Family Planning Program at all levels, for achieving population stabilization and reducing the maternal, infant and child mortality and morbidity. Ensuring the Fixed Day Static Services round the year. Rolling out the comprehensive training plan for development of trained human resources in family planning services which has been an area of concern for a long time. Promoting male participation Increasing the thrust on Post-partum Family Planning services. Organizing state Family Planning dissemination workshops countrywide. State wide dissemination of IEC/BCC and advocacy materials. Increasing the basket of choices in contraceptives offering more options to the clients. Strengthening contraceptive logistics (Decentralization of procurement): allowing state/ districts to procure NSV instruments / IUD kits/ Laparoscopes through the flexi pool Revised monitoring strategy is being put in place with a clear road map for states to achieve dual goals of population stabilisation and better reproductive health: a. Development of key performance indicators for input, process and output b. Categorisation of states based on TFR c. Analysing states performance on the basis of Annual Report 2010-11 134 information available through survey, HMIS, review mission reports etc. d. Conducting visit to states to corroborate the findings of above analysis and analysing underlying causes for poor performance which would lead to the way forward. e. Analysis of information with implication for follow-up action. 9.6 CONTRACEPTIVES IN THE NATIONAL FAMILY WELFARE PROGRAMME The Department of Health and Family Welfare is responsible for implementation of the National Family Welfare Programme by interalia, encouraging the utilization of contraceptives and distribution of the same to the States/UTs through Free Supply Scheme and Public-Private Partnership (PPP) under Social Marketing Scheme. Under Free Supply Scheme, contraceptives, namely, Condoms, Oral Contraceptive Pills, Intra Uterine Contraceptive Device (IUCD), Emergency Contraceptive Pills and Tubal Rings are procured and supplied free to the States/UTs. 9.6.1. The channel for supply of these contraceptives under Free Supply Scheme is Government network comprising Sub-Centers, Primary Health Centres, Community Health Centres and Govt. Hospitals, State AIDS Control Societies throughout the country. 9.6.2. Procurement procedures: Orders are placed on HLL Life Care Ltd. and IDPL (both PSUs) for procurement of contraceptives being manufactured by them as per Govt. instructions. For the remaining quantities, tenders are solicited from the firms through advertisement of Tender Enquiries for concluding Rate Contracts. Rate Contracts are concluded with the manufacturers and Supply Orders are placed upon them as per their competitive rates and the capacity to manufacture the items. 9.6.3. Quality Assurance: Manufacturers do in-house testing of stores before offering them for inspection. At the time of acceptance of stores, all the batches are tested and thereafter, stores are supplied to the consignees. 9.6.4. The quantities given to the States under Free Supply Scheme during the last two years and the current year (upto November, 2010) along with the budget utilized are given in the following tables: Quantities supplied to States/UTs 9.7 SOCIAL MARKETING SCHEME The National Family Welfare Programme initiated the Social Marketing Programme of Condoms in 1968 and that of Oral Pills in 1987. Under the Social Marketing Programme, both Condoms and Oral Pills are made available to the people at highly subsidized rates, through diverse outlets. The extent of subsidy ranges from 70% to 85% depending upon the procurement price in a given year. Both these contraceptives are distributed through Social Marketing Organizations (SMOs). The SMOs are given Deluxe Nirodh condom at Rs.2.00 per packet of 5 pieces and this is sold @ Rs.3/- per packet of 5 pieces to the consumer. One cycle of Oral Pills, which is required for one month, is given to the SMOs @ Re.1.60/- and it is sold to the consumer @ Rs.3/- per strip (cycle) under the brand name-Mala D. Under the Social Marketing programme, currently three Contraceptives 2008-09 2009-10 2010-11 (up to Nov.,10) Condoms 170.30 98.79 60.54 Oral Pills 11.90 4.12 8.54 IUDs 6.48 6.13 14.28 Tubal Rings 1.50 1.07 1.97 ECP 0.44 3.60 1.72 Pregnancy Test Kits 24.47 24.47 8.4460 Budget Utilization (Rs. in Crore) Contraceptives 2008-09 2009-10 2010-11 (upto Nov. 10) Condoms(In million pieces)) 320.322 642.427 389.030 Oral Pills(In lakh cycles) 616.677 123.000 255.000 IUDs (In lakh pieces) 41.686 31.000 72.510 Tubal Rings (In lakh pairs) 16.32 13.744 15.470 ECP(in lakh packs) 6.59 45.000 21.540 Pregnancy Test Kits(in lakhs) 217.48 217.48 78.500 Annual Report 2010-11 135 Government brands and fourteen different SMOs brands of condoms are sold in the market. Similarly for Oral Pills, one Government brand and seven SMOs brands of Pills are sold. Based on the recommendation of the Working Group on Social Marketing of Contraceptives, SMOs have the flexibility to fix the price of branded condoms and OCPs within the range fixed by the Government. 9.8. AREA SPECIFIC PROJECTS FOR SOCIAL MARKETING With a view to providing impetus to Social Marketing in selected regions/districts, area specific projects are initiated under the Social Marketing Programme. This endeavour has been undertaken in the States of Madhya Pradesh, Haryana, Andhra Pradesh, Bihar, Jharkhand and Orissa. During the year 2010-11, till November, 2010 no project under the scheme could be approved. 9.9. SALE OF CONDOMS (QUANTITY IN MILLION PIECES) Sl. Social Marketing 2008-09 2009-10 2010-11 No. Organisation (upto Nov., 2010) 1. HLL Lifecare Ltd, Thiruvananthapuram 223.54 185.50 105.41 2. Population Services International, Delhi 176.87 189.41 50.77 3. Parivar Seva Sanstha, Delhi 61.19 34.32 11.95 4. DKT, India, Mumbai 114.36 105.62 25.50 5. World Pharma, Indore 11.60 3.60 0.00 6. Janani, Patna 25.19 29.23 8.95 7. Pashupati Chem. and Pharmaceutical Ltd., Kolkata 10.57 4.96 0.00 8. Population Health Services( India) 75.71 97.34 21.68 9. Sanskar Shiksha Samiti, Bhopal Total 699.03 649.98 224.26 9.10. SALE OF ORAL CONTRACEPTIVE PILLS (QUANTITY IN LAKH CYCLES) Sl. Social Marketing 2008-09 2009-10 2009-10 No. Organisation (Up to Nov. 2010) 1. HLL Lifecare Ltd, Thiruvananthapuram 122.00 66.21 58.01 2. Population Services International, Delhi 69.01 63.40 54.17 3. Parivar Seva Sanstha, Delhi 30.66 25.00 7.86 4. World Pharma, Indore 15.86 4.00 0.00 5.. DKT, India, Mumbai 102.54 120.50 30.08 6. Eskag Pharma (Pvt.) Ltd., Kolkata 62.51 75.68 0.00 7. Janani, Patna 21.43 22.90 7.58 8. Population Health Services, Hyderabad 51.62 45.30 33.31 9 Sanskar Shiksha Samiti, Bhopal 0.10 0.00 0.00 10 PCPL, Kolkata 19.40 10.05 0.00 Total 495.13 433.04 191.01 9.11. CENTCHROMAN (ORAL PILLS) Since December 1995, a non-steroidal weekly Oral Contraceptive Pill, Centchroman (Popularly known as Saheli & Novex), to prevent pregnancy is also being subsidized under the Social Marketing Programme. The weekly Oral pill is the result of indigenous research of CDRL, Lucknow. The pill is now available in the market at Rs.2.00 per tablet. The Government of India provides a subsidy of Rs.2.59 per tablet towards product and promotional subsidy. Annual Report 2010-11 136 9.12. PERFORMANCE OF SOCIAL MARKETING PROGRAMME IN THE SALE OF CONTRACEPTIVES 9.13. EMERGENCY CONTRACEPTIVE PILLS[ECP] Department of Health &Family Welfare introduced Emergency Contraceptive Pills (E- pills) in the National Family Welfare Programme during the year 2002-03. This contraceptive is used within 72 hours of un-protected sex. The following quantities of E-pills were procured during the years 2008-09, 2009-10 & 2010-11 (upto Nov.2010). Quantity procured (in lakh packs) Item 2008-09 2009-10 2010-11 (Nov.2010) ECP 5.50 45.000 21.54 Contraceptives 2008-09 2009-10 2010-11 (Upto Nov., 2010) Condoms(Million pieces) 699.03 649.98 224.26 Oral Pills (lakh cycles) 495.13 433.04 191.01 Centchroman (Saheli/ Novex) Weekly Oral Pills (lakh tablets) 181.07 203.94 32.94 9.14. PREGNANCY TEST KITS Orders have been placed on HLL Lifecare Ltd, (a PSU under the Ministry), for procurement of 2,17,48,200 Pregnancy Test kits each during the year 2008-09, 2009- 10 and 2010-11 for free-of-cost supply for timely and early detection of pregnancy. The kits are home-based and easy to use. 9.15 COPPER-T Under the National Family Welfare Programme, Cu-T- 200B was being supplied to the States/UTs. From 2003- 04, advanced version of Intra Uterine Contraceptive Device i.e.IUCD-380-A has been introduced in the Programme. This Cu.-T has longer life of placement in the body and thus provides protection from pregnancy for a period of about 10 years. Now the advanced version of IUCDs i.e.IUCD-380A is being procured and supplied to the States/UTs. Annual Report 2010-11 137 State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during Agency acceptors during April to September April to September April to September April to September 2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change from from from from 2009-10 2009-10 2009-10 2009-10 I. High Focus North-East Arunachal Pradesh 528 46.7 1,277 4.8 1317 20 679 57 Assam 28,544 32.5 18,664 14.5 65,821 25 52,680 44 Manipur 640 79.8 2,490 -6.5 3,904 103 2442 -8 Meghalaya 1,033 6.3 1,777 62.6 5,446 9 3,756 3 Mizoram 1,359 -2.2 1,625 56.6 6,909 17 4,801 26 Nagaland 643 -10.4 781 -32 575 -5 706 93 Sikkim 71 . 1,017 52.7 4,406 -1 2383 -36 Tripura 1,540 -15.3 822 -47.1 4,245 -70 6,770 -8 II. High Focus Non North-East Bihar 38,035 12.5 93,454 9.4 48,083 15 81,918 31 Chhattisgarh 28,077 5.3 50,659 1.4 98346 -16 159,055 -23 Himachal Pradesh1,821 -10.8 10,140 -13.8 23,282 -19 81,908 -21 Jammu & Kashmir3,287 -8.7 9,216 -14.4 16,338 24 25,921 7 Jharkhand 26,665 118.1 59,460 35.1 92560 7 134,974 -16 Madhya Pradesh112060 77.8 175876 -24.7 400672 -16 664511 -33 Orissa 29,300 62.4 58,283 -5.1 136736 -25 178,024 -30 Rajasthan 86,725 -1.4 258264 3.8 700969 -19 1,326,489 -18 Uttar Pradesh 53,377 -25.6 575094 -25.3 249664 -66 580,930 -41 Uttarakhand 3,939 -26.7 31,907 -39.1 20,181 -58 38,591 -44 III. Non-High Focus Large Andhra Pradesh391607 -8.4 177431 -11.2 301685 -9 701091 -12 Goa 1954 -18.2 1088 0.6 3903 17 1598 10 Gujarat 87879 -13 256110 -9.8 255353 -12 660135 -35 Haryana 37210 -3.6 85784 -5.6 54337 -38 132796 -56 Karnataka 166709 -16.4 113211 -17.6 117126 -28 227275 -2 ANNEXURE 1: Number and percentage of family planning users, by states: 2010-11 Annual Report 2010-11 138 State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during Agency acceptors during April to September April to September April to September April to September 2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change from from from from 2009-10 2009-10 2009-10 2009-10 Kerala 52544 4 29418 -4.2 10071 -61 83478 -24 Maharashtra 163432 -24.9 153529 -14.8 190143 -32 308440 -29 Punjab 43044 12.6 105769 -22.9 78100 -22 388956 -3 Tamil Nadu 169890 -2.5 172911 10.1 107647 -3 169734 3 West Bengal 88523 -11.6 34269 -15.7 586412 -4 516323 -6 IV. Non-High Focus Small & UTs A &N Islands 224 -43.1 80 -85.7 416 -76 203 -90 Chandigarh 1024 15.4 1,727 -11.6 699 -32 13,064 -9 Dadra & Nagar Haveli 250 -51.7 71 14.5 183 -16 1162 39 Daman & Diu 55 . 39 . 118 . 457 . Delhi 8,522 3.3 21,680 41.7 16,540 17 106,266 6 Lakshadweep 14 366.7 10 -50 3 . 76 -35 Puducherry 5,604 11.9 1,143 -21 2,280 -11 9,006 -12 V. Other Agencies M/O Defence 1,279 -69.1 1,127 -59.2 1,128 -65 8,448 -69 M/O Railways 1,466 -14.2 1,123 -20.1 2,354 -30 17,584 -32 All India 1,638,874 -4.8 2,507,326 -12.8 3,607,952 -23.2 6,692,630 -23.2 Note: Collated from HMIS Periodic RCH Reports (accessed on 29 th November 2010), Provisional Figures (Status as on: Oct 28, 2010) Annual Report 2010-11 139 Chapter 10 10.1 INTRODUCTION One of the key components of the architectural correction envisaged under the NRHM is to strengthen community participation in all health programmes. Community participation is not to be limited to the community acting only as beneficiaries, but rather playing an active role in the design, implementation and monitoring of health programmes. The major schemes through which community processes are strengthened are: a. ASHA programme; b. Village Health and Sanitation Committee (VHSC); c. Un-tied fund provided to the sub-center and VHSC; d. Rogi Kalyan Samitis (RKS) (or Hospital management committees) as a vehicle for public participation in facility management and the provision of un-tied funds for this purpose; e. District health societies and the district health planning process; f. Community monitoring programme and g. Involvement of NGOs/private sector in the mother NGO programme and public- private partnerships. 10.2 ASHA UNDER NRHM The National Rural Health Mission initiated in 2005, rolled out the ASHA programme in a Mission Mode, scaling up simultaneously in several states. Of the community based programmes, NRHMs most well known and talked about face, is undoubtedly the ASHA programme. Going by national and international Training Programme Training Programme Training Programme Training Programme Training Programme experience, community health worker programmes have the potential to make a significant, if not massive, positive contribution to community health and awareness and to impact favourably on major MDG indicators like child survival. There is a need, therefore, to strengthen the ASHA programme and other communitisation initiatives so that much greater outcomes are realized. All reports and evaluations show that the ASHA programme appears to be making a positive impact. However most assessments also show that there are significant gaps in the implementation of each of these programmes in the states and some process of active support to address these gaps is essential. 10.3 SELECTION OF ASHAS The general norm for selection is one ASHA per 1000 population. In tribal, hilly and desert areas the norm may be relaxed to one ASHA per habitation. ASHAs are necessarily a woman resident in the village, preferably married and in the age group of 25 to 45 yrs. ASHA should have effective communication skills, leadership qualities and be able to reach out to the community. She should be a literate woman with formal education up to Eighth Class, which can be relaxed if suitable women with this qualification are not available. Selection of ASHAs are done by the community, and actively facilitated to ensure that weaker sections participate in the selection. Selection has to be endorsed by the gram panchayat. 10.4 PROGRESS MADE IN SELECTION OF ASHAS Of the targeted 8,99,986 ASHAs in the country; 8,42,654 (93.6%) ASHAs have been selected. Progress made in selection and training of ASHAs (as on December 2010) is given in table-1. Annual Report 2010-11 140 Table-1: State wise status of ASHA selection and training of ASHAs up to Dec. 2010 Name of Selection ASHA Percentage ASHA Training states Target of selected of selection ASHA Module Module Module Module Module Module I II III IV V VI EAG Bihar 87,135 78,973 90.63 69402 52859 52859 52859 TOT Done States Chhattisgarh 60092 60092 100.00 60092 60092 60092 60092 60092 Jharkhand 40964 40964 100.00 40115 39482 39214 35675 40964 TOT Done MP 52117 50113 96.15 48159 44938 44518 42426 808 TOT Done Orissa 41,102 40932 99.59 40765 40763 40763 40763 39657 TOT Done Rajasthan 48372 43787 90.52 40310 33811 32652 35499 TOT TOT Done Done UP 136268 136182 99.94 135130 128434 128434 128434 TOT Done Uttarakhand 11086 11086 100.00 11086 11086 11086 11086 8978 8750 NE Arunachal 3862 3629 93.97 3426 3305 3324 2906 2497 756 States Assam 29693 28798 96.99 26225 26225 26225 26225 23271 Manipur 3878 3878 100.00 3878 3878 3878 3878 3878 TOT Done Meghalaya 6258 6258 100.00 6175 6175 6175 6175 3427 Mizoram 987 987 100.00 987 987 987 987 987 TOT Done Nagaland 1700 1700 100.00 1700 1700 1700 1700 1700 TOT Done Sikkim 666 666 100.00 666 666 666 666 666 TOT Done Tripura 7367 7367 100.00 7367 7367 7367 7367 7362 TOT Done Non- EAG Andhra Pradesh 70700 70700 100.00 70700 70700 70700 70700 70700 TOT Done Delhi 5400 3200 59.26 2680 2138 2075 1276 0 Annual Report 2010-11 141 Gujarat 31438 29675 94.39 28809 28052 26373 24201 13589 TOT Done Haryana 14000 13098 93.56 12825 12169 12169 12169 5097 Himachal Pradesh 18248 16888 92.55 16888 0 0 0 0 J & K 9764 9500 97.30 9500 9000 9000 9000 5711 TOT Done Karnataka 39195 32939 84.04 32939 32939 32939 32939 32939 TOT Done Kerala 32854 31868 97.00 30719 29223 25534 20544 697 Maharashtra 60457 58954 97.51 56854 46580 8464 8038 7029 TOT Done Punjab 17360 17014 98.01 15481 14026 14026 14026 0 Tamil Nadu 6850 2650 38.69 2650 2650 0 0 0 West Bengal 61008 39736 65.13 29552 25465 21666 19663 17195 TOT Done UTs Andman & Nicobar 407 407 100.00 407 407 184 49 49 Chandigarh 423 423 100.00 - - - 0 Dadra and Nagar Haveli 250 107 42.80 85 85 85 85 85 Lakshadweep 85 83 97.65 83 83 0 0 Daman & Diu NA Goa NA Pondichery NA Total 8,99,986 8,42,654 93.60 8,05,655 7,35,285 6,83,155 6,69,428 3,47,378 9,506 Name of Selection ASHA Percentage ASHA Training states Target of selected of selection ASHA Module Module Module Module Module Module I II III IV V VI As one can see from the above Table-1, high focus states has selected over 90% of proposed number of ASHAs. The lower figure in MP is as a result of a recent modification to one ASHA per Anganwadi centre (AWC) instead of previous one ASHA per thousand populations. In the north east the figures are even better with the entire process being complete and with much better densities as appropriate to the low population density. Chhattisgarh has a widely dispersed population and had therefore, opted for one Mitanin per habitation- a total of 54,000 habitations. This gives a ratio of one per just 300 population. GOI agreed to finance the programme using Annual Report 2010-11 142 29347 as the number of ASHAs as this was the number of anganwadis in place. In other states and union territories till the beginning of 2009, ASHAs were sanctioned only for tribal areas, which were less than 10% of the blocks. Since January 2009, the programme has been expanded to the whole nation. Some states have availed of this and others have not. It is worth noting that Tamilnadu and Himachal Pradesh which had not opted for this scheme so far have done so this year leaving only Goa and a couple of Union territories without the ASHA programme. 10.5 TRAINING OF ASHAS Capacity building of ASHA is critical in enhancing her effectiveness. It has been envisaged that training will help to equip her with necessary knowledge and skills resulting in achievement of schemes objectives. Training of ASHA is thus a continuous process. ASHAs are trained by block trainers who mostly are women- who are chosen at block level are trained by a district training team who in turn are trained by the state training team. Considering the range of functions and tasks to be performed, induction training is imparted over in 23 days spread over a period of 18 months. After the induction training, periodic refresher training is planned for about 12 to 24 days per year. In many states, existing NGOs, especially those working on community health issues at the district / block level, have been entrusted with the responsibility for identifying trainers and conducting of TOTs. Progress in Training varies across the states. Most states have completed an average 16 to 19 days of training, and few states are working on the sixth round of training. 10.6 ASHA SUPPORT STRUCTURE The success of ASHA scheme depends upon how well the scheme is implemented and monitored. It is also depends crucially on the motivational level of various functionaries and the quality of all the processes involved in implementing the scheme. It is therefore, necessary that well defined and yet flexible and participatory institutional structures are put into place at all levels from state to village. (1) The District Health Society under the chairmanship of the District Magistrate/President Zila Parishad oversees the selection process. The Society had designated a District Nodal Officer and a Block Nodal Officer. The job of the Nodal Officers at the District and Block are to facilitate the selection process by involving the Gram Sabha and Gram Panchayat, holding of training for ASHA and for trainers as per the guidelines of the scheme. (2) At the village level- womens committees (like self help groups or womens health committees), Village Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training are major source of support to ASHA. (3) District ASHA training team/resource centre. There are full time staff hire to play this role. (4) Block coordinators and sub-block facilitators: For every 15-20 ASHAs one facilitator is deployed and to coordinate 10 such facilitators a block coordinator is deployed. District mobilisers are in place in Orissa, Uttarakhand, UP and Jharkhand and almost there in Rajasthan and Madhya Pradesh. Rest of the states are yet to start, Sub- district facilitators are in place in Uttarakhand and Orissa only. State ASHA Resource Centers or equivalent institution has been established in Uttarakhand, Jharkhand, Orissa Assam, Jharkhand and Rajasthan. Chhattisgarh has the SHRC playing this role. Other states have to start this up and there is a long way to go to make it effective. 10.7 ASHA MENTORING GROUP The Government of India has set up an ASHA Mentoring Group comprising of leading NGOs and well known experts on community health. There are 17 members in National ASHA Mentoring Group representing renowned NGOs across the country. Each member of National Mentoring Group has designated for particular states where they are making visit and providing guidance and advice on matter related to selection, training, payment of incentives etc. National Health Systems Resource Centre is secretariat for National ASHA mentoring group. Similar mentoring groups at the State level has been to provide guidance and advise on matter relating to selection, training and support for ASHA Annual Report 2010-11 143 State ASHA mentoring group is functional in Uttarakhand, Chhattisgarh, Orissa, Madhya Pradesh, Uttar Pradesh, Jharkhand, Rajasthan, Kerala, Assam, Arunachal Pradesh, Manipur, Mizoram, Meghalaya, Nagaland, Sikkim, and Tripura. The administration has to recognize the need for bureaucracy to be guided by the best of civil society in theory and practice of community health worker programmes. 10.8 PERFORMANCE BASED INCENTIVES Responsibilities of ASHAs that currently are incentivized includes; promoting institutional delivery, promoting immunization, DOT provider, Malaria slide collection. Most states have an integrated list of incentive package for ASHAs with information on various activities of ASHAs with amount of incentive attached to it. In most States, the bulk of ASHAs incentive are from JSY and immunisation. It has been suggested to the States to expand the activities and attached incentive to it. The mode of payment by cheque has been operationalise in most of the states. The major reason for success in streamlining ASHA incentive payment in some states are ; payment by cheque, a designated point person at district, block and sector level reviews to handle issues relating to ASHA incentive payment, and tight monitoring, and certification of those PHCs having no backlog of incentive payment to ASHAs. 10.9 ASHA DIARY & VILLAGE HEALTH REGISTER Two simple tools essential for strengthening the ASHA programme, which all states are putting in place are the ASHA diary and the other is the village health register. The ASHA diary is a simple record of all the works she does, as and when she does it. It is a useful tool for supportive supervision of her work, a data source for village health planning and an important tool for performance. The Village Health Register (VHR) is an important tool for ensuring access and completion of service delivery, and a major source of information for village level health planning. The Village Health Register provides household and family level data. The VHR is a vehicle for tracking eligible couples, children below 3 (for immunization) and pregnant women to ensure that they receive the services they need. It can also record incidents of serious illness in each family. 10.10 ASHA DRUG KITS In almost all states, drug kits have been distributed to ASHAs. Across the country, 6, 11,821 ASHAs have received drug kit till Dec. 2010. States are now moving on mechanisms of drug kit replenishment. Govt. of India has recently issued a guideline for regular refilling drug kits and maintaining stock card. 10.11 VILLAGE HEALTH & NUTRITION DAY Monthly Health and Nutrition day is expected to be organized in every village (Anganwadi centers) with the help of AWW/ANM. ASHA along with AWW mobilizes women, children and vulnerable population for the monthly health day activities like immunization, careful assessment of nutritional status of pregnant/lactating women, newborn & children, ANC/PNC and other health check-ups of women and children, taking weight of babies and pregnant women etc. and all range of other health activities. A total of 23619245 monthly village health and nutrition days has been organized till September 2010 across the country. 10.12 ASHA INNOVATIONS There is a wide variety of state specific innovations in this programme. To name a few; ASHA gruha (rest house in Orissa), Mitanin help desk (in Chhattisgarh), ASHA Diwas (monthly review meeting- in UP), ASHA radio programme (in Assam, Chhattisgarh, Manipur and Tripura), bicycles for ASHA, Swasth Chetan Yatra (in Rajasthan) and so on. 10.13 COMMUNITY MONITORING PROGRAMME Community-based Monitoring of health services is a key strategy of National Rural Health Mission (NRHM) to ensure that the services reaches to those for whom they are meant for, especially for those residing in rural areas, the poor, women and children. Community Monitoring is also seen as an important aspect of promoting community led action in the field of health. The provision for Monitoring and Planning Committees has been made at Primary Health Centre (PHC), Block, District and State levels. Community monitoring is to review the progress to ensure that the work is moving towards the decided purpose. Community monitoring helps in identifying and meeting the challenges in the field. The process of Community Monitoring is taking place across nine states (Assam, Jharkhand, Chhattisgarh, Madhya Pradesh, Rajasthan, Maharashtra, Tamil Nadu, Karnataka and Orissa). Annual Report 2010-11 144 10.14 CENTRALLY SPONSORED SCHEME OF BASIC TRAINING OF ANM/LHV ANMs/LHVs play a vital role in MCH and Family Welfare Service in the rural areas. It is therefore, essential that the proper training to be given to them so that quality services be provided to the rural population. For this purpose 319 ANM/Multipurpose Health Worker (Female) schools with an admission capacity of approximately 13,000 & 34 promotional training schools for LHV/ Health Assistant (Female) with an admission capacity of 2600 are imparting pre-service training to prepare required number of ANMs and LHVs to man the Sub centres, Primary Health Centres, Community Health Centres, Rural Family Welfare Centres and Health posts in the country. The duration of training programme of ANM is one and half years and minimum admission requirement for this course is 10 th pass. Senior ANM with five years of experience is given six months promotional training to become LHV/ Health Assistant (Female). Health Assistant(Female) provides supportive supervision and technical guidance to the ANMs in sub- centres. Curricula of these training courses are provided by the Indian Nursing Council. The staffing pattern of the school for, which financial assistance is provided by the Department of Family Welfare, varies according to the annual admission capacity of the school. The financial pattern of assistance has been revised w.e.f. 7.2.2001. Other approved costs besides salary to staff are stipend to trainees, contingency and rent. Funds under the scheme are released by Family Welfare Budget Section on the basis of audited accounts submitted by States and unspent balance with states. Under the scheme during 2010-11 under BE Rs.8517.95 lakhs were available. Item Norm (in Rupees) 1. Salary & allowances of staff As per State Government 2. Stipend for trainees 500/- per month/trainee 3. Contingency 10,000/- per annum /school 4. Rent* 60,000/- per annum/school * Rent payable in respect of such schools, which are func- tioning in rented buildings 10.15 CENTRALLY SPONSORED SCHEME OF BASIC TRAINING FOR MULTI PURPOSE HEALTH WORKER (MALE) The Basic Training of Multi Purpose Health Worker (Male) scheme was approved during 6 th Five-Year Plan and taken up since 1984, as a 100% Centrally Sponsored Scheme. This training is provided through forty nine basic training schools of Multipurpose Health Workers (Male). The training is of one-year duration and on successful completion of the training, the Male Health Worker is posted at the sub-centre along with an ANM/Health Worker (Female). The financial pattern of assistance for this scheme has been revised since 7.2.2001. Under the scheme the salary of the staff, rent for school and hostel, stipend for trainees, educational aids and training material, transportation and contingency are supported.The financial norms are as follows: Funds under the scheme are released by Family Welfare Budget Section on the basis of audited accounts submitted by States and unspent balance with states. Under the scheme during 2010-11 under BE Rs.1233.97 lakhs were available. 10.16 MAINTENANCE OF HEALTH AND FAMILY WELFARE TRAINING CENTRE 49 Health and Family Welfare Training centres were established in the country in order to improve the quality and efficiency of the Family Planning Programmes and to bring the changes in the attitude of the personnel Item Norm Rent (for basic schools) Rs. 10,000 / month Rent for hostel (for basic schools) Rs. 250 / month per candidate Stipend Rs. 300 / month / candidate Educational Aids and Training Material Rs. 15,000 per annum Transportation (for hiring bus) Rs. 30,000 per annum Contingency Rs. 50,000 per annum Annual Report 2010-11 145 engaged in the delivery of health services through in service training programmes. These training centres are supported under Centrally Sponsored Scheme of Maintenance of Health and Family Welfare Training Centre. These training centres are now conducting various in- service training programmes of Department of Family Welfare. Apart from in-service education some of the selected centres are also responsible for conducting the basic training of Male Health Workers course of one year. Apart from the salary of the staff of the training centres, other assistance under the scheme includes contingency for purchase of educational material, rent for training centres and payment to guest faculty. The financial pattern of assistance for this scheme has been revised since 7.2.2001. The details of the financial norms are as follows: Item Norms Contingency Rs. 15,000 per annum Rent* Rs. 40,000 per annum Payment to Guest Faculty Rs. 50,000 per annum *Rent payable in respect of such centres that are functioning from rented buildings. Funds under the scheme are released by Family Welfare Budget Section on the basis of audited accounts submitted by States and unspent balance with states. Under the scheme during 2010-11 under BE Rs.1905.00 lakhs were available. 10.17 TRAINING ACHIEVEMENT Details regarding the total number of persons trained since beginning of the programme under each of the above training activities reported up to 31 December 2010 are given in the consolidated table below:- Type of Training Cumulative Progressup to 31/12/2010 Integrated Service Delivery National Level 280 under NRHM State Level 393 PDC National & State 1366 PMU National Level 305 State Level 2606 Workshop 324 SBA National Level 121 State Level 6528 District Level 40182 BEmOC State and District Level 351 Contraceptive Update National Level 133 State Level 13506 IUD 380 A Training National Level 164 State & Dist. Level 23789 NSV Dist. Level 2220 Laparoscopic sterilization State Level 4259 Minilap District Level 9617 MTP State and District Level 8886 Annual Report 2010-11 146 IMNCI State & District Level 191249 F-IMNCI State Level 648 District Level 2418 NSSK State Level 519 District Level 21217 SNCU District Level 168 RTI\STI State & District Level 4372 Anesthesia State Level 1140 District Level 193 EmOC State & District Level 2584 Blood Storage 785 Immunization State Level 774 District Level 22648 ARSH District Level 6351 Specialized Clinical Skill Training National Level 91 State and District Level 64643 Other Disease Control Programme NVBDCP MOs 10089 Lab. Techns. 1779 Other Paramedical Staff 40653 RNTCP MOs 42454 Lab. Techns. 7471 Other Paramedical Staff 123887 NLEP MOs 6227 Other Paramedical Staff 3106 NCBP MO 1479 Pharma & GNM 150 Teacher 1062 IDSP MOs 20126 Lab. Techns. 5302 Other Paramedical Staff 2272 Routine Immunization MOs 887 Others paramedical staff 41921 Other Trainings State and District Level 10711 Type of Training Cumulative Progressup to 31/12/2010 Annual Report 2010-11 147 Chapter 11 Several National Health Programmes are now under the umbrella of NRHM. Details of other National Health Programmes are in this chapter. 11.1. NATIONAL PROGRAMME FOR CONTROL OF CANCER, DIABETES, CVD AND STROKE (NPCDCS) 11.1.1 India is experiencing a rapid health transition with a rising burden of Non Communicable Diseases (NCDs). According to a WHO report (2002), cardiovascular diseases (CVDs) will be the largest cause of death and disability in India by 2020. Overall, NCDs are emerging as the leading causes of death in India accounting for over 42% of all deaths (Registrar General of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentially productive years (aged 3564 years) of life. It is estimated that the overall prevalence of diabetes, hypertension, Ischemic Heart Diseases (IHD) and Stroke is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 population of India. There are an estimated 25 Lakh cancer cases in India at any point of time. The leading sites of cancer are oral cavity, lungs, oesophagus and stomach among men and cervix, breast and oral cavity amongst women. Non-communicable diseases especially cardiovascular diseases, cancers, chronic respiratory diseases and diabetes caused 60% of all deaths globally in 2005. Total deaths from NCDs are projected to increase by a further 17% over the next 10 years. These diseases are largely preventable by modifying the four common risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. To address Non-communicable diseases, Ministry has formulated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) after integrating the National Cancer Control Programme (NCCP) with National Other National Health Other National Health Other National Health Other National Health Other National Health Programmes Programmes Programmes Programmes Programmes Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS). Government of India has approved the programme at an estimated outlay of Rs. 1230.90 crore for the remaining period of the 11 th Five Year Plan. The programme focuses on health promotion, capacity building including human resource development, early diagnosis and management of these diseases and integration with the primary health care system. The major objectives of the NPCDCS are briefly listed below: Prevent and control common NCDs through behaviour and life style changes, Provide early diagnosis and management of common NCDs, Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs. Train human resource within the public health setup viz doctors, paramedics and nursing staff to cope with the increasing burden of NCDs, and Establish and develop capacity for palliative & rehabilitative care. 11.1.2 Strategies: The programme will be implemented in 20,000 Sub-Centres and 700 Community Health Centres (CHCs) in 100 Districts across 21 States/UTs and the strategies are as under: (i) Promotion of healthy lifestyle through massive health education and mass media efforts at country level regarding increased intake of healthy foods, increased physical activity through sports, exercise, etc., avoidance of tobacco and alcohol and stress Annual Report 2010-11 148 management through awareness generation using community education and interpersonal communication methods and social mobilization through NGOs. (ii) Opportunistic screening of persons above the age of 30 years at the point of primary contact with any health care facility, be it the village, community health centre, district hospital, tertiary care hospital etc. Such screening involves simple clinical examination comprising of relevant questions and easily conducted physical measurements (such as history of tobacco consumption and measurement of blood pressure etc.) to identify those individuals who are at a high risk of developing cancer, diabetes and CVD, warranting further investigation/ action. Screening at the community level will be done by the frontline health workers - ANM and Male Health Worker in sub-centres located for every 5000 population. (iii) NCD clinic will be established at the Community Health Centre (CHC) located at block headquarter for every 1, 00,000 population for comprehensive examination of patients to rule out common NCDs. Screening, diagnosis and management (including diet counselling, lifestyle management) and home based care and referral will be the key services provided at this level of care. (iv) At all selected 100 District hospitals a NCD clinic will be established for prevention and management of cancer, diabetes, hypertension and acute cardiovascular diseases including emergency care. District level health facilities will be strengthened for early diagnosis, prompt treatment, chemotherapy (including day care facilities), palliative care and rehabilitative measures including the required level of blood banking and laboratory support. District hospitals will also be strengthened for early detection of cervix cancer, breast cancer and other common cancers. (v) Development of trained manpower with required skills and competencies by providing customised short term training in diabetology, cancer management, cardiovascular diseases, etc. to existing doctors, in the departments of medicine surgery and gynaecology and training in cytology to the pathologist. Non availability of these subspecialties in district level hospitals and below is a severe constraint for scaling up these services to rural areas. (vi) Strengthening of Tertiary level health facilities: 65 Government Medical Colleges/ Government Hospitals will be strengthened as Tertiary Cancer Centres (TCC) to provide comprehensive cancer care services, training and research. 20 TCCs in 2010-11 and 45 TCCs in 2011-12 will be strengthened. These centres will have a high degree of specialization and comprehensive provision of all of the facets of cancer care necessary in modern cancer management. These will also be centres of Human Resource Development in the field of Cancer e.g. Capacity building for initiating/strengthening of courses in Medical/ Surgical/ Radiation/ Gynaecology Oncology etc. (vii) Monitoring & Evaluation: Monitoring and supervision of the programme will be carried out at different levels through NCD cell through reports from the state, regular visits to the field and periodic review meetings. A NCD cell will be established at the National, State and District levels. This cell will be responsible for overall planning, coordination, implementation and monitoring of the programme. During the 11 th Five Year Plan, the NPCDCS will be implemented in 100 Districts. 30 districts will be taken up in 2010-11 and 70 will be added in 2011-12. List of the 21 States along with the list of 30 districts selected for the year 2010-11 is given below:- S. States Districts CHCs Sub No. Centres 1 Andhra Pradesh Nellore 6 481 Vijayanagaram 7 470 2 Assam Dibrugarh 6 240 Jorhat 4 142 3 Bihar Vaishali 2 336 Rohtas 1 186 4 Chhattisgarh Bilaspur 10 379 5 Gujarat Gandhi Nagar 6 171 Surendranagar 11 200 6 Haryana Ambala 3 102 Annual Report 2010-11 149 11.1.3. New Initiatives: (i) Urban Health Check-up Scheme for Diabetes and High Blood Pressure: 14 th November every year, is being observed as World Diabetes Day as an official United Nations Day since 2007. The day marks the birthday of Frederick Banting who discovered insulin in 1922. An Urban Health Check-up Scheme for Diabetes and High Blood Pressure in Urban Slums was launched on 14 th November, 2010 at Baba Ramdev Park, New Delhi. In the first phase, the scheme will be initiated in seven metros, viz. Delhi, Bangaluru, Hyderabad, Kolkata, Mumbai, Chennai and Ahmedabad. The scheme has the following objectives: 1. To screen urban slum population for diabetes and high blood pressure 2. To create database for prevalence of diabetes and high blood pressure in urban slums 3. To sensitize the urban slum population about healthy lifestyle. The Blood sugar and Blood pressure will be checked for all > 30 years and all pregnant women of all age. 7 Himachal Pradesh Chamba 7 170 8 Jammu & Kashmir Leh (Ladakh) 3 24 Udhampur 2 97 9 Jhankhand Bokaro 8 116 10 Karnataka Shimoga 11 307 Kolar 6 201 11 Kerala Pathanathitta 13 230 12 Madhya Pradesh Ratlam 5 158 13 Maharashtra Washim 7 153 Wardha 6 181 14 Sikkim East Sikkim 0 48 15 Orissa Naupada 4 95 16 Punjab Bhatinda 9 136 17 Rajasthan Bhilwara 16 415 Jaisalmer 6 136 18 Uttrakhand Nainital 4 136 19 Tamil Nadu Theni 6 162 20 Uttar Pradesh Rae Bareli 11 377 Sultanpur 14 403 21 West Bengal Darjeeling 11 230 TOTAL 30 Districts 205 6482 Annual Report 2010-11 150 11.1.4. Ongoing Activities: (i) Membership of IARC: International Agency for Research on Cancer is a specialized agency of WHO to coordinate International Cooperation in Cancer Research. India has become a member of IARC at the 48 th Session of the governing Council of IARC held in May 2006 at Lyon, France, which shall provide a fillip to cancer research in the country. IARC has extended technical and financial support for several cancer research and preventive projects in India. (ii) National Cancer Awareness Day: The birth anniversary of Nobel Laureate Madam Curie, 7 th November is being observed as National Cancer Awareness Day since 2001, to create more awareness about cancer. Like the previous years, this year too awareness generation activities were carried through from 6 th November to 13 th November 2010 through All India Radio (AIR), Doordarshan, News Papers, Delhi Metro Rails and DTC Bus Shelters. (iii) Kalyani is a health programme telecast in 9 capital Doordarshan stations and 12 sub regional stations by Prasar Bharti targeting especially those living in the most populous States. It is an interactive programme which provides an interface to the people with experts on various health and social issues including that of cancer. (iv) Awareness generation for cancer, diabetes and healthy life style was also done during the Common Wealth Games 2010 through live broadcast in AIR. Budget Allocation: The budget allocation during 2010- 11 for NPCDCS is Rs. 326.76 crore. 11.2. NATIONAL MENTAL HEALTH PROGRAMME 11.2.1 Burden of mental health disorders: Prevalence of mental disorders as per World Health Report (2001) is around 10% and it is predicted that burden of disorders is likely to increase by 15% by 2020. According to various community based surveys, prevalence of mental disorders in India is 6-7% for common mental disorders and 1-2% for severe mental disorders. With such a magnitude of mental disorders it becomes necessary to promote mental health services for the well being of general population, in addition to provide treatment for mental illnesses. Treatment gap for severe mental disorders is approximately 50% and in case of Common Mental Disorders it is over 90%. National Mental Health Programme(NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participation in mental health service development and to stimulate self-help in the community. Gradually the approach of mental health care services has shifted from hospital based care (institutional) to community based mental health care, as majority of mental disorders do not require hospitalization and can be managed at community level. NMHP evaluation undertaken in 2008 identified following constraints for the effective implementation of NMHP - Lack of an inbuilt and dedicated monitoring and implementing mechanism for programme. Shortage of skilled manpower in Mental Health i.e. Psychiatrists, Clinical Psychologists, Psychiatric Social Workers & Psychiatric Nurses. This is a major constraint in meeting the mental health needs and providing optimal mental health services at the community level. Due to shortage of manpower in mental health, the implementation of DMHP suffered adversely in previous years. Lack of awareness /stigma about Mental Illness. Lack of facilities for treatment of mentally ill. Lack of coordination between implementing departments of DMHP i.e. Medical Education and Health in the states. Lack of Community involvement. Taking into account these constraints, consultations were held with relevant stakeholders and components of NMHP were revised for XI five year plan. 11.2.2 District Mental Health Programme- During IX five year plan, District Mental Health Programme was initiated (1996) based on Bellary Model developed by NIMHANS, Bangaluru. During the plan period, 27 districts were covered under DMHP. At present DMHP is covering 123 districts in 30 states and UTs. In addition to early identification and treatment of mentally Annual Report 2010-11 151 ill, District Mental Health Programme has now incorporated promotive and preventive activities for positive mental health which includes: - School Mental Health Services: Life skills education in schools, counselling services - College Counselling services: Through trained teachers /councillors - Work Place Stress Management: Formal & Informal sectors, including farmers, women etc. - Suicide Prevention Services- Counselling Center at District level, sensitization workshops, IEC, Help lines etc. 11.2.3 Manpower Development Schemes : A. Establishment of Centre of Excellence in Mental Health- Centre of excellence in the field of mental health are being established by upgrading and strengthening identified existing mental health hospitals/ institutes for addressing acute manpower gap and provision of state of the art mental health care facilities in the long run. Eleven such Centre of excellence are envisaged for total budgetary support of up to Rs 338 crore (Rs 30 crore per center ) for undertaking capital work, equipment, library, faculty induction and retention for the plan period. As of now 9 Mental Health institutes have been funded for developing as centers of excellence in Mental Health. B. Establishment/up-gradation of Post Graduate Training Departments -To provide an impetus to development of Manpower in Mental Health other training centers( Government Medical Colleges/ Government General Hospitals/ State run Mental Health Institutes) would also be supported for starting PG courses or increasing the intake capacity for PG training in Mental Health. Support would be provided for setting up/strengthening 30 units of Psychiatry, 30 Departments of Clinical Psychology, 30 Departments of PSW and 30 Departments of Psychiatric Nursing. Total budget allocated for this scheme is Rs 70 crores during plan period with a limit of Rs 51 lacs to Rs 1 crore per PG Department. As of now, 23 PG departments have been taken up during the XI plan period. 11.2.4 Spill Over of X plan schemes- A. Modernization of State-run Mental Hospitals A one time grant of up to Rs 3 crore per mental hospital is available under the scheme to old custodial pattern mental hospital for their modernization. A total of 29 mental hospitals/ institutes have been supported under this scheme. B. Upgradation of Psychiatric wings in the government medical colleges/general hospitals. Some of the deserving areas where there is no well established government medical colleges, government general hospitals/district hospitals could be funded for establishment of psychiatry wing. A one time grant of Rs. 50 lacs per college is available for up- gradation of facilities and equipments. Preference would be given to colleges and hospitals planning to start or increase seats of PG courses in psychiatry. A total of 88 psychiatry wings have availed grant under this scheme. 11.2.5 Research and Training- There is a gap in research in the field of mental health in the country. Funds will be provided to institutes and organizations for carrying basic, applied and operational research in mental health field. In order to address shortage of skilled mental health manpower a short term skill based training will be provided to the DMHP teams at identified institutes. Standard Treatment Guidelines, Training Modules, CME, Distance Learning courses in mental Health, surveys etc will also be supported. Total allocation is Rs. 6.5 crore for the plan period. 11.2.6 Information, Education & Communication- It has been observed that there is low awareness regarding mental illness and availability of treatment. There is also lot of stigma attached to mental illness leading to poor utilization of available Mental Health resources in the country. The awareness regarding provisions under Mental Health Act, 1987 is also very low among the public and implementing authorities. These issues are addressed through IEC activities at the District level by the District Mental Health Programme. In addition to the district level activities, National Mental Health Programme Division conducts nationwide mass media campaign through audio- video and print media. Awareness activities are also conducted during World Mental Health Day, 10 th October, 2010. Annual Report 2010-11 152 11.2.7 Support for Central and State Mental Health Authorities As per Mental Health Act,1987, there is provision for constitution of Central Mental Health Authority (CMHA) at Central level and State Mental Health Authority(SMHA) at state level. These statutory bodies are entrusted with the task of development, regulation and coordination of mental health services in a state/UT and are also responsible for the implementation of Mental Heath Act,1987 in their respective states and union territories. States are required to have functional SMHAs to operationalize the mental health program activities. However in most of the states, there is no financial support for these bodies and as such they function in an ad-hoc manner and are unable to do justice to their statutory role of implementation of Mental Health Act,1987 and development of Mental Health services. Support under NMHP has been approved for SMHAs during the 11 th Plan period. Total allocation is Rs. 5 crores. 11.2.8 Monitoring & Evaluation In order to strengthen the monitoring and improve implementation of existing NMHP schemes in states support has been approved under the program during XI plan period. Total allocation is Rs. 8.0 crore for the plan period. 11.2.9 Mainstreaming NMHP into NRHM Efforts are being made to mainstream the components of NMHP under the overall umbrella of National Rural Health Mission so that the States are able to plan requirements concerning mental health services as part of their respective PIPs. 11.2.10 Expenditure statement under National Mental Health Programme Rs 1000 crore has been approved as XI plan outlay for the National Mental Health Program. Year wise financial Print Media Campaign on World Mental Health Day 10 th October,2010.. Annual Report 2010-11 153 allocation for the NMHP and expenditure incurred is as given in the table below 11.3. TOBACCO CONTROL LEGISLATION 11.3.1 Tobacco is the foremost preventable cause of death and disease in the world today. Globally approx. 5.4 million people die each year as result of diseases resulting from tobacco consumption. More than 80% of these deaths occur in the developing countries. Tobacco is a risk factor for 6 of the 8 leading causes of death. Nearly 8-9 lakhs people die every year in India due to diseases related to tobacco use. Nearly 30% of cancers in India are related to tobacco use. The majority of the cardio vascular diseases and lung disorders are directly attributable to tobacco consumption. India is the second largest consumer (after China) of tobacco products in the world. As per Global Adult Tobacco Survey, India (GATS), 2009-10, 47.8% men and 20.3% women consume tobacco in some form or the other. The Global Youth Tobacco Survey (GYTS), 2009 also indicates that 14.6% children in the age group of 13- 15 years are consuming tobacco in some form. In order to protect the youth and masses from the adverse harm effects of tobacco usage, second hand smoke (SHS) and discourage the consumption of tobacco, the Govt. of India enacted the comprehensive tobacco control laws namely Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003. The Act is applicable to all tobacco products and extends to whole of India. The specific provisions of the Anti Tobacco Law include: 1. Ban on smoking in public places. (Section -4) 2. Ban on direct/indirect advertisement of tobacco products. (Section -5) 3. Ban on sale of tobacco products to children below 18 year. (Section 6a) 4. Ban on sale of tobacco products within 100 yards of the educational institution. (Section 6b) 5. Mandatory depiction of Specified health warnings on tobacco products. (Section - 7). 6. Testing of tobacco products for tar and nicotine. The rules related to prohibition of smoking in public places came into force from the 2 nd October, 2008. As per the rules, it is mandatory to display smoke free signages at all public places and labeling and packaging rules mandating the depiction of specified health warnings on all tobacco product packs came into force from the 31 st May, 2009. 11.3.2. WHO-Framework Convention on Tobacco Control The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first global health treaty negotiated under the auspices of the World Health Organization. India ratified the FCTC on 5 February 2004 and is now a party to the Convention and has to implement all provisions of this international treaty. It enlists key strategies for reduction in demand and reduction in supply of tobacco. Some of the demand reduction strategies include price and tax measures & non price measures (statutory warnings, comprehensive ban on advertisement, promotion and sponsorship, tobacco product regulation etc). The supply reduction strategies include combating illicit trade, providing alternative livelihood to tobacco farmers and workers & regulating sale to / by minors. 11.3.3. National Tobacco Control Programme (NTCP) Launch of the dedicated National Tobacco Control Programme in the 11 th Five Year Plan has been the major milestone to facilitate the implementation of the tobacco control laws to bring about greater awareness about the harmful effects of Tobacco and to fulfill the obligation(s) under the WHO-FCTC. NTCP was launched in 2007- 08 in 18 Districts covering 9 States. In the 2008-09 it has been upscaled to 24 New Districts covering 12 States. The programme at present is under implementation in 42 districts in 21 states in the country. The main components of NTCP are:- Financial Year Allocation Expenditure (Rs. In crore ) (Rs. In crore) 2007-08 38 14 .57 2008-09 70 23.45 2009-10 55 52.27 2010-11 120 (including 58.80 (Till date Rs. 53 crore GIA including ad Rs. 17 crore for Rs. 52.63 NE) crore for GIA) Annual Report 2010-11 154 a. National level i. Public awareness/mass media campaigns for awareness building & for behavioral change. Ministry of Health has launched comprehensive mass media campaign (both print and electronic) in 2010-11. A series of public notices on tobacco control laws were issued in leading National & regional dailies all over the country. A half page coloured advertisement was also issued in the leading National & regional dailies all over the country on World No Tobacco day, 31 st May, 2010. ii. Establishment of tobacco product testing laboratories, to build regulatory capacity, as required under COTPA, 2003. iii. Mainstreaming the program components as a part of the health delivery mechanism under the NRHM framework. iv. Mainstream Research & Training on alternate crops and livelihoods with other nodal Ministries. v. Monitoring and Evaluation including surveillance e.g. Adult Tobacco Survey. b. State level i. Dedicated State Tobacco Control Cells for effective implementation of the national programme and monitoring of anti tobacco initiatives. c. District level i. Training of health and social workers, NGOs, school teachers etc. ii. Local IEC activities. iii. School Programme iv. Provision of tobacco cessation facilities v. Monitoring of tobacco control laws. 11.3.4. Other initiatives in collaboration with WHO/ BGI I. Advocacy Workshops Ministry of Health & Family Welfare had organized one National Workshop and five Regional Advocacy Workshops for Western, Central, Southern, Eastern & North-eastern and Northern region of the country to sensitize various stakeholders on tobacco control laws and related issues in India in the collaboration with WHO. The purpose of these workshops was to build awareness about tobacco control issues including the existing legislations and to improve enforcement capacity of the provisions of the India Tobacco Control Act, 2003. Through these workshops nearly 800 key personnel in the Government(s) and civil society groups were sensitized on the anti-tobacco laws and its related enforcement strategies. Subsequent to the successful national and regional level workshops, 11 State Advocacy Workshops were held and nearly 1200 key personnel in the Government(s) and civil society groups were sensitized on the anti-tobacco laws and its related enforcement strategies. Extensive list of recommendations were generated for preparation of national and state-wise enforcement action plans for effective implementation of tobacco control laws at district level. Through these workshops, the key stakeholder ministries / departments such as Police, Education, Custom & Excise, Information and Broadcasting, Tourism, Transport, Labour, Agriculture, etc were sensitized on their role in tobacco control. In addition, Annual Report 2010-11 155 various advocacy materials were developed and disseminated through these workshops. A workshop for developing media strategy for the north-east region was organized at Guwahati, Assam and participants were from all the seven north-east states. II. Global Adult Tobacco Survey (GATS): The Global Adult Tobacco Survey (GATS) is the global standard for systematically monitoring adult tobacco use (smoking and smokeless) and tracking key tobacco control indicators. Global Adult Tobacco Survey- India was carried out in all 29 states of the country and 2 Union Territories of Chandigarh and Puducherry, covering about 99 percent of the total population of India. The major objectives of the survey were to obtain estimates of prevalence of tobacco use (smoking and smokeless tobacco); exposure to second-hand smoke; cessation; the economics of tobacco; exposure to media messages on tobacco use; and knowledge, attitudes and perceptions towards tobacco use. The Global Adult Tobacco Survey, India (GATS), Report was released on 19 th October 2010. The key highlights of the survey are: Current tobacco use in any form: 34.6% of adults; 47.9% of males and 20.3% of females Current tobacco smokers: 14.0% of adults; 24.3% of males and 2.9% of females Current cigarette smokers : 5.7% of adults; 10.3% of males and 0.8% of females Current bidi smokers: 9.2% of adults; 16.0% of males and 1.9% of females Current users of smokeless tobacco: 25.9% of adults; 32.9% of males and 18.4% of females Average age at initiation of tobacco use was 17.8 with 25.8% of females starting tobacco use before the age of 15 Among minors (age 15-17), 9.6% consumed tobacco in some form and most of them were able to purchase tobacco products Five in ten current smokers (46.6%) and users of smokeless tobacco (45.2%) planned to quit or at least thought of quitting Among smokers and users of smokeless tobacco who visited a health care provider, 46.3% of smokers and 26.7% of users of smokeless tobacco were advised to quit by a health care provider About five in ten adults (52.3%) were exposed to second-hand smoke at home and 29.0% at public places (mainly in public transport and restaurants) About two in three adults (64.5%) noticed advertisement or promotion of tobacco products. Three in five current tobacco users (61.1%) noticed the heath warning on tobacco packages and one in three current tobacco users (31.5%) thought of quitting tobacco because of the warning label on tobacco products package. GATS India Report is available on the website at www.mohfw.nic.in III. Intervention related to alternative crops/ alternative vocations. A pilot project for alternatives to tobacco/bidi crops in collaboration with Central Tobacco Research Institute, Andhra Pradesh (Ministry of Agriculture) was launched in 6 agro-climatic zones of the country. This project costing Approx Rs. 3.28 crores will be completed in three years. The Ministry of labour also undertook a pilot project to provide alternative vocations to bidi rollers in the regions where bidi is produced viz Karnataka, Madhya Pradesh, Maharashtra, West Bengal and Rajasthan. Ministry of Rural Development has taken up the matter of rehabilitation of bidi rollers in 10 States where bidi roller are concentrated. The State Government were advised to work out special projects for developing alternative livelihood options for bidi rollers under Swarnjayanti Gram Swarozgar Yojana (SGSY) and other similar schemes of the Ministry. Annual Report 2010-11 156 11.4 NUTRITION 11.4.1 Introduction and Initiatives The Nutrition Cell in the Directorate General of Health Services provides technical advice in all matters related to policy making, programme implementation, monitoring & evaluation, training content for different levels of Medical and Para Medical workers. It also provides technical inputs on standards and labels for foods, fortification of foods, nutrition related proposals, project evaluation, review of research project etc. 11.4.2. Initiatives and Progress 11.4.2.a. The cell has been making efforts in creating awareness regarding prevention of micro-nutrient deficiency disorders, diet related chronic disorders and promotion of healthy life style. This has been done by disseminating posters and pamphlets on the above mentioned issues. In addition to this video films and radio programme have been developed on National Iodine Deficiency Disorders Control Programme (NIDDCP), diet related Non Communicable Diseases (NCD) and promotion of healthy life style including micro-nutrient deficiency. The cell has also developed, published and disseminated a handbook on Current Nutritional Therapy Guidelines, in Clinical Practices for Physicians, Dieticians and Nurses. 11.4.2.b. National & Regional levels workshops and meetings were conducted on core issues related to nutrition (i.e micro-nutrient, hospital diets, fluorosis, diet related chronic disorders & promotion of healthy life style, fast/ junk food etc). 11.4.2.c. At national level the nutrition cell coordinates, monitors all administrative and technical issues related to implementation of the new health initiative namely National Programme for Prevention & Control of Fluorosis (NPPCF) which was launched in the year 2008-09. The programme was launched to address fluoride related health problems in the country. 11.4.2.d. In 17 States/UTs Nutrition Division have been established to provide updates on development in the field of nutrition, micro-nutrient deficiencies, diet related chronic non-communicable diseases, ill effects of junk/ fast foods etc. 11.5. STRENGTHENING OF EMERGENCY FACILITIES OF STATE HOSPITALS LOCATED ON NATIONAL HIGHWAYS Expansion in road network, motorization and urbanization in the country has been accompanied by a rise in road accidents leading to Road Traffic Injuries (RTIs) and fatalities as major public health concern. Today road traffic injuries are one of the leading causes of deaths, disabilities and hospitalization with severe socio-economic costs across the world. In view of the above, the Ministry of Health & FW has been implementing a project for upgradation & strengthening of Emergency Trauma Care Facility in State Government Hospitals located on National Highways under the scheme Assistance for Capacity Building with a view to provide immediate treatment to the victims of road traffic injury. Financial assistance was provided up to a maximum of Rs.1.5 crores per hospital or actual requirement of the hospital whichever was less, during the 9 th & 10 th five year plan periods. During the 9 th Five year plan, 18 Hospitals/ Medical Institutions in 13 States/ UTs received grant @ Rs. 1.5 crores each for strengthening of emergency facilities of State hospitals of cities located on National Highways. During the 10 th Plan Rs. 110 crores have been allocated. 85 Hospitals/ Institutions in 30 States received the grants during 10 th Plan. In total about 139.00 crores has been released to 103 institutes during 9 th & 10 th Plan. The scheme was subsequently evaluated by the Ministry and certain deficiencies were observed like shortage of required manpower, inadequate funding for civil work etc. In the light of the facts, a revised new scheme at a total outlay of Rs.732.75 crores has been approved for developing a network of 140 trauma care centres along the Golden Quadrilateral covering 5,846 Kms connecting Delhi-Kolkata-Chennai-Mumbai-Delhi, North-South & East-West corridors covering 7,716 Kms connecting Kashmir to Kanyakumari and Silchar to Porbandhar respectively of the National Highways during the 11 th five year plan period. The scheme provides for 3-category of trauma care centres viz. L-III, L-II and L-I. The level-III trauma centre is designed to stabilize the patients and to manage the trauma victim and to refer the trauma victim to level- II and Level-I centers as per the requirement for further management. The level-II would provide definite care to severe trauma victim while the L-I would provide the highest level of definite and comprehensive care patients with complex injuries. So far 113 trauma care centers have been provided financial assistance in 15 states which are at various stages of progress. Annual Report 2010-11 157 The financial assistance amounting to Rs. 4.8 crores, 9.65 crores and 16 crores are provided to level-III, level-II and level-I respectively, to strengthen the manpower, building, equipments, communication network and legal services and data entry operator of existing State Govt. Hospitals. One advances life support ambulance is augmented by Ministry of Surface Transport at each of the trauma care centers, while NHAI is providing one basic life support ambulance at every 50 kms of the highways. The total outlay and the year wise budget allocation viz- a-viz the expenditure incurred on the scheme is as under: Total outlay for the scheme during the 11 th five year plan - Rs. 732.75 crores. Subsequently and after evaluation of the project, National Highways (other than Golden Quadrilateral, North- South and East-West corridor) with substantial number of accidents and considering the following parameter another 160 Trauma care centres could also be added to the existing network of trauma care centres during the 12 th five year plan: Connecting two capital cities Connecting major cities other than capital cities Connecting ports to major cities Connecting industrial townships with capital cities. 11.6. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS Hearing loss is the most common sensory deficit in humans today. As per WHO estimates in India, there are approximately 63 million people, who are suffering from Significant Auditory Impairment; this places the estimated prevalence at 6.3% in Indian population. As per NSSO survey, currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2002). Of these, a large percentage is children between the ages of 0 to 14 years. With such a large number of hearing impaired young Indians, it amounts to a severe loss of productivity, both physical and economic. An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral (one sided) hearing loss. 11.6.1. Objectives of the Programme 1. To prevent the avoidable hearing loss on account of disease or injury. 2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. 3. To medically rehabilitate persons of all age groups, suffering with deafness. 4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for persons with deafness. 5. To develop institutional capacity for ear care services by providing support for equipment and material and training personnel. 11.6.2. Components of the Programme: Manpower Training & Development Capacity Building Service Provision including Rehabilitation Awareness Generation through IEC Activities Monitoring and Evaluation 11.6.3. Programme Execution & Expansion The programme has been launched in 25 districts of 10 states and 1 union territory in Jan, 2007 on the pilot phase till March 2008. The programme was extended to another 35 districts in the year 2008-09, 41 districts in the year 2009-10 and 75 districts in the year 2010-11 making it a total of 176 districts of 15 States and 4 Union Territories. It is proposed to expand the programme to 203 districts by the end of eleventh five year plan. The programme Year Funds allocated Allocated Funds released (Rs. in crores) for NE States (Rs. in crores) (Rs. in crores) 2007-08 Rs. 42 Rs. 5 Rs. 37 2008-09 Rs. 120 Rs. 14 Rs. 110.34 (including Rs. 10 crores for NE States) 2009-10 Rs. 120 but at FE Stage reduced to Rs. 55 Rs. 14 Rs. 55 2010-11 Rs.113 Rs. 15 Rs. 75.63 Annual Report 2010-11 158 has got into fourth year of implementation in the year 2010-11. 11.6.4. Training activities under NPPCD In the current year 2010-11 the funds amounting for conducting training has been released to the states to carry out the trainings prescribed under the programme. 11.6.5. Capacity building of PHCs/CHCs/Distt. Hospitals i) Manpower capacity building: Launched one year DHLS(Diploma in Hearing Language and Speech) programme to address the issue of shortage of audiometric manpower at 11 centres in the country i.e. JIPMER Puducherry, AIIPMR Mumbai, RIMS Imphal, RML, N. Delhi, IGMC Shimla, JLNMC Ajmer, KGMC Lucknow, GMC Jabalpur, SRBMC Cuttack, RIMS Ranchi along with the nodal centre AIISH Mysore with the total intake capacity of 220 students annually. The programme was officially launched on 25 th August 2007. ii) Infrastructure capacity building of District Hospitals/CHCs/PHCs: Funds for 75 new districts have been released for procurement of ENT/Audiology equipments and construction of sound proof room for audiology at the district hospitals (Rs. 9.50 lakh per district) and CHC/PHC Kit (Rs. 10000 per kit). The States/U.Ts are in the process of procurement of above stated equipments for their respective district hospitals, CHC and PHC. 11.6.6. IEC and awareness campaign: IEC material in the form of 6 different posters in English, Hindi and regional languages have been printed and distributed to various health centers, hospitals. 6 video spots and 3 audio spots were prepared and telecast/ broadcast through national TV and satellite to facilitate wider outreach of the programme. 11.6.7. Distribution of Hearing aids Funds for distribution of hearing aids were given to 25 districts in which approximately 2484 Hearing aids (BTE) have been given to the hearing impaired children who belong to families having monthly income of less than Rs 6500/- per month. 11.6.8. Under the 11 th Five Year Plan, it is proposed to upscale the NPPCD to 203 districts all over the country. The EFC of Rs.94.77 crore for NPPCD has already been approved in the year 2008. 11.7. NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF FLUOROSIS Fluorosis, a public health problem is caused over a long period by excess intake of fluorosis through drinking water/ food products/industrial pollutants. Besides inducing ageing it also results in major health disorders like dental fluorosis, skeletal fluorosis and non-skeletal fluorosis. 11.7.1. Initiatives and Progress In the 11th Five Year Plan with a goal to prevent & control fluorosis in the country National Programme for Prevention and Control of Fluorosis have been launched. The programme was with a financial allocation of Rs. 68.00 crore for implementation in 100 districts of the country. The objectives of the programme is to (a) collect, assess and use the baseline survey data of fluorosis from Department of Drinking Water & Supply, (b) comprehensive management of fluorosis in the selected areas and (c) capacity building for prevention, diagnosis and management of fluorosis cases. The strategies under the porogramme are (a) imparting training to health personnel for preventive health promotion, (b) early diagnosis and prompt intervention (c) capacity building of district and medical college hospital for reconstructive surgery and rehabilitation (d) establishment of diagnostic facilities in the district hospitals, (e) health education for prevention and control of Fluorosis cases. As per the plan, the programme will be implemented in phased manner in the 100 fluoride affected districts of the country. Presently the programme is being implemented in 20 Districts of 16 States and in the financial year 2010-11 another 40 districts of the country have been selected. 11.8. NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY (NPHCE) According to 2001 census, there were 76.62 million Indians above the age of sixty years. The projections for Annual Report 2010-11 159 next five censuses till the year 2051 are: 96.30 million (2011), 133.32 million (2021), 178.59 (2031), 236.01 million (2041) and 300.96 million (2051). Along with rising numbers, the expectancy of life at birth is also consistently increasing indicating that a large number of people are likely to live longer than before. On the medical front an epidemiological transition is underway whereby as a result of longer survival of man, more and more chronic degenerative diseases will have to be handled. This will also be accompanied by medical, psychological, social and economic problems for the burgeoning population of older persons. At present elderly persons are sharing health care with general public which is causing severe problem to the elderly people. Considering the growing number of elderly population accompanied by changes in society & economy and its impact on the morbidity pattern, Government of India declared National Policy on Older Persons (NPOP) in 1999 and enacted The Maintenance & Welfare of Parents & Senior Citizens Act, 2007". Keeping in view the recommendations made in the National Policy on Older Persons as well as the States obligation under the Maintenance & Welfare of Parents & Senior Citizens Act 2007, the Ministry of Health & Family Welfare has formulated a National Programme for the Health Care of Elderly (NPHCE) during the 11th Plan period to address various health related problems of elderly people. The Planning Commission had allocated Rs.400 crore for the 11th Plan period for this Programme. Broad guidelines on the National Programme were decided by the Working group on communicable and non communicable diseases for 11th Five Year Plan set up in September, 2006. Based on these guidelines, National Programme for Health Care of Elderly (NPHCE) was formulated and the EFC was approved in May 2010 for an amount of Rs. 288 crore for the remaining period of 11th five year plan, out of which Rs. 48 crore will be shared by the state Government towards 20% contribution of the total expenditure. The programme will cover 100 identified districts covering 21 states Main objective of the programme is to provide preventive, curative and rehabilitative services to the elderly persons at various level of health care delivery system of the country. Other objectives are, to strengthen referral system, to develop specialized man power and to promote research in the field of diseases related to old age. Major components of the NPHCE programme are, establishment of 30 bedded department of Geriatric in 8 identified Regional Medical Institutes in different regions of the country, providing dedicated health care facilities Sl. States Districts CHCs PHC Sub No. Centres 1 Andhra Nellore 6 65 481 Pradesh Vijayanagaram 7 59 470 2 Assam Dibrugarh 6 26 240 Jorhat 4 39 142 3 Bihar Vaishali 2 53 336 Rohtas 1 36 186 4 Chhattisgarh Bilaspur 10 74 379 5 Gujarat Gandhi Nagar 6 24 171 Surendranagar 11 31 200 6 Haryana Ambala 3 17 102 7 Himachal Pradesh Chamba 7 42 170 8 Jammu & Leh (Ladakh) 3 13 24 Kashmir Udhampur 2 21 97 9 Jhankhand Bokaro 8 16 116 10 Karnataka Shimoga 11 88 307 Kolar 6 60 201 11 Kerala Pathanathitta 13 37 230 12 Madhya Pradesh Ratlam 5 25 158 13 Maharashtra Washim 7 25 153 Wardha 6 27 181 14 Sikkim East Sikkim 0 8 48 15 Orissa Naupada 4 17 95 16 Punjab Bhatinda 9 17 136 17 Rajasthan Bhilwara 16 63 415 Jaisalmer 6 14 136 18 Uttrakhand Nainital 4 18 136 19 Tamil Nadu Theni 6 23 162 20 Uttar Rae Bareli 11 71 377 Pradesh Sultanpur 14 77 403 21 West Bengal Darjeeling 11 21 230 in District hospitals, CHCs, PHCs and sub centres in the 100 identified districts, covering 21 States of the country. The 8 Regional Medical Institutions and 100 districts have been identified. 30 districts will be taken up in 2010-11 and 70 will be added in 2011-12. List of the 21 States along with the list of 30 districts and the number of CHC/PHC/Sub Centres to be covered under these districts for the year 2010-11 is given below:- Annual Report 2010-11 160 Operational guidelines have been developed for the implementation of the programme. Monitoring of the programme will be done by the common NCD Cells, being established at various levels under the National programme for Cancer, Diabetes, Cardiovascular Diseases and Stroke. Annual Report 2010-11 161 Chapter 12 12.1. INTRODUCTION Various International Organisations and United Nations Agencies continued to provide significant technical and material assistance for many Health and Family Welfare programmes in the country. The status of international assistance from various agencies is discussed in this chapter. 12.2 WORLD HEALTH ORGANIZATION (WHO) World Health Organisation (WHO) is one of the main UN agencies collaborating in the Health Sector with the Ministry of Health & Family Welfare, Government of India. WHO provides technical support in the major areas of Health & Family Welfare programmes and health care facilities in the country. Activities under WHO are funded through two sources: - The Country Budget which comes out of contributions made by member countries and Extra Budgetary Resources which comes from (a) donations from various sources for general or specific aspects of health; and (b) funds routed through the WHO to countries by other member countries or institute agencies. India is the largest beneficiary of the country budget within the SEA Region. The budget is operated on a biennium basis, calendar year wise. 12.2.1. Nodal Functions of WHO: World Health Assembly: The World Health Assembly (WHA) is the most important annual event of the World Health Organisation. The WHA is held once every year and deliberates various draft resolutions that are put up for its approval by the Executive Board of WHO. It is the highest policy making body of World Health Organisation where all member countries are represented by high-level delegations (led by Honble Health Ministers). International Co-Operation For International Co-Operation For International Co-Operation For International Co-Operation For International Co-Operation For Health & Family Welfare Health & Family Welfare Health & Family Welfare Health & Family Welfare Health & Family Welfare The 63 rd WHA was held in May, 2010 at Geneva and a high level delegation comprising of technical officials of this Ministry under the leadership of Shri Ghulam Nabi Azad, Honble Minister of Health & Family Welfare attended. The 63 rd WHA has, inter-alia, discussed the following agenda items and the resolutions were adopted on some of the agenda items Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits. Implementation of the International Health Regulations (2005) Public health, innovation and intellectual property: global strategy and plan of action Monitoring of the achievement of the health related Millennium Development Goals International recruitment of health personnel: draft global code of practice Infant and young child nutrition: quadrennial progress report. Birth defects Food safety Prevention and control of non-communicable disease: implementation of the global strategy Viral hepatitis Tuberculosis Control Leishmaniasis control Chagas disease: control and elimination Global eradication of measles Annual Report 2010-11 162 Smallpox eradication: destruction of variola virus stocks Availability, safety and quality of blood products Strategic Approach to International Chemicals Management WHOs role & responsibilities in health research Counterfeit medical products Human organ and tissue transplantation Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services Treatment and Prevention of Pneumonia Progress Report on Poliomyelitis, human African trypanosomiasis, Reproductive health, Health of migrants, Climate Change and health etc. Meeting of Ministers of Health and Regional Committee of WHO South East Asia Regional Countries: The Health Ministers Meeting (HMM) and the Regional Committee (RC) Meeting of WHO SEAR countries are held annually. HMM provides a forum for Health Ministers to discuss important health issues in the region as well as for forging bilateral arrangements and the Regional Committee is a forum to review progress made on health issues and to lay down the roadmap for future action. The 28 th HMM and the 63 rd Session of RC held in Bangkok, Thailand during 7-10 September, 2010 and a high level delegation of this Ministry under the leadership of Honble Minister of Health & Family Welfare attended. During the 28 th HMM the following agenda items have come up for discussion viz. i) Review of Kathmandu Declaration on Protecting Health Facilities from Disasters/follow up actions on the decisions and recommendations of the twenty-seventh meeting of Ministers of Health, ii) Urbanization and Health, iii) Decentralization of health lower case care services. 12.2.2. GOI contribution to WHO: As a member country of WHO, India makes regular contribution to WHO for each biennium. A WHO biennium commence in January of the first year of the biennium and ends in December of the second year of the biennium. For the biennium 2010-11, the total Assessed Contribution (AC) and Voluntary Contribution (VC) to the working capital of WHO, to be paid by Government of India was US $ 45,69,900 and US $ 1,20,000 respectively. The first installment of the contribution AC & VC for the year 2010 amounting to US $ 20,89,890 and US $ 60,000 respectively, have already been paid in 2009. The second installment of US $ 24,80,010 and US $ 60,000 have also been paid on 21.12.2010. 12.2.3. GOI/WHO collaborative Activities: WHO funding is available for taking services of the experts on contractual basis on specific terms and references; training within and outside the country; holding of workshops, seminars and meetings for raising awareness or exchange of information and medical supplies of equipment, viz: (i) Technical Services Agreement; (ii) Fellowship; (iii) Agreement for Performance of Work; (iv) DFC; and (v) Supplies and Equipment etc. Since the biennium 2010-11, 11 Strategic Objectives have been introduced under which the GOI/WHO collaborative activities are being implemented. Monitoring the activities for timely and effective utilization of funds and their proper accounting is one of the main tasks. The areas of work financed by WHO, inter alia cover HIV/AIDS, communicable and non communicable diseases, mental health, drug abuse, environment, food safety, maternal and child health besides health policy, health financing & social protection as well as emergency preparedness & response. For the biennium 2010-11, under the Country Budget an amount of US $ 7,852,000 was allocated for carrying out various GOI/WHO collaborative activities. All the programme are being implemented efficiently with close monitoring and approx. 30% funds have been utilized till 30 th November, 2010. 12.3. SPECIAL ACHIEVEMENT During the last World Health Assembly held in May 2010, India have presented successful intervention on the agenda Counterfeit Medical Products which was almost accepted by WHO and a resolution was adopted accordingly. The brief of Indias achievements in this regard is as under: On the opening day of the World Health Assembly (WHA) Honble Minister of Health & FW raised the issue counterfeit medicines in his statement. He urged countries to steer clear from the commercially motivated Annual Report 2010-11 163 debates over the counterfeit issue which have hampered public health by preventing access to good quality and low cost generic drugs. The resolution submitted by India on behalf of South East Asia Region (SEAR) on Measures to ensure access to safe, efficacious, quality and affordable medical products contextualized the problem in the public health arena and sought World Health Organizations (WHOs) support in strengthening the national drug regulatory authorities to ensure the availability of quality, safe and efficacious medical products. It requested the Director General (DG) to replace WHOs involvement in IMPACT and the programme on counterfeit medical products with an effective member driven programme to address the issues of quality, safety and efficacy. The resolution also requested the WHO not get involved with Intellectual Property (IP) enforcement and other measures that could potentially undermine availability of quality, safe, efficacious and affordable medical products and production of generic medical products. As a result WHA has adopted a resolution establishing a time limited and result oriented working group on substandard/ spurious/ falsely-labelled/falsified/counterfeit medical products comprised of and open to all Member States. The Working Group will examine, from a public health prospective, excluding trade and intellectual property considerations. 12.4. AIRPORT HEALTH ORGANISATIONS/ PORT HEALTH ORGANISATIONS Airport and Port Health organizations (APHO/PHOs) are subordinate offices of Directorate General of Health Services. At present, there are 9 PHOs and 5 APHOs established at all major international Airports and Ports of the country. There is also one border quarantine centre at Attari border, Amritsar. In addition to these, the health offices at Bangalore and Hyderabad Airports have also been established and started functioning in full swing and action has been taken to set up the health offices at Ahmadabad, Lucknow and Trivendrum Airports. The Budget Division of the Ministry has been requested to provide sufficient budget so that contractual staff could be recruited at these 3 APHOs during the financial year 2010-2011. These are statutory organizations and are discharging their regulatory functions as delineated under Indian Aircraft (Public Health) Rules 1954 and Port Health Rules 1955 respectively. Apart from this, India is also signatory to International Health Regulations (IHR), 2005 framed by WHO and therefore, it is obligatory on our part to implement these regulations. Accordingly, both Indian Air craft Public Health Rules as well as the Indian Port Health Rules have been framed in agreement with these International Health Regulations. Main objective of the APHO/PHSs is to prevent spread of infectious disease of epidemic proportion from one country to another with minimum interference to the international traffic. Some of the important functions of this organization are - Health Screening of International passengers, Quarantine, Clearance of dead bodies, Supervision of airport sanitation, clearance for imported food items, vaccination to international passengers, vector control etc. Apart from this, issuance of deratting exemption certificate is another major responsibility at international ports. WHO has notified a list of yellow fever endemic countries under IHR and any person coming to India from these notified endemic countries is required to possess valid yellow fever vaccination certificate, failing which such passengers are quarantined for a maximum period of six days. In the light of changing global health scenario, existing IHRs have been revised by WHO and these new IHRs have come to effect from June, 2007. 12.5. CUSTOM DUTY EXEMPTION CER- TIFICATE During 2010-2011 (i.e. upto November, 2010) this Ministry has issued one time Custom Duty Exemption Certificates in favour of Additional Director Medical Store Depot, CGHS, New Delhi. 12.6. FOREIGN TRAVEL BY SENIOR OFFICERS For the year 2010-2011, a provision of Rs.200.00 lakhs has been made against Foreign Travel Expenses under Non-Plan. Out of this, the expenditure till November, 2010 is Rs. 105,09,493 (approx.) 12.7. VISIT ON FELLOWSHIP/CONFERENCE ABROAD During the period under report (Upto November, 2010), 116 medical personnel were permitted to participate in International conference/symposia etc. abroad. This includes 20 medical personnel from CHS cadre who have been granted financial assistance subject to a maximum of Rs.1.00 lakh- each to attend International Conference Annual Report 2010-11 164 abroad under the scheme which provides financial assistance to attend seminars/conferences abroad in order to acquaint themselves with the latest developments in the field of medicine and surgery in other countries and to exchange views with their counterparts. 12.8. AGREEMENTS/MOUS In the year 2010-2011, this Ministry has signed the following Agreements/MoUs:- I. An MOU on Cooperation in the field of Health between the Ministry of Health and Family Welfare of the Republic of India and the Ministry of Social Protection of the Republic of Colombia was signed on 19 th January, 2010. II. An MOU between the Government of the Republic of India and the Government of the Republic of the Croatia on Cooperation in the field of the Health and Medicine was signed on 9 th June, 2010. III. An MOU between the Government of India and the Government of Malawi in the field of Health and Medicine was signed on 3 rd November, 2010. IV. An MOU between the Government of the Republic of India and the Government of the Republic of Rwanda in the field of Health and Medicine was signed on 12 th November, 2010 at New Delhi. V. An MOU on the Establishment and Operation of Global Disease Detection- India Center between National Centre for Disease Control, Delhi (Ministry of Health and Family Welfare, Government of India) and Centres for Disease Control and Prevention, Atlanta (The Department of Health and Human Services of the United States of America) has been concluded on 6 th November, 2010. 12.9. MEETINGS/CONFERENCES UNDER THE AEGIS OF INTERNATIONAL COOPERATION (i) An Indo-Swedish Health Week was organized in New Delhi and Hyderabad to commemorate the completion of one year of the Memorandum of Understanding on Health between India and Sweden and to explore and enhance the potential for strengthened collaboration between various stake holders in the public and private health care sector in India and Sweden. (ii) The Joint Working Group (JWG) set-up under the Memorandum of Understanding MOU on cooperation in the field of Health Care and Public Health between the Government of India and Sweden held its third joint meeting in New Delhi on 8 th February, 2010, in which issues of mutual interest in health sector were discussed. (iii) An Indian delegation led by Honble HFM visited Bangladesh from 13-16 th February, 2010 to attend the meeting of the Executive Committee of Partners in Population and Development (PPD) (iv) The Joint Working Group (JWG) constituted under the Agreement on bilateral cooperation in the field of Health and Medicine between India and Fiji held its first Joint meeting in New Delhi. Ministerial/Official bilateral meeting between India and Turkey, Nigeria, Australia, Pakistan, China, U.K., Iraq, Sweden, Armenia were held with a view to improving the bilateral relations in the Health Sector during the year 2010-2011 (upto November, 2010.) 12.10. PERMISSION FOR INTERNATIONAL CONFERENCES In the year 2010-2011 (upto November, 2010), permissions were granted to 70 Organizations/ Instsitutions for holding health related international Conferences in India. Annual Report 2010-11 165 Chapter 13 Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies 13.1 CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) Central Government Health Scheme has been in existence since 1954, when it started functioning in Delhi. Central Government Health Scheme has since come a long way and presently Central Government Health Scheme covers 25 cities. In order to make the CGHS user friendly, its functioning has been streamlined and revamped. Important actions in this direction have been the computerisation of the functioning of the CGHS and its dispensaries, delegation of enhanced financial powers to CGHS functionaries and to Ministries / Departments, issue of plastic cards to beneficiaries enabling them to take treatment in any dispensary, introduction of direct indenting of commonly prescribed medicines by CMOs in charge of dispensaries, empanelment of private hospitals and diagnostic centres to provide options, in addition to the facilities available in Government hospitals, polyclinics and laboratories, outsourcing of sanitary work in dispensaries, outsourcing of dental services, opening of stand-alone dialysis unit in Delhi, appointment of the Bill Clearing Agency (BCA) of settlement of bills of hospitals of pensioner beneficiaries treated in hospitals, etc. These measures have resulted in increased satisfaction level of CGHS beneficiaries. The Central Government Health Scheme (CGHS) is a scheme for providing health care to serving Central Government employees and their dependant family members. Over the years, the scheme has been extended to cover central government pensioners, their dependant family members and certain other categories like Members of Parliament and ex Members of Parliament, freedom fighters etc. Employees of some select autonomous bodies as also PIB accredited journalists have also been extended CGHS facilities on cost-to-cost basis in Delhi. 13.1.1. Membership Profile As on 31 st March 2009, CGHS had 9.34 lakh members with coverage of over 31.81 lakh beneficiaries. The break-up of the current membership profile is given in the table below: Membership profile (31.3.2009) Category Card Holders Beneficiaries Serving 627004 2518805 Pensioners 290880 634167 Freedom Fighters 13068 18293 MPs 609 2437 Ex-MPs 1010 2593 Journalists 128 220 Others 1452 3235 General Public 674 1969 Total 9,34,825 31,81,719 COVERAGE CGHS was started initially in Delhi. Today it covers 25 cities as indicated below: Ahmedabad Allahabad Bangaluru Bhubaneshwar Bhopal Chennai Chandigarh Delhi Dehradun Guwahati Hyderabad Jaipur Jabalpur Kanpur Kolkata Lucknow Meerut Mumbai Nagpur Patna Pune Ranchi Shillong Jammu Thiruvananthapuram Annual Report 2010-11 166 There is no CGHS coverage in the States of Himacjhal Pradesh, Chattisgarh, Punjab, Haryana, Tripura, Manipur, Mizoram, Nagaland, Sikkim, Goa and Union Territory of Puducherry. 13.1.2. CGHS Infrastructure The beneficiaries are being provided health service through a huge network of: A) Dispensaries (247 Allopathic, 82 AYUSH), B) Yoga Centres (4), C) Polyclinics (19), D) Laboratories (65)+ 1(Hind lab) E) Dental Units (21) F) Gynae maternity Hospital (1) G) Dialysis Centre (Sadiq Nagar, New Delhi). In addition, beneficiaries are offered medical facilities in private hospitals and diagnostic centres empanelled by the CGHS by following an open tender system. CGHS was finding it difficult to fill up the vacancies of medical officers as the majority of the doctors recommended by the Union Public Service Commission did not assume charge in the CGHS for various reasons. To overcome the problem of unfilled vacancies, it has been decided to appoint, on contract basis, doctors who had retired from Government service. As a result of this decision, 79 retired doctors have been appointed on a contract basis in the CGHS. 13.1.3. Facilities provided under CGHS Facilities of outpatient care in all systems and emergency services in allopathic system, supply of necessary drugs, laboratory and radiological investigations, domiciliary visits to the seriously ill patients, specialists consultation both at the dispensary and hospital level, family welfare services, treatment in specialised hospitals, both Government and CGHS empanelled private hospitals etc. are being provided to the beneficiaries through dispensaries, polyclinics and Government / CGHS empanelled private hospitals / diagnostic centers. There are special facilities for the convenience of pensioners and senior citizens. CGHS Pensioner beneficiaries can obtain a CGHS pensioner card with life-time validity, by paying an amount equivalent to ten years subscription. The pensioners living in areas not covered by the CGHS have the option to get their CGHS pensioner cards from the nearest CGHS covered city. Credit facilities are also available to the pensioners for treatment taken in private hospitals /diagnostic centers empanelled under CGHS by obtaining a permission / referral letter from CGHS. In such cases, the hospitals are directed to send the bill for the treatment to the CGHS and not to charge from the pensioners. Pensioner beneficiaries are being allowed to get medicines for chronic ailments up to three months at a stretch. Two Geriatric Clinics have been established and are functioning at CGHS Timarpur and Janakpuri in Delhi. 13.1.4. Computerisation of CGHS The computerisation of CGHS and its dispensaries which was initiated in 2005 has been completed in all cities. Computerisation of CGHS Wing in Dr. Ram Manohar Lohia Hospital in Delhi has also been completed. 13.1.5. Issue of Plastic Cards All the new cards in Delhi and other cities are made only in the form of Plastic Cards to each beneficiary with a distinct beneficiary identification number. Each card will have a bar code. In Delhi so far 8.5 lakh cards have been printed and distributed to CGHS beneficiaries.The benefit of having a plastic card is that the beneficiaries, while on tour to any CGHS city, can go to the wellness centre in that city and obtain treatment in case of need. 13.1.6. Subscription to CGHS Serving Government servants residing in areas covered by the CGHS are compulsorily covered by the CGHS. In order to avail the CGHS facility, they have to contribute on a monthly basis at the rates brought into force from 1 st June, 2009, which are as below: S. No. Grade pay drawn by the officer Contribution(Rupees per month) 1 Upto Rs. 1,650/- per month 50/- 2 Rs. 1,800/-; Rs. 1,900/-; Rs.2,000/-; Rs.2,400/-; and Rs.2,800/- per month 125/- 3 Rs. 4,200/- per month 225/- 4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and Rs. 6,600/- per month 325/- 5 Rs. 7,600/- and above per month 500/- Annual Report 2010-11 167 Central Government pensioners can avail CGHS facilities by depositing the applicable subscription rates. Pensioners have the option of either subscribing on an annual basis or pay a lump sum equivalent to 10 years contribution and avail CGHS facilities for life time alongwith dependent family members. 13.1.7. Definition of Family A. Family for purposes of availing CGHS facilities has been defined as under: (i) Husband / wife (ii) Parents and stepmother (iii) Female employee has a choice to include her parents or her parents-in-law and option exercised can be changed once during the service period (iv) Children (including legally adopted children) subject to the conditions that: (a) Son till he starts earning or attains the age of 25 years, whichever is earlier. A son, if married, even if he is dependent on his parents and is below 25 years of age will not be part of the family for CGHS purposes Son, even if he is more than 25 years of age, but is suffering from permanent disability [as defined in (i) Disabilities defined in Section 2(i) of The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (No: 1 of 1996), and in Clause (j) of Section 2 of National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 (No: 44 of 1999)] and is fully dependent on his parents will be entitled to CGHS facility. The matter regarding ineligibility of sons above the age of 25 years has been challenged in Delhi High Court and final orders of the Court are awaited. (b) Daughter Till she starts earning or gets married, whichever is earlier, irrespective of age-limit. Widowed dependent daughters, divorced / separated daughters if dependent on her parents will be entitled to CGHS facility irrespective of age- limit. (v) Sisters including unmarried / divorced / abandoned or separated from husband / widowed sisters, if dependent on the Government servant will be entitled to CGHS facilities irrespective of age-limit. (vi) Minor brothers 13.1.8. Dependency Criteria Members of the family (other than one spouse) whose income from all sources is less than Rs.3,500/- plus an amount equivalent to the DA announced by the Government from time to time will be treated as dependent on the Government servant and hence are entitled to avail CGHS facilities. 13.1.9. Empanelment of private hospitals and diagnostic centres As CGHS does not have adequate facilities to offer medical treatment to its beneficiaries in Government hospitals, it empanels private hospitals and diagnostic centers in all CGHS covered cities. For this purpose tenders were floated in 2009 calling for private hospitals and diagnostic centers interested in being empanelled under CGHS to offer their rates for various procedures / tests, etc. Based on the rates quoted by the private hospitals and diagnostic centers, the lowest rates in respect of each procedure / test were offered to the private hospitals and diagnostic centers and those private hospitals and diagnostic centers which accepted the rates have been empanelled under CGHS in Delhi and most of other cities. It is expected that with the completion of the tender process and introduction of continuous empanelment scheme, almost all the cities will have private hospitals/ diagnostic centres in the CGHS panel. Private hospitals and diagnostic centers which were empanelled under CGHS have signed MOAs with the CGHS. Any violation of the provisions of the MOA meant that fines would be levied on these private hospitals and diagnostic centers and bank guarantee could also be utilised. 13.1.10.Procedure for referral to empanelled hospitals & diagnostic centres The CGHS beneficiary first visits the dispensary (now renamed as Wellness Centre) for treatment of an ailment. The CMO in the wellness centre will refer to the patient to a specialist in a Government hospital for suggesting the procedure / tests, etc., to be undergone by the patient. If the CGHS beneficiary is a pensioner, then the wellness centre will issue a referral letter to the private hospital and diagnostic centre where the beneficiary wants to be treated. The private hospitals and diagnostic centres will provide credit facility to the beneficiary and raise their bill on the CGHS. Annual Report 2010-11 168 If, however, the CGHS card holder is a serving Central Government servant, then he / she will have to obtain permission from his / her Ministry / Department. 13.1.11.Change in procedure for payment of hospitals / diagnostic centres bills: Private hospitals and diagnostic centres have to provide credit facility to pensioner CGHS beneficiaries referred to them by the CGHS. Due to paucity of funds and procedural bottlenecks, settlement of the bills of private hospitals and diagnostic centers got delayed with the result that many private hospitals and diagnostic centers refused to extend credit facility without receiving payment towards the bills already submitted. To overcome the problem, a Third Party Administrator (TPA) (the Bill Clearing Agency UTI TSL) has been engaged for processing of bills and release of payments electronically. CGHS will then carry out medical audit of the bills passed for payment by the TPA. 13.1.12. Supply of medicines to beneficiaries Medicines for CGHS are procured by HSCC / Medical Stores Depot and Medical Stores Organisation, on the basis of the indents made by different wellness centres, and supplied to the wellness centres. The medicines prescribed by the treating doctor, if available in the store of the wellness centre, are supplied to the beneficiary. If, however, the prescribed medicine is not available by the brand name but in another brand name or there is another medicine with the same active ingredients, then the same is supplied to the beneficiary. 13.1.13. Local indenting of medicines Each wellness centre holds certain quantity of branded and generic drugs, which are distributed to the beneficiaries on the basis of prescriptions of specialists. If any drug is not available in stock, then the wellness centre places an indent on the locally authorised chemist for the wellness centre for the supply of the drugs. As it is not possible for the wellness centers to keep in stock all the drugs that are prescribed by the specialists and if drugs with the same active ingredients are also not available, then the wellness centre is authorised to place an indent on the local authorised chemist for the supply of the drug prescribed by the specialist. Authorized local chemists for wellness centres are appointed on the basis of tenders floated by the CGHS for such appointment. The selection of the chemist is done on the basis of the highest rebate offered by the chemist on the printed MRP. Before the chemist is appointed, his premises are inspected to ensure that he has the capacity to handle the volume of indents that will be placed by the wellness centre on the chemist. 13.1.14. Treatment for Cancer As there is no private hospital empanelled (both old and new) under CGHS for treatment of cancer patients, ad- hoc arrangements for treatment of cancer patients have been made in view of the hardships faced by CGHS beneficiaries undergoing treatment for cancer. Patients can be referred to any hospital offering treatment to CGHS beneficiaries suffering from cancer. In addition, orders have been issued for treating the following Regional Cancer Centres as empanelled under CGHS / CS (MA) Rules. 13.1.15.Regional Cancer Centres deemed to be empanelled under CGHS:- 1. Kamla Nehru Memorial Hospital, Allahabad, Uttar Pradesh; 2. Chittaranjan National Cancer Institute, Kolkata, West Bengal; 3. Kidwai Memorial Institute of Oncology, Bangaluru, Karnataka; 4. Regional Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu; 5. Regional Cancer Centre, Thiruvananthapuram; 6. Gujarat Cancer Research Institute, Ahmedabad, Gujarat; 7. MNJ Institute of Oncology, Hyderabad, Andhra Pradesh; 8. Dr. B.B. Cancer Institute, Guwahati, Assam; 9. Indian Rotary Cancer Institute (AIIMS) , New Delhi; 10. RST Hospital & Research Centre, Nagpur, Maharashtra; 11. Tata Memorial Hospital, Mumbai, Maharashtra; and 12. Indira Gandhi Institute of Medical Sciences, Patna, Bihar. Annual Report 2010-11 169 13.1.16. Regional Cancer Centres deemed to be empanelled under CS(MA) Rules, 1944 1. Acharya Harihar Regional Cancer Centre for Cancer Research & Treatment, Cuttack, Orissa; 2. Puducherry Regional Cancer Society, JIPMER, Puducherry; 3. Regional Cancer Control Society, Shimla, Himachal Pradesh; 4. Cancer Hospital and Research Centre, Gwalior, Madhya Pradesh; 5. Pt. JNM Medical College, Raipur, Chhatisgarh; 6. Acharya Tulsi Regional Centre Trust and Research Institute (RCC), Bikaner, Rajasthan; and 7. Regional Cancer Centre, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana. 13.1.17. Other facilities CGHS beneficiaries in Kolkata can avail treatment / facilities in the Afternoon Pay Clinics run by the Government of West Bengal, with a provision for reimbursement of the consultation fee. The OPD consultation fee charged by the Pay Clinics will be reimbursed at the rate of Rs. 100/- (Rupees one hundred only) for the first visit and Rs. 60/- (Rupees Sixty only) for subsequent visits. The reimbursement of the expenditure will be made by the concerned Department / Ministry in case of serving employees and by CGHS in case of pensioner beneficiaries. Beneficiaries under CGHS possessing a valid CGHS card can avail treatment / investigation facilities at Nizams Institute of Medical Sciences, Hyderabad, for which prior referral / permission / approval will not be necessary from the concerned Department / CGHS Dispensary. Similarly, beneficiaries under Central Services (Medical Attendance) Rules, 1944 can also avail treatment / investigation facilities at Nizams Institute of Medical Sciences, Hyderabad without prior referral / permission / approval. 13.1.18. Grievance Redressal Mechanism 13.1.18.a. Local Advisory Committees Instructions have already been issued to all CGHS cities that meetings of Local Advisory Committees should be held on Second Saturday of every month in each dispensary. The meetings are held under the chairmanship of CMOs in charge of the dispensaries, in which Area Welfare Officers and representatives of pensioners associations are members to discuss local problems faced by the beneficiaries and dispensaries and to resolve such issues. All wellness centers have been directed to keep a complaints / suggestions Box and also to maintain a complaints / suggestions register. The complaints Box will be opened at the time of the meeting of the Local Advisory Committee. CGHS Help Lines (No. 011-66667777 & 155224), are in operation between 9.30 A.M. to 5.30 P.M. There is also a e-mail help line cghs @ nic.in where readily available information is provided E-mails are addressed. Otherwise, beneficiaries are directed to contact the concerned nodal officers to get the desired information. 13.1.18.b. Holding of Caims Adalats under CGHS Complaints were received in the CGHS and in the Ministry that old cases of reimbursement of medical expenses incurred by pensioners had been pending for settlement for a long time. It was decided that Claims Adalats be held in each CGHS city under the chairmanship the Additional / Joint Directors of the respective city. For holding of the Adalats, advertisements were released in local leading newspapers requesting aggrieved pensioners to apply to the respective Additional Directors by furnishing the details of their long pending claims. A good number of long pending cases could be settled in Delhi and in outside CGHS cities through this mechanism. Instructions have been issued for holding such Adalats in 2011 also. 13.1.18.c. Expenditure: Over the years, expenditure under CGHS has been showing an increasing trend. The details of actual expenditure since 2005 06 are as under:- S. No. Year PORB Head Other heads Total Expenditure 1. 2006-07 349.47 397.86 747.39 2. 2007-08 438.45 470.69 909.14 3. 2008-09 498.00 547.91 1045.91 4. 2009-10 617.00 532.00 1149.00 5. 2010-11 600.00 Proposed (RE) 568.65 811.07 (Till 22-12-10) 6 2011-12 Proposed (BE) 604.00 680.81 1,284.81 ( Rs. In crores) Annual Report 2010-11 170 13.1.19.Status in respect of North East: The CGHS is in operation in two cities in the North Eastern States viz. Guwahati and Shillong since 1996 and June 2002 respectively. One Ayurvedic and one Homeopathy dispensary in Guwahati have since started functioning. There were 12,008 card holders with 45,427 beneficiaries in Guwahati and 1,857 card holders with 6,544 beneficiaries in Shillong as on 31-3-09. 13.1.19.a. Recent initiatives taken 1) Strengthening of administrative set up of CGHS: To further improve the functioning of CGHS, a senior position at the level of Additional Secretary & Director General (CGHS), to be filled up under the Central Staffing Scheme has been newly created. The full administrative control of the entire CGHS staff has been vested with Additional Secretary & Director General (CGHS). 2) Simplification of procedures under referral System and Reimbursement : a. Submission of Medical claims has been simplified by doing away with the requirement of verification of bills by the treating doctor and Essentiality Certificate. b. Specific guidelines have been issued for examining requests for full reimbursement of claims. The power for relaxation of rules is vested with the Ministry of Health & Family Welfare, except in case of Honble Members of Parliament and Sitting Judges and Former Judges of Honble Supreme Court of India. 3) Reimbursement from two-sources: Instructions were issued in February 2009 regarding reimbursement under CGHS and Health Insurance Scheme. As per the revised guidelines beneficiaries have the option to submit the original bills under the Health Insurance Scheme and claim the balance amount from CGHS / Department subject to the condition that the reimbursement (balance amount) from CGHS/ Department shall be as per CGHS rates and regulations. 4) Bulk Procurement of Commonly Indented Medicines from Manufacturers/ Suppliers: Based on the Data generated by Computers a list of 272 medicines commonly indented through Authorised Local Chemists (ALCs) was prepared. Based on the success of a pilot project which was started in 10 WCs in Delhi to procure these commonly indented medicines directly from manufacturers / suppliers on a monthly basis, the same has been replicated in 16 cities namely Ahmedabad,, Allahabad, Bengaluru, Bhubaneswar, Chennai, Guwahati, Hyderabad, Jabalpur, Jaipur, Kolkata, Lucknow, Mumbai, Nagpur, Patna, Pune, and Ranchi..The advantage being that medicines are readily available for issue to beneficiaries instead of indenting through ALC. Manufacturers / suppliers offer a better discount on rates as compared to ALCs. 5) Health Check-Up of Beneficiaries above 40 years in Delhi A pilot project is being implemented in 2 Wellness Centres, namely Sector 8 and Sector 12 in Ramakrishna Puram, for the Health Check-up of all beneficiaries above the age of 40 years in Delhi. 30 beneficiaries per day would be registered in advance online and would undergo a list of identified investigations. Beneficiaries would have a clinical check up on the date of appointment along with investigation report. The health check-up is proposed to identify risk factors including Life style related diseases for prevention / early identification for further follow-up and treatment, if required. So far, 1200 beneficiaries have availed of this facility. 6) Outsourcing of Dental Services: Dental services in eight dispensaries in Delhi have so far been outsourced though Public Private Partnership (PPP). These are at Moti Bagh, Ramakrishna Puram Sector 12, Kidwai Nagar, Sadiq Nagar, Srinivas Puri, Kalkaji I, Pushp Vihar Sector IV and Faridabad. 7) Delegation of Financial Powers to settle reimbursement claims in CGHS: Powers for settlement of reimbursement claims by pensioner beneficiaries by CGHS were last delegated in 1999. This resulted in delay in settlement of claims by CGHS. Instructions have been issued on 24 th January, 2011, delegating enhanced financial powers to AS & DG (CGHS), Director CGHS and all Additional Directors / Joint Directors of CGHS. This is expected to ensure speedy settlement of reimbursement claims of all hospitals and individual beneficiaries. Annual Report 2010-11 171 8) Increasing the level of Imprest Money at dispensary level: Imprest money available with the Chief Medical Officer in charge of dispensaries were very low resulting in CMOs not being able to attend to minor items of work. In order that minor items of work do not get delayed, the quantum of Imprest Money available with CMO in charge of each dispensary has been increased to Rs. 20,000/ - (Rupees Twenty thousand only) per annum. Instructions have been issued to declare Chief Medical Officers in charge of dispensaries as Heads of Office under provisions of the Delegation of Financial Power Rules. 9) Engagement of Bill Clearing Agency (BCA): The major grouse of private hospitals and diagnostic centres empanelled under CGHS was that settlement of bills sent to CGHS in respect of treatment given to pensioner CGHS beneficiaries took unduly long time, which was one of the reasons why hospitals and diagnostic centres were showing their unwillingness to provide credit facility to CGHS beneficiaries. In order to overcome this difficulty, CGHS has appointed UTI TSL as the Bill Clearing Agency, by signing a MOA with it. Under the procedure, hospitals and diagnostic centres are required to submit their bills electronically to UTI TSL after discharge of the patient, followed by forwarding of bill physically. UTI TSL is required to pay to the hospitals the applicable amount as per package rates for the treatment within ten days of receipt of the bill physically. To enable UTI TSL to make payments to hospital, an advance of Rs. 70.00 crores has been forwarded to it by the CGHS. After UTI-TSL makes payments to the hospitals, it will submit the bills to CGHS periodically for recouping the money paid to hospitals. 13.2 SAFDARJANG HOSPITAL &VMMC 13.2.1. Introduction of the Hospital Safdarjang Hospital was founded during the Second World War in 1942 as a base hospital for the allied forces. It was taken over by the Government of India, Ministry of Health in 1954. Until the inception of All India Institute of Medical Science in 1956, Safdarjang Hospital was the only tertiary care hospital in South Delhi. Based on the needs and developments in medical care the hospital has been regularly upgrading its facilities from diagnostic and therapeutic angles in all the specialties. The hospital when started in 1942 had only 204 beds, which has now increased to 1531 beds. The hospital provides medical care to millions of citizens not only of Delhi but also the neighboring states free of cost. Safdarjung Hospital is a Central Government Hospital under the Ministry of Health & Family Welfare and is receives its budget from the Ministry. Safadarjung Hospital has a Medical College associated with it named Vardhman Mahavir Medical College. 13.2.2. Vardhman Mahavir Medical College was established at Safdarjung Hospital in November 2001 and on 20 th November 2007, the Vardhman Mahavir Medical College building was dedicated to the nation. The first batch of MBBS students joined the college in February 2002. The college has recognition from the Medical Council of India. The college is affiliated to Guru Govind Singh I P University, Delhi. From 2008 onwards the post graduate courses are also affiliated to GGSIP University which were with Delhi University. NEW OPD BUILDING AT SAFDARJANG HOSPITAL Vardhman Mahavir Medical College Annual Report 2010-11 172 13.2.3. The Services Available: The hospital provides services in various Specialties and Super Specialties covering almost all the major disciplines like Neurology, Urology, CTVS, Nephrology, Respiratory Medicine, Burns & Plastics, Pediatric Surgery, Gastroenterology, Cardiology, Arthroscopy and Sports Injury clinic, Diabetic Clinic, Thyroid Clinic. Further, it has two Whole Body CT Scanner, MRI, Colour Doppler, Digital X-ray, Cardiac Cath. Lab. A Homoeopathic OPD and Ayurvedic OPD are also running within this hospital premises. 13.2.4. OPD Services OPD Services are running in New OPD Building of V.M.M.C & Safdarjang Hospital. Patients coming to OPD of Safdarjang Hospital find a congenial and helpful atmosphere. Various Public Friendly Facilities exist in the OPD registration area of the New OPD Building like the May I help You Counter, Computerized Registration Counters, which are separately marked for Ladies, Gents , Senior Citizens and Physically Challenged. The hospital has an ever increasing attendance of 23,21,526 in the year 2010 i.e. @ 7790 per working day of patients in the OPD. To cater to this load and for convenience of the patients a new OPD Block was commissioned in August, 1992. All Departments run their OPD in the new OPD block. There are several disciplines for which the OPD services are provided daily. The OPD complex has a spacious registration hall with 18 registration windows. The OPD registration services have been computerized and the new system is functional since mid February 2005. The first floor of the OPD complex caters to the Department of General Medicine and allied Super-specialties; the second floor caters to the Department of General Surgery and allied super- specialties; the third floor is occupied by Pediatrics and Homeopathy; the fourth floor houses the ENT & Eye OPDs and the fifth floor is occupied by the Department of Skin & STD. The out patient attendance for the last 5 years are as under :- YEAR OPD ATTENDANCE 2006 21,17,201 2007 21,19,980 2008 22,18,294 2009 23,13,585 2010 23,21,526 13.2.5. Sports Injury Centre (SIC) : The Government of India has established the Sports Injury Centre (SIC) at Safdarjang Hospital, New Delhi at an approved cost of Rs. 70.72 crores with an objective of providing Comprehensive Surgical, Rehabilitative and Diagnostic services under one roof for specialized treatment of Sports and related Joint disorders. The benefits would not be limited only to the sports persons but will also be extended to other patients sustaining similar and related joint injuries. The Centre has become functional from 26.9.2010 after its inauguration by the Honble Prime Minister. The Centre also aims to develop the specialty of sports medicine in due course. Annual Report 2010-11 173 Besides the OPD and emergency services, the Centre has an in-patient capacity of 35 beds in single bed, two bed, 4 bed wards and is expected to take care of about 2500 cases pertaining to Arthroscopic & specialized joint surgical procedures every year. The SIC building comprising of seven floors apart from the basement has been equipped with state of the art Operation Theatres and Physiotherapy Centre with all latest facilities adhering to the global standards. The Centre, as part of providing diagnostic services under one roof is housing all modern diagnostic facilities such as MRI and CT scan, Ultrasound, Bone Densitometer, Colour Doppler, etc. and laboratory services which have been wet-leased under PPP mode on revenue sharing basis. The centre will have its own facilities of CSSD and laundry which are being outsourced. 13.2.6. In-Patient Services The hospital has total bed strength of 1531 including bassinets. There are in addition observation beds for Medical (Ward A) and Surgical (Ward B) patients in the first and second floor of the main causality building. There are 10 beds in the causality for observation. As a policy the hospital does not refuse admission if indicated to any patient in the causality. As a major shift in policy decision, the casualty is now run by post graduate doctors. Senior Residents from the disciplines of Medicine, Surgery, Paediatrics, Orthopaedics and Neuro-Surgery are available round the clock in the causality to provide emergency care. The administrative requirements of the causality are taken care of by a chief medical officer and a specialist (nodal officer) who are also posted in the causality from various Departments by rotation. There is a 24 hour laboratory facility besides round the clock ECG, Ultrasound, X-ray & CT Scan services. The Departments of Obst. & Gynaecology and the burns have separate, independent causalities. 13.2.7. Casualty Services CMO I/c Casualty- Dr. Veer Bhushan, was nominated as the Nodal Officer for CWG 2010 for SJH. He successfully coordinated & managed two venues at Sirifort Stadium & also provided medical facility at JLN Stadium, SJH was supplementary response hospital for many stadium. One Defibrillator for casualty procured for Patient care. Surveillance Cameras were installed to strengthen the Security System. Safdarjang Hosptial successfully managed the Epidemics of Swine Flu and Dengue. Waste management training has been made compulsory for casualty. The guidelines for referral of poor patient to other hospital have been strengthened. Large display board in Hindi regarding Poor Patient referral to Pvt. Hospital were put at several prominent places. Several New Super Speciality Departments (Endocrinology, Medical Oncology, Nephrology, Nuclear Medicine and Haematology) are also being run in this hospital. The hospital also provides the services for cardiac catheterisation, lithotripsy, sleep studies, endoscopies, arthroscopies, video EEG, spiral CT, MRI, colour Doppler, mammography and BAC T ALERT microbiology rapid diagnostic system. Total No. of In-Patients admitted and operations conducted in this hospital for the last 5 years are as under :- ADMISSION:- OPERATIONS Years Admissions Major Minor Total 2006 1,15,441 21,385 57,827 79,212 2007 1,18,923 19,638 61,847 81,485 2008 1,29,271 21,604 69,640 91,244 2009 1,28,175 23,354 69,091 92,445 2010 1,25,192 23,096 70,544 93,650 Annual Report 2010-11 174 OPERATIONS:- The total number of deliveries conducted in the Department of Obst. & Gynae during the year 2010 was 25439. The details of Lab Examination and X-ray examinations since 2006 are given below: The Significant Achievements during the year 2010 1. The transport Deptt. VMMC & Safdarjang Hospital intent to purchase 16 new vehicles. out of which presently 9 (Nine) Ambulances including (2 Advance Life Support & 4 Basic Life Support) and 3 normal ambulances have been procured and put on service. 2. Two Ultrasound machines, Multi load CR system, Digital OPG X-ray Machine, Bone Mineral Density Measurement Equipment & HD 11 XE High Definition U/S system (Color Doppler Machine) have been installed in the Deptt. of Radiology. 3. The construction of residential hostel for MBBS Student, VMMC was started in 18.01.2008 and the same has completed on May 2010, 254 MBBS students have been accommodated since August 2010. 4. The hospital has successfully completed Community Based Rehabilitation, Pilot Project sponsored by WHO at District Gurgoan in selected rural area. A rural rehabilitation programme is being run in the selected areas of Gurgaon district by the Deptt. of Physical Medicine and Rehabilitation. Regular rehabilitation services are being given at the door steps at selected rural communities. 5. Hematology OPD in the H Block extension has been started. 6. Blood Bank and Transfusion Medicine has 25005 donations and 14,241 components (from Jan09 to Nov.09) and it has issued 31,988 units of blood and components to hospital. 7. A Museum has been built up in VMMC Pathology. Fluid cytology on cytospin has been introduced and 2006 2007 2008 2009 2010 Daily Average 2010 Lab. examination 3392554 3431028 3354439 3698191 4239160 11614 X-Ray examination 214802 225793 230530 248211 256432 703 Annual Report 2010-11 175 DNB course has been started in the Pathology Department. 8. Three new tests 1) VMA 2) Anti HBs 3) Parathyroid Hormone have been introduced in the Lab. Medicine Deptt. of Clinical Pathology. 9. A total no. of 156 CCTV cameras have been installed on approved locations and are functional. 10. A special counter for senior citizens, physically handicapped patients and hospital staff was opened in Central Dispensary to avoid inconvenience to these patients. Additional counter for Clinic patients was opened with in the existing strength of Pharmacists in order to minimize waiting time of the patients. 11. M.Sc. Perfusion Training Course has been started w.e.f. 01.08.2009. 12. A total of 6399 poor patients were given free sanction for various tests. 13. A Dual Head Gamma Camera with integrated Multislice CT, Turnkey works has already been installed and is functional in the Deptt. of Nuclear Medicine . 14. Blood Gas & Electrolyte Analyzer Model ABL800 Basic Radiometer-Copenhagen: was installed in the Deptt. of Respiratory Medicine in January 2009. A Tyco-sleep lab was established in the Deptt in February 2009. 15. A new pharmacokinetic lab has been established in the Deptt. of Pharmacology. Animal house facility too has been created in the Department. 16. The Casualty Deptt. has been equipped with Tracked overhead IV system. 17. The Deptt. of Burns, Plastic and Maxillofacial Surgery has been equipped with Scrub station in Plastic & Burn O.T., Transport ventilator in Burn I.C.U. & Deep Freezer in Burn O.T. to store skin graft for longer period and Six Vital monitor have also been procured in the Deptt. for managing seriously ill patients. 18. Mother & Child care 100 bedded satellite hospital in Gurgaon Sec. 10 has been taken over by Safdarjang Hospital. 19. A 360 bedded new Super specialty building proposal has been sent to Min. of Health & Family Welfare Site earmarked. 13.2.8. Transport Services Safdarjang Hospital has 21 Ambulances which are available for emergency services round the clock. Out of 21 ambulances six ambulances were purchased during C.W.G. 2010, of which 4 are Basic Life support ambulance and 2 Advance Life Support ambulance. Three other newly acquired ambulances will be used as patient transport ambulances for needy patients. Besides this 8 other vehicles are available which include 2 Buses, 1 STD Van, 1 Truck and 4 Staff cars. 13.2.9. Right To Information Cell (RTI) An R.T.I. Cell is also functioning on the guidelines of Ministry of Law & Justice, as per the RTI Act 2005, in the Gazette of India on 15 th June 2005. 13.2.10. Hindi Section: It is constant endeavor of Hospital to regularly monitor and see the progressive use and implementation of the Official Language in the functioning of hospital. Due to the constant efforts, the use of official language has reached to approximately 60%. 13.2.11. Web Site VMMC & Safdarjang Hospital had launched its web site (www.vmmc-sjh.nic.in) which was inaugurated on 17.09.2002 by the then Union Health Minister. The website is a user friendly and reveals all the necessary information about hospital and its activities. 13.2.12. Training And Teaching Teaching of Post-graduate Degree & Diploma to the students enrolled through GGSIP University are conducted in the Departments of Medicine, Surgery, Orthopaedics, Obst. & Gynae, Paediatrics, Anaesthesia, Radio-Diagnosis, Radiotherapy, Opthalmology, ENT, Dermatology, PMR, Physiology, Anatomy, Community Medicine, Microbiology, Biochemistry, Pathology, Pharmacology. In the year 2010, 10 students have been enrolled for M.Ch. Plastic surgery course & 1 student for M.Ch. CTVS course. Out of 173 seats sanctioned for PG Degree courses, 130 students have joined for the session 2010-11 & PG Diploma courses are abolished from the 2010-11 session. Annual Report 2010-11 176 The regular courses are also being run for Nurses Training, Medical Lab. Technology (MLT) apprenticeship; Diploma in Lab Technology; Pre-hospital trauma technician course and courses in pharmacy. Medical Record Technician (MRT) and Medical Record Officer training, Physiotherapy training, O.T. Assistants training and Short term laboratory training programs for all MLT are being conducted regularly. The proposal for starting MDS course in prosthodontis was approved by Ministry of H.& F.W and extra space for that purpose has been allotted to Dental Department. The branch of Prosthodontics deals with replacement of teeth and associated structures. With starting of this course this hospital will be able to provide facilities of crowns, bridges and dentures to common OPD patients in large scale. The post graduate course will start in near future. 13.2.13. Research Activities Besides the regular clinical work various research activities are undertaken on a regular basis in the different Departments of the hospital. A number of those have been published in national and international medical journals. A few journals have been also published from Safdarjang Hospital. The research activities are often in coordination with ICMR, DST& WHO. o ICMR Research Project Multi Centric National Task Force Project on Epidemiology of Musculoskeletal conditions in India is being followed in Rehabilitation Section. o WHO Project Community Based Rehabilitation- Pilot Project- Gurgaon has been completed by Rehabilitation Deptt. o Comparative efficacy of Novamin vs Potassium Nitrate in treatment of Dentinal Hyper-sensitivity. o Comparative efficacy of Tacrolimus vs Triamcinalone in treatment of Lichen Planus. o Effect of gum disease in pregnant patients on incidence of preterm low birth weight babies. 13.2.14. Construction Activities Two additional theatres for general surgery have been started on 1 st floor OT. One theatre has been added for Cancer surgery and Urology services. The microsurgery operational theatre is under up-gradation . 13.2.15. Budget Allocation (Rs. In crores) Safdarjang Hospital & VMMC Funds Budget Allocated (2006-2007) (2007-2008) (2008-2009) (2009-2010) (2010-2011) Plan 48.00 70.00 70.00 84.00 132.53 Non Plan 74.40 79.90 95.70 157.00 160.00 Total 122.40 149.90 165.70 241.00 292.53 VMMC (Revenue) (Rs. in crores) Budget allocated Expenditure incurred 2004-05 5.00 4.66 2005-06 BE 28.76 FE 32.25 32.24 2006-07 (plan) 4.00 FE 4.20 4.03 2007-08 (Plan) 1.00 FE 2.50 2.49 2007-08 (Non-Plan) 0.01 - 2008-09 Nil Nil 2009-2010 Nil Nil 2010-2011 2.00 2.00 (till mid Dec-2010) Annual Report 2010-11 177 Plan Revenue (SJH) (Rs. in crores) Year Allocation (Year wise) Expenditure 2006-07 48.00 47.66 2007-08 30.00 FE 37.22 37.08 2008-09 30.00 63.12 2009-2010 44.00 101.68 2010-2011 77.00 63.03 Non Plan Revenue (SJH) (Rs. in crores) Year Allocation Expenditure (Year wise) 2006-2007 (non plan) 74.40 FE 81.41 81.33 2007-2008 79.89 F.E 95.79 95.65 2008-2009 95.70 141.81 2009-2010 157.00 189.89 2010-2011 160.00 146.18 (till mid Dec-2010) VMMC(4210) Construction (Rs. in crores) BE Expenditure incurred 2006-07 26.00 25.32 2007-08 20.00 FE 15.00 15.00 2008-09 20.00 19.99 2009-10 15.00 04.73 2010-11 05.00 04.30 (till mid Dec 2010) 4210 (SJH) BE Expenditure incurred 2007-08 19.00 16.06 2008-09 20.00 37.08 2009-10 20.00 29.62 2010-11 43.53 22.20 (till mid Dec-2010) 13.2.16. Library The library in SJH has all the basic essential tools including Photostat, computers (in computer lab) and Internet facilities. Book bank facilities are given to poor students. It has electronic security system of books and journals for safety purpose. The library has latest and international books and journals. A total number of 360 books were purchased during the last year. 13.2.17. Telephone Exchange The Telephone Department is located in a double storey building near Gate No.1 next to Dental Surgery Department. Ground floor of the building has an Operator room with console of Exchange and Administrative office. On the first floor is the EPABX Electronic Exchange with other Machinery and Equipments. It interconnects the various Deptts. of SJ Hospitals and also to the medical college through telephonic services. One hundred lines for V.M.M.C are operational for the benefit of many Departments of VMMC. One Mini Intercom Exchange with capacity of 100 lines also has been made operational in casualty recently so as to avoid any interruption in Emergency Services due to power failure or any other circumstance. 13.3.18. Staff Strength as at the end of November 2010 S. No. Name of the Group No. of In Post Position Sanctioned 1. Group A Gazetted 382 314 2. Group A Non Gazetted 95 94 3. Group B Gazetted 56 28 4. Group B Non Gazetted 1362 1199 5. Group C 961 807 6. Group D 1234 1076 7. Resident Doctors/ PG/DNB/Intern 1279 1096 Total 5369 4614 4216(SJH) BE Expenditure incurred 2009-10 5.00 0.78 2010-11 5.00 0.10 (till mid Dec 2010) Annual Report 2010-11 178 13.3 DR. RAM MANOHAR LOHIA HOSPITAL 13.3.1. Background The Hospital, originally known as Willingdon Hospital and Nursing Home, renamed as Dr. Ram Manohar Lohia Hospital, was established by the British Government in the year 1933. The hospital has thus surpassed over 75 years of its existence and also emerged as a Centre of Excellence in the Health Care under the Government Sector Hospitals. Its Nursing Home was established during the year 1933-35 out of donations from His Excellency Marchioner of Willingdon. Later, its administrative control was transferred to the New Delhi Municipal Committee, now Council (NDMC). In the year 1954, this hospital was taken over by the Central Government. In the recent past, the Old Building portion of the hospital has been declared as a Heritage Building. Starting with 54 beds in 1954, the hospital has been expanded to meet the ever-increasing demand on its services and now is a 1055 bedded hospital, spread over an area of 37 acres of land. The hospital caters to the needs of C.G.H.S. beneficiaries and Honble MPs, Ex- MPs, Ministers, Judges and other V.V.I.P. dignitaries besides other general patients. The mandate of the hospital is to provide utmost patient care and the hospital authorities are making all out efforts to fulfill the mandate for which it has been set-up. The hospital is providing comprehensive patient care including specialized treatment to C.G.H.S. beneficiaries and General Public. Nursing Home facilities are available for entitled CGHS beneficiaries. The Nursing Home, including Maternity Nursing Home , is having 75 beds for the CGHS and other beneficiaries The hospital is one of the most prestigious Government Hospitals not only because of its central location, near the Parliament House and in close proximity to North and South Block where most of the V.V.I.Ps stay but also because of availability of expertise and super specialties. The Government of India has chosen this Hospital for NABH accreditation, an international hallmark for health care service provider, through the Quality Council of India (QCI). The accreditation application has already been made to QCI for undertaking inspection to get the accreditation and to become the first NABH accredited Central Government Hospital. The hospital annually provides health care services to approximately 16 lacs outdoor patients and admits around 50000 indoor patients. About 1.99 lacs patients are attended in the Emergency and Casualty Department annually. The hospital has round-the-clock emergency services and does not refuse any patient requiring emergency treatment irrespective of the fact that beds are available or not. All the services in the hospital are free of cost except Nursing Home treatment and some nominal charges for specialized tests. 13.3.2. The Services Available The hospital provides services in the following Specialties and Super Specialties covering almost all the major disciplines: Clinical Services Accident & Emergency Services Anaesthesia Services Dermatology Eye ENT Family Welfare General Medicine General Surgery Gynaecology & Obstetrics Orthopedics Paediatrics Psychiatry Physiotherapy Dental Super Speciality Departments / Units Neuro-Surgery Burns & Plastic Surgery Cardiology Cardio Thoracic & Vascular Surgery Gastroenterology Neurology Paediatrics Surgery Annual Report 2010-11 179 Urology Nephrology Endocrinology Departmental Special Clinics Diabetic Clinic Asthma Clinic Pre Anaesthetic Clinic ART Clinic ARC Clinic Paediatrics & Neonatology Specialty Clinics Neonatology & Well Baby Clinic Follow up clinic Neurology Clinic Nephrology Clinic Rheumatology Clinic Asthma Clinic Thalassemia clinic Nutrition Clinic Gynaecology & Obstetrics Antenatal Clinic Infertility Clinic Skin Leprosy Clinic Leukoderma Eye I.O.L Glaucoma Retina Psychiatry Child Guidance Clinic Drug De-addiction Clinic Marriage counselling Psycho-Sexual Clinic Geriatric Psychiatry Clinic Yoga Centre for cardiac and other patients Unani OPD (Daily) Ayurveda clinic has been started and Homeopathy clinic has been planned Blood Bank Services Dental Dental Fracture DIAGNOSTIC SERVICES Hematology Pathology Microbiology Histopathology & Cytology Biochemistry Radiology including CT Scan, digital X-ray, Color Doppler, Ultrasound & MR SUPPORT SERVICES State of the art Library C.S.S.D Laundry Pharmacy Bank Post Office ISD, STD, PCO Booth Mortuary including Hearse Van Hospital Waste Management Facilities Departmental Canteen Ambulance Services 13.3.3. Emergency & Trauma Care Services This hospital has well- established Emergency services including round- the-clock services in Medicine, Surgery, Orthopedic and Paediatrics while other specialties are also available on call basis. All services like laboratory, Annual Report 2010-11 180 X-Ray, CT-Scan, Ultra-sound, Blood Bank and Ambulances are available round the clock. A well established Coronary Care Unit (CCU) and an Intensive Care Unit (ICU) exist in the hospital for serious Cardiac and Non-Cardiac patients. The Coronary Care Unit of the hospital has been completely renovated recently with new equipments and infrastructure. The hospital has a well laid down disaster action plan & disaster beds, which are made operational in case of mass casualties and disasters. A Disaster Management Unit is also functioning in the Casualty Department to attend the serious patients with the desired care. An H1N1 Screening centre has been started since June, 2009 to screen the patients roundthe-clock which is supported with Information Cell & Call Centre to inform & follow up the treating patients. A separate H1N1 Isolation Ward & a 5- bedded ICU has also been set up in the Hospital on the need basis for treatment of H1N1 patients. The Hospital has comprehensive trauma care facility with 74 beds at the Trauma Care Centre in readiness to shoulder the added responsibility of providing comprehensive & timely emergency medical care to victims of trauma in the event of any accidents occurring in Delhi especially in Lutyens Delhi. 13.3.4. Sanitation & Enviournmental Concern in Hospital Campus The hospital has given high importance to the sanitation and beautification of entire campus to create a nature friendly ambience. Under a Special Drive, remodeling of Plants, landscaping of Central Park Lawns, relaying of grass, creation of Artificial Water Falls with colorful lights & fountains and a beautiful Herbal Garden in the Nursing Home Block have been under taken to give a refreshing look to the visitors and the patients alike. Special Sanitation Drives are undertaken at regular intervals to ensure proper cleanliness and hygienic atmosphere in the hospital. The Hospital has been adjudged by the FICCI as the best Hospital under the enviourrnental concern category in 2010. 13.4.5. Resident Hostels for Doctors & Nurses: The hospital has provided accommodation to Resident Doctors as well as Nurses/Nursing students to improve the Health Care Services by ensuring their availability on duty in the campus at the time of requirement. There are 143 rooms in the Doctors Hostel and 100 rooms in the Nurses Hostel. 13.4.6. Benefits/Activity for person with disability: The Hospital has facilitated for setting up ramps and wheel chair service through porters for the person with disability. 13.4.7. Recent Achievements of the Hospital The following are the latest additions of the patient care facilities in the hospital; 1. Sanction of General Maternity Ward and Neo- natal Ward in the Hospital: The Hospital has received the approval for sitting up of a General Maternity and Neo-natal Ward at a total cost of Rs. 2.45 Crores for which 79 posts have been provided to support the General Maternity and Neo- natal Services. Till now, the Maternity services were confined to entitled CGHS beneficiary in the Maternity Nursing Home having 25 beds with the approval of General Maternity Ward. It is expected that with the start of extended Maternity Services in the year 2010, the quality Maternity services would be available to all CGHS beneficiaries. 2. College of Nursing: The Hospitals School of Nursing set up in 1963 with 25 students capacity per year has been upgraded into College of Nursing with intake capacity of 50 students per year. Two batches of B. Sc (Nursing) have since been admitted. The estimated cost of the project is Rs.3.00 crores. The Construction work of the new campus of college has been completed by HSCC and the teaching classes have been started in the New Campus in the year 2010. 3. Dharamshala: A Dharamshala for attendants of patients has been planned to be constructed on one acre of land allotted to hospital near the Birla Mandir to help the attendants/relatives of the outpatients coming from different parts of the country. The designs /clearances have been approved & Govt.s approval on the estimates of Rs. 6.14 crores has been received. The detailed estimates and drawings have been got approved from NDMC. The construction activity is planned to be started by CPWD during the current Financial Year itself. 4. Computerization: The computerization of centralized OPD Registration was started from 2005 to facilitate the outdoor patients to get their Annual Report 2010-11 181 registration done from any of the 20 Counters in the OPD Block. There are separate Registration Counters opened for Senior Citizens, physically handicapped persons and the staff. The computerization of Administration & Accounts and cash handling work has also been started for easy retrieval of information/record. Only recently, NIC has undertaken the comprehensive E-Hospital Project with approved cost of 3.50 crores to cover all the activities under its umbrella. OPD registration & repeat visits, IPD registration & ward allotment, casualty registration, transfer and discharges under E-Hospital software had been implemented. E- Hospital implementation covering all aspects of patient care, Labs, Human Resources of the Hospital, Inventory control System for the Hospital and IT induction . The online monitoring of lab tests has since been made operational. 5. Construction of New Casualty Building: In order to provide state of the art Emergency Medical Care, a new Casualty Building is under construction with a provision of 280 beds. The estimated cost of the project is about Rs. 26 crores. Moreover, 16 VIP Rooms in the Nursing Home are also under complete renovation, out of which 6 Rooms have since been renovated for patients care. 6. Medical Care Arrangements during the Commonwealth Games-2010: The Hospital was designated as Nodal Hospital for Medical Care Arrangements for SPM Swimming Center and Boxing Center at Talkatora Stadium and National Stadium. Moreover, the Hospital had created necessary infrastructure in the Nursing Home for delegates, Sports person and their families for Medical Care during the Commonwealth Games- 2010. 7. Improvements in the Super Specialty Services: The hospital has focused attention towards the patient care and improved services. Many new and sophisticated types of equipments have been procured in the hospital to update the hospital services. In order to strengthen the super specialty services to the patients, the Hospital has planned to construct a new Multi-story Super Specialty Block on the land available at G- point, adjacent to Trauma Center which has been recently handed over to the Hospital by the Land and Development Office. This will considerably improve the patient care services and also reduce the waiting time for the patients. Several new disciplines are also planned to be aided in proposed new Super Specialty Block. 8. Citizen Charter & Public Grievance Redressal: The Hospital has adopted a Citizen Charter since 1998 and as per the directives of Honble High Court of Delhi, Public Grievance Redressal Machinery has also been set up to inform the patients about the facilities available and also for redressal of their grievances, if any. There are 19 Complaint & Grievance Boxes placed at various strategic locations which are opened periodically and put up before a High Powered Committee headed by a Consultant & HOD & reviewed by a Designated Addl MS and also by the Medical Superintendent. The complainants are given an opportunity to speak in person to the CMO in charge and a written reply of the outcome of the complaint is also sent to the complainant. The Hospital is revising the Citizen Charter under the scheme Sarvotam. 9. Advance Trauma Life Support (ATLS) Training: The Hospital started an intensive ATLS Training Programme for the Senior Doctors to train them on latest advancement in the Trauma life support systems. Ten batches, each with 16 trainees have since been conducted in the Hospital training centre equipped with latest equipments required for ATLS. In India this course is conducted only at Lok Nayak Jai Prakash Narayan, Apex Trauma Centre of AIIMS and at Trauma Care Centre of Dr. Ram Manohar Lohia Hospital. 10. Distance Education Learning Programme: The Hospital has started e-diploma course DHLS (Diploma in Hearing and Learning Speech) in association with All India Institute of Speech and Hearing (AIISH) Mysore in which 20 students are trained each year. Till now, the Hospital has conducted three courses. The Hospital has also started a PG Diploma in Hospital Administration (PGDHA) in collaboration with IGNOU on distance learning basis. This is one year diploma course in which 30 students are admitted. This is third course in a row. Annual Report 2010-11 182 11. A New Modular Operation Theaters Complex. The Hospital has proposed for setting up of a New modular OT complex comprising new State of the Art 20 modular Operation Theaters in X-ray Block Building with an estimated cost of Rs. 36.00 crore. On execution, the OT complex will provide relief to the patients in getting operation done and reducing the waiting time. Financial Allocations: -The financial allocations made to the hospital during the last five financial years are given below: 13.4 INDIAN RED CROSS SOCIETY The Indian Red Cross is the largest independent humanitarian organization in India. It has always been at the forefront to alleviate suffering at the time of any man made or natural disaster. It is a huge family of 12 million volunteers and members and staff exceeding 3500. It reaches out to the community through 700 branches spread through out the country. Its attempt to reduce vulnerability and empower the community for disaster mitigation is highly commended. The last Managing Body meeting was held on14th June 2010 under the chairmanship of Shri Ghulam Nabi Azad. Final Estimate Expenditure ( Figures in lakhs) 2006-2007 Plan 5673.50 5672.95 Non Plan 5801.05 5794.82 2007-2008 Plan 7071.12 7078.33 Non Plan 6381.00 6360.73 2008-2009 Plan 8364.01 8400.26 Non Plan 9315.00 9313.47 2009-2010 Plan 9430.00 7441.88 Non Plan 12738.00 11990.56 2010-2011 Plan 13397.00 9037.00 Non Plan 12347.00 9516.00 (up to Jan,2011) 13.4.1. Disaster Management: During the reporting period, a flash flood instigated by cloud burst occurred at Leh (Jammu & Kashmir) in the intervening night of 5 th and 6 th August 2010. About 400 families were badly affected due to the flash flood and subsequent massive landsliding made the situation worse. The Secretary General accompanied the Honble Chairman IRCS, (Union Health Minister) Shri Ghulam Nabi Azad to assess the needs and formulate a response strategy for the affected . Indian Red Cross was the only organization that deployed water purification unit for providing clean drinking water to the affected population. Along with the drinking water, IRCS provided shelter ,relief material and non-food items . Entire relief consisted of 2 Nomad Water purification units, 123 pairs of gum boots, 1000 woollen blankets, 1000 kitchen sets, and 300 family tents. The total estimated cost for the non food items released was Rs 76, 74 600. Relief activities were undertaken also in Andhra Pradesh, Haryana , Punjab , Uttar Pradesh and Tripura which Annual Report 2010-11 183 were affected by storm , rainfall, and flooding. From The IRCS National Headquarters, the Honble Chairman, IRCS,(Union Health Minister) Shri Ghulam Nabi Azad flagged off relief supplies for Bihar cyclone on 23-4-2010. WatSan units deployed served 60,000 people with safe drinking water during AP floods. Total Relief sent across to the states during the adverse times amounted to Rs 7 crores. 13.4.2. DRR & Livelihood Disaster Risk Reduction (DRR) The purpose of the programme, Community centered Disaster Risk Reduction in India is based on the approaches founded in the Indian Red Cross Society strategic development plan. This plan of the National Society addresses practical DM strategic measures to minimize vulnerability and risk of affected communities. For IRCS this means working with vulnerable communities, identifying their capacities, plan for actions that reduce specific risks and build safer communities. IRCS seeks to implement its DM strategic measures by addressing locally based risks, vulnerabilities, communitys coping capabilities, and required institutional capacities to manage disaster events. IRCS being efficient in disaster response and rehabilitation activities has also implemented successfully community based disaster preparedness programmes. IRCS is implementing Disaster Risk Reduction (DRR) program in 3 states - Maharashtra, AP and Orissa supported by Hong Kong & Canadian RC. DRR program implementation guidelines have been developed. 13.4.3. Livelihood Projects The project supported by Spanish Red Cross has been completed in the states of Andhra Pradesh and Tamil Nadu to benefit fisher folk community, at a total cost of Rs.4.72 crores for 11,000 beneficiaries. 13.4.4. Health: During the reporting period, the Society continued its HIV/AIDS activities under which Youth Peer Education, Stigma & Discrimination and care for children of HIV positive parents were covered. The Red Cross India HIV Consortium has 11 members with German and Hungarian Red Cross as new members and Italian Red Cross also joining the HIV activities.Tuberculosis Project India is a Pilot Project to take care of 200 CAT II patients who are defaulters or likely to default .The Project has been implemented in the states of Punjab, Uttar Pradesh and Karnataka. TB Project has been successful and through Programme Integration TB as an opportunistic infection has been addressed. H2P Programme supported by USAID is implemented in 9 districts of the state of Punjab, AP and Maharashtra with the total budget amounting to INR 1.62 crores. Community preparedness for influenzas programme supported by WHO is being implemented in 9 target states i.e., West Bengal, Tripura, Orissa, Uttarakhand, J&K, Chhattisgarh, Gujarat, Dadra & Nagar Haveli and Andhra Pradesh. Total Budget INR 20.00 lakhs. The health maternity and child welfare services continued throughout the services under the Red Cross banner at its 440 centres. Indian Red Cross blood banks contribute 10% of the total blood requirement in the country. The IRCS NHQ Blood Bank collects 85% blood from voluntary donors against the national average of 62%.The(NHQ) Blood Bank is fully equipped with infrastructure to provide blood services and training facilities of the highest standards, as per national guidelines. IRCS,NHQ Blood Bank is the first Red Cross Blood Bank in the non governmental set up in the country to be designated as Model Blood Bank by NACO.The upgraded Model Blood Bank was inaugurated by Honble Minister of Health& Family Welfare ,(Chairman of IRCS )Shri Ghulam Nabi Azad on 14 th June 2010. During the period 2009-10 the blood bank collected were 26486 units of blood and 293 blood donation camps held. 13.4.5. Family News Service (FNS) FNS is provided to the anguished families and its members separated due to conflicts, disasters, migration and other socio-economic situations. During the last financial year 560 Red Cross Messages were exchanged, and 21 tracing cases were successfully solved. 13.4.6. Post Graduate Diploma Course in Disaster Preparedness and Rehabilitation This course has been initiated by the Indian Red Cross Society to develop knowledge on disaster preparedness, rehabilitation, and sustainable development including framework and skills for addressing anticipated hazards, disaster and complex emergencies with an emphasis on either post development or majority world context. Four batches have successfully completed the course and process for enrollment for the 5th batch has started. Annual Report 2010-11 184 Following facilities have been added and upgraded: Ham Radio GIS lab Emergency operation centers Facilities for computer training. 13.4.7. Health Promotion through Ayurveda & Yoga IRCS in collaboration with Department of Ayush, Ministry of Health and Family Welfare, has started 50 hours certificate course (3 month part-time programme). Due to drug resistance in the post antibiotic era this course shall initiate people to discover alternate ways of medication, recovery and better health. The first batch was started on 2-2-2010 with 50 students. Most of the course participants reported enhanced level of energy, cure from ailments and overall better health. Due to overwhelming response and excellent feedback more batches are being started on regular basis. 13.5 ST. John Ambulance India The National Council of St John approved the upgraded version of the First Aid Manual for use by the St John Ambulance (India) as well as the Indian Red Cross, which would be available from January 2011.The National Council also approved the establishment of fourteen St John Centers in Tamil Nadu besides one centre each in Jharkhand, S.E.C.R Railway Chattisgarh ,Bilaspur. During the period April 2010 to November 2010, National Headquarters computerized, printed and issued 3,93,187 proficiency certificates to the eligible candidates who have qualified for First Aid, Home Nursing, Hygiene and Sanitation, Mother Craft and Child Care. 13.6 EMERGENCY MEDICAL RELIEF Health Sector Disaster Management: Emergency Medical Relief Division (EMR) of Directorate General of Health Services, Ministry of Health & Family Welfare, Govt. of India is mandated for prevention, preparedness, mitigation and response on health sector disaster management activities and coordinates health activities in terms of manpower and material logistics support to the states. 13.6.1. Preparedness and Response for Disasters 13.6.1.a. Preparedness for disasters: The Emergency Support Function Plan was circulated to all concerned and it contains the emergency support functions assigned to the MOHFW which includes details of nodal officers for coordination, crisis management & quick response at Hqrs. and field level, resource inventory etc. This plan also contains instructions regarding deployment of resources in the event of disasters. Advance Trauma Life Support training were institutionalized in two Central Government Hospitals. About 200 doctors from Delhi & Central Government Hospitals were trained in Advance Trauma Life Support. 13.6.1.b. Response Ministry of Health and Family Welfare was represented in the central assessment teams of the Ministry of Home Affairs that visited Leh (flash floods), Uttarakhand (flood) and Uttar Pradesh (flood) for Rapid Health Assessments. Relief were recommended in terms of norms under Calamity Relief Fund /National Calamity Contingency Fund. Public Health Expert teams were deputed to investigate disease outbreaks in the States of Gujarat, Uttar Pradesh, Orissa, Bihar and Kerala during the current year. The concerned State Governments were advised on prevention and containment measures. 13.6.2. Public Health Emergencies 13.6.2.a. Pandemic Influenza Preparedness and Response. Influenza like Illness caused by Influenza A [H1N1], a re-assorted influenza virus, was reported from Mexico on 18 th March, 2009 and rapidly spread to affect 214 countries. World Health Organization raised the pandemic alert level to 6, declaring pandemic of influenza H1N1 of moderate severity. The preparedness measures undertaken for avian influenza came handy. The existing measures were scaled up and additional measures put in place to limit the entry / spread of disease into India and to mitigate the impact of the evolving pandemic. 13.6.2.b. Action Taken by Govt. of India Government of India took a series of action to prevent/ limit the spread of Pandemic Influenza A H1N1 and to mitigate its impact. Surveillance to detect clusters of influenza like illness is being done through Integrated Disease Surveillance Project. Laboratory network has been strengthened, from the then existing two laboratories to forty five laboratories (26 in Govt. Sector and 19 in Annual Report 2010-11 185 Private Sector) for testing the clinical samples. Government of India procured 40 million capsules of which about 28 million have been given to the States/UTs which is also used for preventive chemoprophylaxis. Government of India supported State Government/UTs by strengthening of logistics (medicine, PPE, diagnostic kits, etc.). Retail sale of Oseltamivir was allowed under Schedule X of Drugs & Cosmetic Act. Number of retail outlets have been increased to improve access to anti- virals. Three Indian manufacturers of Vaccine are being supported to manufacture H1N1 vaccine. 1.5 million doses of vaccine have been imported to vaccinate health care workers. Training of State/District level rapid response teams are supported by Ministry of Health and Family Welfare. Indian Medical Association has been also provided funds to train private practitioners. All States were requested to gear up the State machinery, open large number of screening centres and strengthen isolation facilities including critical care facilities at district level. A task force in the I&B Ministry is implementing the media plan. Travel advisory, dos and donts and other pertinent information has been widely published to create awareness among public. Senior Officials and Public health teams were deployed to monitor the situation from time to time. Necessary guidelines were issued to the States from time to time. All informations were made available on dedicated website www.mohfw-h1n1.nic.in. 13.6.3. Medical Care Arrangements on Special Occasions Medical care arrangements were organised by the Dte.G.H.S. for Republic Day and Independence Day celebrations and important International Conferences etc. Medical care arrangements were also made during the State Visits of Heads of States. EMR Division has been the focal point in monitoring the medical care arrangements for the Commonwealth Games 2010. Regular meetings were held and progress reviewed. It also supported the Delhi Government in providing medical care at 7 competition and 3 training venues. Ministry of Health & FW supported the State of Uttarakhand in terms of manpower, drugs, equipments to the Maha Kumbh held between January to April 2010. 13.7 E- HEALTH (TELEMEDICINE) E-Health/Telemedicine can expand the reach, range and quality of Primary Health care services available in Public Health system. The efforts would seamlessly synergize with the overall health sector rejuvenation being undertaken under NRHM. In most hard to reach areas of the country, the telemedicine technology has the potential to transform the quality and range of services initiated through health sector reforms under National Rural Health Mission. Many other agencies are also undertaking e-Health initiatives like Department of Information Technology, Indian Space Research Organization, Sanjay Gandhi Post Graduate Institute, Lucknow, All India Institute of Medical Sciences, New Delhi, Post Graduate IInstitue of Medical Education and Research, Chandigarh. As part of the e-Health initiative in the Ministry of Health & Family Welfare, Government of India, has initiated a scheme for establishing National Medical College Network for Rs.60 crores. The National Medical College Network will be used for the educational needs of medical students, teachers & healthcare professionals. The Telemedicine Centre at SGPGI, Lucknow would be the National Resource Centre and network hub. The National Resource Centre and the Regional Resource Centres identified under National Medical College Network would be strengthened/upgraded and linked through a network to various medical colleges and medical institutes to undertake a capacity building exercise and bridge the knowledge and resource gap. Tele-Ophthalmology Tele-ophthalmology is a new approach for ensuring connectivity and data transfer. With the objective to provide health care services in the rural areas and to nullify the shortage of ophthalmologist in the country, National Program Control of Blindness launched Tele- ophthalmology project in India. It is important in the view of the fact that most of the health facilities are centered on big cities and towns and significant no. of patients from rural/tribal areas can be managed with some advice and guidance from specialists and super specialist in the cities and towns. This technology is helpful in elimination of preventable blindness from the rural, tribal and un- served area in the country. OncoNET India Project Under this project 2 Regional Cancer Centers (RCCs) and two associated Peripheral Cancer Centers (PCCs) have been connected. These are: 1. PGIMER, Chandigarh (RCC) with Civil Hospital, Bhatinda Annual Report 2010-11 186 2. KMIO, Bangaluru (RCC) with District Hospital, Mandya These four centers are using this facility for early diagnosis and treatment of patients and further referring of patients to the respective RCC. At present, the following are in the process of being connected with the network and these are: 1. JIPMER Puducherry (RCC) with Government Hospital, Yanam (PCC) 2. Govt. Arignar Anna Memorial Cancer Hospital, Kancheepuram (RCC) with Govt. Hospital Arakkonam (PCC) 3. SKIMS, Srinagar (RCC) with District Hospital, Poonch (PCC). 13.8. CLINICAL ESTABLISHMENTS ACT, 2010 The Clinical Establishments (Registration & Regulation) Bill, 2010 which aims at providing registration and regulation of clinical establishments in the country with a view to prescribing the minimum standards of facilities and services for them, has been passed by both Houses of Parliament. This Act has been notified in the Gazette of India on the 19 th August, 2010. The Act will initially take effect in four states viz., Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikim, and all union territories. Subsequently, the Act may be adopted in other States also. The Ministry is now in the process of formulating Rules under the Act. This is a progressive, pro-public and user friendly legislation which will enable a national data base for all clinical establishments including the Government hospitals in the country. 13.9 INDIAN ORGAN DONATION DAY The 6 th World and 1 st Indian Organ Donation Day and Organ Donation Congress 2010 was organized on 27-28 November 2010 at New Delhi. Scientific meeting of Organ Donation Congress 2010 was held at Vigyan Bhawan and inaugurated by Shri Ghulam Nabi Azad Honble Union Minister of Health & Family Welfare. Shri Dinesh Trivedi, Honble Union Minister of State Health & Family Welfare was the guest of honour on the occasion. About 500 delegates and invited guests participated in the scientific event. Experts in the field of organ transplant from various organizations like World Health Organization (Geneva), Fair Transplant (Geneva), The Transplantation Society (USA), German Organ Procurement Organisation (Germany), National Transplant Organization (Spain), Red Cross Society (Thailand), International Society of Nephrology (Australia) and various other international societies from China, South Africa etc. participated in these two day events. Various national associations related to organ transplantation like Indian Society of Organ Transplantation, Indian Society of Nephrology, Indian Society of Urology, Gastroenterology Society of India, Cardiothoracic Society etc were co-partners of the event. Private sector and NGOs also extended their support and participated. Nine deceased organ donors were also honoured by Shri Ghulam Nabi Azad, Honble Union Minister of Health & Family Welfare with silver plated plaques at Vigyan Bhawan. A painting competition and slogan competition on the theme of organ donation was also held at Delhi University before the main event was held. A rally and painting competition was also organised at India Gate on 27 th November 2010. About 2500 children and others participated in the rally and painting competition. Mrs. Sheela Dixit, Honble Chief Minister of Delhi was chief guest at India Gate function. Shri Ghulam Nabi Azad, Honble Union Minister of Health & Family Welfare presided over the function. The evening function was attended by about 5000 people including eminent invited experts, faculty, international and national delegates of the conference and general public. The winners of various activities and distinguished international delegates were also honoured in the evening function. This event has taken the agenda of deceased organ donation to the Shri Ghulam Nabi Azad, Honble Union Minister of Health & Family Welfare honoring a relative of deceased organ donor on the occasion of inauguration of Organ Donation Congress 2010. Annual Report 2010-11 187 forefront and increased awareness in the general public which is likely to change the attitude in increasing the organ availability. Action plan for implementation of THOA amendments to initiate National Organ Transplant Program, was approved in November 2010. An amount of Rs. 25 crores for 2010-11 & 2011-12 has been allocated for 11 th plan for this purpose which will be utilized for Tissue bank, Model Organ procurement & distribution organization (MOPDO), transplant coordinators training and IEC/ media purpose for mass awareness. A view of painting competition on the occasion of Organ Donation Day on 27 th November 2010. Annual Report 2010-11 189 Chapter 14 14.1 FOOD SAFETY AND STANDARDS AUTHORITY OF INDIA The Food Safety and Standards Authority of India (FSSAI) has been established under the Food Safety and Standards Act, 2006 as a statutory body for laying down science based standards for articles of food and regulating manufacturing, processing, distribution, sale and import of food so as to ensure safe and wholesome food for human consumption. Highlights of the Food Safety and Standards Act, 2006 aims to establish a single reference point for all matters relating to Food Safety and Standards, by moving from multi-level, multi-departmental control to a single line of command. Various Acts and Orders that have hitherto handled food related issues in various Ministries and Departments have been integrated in the Food Safety and Standards Act, 2006. Thus, the Central Acts like Prevention of Food Adulteration Act, 1954, Fruits Products Order, 1955, Meat Food Products Order, 1973, Vegetable Oil Products (Control) Order, 1947, Edible Oil Packaging (Regulation) Order, 1998, Solvent Extracted Oil, De-oiled Meal and Edible Flour (Control) Order, 1967, Milk and Milk Products Order, 1992 etc will be repealed after commencement of the FSS Act, 2006. Notification Ministry of Health and Family Welfare, Government of India is the administrative ministry for FSSAI which is the agency for implementation of the new law. The Authority was notified on 5 th September, 2008 with 22 members. The head office of the Authority is at Delhi. The Authority has started its operations with Chairperson and Chief Executive Officer who are in the rank of Secretary and Additional Secretary to Government of India respectively, and the staff who were implementing the various food related orders. Quality Control in Food & Quality Control in Food & Quality Control in Food & Quality Control in Food & Quality Control in Food & Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores Shri P.I. Suvrathan, former Secretary to Ministry of Food Processing Industries, is the Chairperson of FSSAI. Shri V. N. Gaur in the rank of Additional Secretary to Government of India, is the Chief Executive Officer of the Authority. FSSAI has been mandated by the FSS Act, 2006 for performing the following functions: Framing of Regulations to lay down the Standards and guidelines in relation to articles of food and specifying appropriate systems of enforcing various Standards thus notified. Laying down mechanisms and guidelines for accreditation of certification bodies engaged in certification of food safety management systems for food business. Laying down procedure and guidelines for accreditation of laboratories and notification of the accredited laboratories. To provide scientific advice and technical support to the Central Government and State Governments in matter s of framing the policy and rules in areas which have a direct or indirect bearing on food safety and nutrition. Collect and collate data regarding food consumption, incidence and prevalence of food hazards, contaminants in food, identification of emerging risks, food surveillance, introduction of rapid alert system etc. Creating an information network across the country so that the public, consumers, Panchayats etc receive rapid, reliable and objective information about food safety and issues of concern. Annual Report 2010-11 190 Provide training programmes for persons who are involved or intend to get involved in food businesses. Contribute to the development of international technical standards for food , sanitary and phyto- sanitary standards. Promote general awareness about food safety and food standards. Composition of FSSAI The FSSAI consist of a Chairperson, Member Secretary and 22 members which includes representative of Food industry (Small Scale & Large), Food technologists, States & UTs, Farmers orgn etc. Steps Taken By FSSAI till December, 2010 1. Six meetings of the Authority have been held so far in which various rules and regulations have been approved. 2. The Central Advisory Committee (CAC), as per Section 11 of the Food Safety and Standards Act, 2006, was constituted and notified on 5 th October, 2009. The CAC comprises of 44 members and the Chief Executive Officer of FSSAI is the ex- officio Chairperson. Two meetings of Central Advisory Committee have been held so far. 3. Food Authority has constituted a Scientific Committee and eight Scientific Panels for providing scientific opinion to the Food Authority on various issues consisting of independent scientific experts: a) Panel for food additives, flavourings, processing aids and materials in contact with food. b) Panels for pesticides and antibiotic residues. c) Panel for genetically modified organisms and foods. d) Panels for functional foods, nutraceuticals, dietetic products and other similar products. e) Panel for biological hazards. f) Panel for contaminants in the food chain g) Panel for labelling and claims/Advertisements. h) Panel for method of sampling and analysis. Two meetings of the Scientific Committee have been held so far. The second meeting of the scientific panel for functional foods, nutraceuticals, and dietetic products, genetically modified organisms and foods were held on 29 th March, 2010 and 5 th April, 2010 respectively. The third meeting of the scientific panel for genetically modified organisms and foods was held on 20 th December, 2010. 4. Consultation meetings on the draft Rules and Regulations under Food Safety and Standards Act, 2006 including process for Registration and Licensing were held region wise across India during 2009 with State Government/UTs Food Safety Commissioners, stakeholders. A notification on the draft Food Safety and Standards Regulations (including Draft Regulations for Licensing Registration) had been published in part III Section 4 of Extraordinary Gazette of India dated the 21 st October, 2010 for the information of all persons like to be affected thereby inviting objections and suggestions within thirty days. It has also been notified by the Ministry of Commerce and Industry to WTO as per the requirements of SPS and TBT agreements. 5. An Integrated IT-enabled food import information system is required to be established to facilitate FSSAI to regulate safety of food imports into the country an efficient, transparent and hassle free manner. For this purpose, the project of Structuring and Implementation of Integrated IT-enabled Imported Food Safety System by Food Safety and Standards Authority of India (FSSAI) was assigned to the National Institute of Smart Government (NISG). National Visioning workshop and Regional workshop to discuss on the preparation of a Blue Print for Structuring and Implementation of integrated IT enabled Imported Food Safety System under FSSAI were held during 2010. Based on the reports submitted by NISG and in active consultation with all stake holders, the imported food clearance process is being taken over by FSSAI in a phased manner to ensure that safe food is imported into the country. FSSAI has since taken over the function of PHO in the ports of Kolkata, Haldia, Chennai, Mumbai, Jawahar Lal Nehru Port Trust in Aug-Sep, 2010. Annual Report 2010-11 191 6. The Food Authority is now the National Codex Contact Point (NCCP) for maintaining contact with the Codex Alimentarius Commission, exchanging information, responding to queries, participating in meetings etc. The Food Authority has approved the guidelines for participation in codex meetings and preparation of response to Codex matters and also guidelines for the Codex Contact Point, the National Codex Committee and National Shadow Committees. The Food Authority has also established the various Shadow Committees for reviewing the agenda of the Codex Alimentarius Commission and its subsidiary committees and finalizing Indias comments on the various agenda items before they are sent for approval of the government. During the year 2009-10, Food Authority had participated in the 26 th Session of Codex Committee on General Principles (CCGP) held in April, 2010 in Paris, 34 th Session of Codex Alimentarius Commission (CAC) held in July, 2010 in Geneva, 17 th Session of Coordinating Committee for Asia (CCASIA) held in November, 2010 in Indonesia. 7. FSSAI constituted the following Expert Groups to handle specific assignments for a specific duration: Amaze Brain Food Energy Drinks Fats and Oils Food for special purpose and nutritional uses. 8. Meeting with State Food Commissioners and other stakeholders have been organised for obtaining feedback on transition to FSSA. 9. Workshops have also been conducted across India inviting suggestions on transition from PFA to FSSA. 10. Advisories have been issued on hazards from Melamine contamination in Chinese milk products, Salmonella contamination in Peanut Butter, antibiotics in honey. 11. The following studies which were initiated by FSSAI are in various stages of operation as enumerated below: To review the present status of safety and quantity of food as well as sanitary and hygiene conditions of the food made available to children in school premises and to develop guidelines/manual for improvement in quality of food served in schools. In this regard FSSAI have received a proposal from IIM Bangaluru which is being evaluated. The expected outcome of the study would be development of guidelines for safety of food available to children in schools. Diet Study titled, Assessment of consumption of processed and non-processed foods in India by NIN. Laboratory Gap Study by QCI is under process. QCI has submitted interim report containing assessment of 35 laboratories, which has been duly approved by the Authority. 12. Draft framework for interim arrangements of GM processed food was earlier approved by FSSAI but now it would be regulated under Biotechnology Regulatory Authority of India (BRAI) Bill, 2010 moved by Department of Biotechnology. 13. Training programmes have been held for Food Safety Commissioners, Food Safety Officers and Designated Officers during June- September, 2010 with a view to prepare them for transition from PFA to FSSA regime. 14. An International Conference on Best Practices in Food Safety Implementation was organised in Delhi in November, 2010 in collaboration with TERI and MSU. 15. Following drafts for Consultation have been prepared: Draft on Regulation of Trans Fatty Acids, TFAs, in Partially Hydrogenated Vegetable Oils, PHVOs. Draft Regulation on Foods for Special Nutritional or Dietary Uses 16. Guidelines on the following have been prepared: Scheme of Research and Development for Food Quality and Safety. Guidelines and Application Forms Meat Food Product Order- MFPO Setting up of unit under Fruit Products Order. Annual Report 2010-11 192 17. The following are being finalised keeping in view recommendations of stakeholders: The draft of Code of Self Regulation in Food Advertisement The draft document for Food Safety in Eating Establishments. 18. New structure of the Authority has been approved. 19. Portal of FSSAI is in place. Public notices and various drafts for public consultation are posted on web through this portal. 20. Modernisation of the existing offices has been undertaken by hiring new offices, providing computers and internet, installing various software packages for office automation like com- ddo package, file tracking system, e- office etc. 21. A Pilot project called Safe Food, tasty Food a first of its kind for upgrading the safety and quality of food served in eating establishments across the country has been prepared and circulated to all the State Govts. /UTs for guidance. What to expect in the near future Implementation of FSS Act and repeal of the PFA Act & other Orders, relating to Fruits & Vegetables, Edible Oil, and Meat & Milk. Draft paper on surveillance of food & food borne disease. A framework for Food Safety Management System comprising of : Competency framework for food safety professionals to ensure that they retain the skill and competence requirements needed. Framework for Certification bodies / Registration bodies Procedure for recognizing equivalence of food safety system with national standards. Guidance document for implementation of GMP/ GHP. Training policy for FSSAI Laboratory upgradation policy Consumer food safety scheme/ competitive grant for R&D projects Scheme for Centre of Excellence and Food Safety Centres Strategy for revision of standards Communication strategy as a part of the risk analysis and awareness generation Pilot project on traceability and recall Manuals and guidelines for implementing the rules and regulations Finalization of voluntary code on advertising Regulation on labelling & claim and advertising Accreditation mechanism and procedure for the food testing laboratories A system for accreditation of food safety audit personnel and organisations. Fixation of limit on Trans Fatty Acids Implementation of IT enabled import monitoring system related to food safety in major entry points of imported food in the country Regulation of GM Foods, Alcoholic drinks, Olive oil and Energy drinks. Continuation of capacity building programmes for food safety personnel all over the country. 14.2 CENTRAL DRUGS STANDARD CONTROL ORGANIZATION(CDSCO) Public Health is one of the major objectives of the Government of India and to achieve this it is important that drugs available to the public are safe, potent and efficacious. Regulatory control over the quality of drugs in the country is exercised through the Drugs and Cosmetics Act, 1940 and Rules made there under. The manufacture and sale of drugs is looked after by the State Governments while imports, permissions for marketing of New Drugs in the country, Clinical Trials on New Drugs are the responsibility of the Central Government. At the Central level these functions are performed by the Central Drugs Standard Control Organization (CDSCO) headed by the Drugs Controller General (India). Annual Report 2010-11 193 A. CDSCO Organization The Central Drugs Standard Control Organization (CDSCO) has its head quarters at Food and Drug Bhawan, Kotla Road, Near ITO, New Delhi-110002. CDSCO has under its control Zonal/Sub-zonal offices, Port offices and Drugs Testing Laboratories to perform various regulatory functions in respect of quality control of drugs. CDSCO has six zonal offices situated at Mumbai, Ghaziabad, Kolkata, Chennai and Ahmadabad and three sub-zonal offices at Bangaluru, Chandigarh and Jammu. These offices are involved in the GMP audits and inspection of manufacturing units of large volume parental, sera and vaccine, recombinant DNA (r-DNA) derived drugs, blood banks and blood product manufacturing units. Zonal offices also coordinate with the State Drugs Control Organizations situated under the respective zone or subzone in matters of quality control of drugs in the country. Regulatory control over the quality of drugs, cosmetics and medical devices imported into the country is exercised by the Port offices situated at Sea ports/Airports in Delhi, Mumbai, Nhava Sheva, Chennai, Kolkata, Cochin and Ahmadabad. There are Six laboratories functioning under CDSCO. Four Central Drug Testing Laboratories are situated at Kolkata, Mumbai, Chennai and Kasauli and two regional Drug Testing Laboratories are situated at Guwahati and Chandigarh. These laboratories are engaged in testing of samples of drugs in the country. Functions of CDSCO 1. Approval of new drugs including vaccines to be introduced in the country. 2. Grant of permission to conduct clinical trials in the country. 3. Registration and grant of import licenses for drugs, cosmetics and notified medical devices. 4. Regulation of quality of drugs, cosmetics and notified medical devices imported into the country. 5. Meetings of the statutory committees like Drugs Technical Advisory Board and Drugs Consultative Committees. 6. Laying down regulatory measures and recommend amendments to the Drugs and Cosmetics Act and Rules made there under. 7. Prescribing regulatory procedures for regulating quality of drugs, cosmetics, diagnostic reagents and medical devices. 8. Approval of Licence as Central License Approving Authority for manufacture of large volume parenterals, sera and vaccines, biotechnology products, medical devices and operation of blood banks and manufacture of blood products. 9. Coordinating the activities of the States and advising them on matters relating to uniform administration of the Act and Rules in the country. B. Drug Industry Indian pharmaceutical industry is one of the most vibrant sectors of Indian industry and has maintained a growth of 11-12%. It is 3rd largest in the world by volume. The total size of the Indian Pharmaceutical Industry is about Rupees 1,00,000 crore out of which exports account for Rupees 42,000 crore and the rest is the size of the domestic market. It is 8% of global Production and 2% of world Pharma market. A large number of bulk drug units from India are exporting drugs to the US and Europe. India has the highest number of USFDA approved plants outside USA. There are 169 USFDA approved manufacturing facilities in India. Indian pharma companies are filing highest Abbreviated New Drugs Approval (ANDA) applications in the USA. Further, there are 153 manufacturing facilities in the country which have been certified by European Directorate of Quality Medicine (EDQM) for export of drugs to the European Union. Such excellent growth in the Pharma sector has resulted in high expectations from the office of Drugs Controller General (India). There is significant increase in the workload of CDSCO in the last few years as shown in the graph given below:- Annual Report 2010-11 194 The number of applications received and processed in CDSCO has increased from around 10,000 in 2005 to 23,000 by 2010. C. Strengthening of CDSCO In view of this scenario, the Ministry of Health and Family Welfare has taken initiatives to strengthen the manpower at CDSCO to cope up with the increased workload. The Government of India sanctioned 216 new posts in the CDSCO to strengthen the headquarters as well as zonal and port offices of CDSCO. The present strength of CDSCO is 124 and by filling of the vacant posts the strength would rise to 327. The posts are being filled through UPSC. 63 New Drug Inspectors have already joined while the remaining vacant posts are at various stages of recruitment process through UPSC. The Government is also providing additional manpower to CDSCO through the appointment of contractual staff to assists the Department in handling the workload. New Sub-zonal offices have been created at Bangalore, Jammu and Chandigarh for better coordination with the State Drugs Regulatory Authorities in these regions. D. Regulatory Activities at the Headquarters 1. Quality Control over import of drugs and cosmetics The CDSCO regulates the quality of drugs and cosmetics imported in to the country through the system of registration and licensing as provided under the Drugs and Cosmetic Rules, 1945. This includes registration of overseas manufacturing sites and of drugs, both bulk drugs and finished formulations. Import licences are then granted to the Indian importers for import of the drugs from these manufacturers. The quality of imported drugs is, however, further regulated at the port offices when the drugs are actually imported. During the year 2010-11, the office of DCG(I) has granted 391 registration certificates of the manufacturers of the drugs who intended to export their drugs to India and have granted 2509 licences for import of drugs into the country. The Office of DCG(I) also grants no objection certificates for dual use items (drugs) which may not be imported for use as a drug and extension of shelf life on the basis of stability studies conducted by the manufacturer for the purpose of export. The office of DCG(I) granted 241 No Objection Certificates for dual use items and shelf life extension for export purposes in the year 2010. Drugs and Cosmetics Rules have been amended to incorporate a system of registration of cosmetics imported into the country and the registration will become mandatory for import of cosmetics from April 2011. 2. Quality Control Over Notified Medical Devices Medical Devices notified by the Government of India under the Drugs and Cosmetics Act, 1940 are regulated by CDSCO under the provisions of the Drugs and Cosmetics Rules. The quality control over these devices is regulated through the system of registration and import licences as applicable for drugs. During the year 2010 the office of DCG(I) has granted 301 registration certificates of the manufacturers of the Medical Devices who intended to export their products to India and has granted 680 licences for import of Medical Devices into the country. Apart from this, in 150 cases permissions for import of Medical Devices for test and analysis have also been granted. The manufacture of the notified devices is approved by the DCG(I) as Central Licence Approving Authority. During the year 2010, 37 manufacturing licences were approved by DCG(I). The Office of DCG(I) also processes the applications for grant of permissions for clinical trials in the country. The office of DCG(I) has processed 40 such applications for grant of permissions for clinical trials on Medical Devices and granted permission for clinical trials in three cases. 3. Grant of permission for introduction of new drugs in the country New Drugs are permitted to be marketed in the country in accordance with the permission granted by the Drugs Controller General (India) after ensuring that these are safe and efficacious and comply with the requirements of Schedule Y of the Drugs and Cosmetics Rules. The applicants are required to provide technical data in respect of safety and efficacy before these could be permitted to be marketed in the country. The definition of the new drug also includes Fixed Dose Combinations which are required to be marketed for the first time in the country. Annual Report 2010-11 195 During the year 2010-11, the office of DCG(I) granted 1057 permissions for manufacture or import of new drugs. Apart from this, 180 permissions for additional indications / additional strength in already approved drugs were also granted. In case of vaccines each manufacturing process is required to be approved as a new drug and is evaluated for safety and efficacy before permission for marketing is granted. During the year 2010-11, permission for manufacture of vaccine as New Drugs was granted in 17 cases. 4. Clinical trials Clinical research is gaining momentum in the country as there is an increased level of acceptance of Indian research in the developed countries. The availability of highly developed infrastructure of clinical research has made India a destination for global clinical research. Multi centric trials are conducted by pharma companies simultaneously in different parts in the world to assess the safety and efficacy of the drug in different ethnic groups and these are termed as Global Clinical Trials. The office of DCG(I) is receiving a large number of applications for grant of permissions for conducting global clinical trials in India. During the year 2010, the office of DCG(I) has granted permissions for 239 Global clinical trials. Clinical Trials are also permitted to be conducted in the country to examine the safety and efficacy of the drugs proposed to be marketed in the country. The protocols of such trials are examined by the office of DCG(I) before these permission are granted. 272 permissions for conducting such clinical trials in the country were granted in 2010. In case of vaccines, permissions for clinical trials were granted in 26 cases. The Office of DCG(I) also grants permissions for conducting bioequivalence studies in chemically equivalent drug formulations to study whether they produce identical therapeutic response in patients. Permissions for 443 such studies were granted to conduct of bioequivalence studies in 2010. Various initiatives have been taken for further streamlining the regulatory control over the conduct of clinical trials. a. Registration of clinical trials has been made mandatory with the Centralized Clinical Trial Registry of ICMR with effect from 15th June 2009. b. Guidelines for conducting Clinical Trials inspections have been posted on the website of CDSCO (i.e. cdsco.nic.in). c. Dugs and Cosmetics Rules are being amended to make mandatory the registration of Clinical Research Organizations. d. The Drugs and Cosmetics Act is proposed to be amended to include a separate Chapter on Clinical Trials. 5. National Pharmacovigilance Programme A Pharmacovigilance Programme of India (PVPI) has been launched on 14.07.2010 to capture Adverse Drug Reactions data in Indian population in a systematic way. The programme will be coordinated by the Department of Pharmacology, All India Institute of Medical Sciences, New Delhi which will act as the National Coordinating Centre (NCC). The Centre will operate under the supervision of a Steering Committee, under the chairmanship of Director, AIIMS, New Delhi with DCG(I) as one of the members of the Committee. The objectives of the programme are as under: To monitor Adverse Drug Reactions (ADRs) in Indian population To create awareness amongst health care professionals about the importance of ADR reporting in India To monitor benefit-risk profile of medicines Generate independent, evidence based recommendations on the safety of medicines Support the CDSCO for formulating safety related regulatory decisions for medicines Communicate findings with all key stakeholders Create a national centre of excellence at par with global drug safety monitoring standards In the first phase of the programme, ten medical colleges spread across the country will collect the data of Adverse Drug Reactions (ADRs) in Indian population, and subsequently it will be expanded to other medical colleges also. These medical colleges will act as peripheral Adverse Drug Reaction Monitoring and Reporting (ADR) Centres. Annual Report 2010-11 196 These ADR Centres will be responsible for collecting the ADR reports, performing the follow up with the complainant to check completeness of the ADR reports as per Standard Operating Procedures (SOPs) prescribed for the purpose. The Data so collected will be forwarded to the National Coordinating Centre (NCC) at AIIMS, New Delhi. The Medical Colleges involved in the programme will be provided Technical, Administrative & financial support by CDSCO. This support will have the following components: 1) Providing contractual Manpower in the form of one Technical Associate (TA) to each of the ADR Centre. 2) Administrative & financial support in the form of Computers, Printers, Photocopiers, internet services etc. 6. Drugs Technical Advisory Board Drugs Technical Advisory Board is a statutory body under the Drugs and Cosmetics Act, 1940 to advise the Central Government on technical matters arising out of the administration of the said Act and Rules made thereunder and to recommend amendments to the Drugs and Cosmetic Rules. 7. Drugs Consultative Committee The Drugs Consultative Committee is another statutory committee consisting of Central and State Drug Controllers to advise the Government on matters relating to uniform implementation of the Drugs and Cosmetics Act and Rules made thereunder throughout the country. The 41 st meeting of the DCC was held on 28 th October, 2010. 8. Banning of Drugs The Drugs and Cosmetics Act, 1940 provides powers to Central Government to prohibit manufacture etc., of any drug or cosmetic in public interest. Drugs about which reports are received that these are likely to involve risk to human beings or animals in the present context of the knowledge are examined for their safety and rationality through the expert committees and DTAB. Manufacture and sale of the drug if considered necessary is prohibited by Central Government in public interest through a gazette notification. During the year 2010 the Drug Rosiglitazone, an anti-diabetic drug, was prohibited for manufacture and sale in the country vide Gazette Notification GSR 910(E) dated 12.11.2010. 9. Training Programmes Training Programmes for updating the skills of the personnel working in CDSCO were held during the period in various fields. Workshops were held on clinical trial inspections, Medical Devices, training of New Drug Inspectors, Regulatory affairs and Pharmacovigilance. 10. Transparency in the functioning The approvals granted by the CDSCO are regularly posted on the website www.cdsco.nic.in for the purpose of transparency and accountability. The licences and approvals granted are put on display daily on two LCDs for the information of the general public at FDA Bhavan, Kotla Road, New Delhi. File tracking system has been introduced in the CDSCO headquarters. The approval letters in respect of Clinical trials and registrations of imports have also been started to be posted on the website. E. Port Offices The regulatory control over the quality of imported drugs and cosmetics is exercised at the port of entries at Sea ports/Airports situated at Delhi, Mumbai, Nhava Sheva, Chennai, Kolkata, Cochin and Ahmadabad. The quality is checked through random sampling of drugs from consignments, for test and analysis. Initiatives have been taken for creation of pharmaceutical zones at Delhi and other air ports for providing dedicated areas for storage of drugs and sampling of drugs meant for import or export to ensure that the quality of drugs does not deteriorate at the ports because of inappropriate storage. F. Zonal Offices Six Zonal offices located at Ghaziabad, Mumbai, Kolkata Chennai, Ahmadabad, Hyderabad and three sub zonal offices at Chandigarh, Jammu and Bangaluru, co-ordinate with State Drug Control Authorities under their jurisdiction for uniform standards of inspection and enforcement. The zonal offices are involved in the GMP audits and inspection of manufacturing units of large volume parental, sera and vaccine, recombinant DNA (r-DNA) derived drugs and blood banks and blood product manufacturing units and coordination with the State Drugs Control Organizations situated under the respective zone or subzone. Annual Report 2010-11 197 G. Central Drugs Testing Laboratories There are six Central Drug Testing Laboratories engaged in the testing of drugs and cosmetics in the country. 1. Central Drug Laboratory, Kolkata 2. Central Drug Testing Laboratory, Mumbai 3. Central Drug Testing Laboratory, Chennai 4. Central Drug Laboratory, Kasauli 5. Regional Drug Testing Laboratory, Guwahati 6. Regional Drug Testing Laboratory, Chandigarh. The Central Drug Laboratory, Kolkata is the National statutory laboratory for quality control of Drugs and Cosmetics in the country. It is an appellate laboratory in matters of dispute regarding testing of drugs. The laboratory is NABL accredited laboratory for chemical and biological sections. The Central Drug Testing Laboratory, Mumbai is a statutory laboratory involved in testing of samples of drugs from the ports, new drugs and oral contraceptive pills. It is an appellate laboratory for copper T intrauterine contraceptive device and tubal rings. The Central Drug Testing Laboratory, Chennai is an appellate laboratory for condoms and is testing, as Government analyst, samples of cosmetics and drugs. The laboratory has been granted NABL accreditation for both chemical and mechanical sections. Central Drug Laboratory, Kasauli is Government testing laboratory for sera and vaccines. Regional Drug Testing Laboratory, Guwahati is testing samples of drugs received especially from States in the East Zone. The laboratory is NABL accredited laboratory for both chemical and biological testing. The Regional Drug Testing Laboraotry, Chandigarh which has been recently established is involved in testing of survey samples. H. New Regulatory Initiatives 1. Overseas Inspections Overseas inspections of drug manufacturing sites would be initiated from the year 2011. The inspections would be carried out in the first place in certain units located in Italy and China. 2. Strengthening of Drugs Testing Laboratories The testing capacities of the Central Drugs Testing Laboratories are being strengthened by increasing the manpower as well as equipments available for testing at these laboratories. An amount of Rs. 6.39 Crore for procurements of essentials laboratory equipments through HSCC has been sanctioned and 50% of this amount i.e. Rs. 3.195 crore has already been released to HSCC for procurement of equipments. Further requirements of equipments for various laboratories for upgrading their testing facilities are also under consideration of the Government. For the purpose of strengthening of manpower in the Central Drug Testing Laboratories, a proposal for the creation of 397 additional posts is under consideration in the Ministry of Finance, Department of Expenditure. For strengthening of State Drug Testing facilities assistance was provided to establish or upgrade testing laboratories in the State to enhance testing facility in the State laboratories under capacity building project through World Bank. States have been further requested to strengthen infrastructure in the State laboratories so as to increase the testing facilities in the country. 3. Common Technical Documents for New Drug It is proposed to introduce Common Technical Documents for submission of technical information for new chemicals entities by the applicants. Draft guidelines have been placed on the website of CDSCO. Common Technical Documents for submission of information for biological products was earlier introduced in October, 2008. 4. Guidance Documents Guidance documents for applications for approval of Fixed Dose Combinations have been put on website for the benefit of the applicants in providing necessary technical data along with the applications. A system of preliminary scrutiny at the time of the receipt of the applications has also been introduced to expedite the processing of applications. 14.3 INDIAN PHARMACOPOEIA COMMISSION DRUG AND ALCOHOL DE-ADDICTION PROGRAMME In order to full-fill its main objectives, the commission has to focus on its priority works with limited resources being the formative years. By accepting these challenges, during the period, the one of the important work to be accomplished was updating of the Indian Pharmacopoeia, the book of standards for drugs by ways of bringing out the 6 th edition. This work was completed within the stipulated time schedule. The book was released by Annual Report 2010-11 198 Shri Ghulam Nabi Azad, Union Health & Family Welfare Minister. The book comprises three volumes. The salient features are 287 new monographs are included, 1/3 rd of the existing monographs of IP 2007 have been updated, harmonized the monographs on vaccines and sera, special emphasis on herbal drugs monographs, added monographs of commonly used exciepents are included, the Appendices and general chapters are updated, special emphasis on Liposomal drugs, 8 new and upgraded existing monographs related to Veterinary products have been added. It is getting overwhelming response from the stakeholders for its scientific content and presentation. The other mandate of IPC is publication of the National Formulary of India. The process has made substantial progress as the compendium is under printing and could be published during 2010. As the compendium had been last published in 1979, a lot of data had to be collected for compilation of the new publication and the task was accomplished with concerted efforts. In the matter of infrastructure development also the Commission has made substantial progress. The existing buildings are redesigned and renovated to accommodate the new task of Reference Substances production and supply to the Regulatory Bodies and Industry including private drugs testing laboratories. The Commission has made available reference substances in respect of 51 active pharmaceutical ingredients during 2010 and more are to be added in the coming times. Scientists have been recruited in place of those who left the organization and in the posts created to take up the task of Reference Substances manufacture. 14. 4 DRUG AND ALCOHOL DE-ADDICTION PROGRAMME Drug addiction in India has of late emerged as a matter of great concern both concerned both due to the social and economic burden caused by substance use and due to its establishment linkage with HIV/AIDS. The onus of responding to the problems associated with drug use lies on the central and state governments. The constitution of India under Article 47, enjoins that the state shall endeavor to bring about prohibition of the consumption, except for medical purposes, of intoxication drinks and of drug, which are injurious to health. The activities to reduce the drug use related problems in the country could broadly be divided into two arms supply reduction and demand reduction. The supply reduction activities which aim at reducing the availability of illicit drugs within the country come under the purview of the Ministry of Home Affairs with at the Department of Revenue as the nodal agency and are executed by various enforcement agencies. The demand reduction activities focus upon awareness building, treatment and rehabilitation of drug using patients. These activities are run by agencies under the Ministry of Health and Family Welfare, and the Ministry of Social Justice and Empowerment. The role of Ministry of Health & Family Welfare in the area of Drug De-addiction is demand reduction by way of providing treatment services. The Drug De-addiction Programme in the Ministry of Health & Family Welfare was started in the year 1987-88 which was later modified in 1992-93. The programme was initiated as a scheme with funding from the central government and implementation through the states. Under the scheme, a one time grant in aid of Rs. 8.00 lakhs was given to states for construction of each Drug De-addiction Centre and a recurring grant of Rs. 2.00 lakhs was given to Drug De-addiction Centres established in North Eastern Regions to meet the expenses on medications and other requirements. At present 122 such Centres have been established across the country including centres in Central Government hospitals and institutions of which 43 Centres have been established in the North Eastern Region. Under this programme, a national nodal centre, the National Drug Dependence Treatment Centre, has been established under the All India Institute of Medical Sciences (AIIMS), New Delhi which is located in Ghaziabad while two centres i.e. NIMHANS, Bangaluru and PGI, Chandigarh have also been upgraded by this Ministry. The purpose of these centres would not only to provide de-addiction and rehabilitation services to the patients but also to conduct research and provide training to medical doctors in the area of drug de-addiction. Annual Report 2010-11 199 14. 5 NATIONAL DRUG DEPENDENCE CENTRE, AIIMS National Drug Dependence Treatment Centre, AIIMS which was established during the year 1987-88 and functioning at Deen Dayal Upadhyay Hospital, Hari Nagar has now shifted in its own building constructed at CGO complex, Kamla Nehru Nagar, Ghaziabad started indoor facilities. Community Clinic of this centre at Trilokpuri has been functioning from August, 2003 and a mobile clinic in an urban slum area of Delhi w.e.f. March, 2007. Apart from rendering patient-care services, the centre, engaged in a number of research projects has an well equipped laboratory for both clinic and pre- clinical research and CME activities. Education: Undergraduate and Post graduate medical and nursing students undergo formal training. This includes attendance to Journal discussions, seminars, case conferences and staff presentations held every week apart from clinical training. 14. 6 DE-ADDICTION CENTRE, NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS), BANGALURU Activities at the De-addiction Centre The De-addiction Centre has entered into its 20 th year of functioning. In addition to expanded inpatient facilities, the centre has been actively providing in-house post- graduate training in substance use management for postgraduates in psychiatry, psychology, psychiatric social work and psychiatric nursing. Short-term training has been provided for deputed medical officers and social work trainees from several parts of the country. This includes WHO fellows from the Asian region and DMHP trainees. As the regional centre for South India, the DAC has carried out training programmes in substance abuse management for de-addiction centres in South India in addition to functioning as the nodal centre for monitoring the functioning of these centres. The centre has a thrust on community interventions primarily workplace interventions. Patient care: The Centre has seen 1514 new patients and 4132 patients have come for follow up during the period from April 2010 to October 2010. Training: The centre has conducted the following training programmes: 1. One day workshop for medical officers on 26 th September 2010 at Bidar 2. Two day workshop for medical officers and lay counselors at South Central Railways, Secunderabad on 24 th and 25 th September 2010. 3. One month orientation program on Substance Use Disorders in the month of November 2010. 4. Conducted Workshop on tobacco cessation for dentists from Indian Dental Association conducted by National Resource Centre for Tobacco Control, Department of Psychiatry, NIMHANS, Bangaluru at Deaddiction Centre, NIMHANS, during the months of April, August and September 2010. Toxicology tests: The toxicology lab has conducted more than 3000 tests for Urine by HPTLC, Urine kits both single and poly kits during the above period. One month Orientation programme on Substance Use Disorders. Annual Report 2010-11 200 Release of Information Booklet, Addiction-What to know & How to get Help 14. 7 DE-ADDICTION CENTRE, PGI, CHANDIGARH The Drug De-addiction and Treatment Center was actively involved in various extramural activities during this period. This was aimed at making the general population and, special and high risk groups aware of various types of addictive substances, their harmful effects, myths involved, and various treatments options and accessibility. A. Following were the activities and achievements of the center during the period. 1. International Day against Drug Abuse and Illicit Trafficking was celebrated by the Youth Affairs Organization in their 3 rd State Level function in the Red Cross Bhawan, Sector-16 Chandigarh. Doctor from the Drug Deaddiction Center gave a talk on medical, psychological, social aspects of drug and alcohol abuse. 2. The Faculty of the Center participated in the Doordarshan program on the problem of addiction, its prevention and treatment. 3. Doctors of the center held two interactive programmes with NSS Volunteers of Chandigarh region. 4. Doctors from the Center participated in three Chandigarh Administration sponsored lectures and interactive sessions with the students of Government and Private Colleges Chandigarh. 5. The Center also organized 3 interactive programmes with school children and women on various aspects of drug abuse in the Villages of Tehsil Kharar of Distt. Mohali of Punjab. 6. A Centre doctor addressed Punjab Armed Police (PAP) on the various aspects of drug and alcohol related problems. 7. Center organized three drug deaddiction awareness and treatment camps in the villages of Tehsil Kharar of Distt. Mohali of Punjab. B. The center commissioned 500 SQMT expansion for Outpatient services. This expansion included spacious Waiting Halls for patients and their relatives, larger Record Room cum Registration room. 8 rooms for Consultant, Senior Residents, Junior Residents and Medical Social Workers, and toilets for OPD visitors and staff members. The facility became operational from 21 st October 2010. C. The Outpatient facility has incorporated a ramp for the disabled patients. D. The center has started well equipped 2-bed isolation facility from the existing beds of inpatient for acutely ill intoxicated patients from 6 th December 2010. 14. 8 REGIONAL DE-ADDICTION CENTRE (UNDER DEPARTMENT OF PSYCHIATRY), JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION AND RESEARCH(JIPMER) , PUDUCHERRY Background Department of Psychiatry came into existence at JIPMER from 1962. The clinical services provided by the department in the area of substance use disorder was upgraded and designated as a Regional De-addiction Centre in 1991 by Ministry of Health and Family Welfare, Government of India. This centre has inpatient facilities for the management of substance abuse disorders. Drug De-addiction Clinic is conducted on every Saturday (forenoon) which offers comprehensive psychosocial assessment and management of substance abuse disorders. The services for Tobacco cessation facility are also available in this clinic. This centre is mainly involved in : 1. Providing clinical care of patients through the hospital, community based out-reach care. Services offered have been daily OPD, in-patient care. Annual Report 2010-11 201 2. Health education-talks on radio and talks in school on substance use disorders delivered by our faculty 3. Manpower development-training of several categories of staff 4. Overall quantification of health damage as all specialities of medicine are available at JIPMER 5. Documentation and creation of data base to facilitate research in this area. The services and facilities at the Centre include the following: Clinical Service: (out patients department, In- patient, brief intervention, community care in urban and rural areas through community health camps) Teaching/ training: (Junior Residents, General Duty Medical Officers from various states, Nursing staff and Anganwadi workers) Laboratory Service: (Biochemical, haematological tests and screening for HIV/AIDS as a part of assessment of health). Information and Library: (for substance abuse related health education various pamphlets, videos are available in local languages). Education: A) Under Graduate-During their posting in the department of Psychiatry, they are posted for a day in the de-addiction clinic. B) Post Graduate-Residents doing MD (Psychiatry) are posted for 6 months during their entire course duration. C) Post graduate teaching Seminar- Weekly Journal discussion- Once in two weeks Case Conference- Once in two weeks Continuing Medical Education Our faculty attends regularly conferences, workshops, seminars, symposium, training courses related to this field Training by Trainers programme Lectures delivered by faculty for workers in transport services, state of Puducherry and to nursing students from different medical colleges International Conferences Effectiveness of Yoga in reduction of stress in primary caregivers of patients with alcohol dependence. Patient Care (Statistics 2010-11) General Information 1. Total No. of beds : 07 2. OPD Attendance : 1715 3. Admission : 118 4. Discharges : 100 OPD & Specialty New Old Total Clinics Attendance Cases Cases General OPD: (Follow up-cases) 315 1400 1715 Admitted patients 118 - 118 Total: 433 1400 1833 Annual Report 2010-11 203 Chapter 15 15.1 INTRODUCTION The Centre has set up regulatory bodies for monitoring the standard of medical education, promoting training the research activities. This is being done with a view to sustain the production of medical and para-medical manpower to meet the requirements of health care delivery system at the Primary, Secondary and Tertiary levels in the country. This chapter discusses the status of these activities conducted by the various bodies and institutions. 15.2 MEDICAL COUNCIL OF INDIA The Medical Council of India was established as a statutory body under the provisions of the Indian Medical Medical Education, Training Medical Education, Training Medical Education, Training Medical Education, Training Medical Education, Training & Research & Research & Research & Research & Research Council Act, 1933, which was later, replaced by the Indian Medical Council Act, 1956 (102 of 1956). The main functions of the Council are (1) Maintenance of uniform standard of Medical Education at undergraduate and postgraduate level; (2) Maintenance of Indian Medical Register; (3) Reciprocity with foreign countries in the matter of mutual recognition of medical qualifications; (4) Provisional/permanent registration of doctors with recognized medical qualifications, registration of additional qualifications, and issue of good standing certificate for doctors going abroad (5) Continuing Medical Education, etc. Inspections: A) Undergraduate: 1) Inspections for establishment of new medical colleges = 25 2) Inspections for renewal of permission = 50 3) Compliance Verifications Inspections +Esst. + 11(2) + Surprise Inspections (Esst.(10+25+3+1) = 39 4) Inspections for Approval of the colleges = 02 5) Inspections for Increase of seats = 03 6) Inspections for renewal of permission for increase of seats = 14 7) Compliance verification inspections for renewal of Increase of seats+ increase+ 11(2) Surprise (14+ 0+0) = 14 8) Inspections for approval of the colleges for increase of seats = 01 9) Pre-PG inspection = 01 10) Compliance Verification Inspection for Pre-PG = 00 11) As per Court Order = 00 12) Periodical Inspection + Compliance verification (7+20) = 27 Total 176 Annual Report 2010-11 204 B) Postgraduate: (i) 279 inspections for approval of starting various postgraduate medical courses at Medical Colleges were carried out subsequent to request received u/s 10A of the IMC Act, 1956 through Central Government, Ministry of Health &family Welfare. (ii) 288 inspections for recognition (including compliance verification) of postgraduate medical qualification u/s 11(2) of the IMC Act, 1956 were carried out. (iii) 223 inspections for increase of seat in various course u/s 10A of the IMC Act, 1956 were carried out. Registration: Various types of Registration Certificate issued from 1.04.2010 to 30-11-2010 by this Council during the year under review are as under: (i) Permanent Registration Certificate - 1387 (II) Provisional Registration Certificate - 1222 (III) Additional Qualification Certificate - 0332 (IV) Good Standing Certificate - 0804 (V) Eligibility Certificate - 1054 Continuing Medical Education: During the year 2010- 2011, the Council has planned to hold 200-250 CME programmes. Till November, 2010, 200 CME programmes have been approved are likely held at various medical institutions in the country. Accounts & Establishment: The following outlay has been approved by the Central Government as Grant-in- aid (Plan & Non-Plan) for the year 2010-2011: Out lay approved (Rs.) Plan (including CME) 100 Lakhs Non Plan Nil A sum of Rs. 67,19,66,154/- has been received by the Council till December, 2010 from other resources. A sum of Rs. 50,00,000/- was received so far under plan Grants- in- aid (plan) till December 2010 from the Central Government. Policy regarding Establishment of Medical College: As on date November, 2010 there are 314 medical colleges in the country out of which 237 medical colleges have been recognized under Section 11(2) of the IMC Act, 1956 by Medical Council of India. The remaining 77 colleges have been permitted under section 10A of the IMC Act, 1956 for starting MBBS course. The provisions of IMC (Amendment) Act, 1993 whereby Section 10A was introduced and came into deemed effect from 27 th August, 1992 (initially promulgated as an ordinance). As per the amended Act prior permission of the Central Government is mandatory for opening of a new medical college, increase in admission capacity and starting of new or higher course of studies. The eligibility and qualifying criteria for opening of a new medical college is laid down in Establishment of Medical College Regulations, 1999. The minimum requirement for 50/100/ 150/200/250 students admission are contained in the minimum standard requirements for the medical college Regulations, 1999. As per the newly inserted Section 3B (b) (ii) in Indian Medical Council (Amendment) Act, 2010, the Board of Governors shall grant independently permission for establishment of new medical colleges or opening a new or higher course of study or training or increase in admission capacity in any course of study or training referred to in Section 10A without prior permission of Central Government including exercise of power to finally approve or disapprove the same. At present, there are 314 medical colleges in the country out of which 238 medical colleges have been recognized under Section 11(2) of Indian Medical Council Act, 1956 by Medical Council of India. The remaining 76 medical colleges have been permitted under Section 10(A) of Indian Medical Council Act, 1956 for starting MBBS course. Out of these 314 Medical colleges, 149 medical colleges with annual admission capacity of 17382 students are in Government Sector and 165 medical colleges with annual admission capacity of 19645 students are in Private Sector. The admission capacity both in Government and Private medical colleges is about 37027 students per year. During the academic year 2010-11, 08 new medical colleges in private sector and 06 medical colleges in government sector with admission capacity of 1650 students were granted permission. Out of these, 03 medical colleges were granted permission by the Central Government and rest 11 medical colleges were granted permission by the newly constituted Board of Governors, Medical council of India in view of the Indian Medical Council (Amendment) Act, 2010. The Central Annual Report 2010-11 205 Government/Board of Governors has also granted permission for increase in seats of 175 students in existing medical colleges during the academic year 2010-11. The Post Graduate intake capacity of these colleges is about 18625 students annually. The Central Government has a Centrally Sponsored Scheme for Strengthening and Up-gradation of State Government Medical Colleges for starting/increasing post graduate seats in existing disciplines with priority given to the disciplines like Anatomy, Forensic Medicine, Obst. & Gynaecology, Paediatrics, Anaesthesiology, General Medicine, General Surgery, Microbiology, Paediatrics, Anaesthesiology, General Medicine, General Surgery, Microbiology, Physiology, Pharmacology, Community Medicine, Geriatric, Transfusion Medicine and Bio- Chemistry. Under this scheme, an amount of Rs. 1350 crores has been earmarked for this purpose. With the implementation of the scheme, approximately 4000 more PG seats would be available. Till December 2010, 44 State Government Medical Colleges from Bihar, Chandigarh, Himachal Pradesh, Jharkhand, Kerala, Madhya Pradesh, Orissa, Punjab, Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal including 03 medical colleges from Assam have been covered under this scheme. 15.3 DENTAL COUNCIL OF INDIA (DCI) The Dental Council of India is a statutory body constituted by an Act of Parliament viz. Dentists Act, 1948 (XVI of 1948) with the main objective of regulating the Dental Education, Dental Profession, Dental ethics in the country and recommend to the Govt. of India to accord permission to start a Dental College, start higher course & to increase of seats. For this purpose the Council periodically carries out inspection to ascertain the adequacy of courses and facilities available for the teaching of Dentistry. The Council had received 348 applications in prescribed form/scheme from the Central Govt. for (i) establishment of new Dental colleges (ii) starting of MDS Courses (iii) increase of seats in BDS/MDS Courses, and (iv) starting of P.G. Diploma Course, for evaluation & recommendations in accordance with the provisions of the Section 10A of the Dentists Act, 1948. During the said period, the Central Govt. on the recommendations of the Council had permitted for 01 new Dental College and increase of admission capacity in BDS course in 01 Dental College, starting of MDS Courses in 114 specialities at 43 Dental Colleges, increase of seats in MDS Courses in 40 specialities in 14 Dental Colleges and starting of PG Diploma Course in 01 speciality at 01 Dental College. The Central Govt. on the recommendations of the Council had allowed / renewed its permission for 2 nd /3 rd /4 th /5 th / 6 th year BDS course in 83 Dental Colleges and renewed its permission for increase of seats for 2 nd /3 rd /4 th /5 th /6 th year BDS Course at 27 Dental Colleges, renewed its permission in MDS Course for 2 nd /3 rd /4 th year at 83 Dental Colleges in 323 specialities and with increased intake capacity at 17 Dental Colleges in 56 specialities and also renewed its permission in PG DiplomaCourse for 2 nd /3 rd year at 03 Dental Colleges in 13 specialities. 1012 Inspections of the various Dental Colleges in the country had been carried out by the Councils Inspectors/Visitors during this period. The Council had granted its permission to start Dental Mechanic Courses at 07 Dental Colleges & Dental Hygienist Course at 03 Dental Colleges. The applications for starting of MDS courses / increase of MDS seats / renewal of MDS course for 2011-12 will be finalised in February/March, 2011 after considering the recommendations of DCI. The Govt. of India on the recommendation of the Council had issued 87 notifications of recognition of BDS/MDS qualifications awarded by the 34 Indian Universities & 02 Foreign Universities under Section 10(2) & 10(4) of the Dentists Act, 1948. The Council had recognized the Dental Mechanic Course at 05 Dental Colleges and Dental Hygienist Course at 04 Dental Colleges. A sum of Rs.19.00 Lakhs has been provided as grant-in-aid to the Council during the year 2010-2011. 15.4 PHARMACY COUNCIL OF INDIA The Pharmacy Council of India (PCI) is a body constituted under section 3 of the Pharmacy Act, 1948 to regulate the profession and practice of Pharmacy. The objectives of the Council is to be prescribe minimum standards of education required for qualification as a pharmacist, uniform implementation of educational standards, approval of course of study and examination for pharmacists, withdrawal of approval, approval of qualifications granted outside India and maintenance of Central Register of pharmacists. The Council arranged 775 inspections of diploma and degree institutions and held a number of meetings of the Executive Committee and central council during the last one year as a result of which approval of 80 Diploma & Degree institutions was extended u/s 12 of the Pharmacy Annual Report 2010-11 206 Act; 32 new Diploma & Degree institutions were granted approval u/s 12 of the Pharmacy Act; 16 new Pharm. D. institutions were granted approval for the conduct of course and 5 new Pharm. D. (Post Baccalaureate) institutions were granted approval for the conduct of course. At present 561 institutions with 33635 admissions for Diploma in Pharmacy and 383 institutions with 22,715 admissions for degree in Pharmacy has been approval by the Pharmacy Council of India. Continuing Education Programmes (CEP) play an important role in the growth of the knowledge bank of the pharmacist. The PCI from its own resources is giving a financial assistance of Rs. 10,000/- per course subject to ceiling of 12 courses to the State Pharmacy Councils for the conduct of CEP for pharmacists. PCI further decided to give a financial assistance of Rs. 10,000/- to one pharmacy institution per state once in a year for conduct of orientation programme for pharmacy teachers. The Council has taken up the matter with the State Govts./ State Pharmacy Councils for setting up of Drug Information Centres for dissemination of knowledge. The Council is constantly pursuing with the State Governments for appointment of inspectors to ensure implementation of section 42 of the Pharmacy Act, 1948. A new initiative for strengthening/upgradation of Pharmacy institutions and continuing education programme for pharmacy teachers and practicing pharmacists has been approved by Govt. for Rs. 85.00 crores during the 11th Five year plan. 15.5 DEVELOPMENT OF PARAMEDICAL SERVICES A Centrally Sponsored Scheme for establishment of one National Institute of Paramedical Sciences (NIPS) at Delhi and eight Regional Institutes of Paramedical Sciences (RIPS) as well as developing the existing RIPANS, Aizawal as the 9th RIPS and manpower development to support State Government Medical Colleges through one time grant has been initiated by M/o H&FW during the 11th Plan period at the cost of Rs. 1156.43 crores to be shared in the ratio 85:15 between Centre and the State Governments. The Scheme aims to augment the supply of skilled paramedical manpower and promote paramedical training through standardization of such education/courses across the country. This Capacity Building scheme will also lead to:- Reduction in regional imbalances in availability of Paramedics Introduction of courses in New/Cutting Edge Disciplines Augmentation of Capacity for Planning, Monitoring, Evaluation etc. Provision of quality assured services through in-service training, action research, onsite support etc. 15.6 INDIAN NURSING COUNCIL (INC) The Indian Nursing Council is an autonomous body under the Government of India, Ministry of Health and Family Welfare. Indian Nursing Council Act, 1947 enacted by, giving statutory powers to maintain uniform standards and regulation of nursing education all over the Country. Indian Nursing Council prime responsibility is to set the norms and standards for education, training, research and practice with in the ambit of the relevant legislative framework. First Inspection is conducted to start any nursing program prescribed by Indian Nursing Council. Periodic inspections are conducted as per the requirement of the institution for new programmes as well as enhancement of seats. A sum of Rupees 3,67,32,530.00 has been received from the training institution as inspection/affiliation fees upto 30 th November 2010. Institutions recognized by Indian Nursing Council Number of Nursing Institutions recognized upto 30 th November 2010 is as follows: Number of Registered Nurses 11,28,116 Nurses, 5,76,810 ANMS and 52,490 Health Visitors have been registered with various State Nursing Council upto 31 st December 2009. Programme Total ANM 944 GNM 2287 B.Sc. (Nursing) 1502 P.B.BSc. (Nursing) 462 M.Sc. (Nursing) 432 Post Basic Diploma Programme 173 Annual Report 2010-11 207 New Initiatives i) National consortium for Ph.D. in Nursing : National Consortium for Ph.D. in Nursing has been constituted by Indian Nursing Council to promote research activities, in various fields on Nursing in collaboration with Rajiv Gandhi University of Health Science, supported by WHO. Total 153 students have been enrolled under National consortium of Ph.D. in Nursing. ii) Indian Nursing Council has initiated pro active measures to relax certain norms with regard to student patient ratio, student teacher ratio, experience, having constructed building instead of five acre land, allowing sharing of physical and clinical facility to run different programmes. iii) Relaxing of Govt. order for opening of Additional Programme in institutions which are running already INC recognized programme. iv) Syllabus for different speciality nursing programme one year post basic has been developed for Training of Nurses in various speciality courses. v) 14 Speciality courses have been developed. vi) Nurse Practitioner programme: The council has developed Nurse Practitioner programme and under implementation in various states. vii) Recipient of Global Funding (GFATM) for training of 90,000 Nurses in HIV/AIDS and capacity building of 55 nursing educational institutions in India. The website of Council is www.indiannursingcouncil.co.in & www.indiannursingcouncil.org is being updated regularly. 15.7 DEVELOPMENT OF NURSING SERVICES In order to improve the quality of Nursing Services, the following activities are being implemented under the scheme of Development of Nursing Services: - (i) Training of Nurses. (ii) Strengthening of existing Schools/Colleges of Nursing. (iii) Upgradation of Schools of Nursing attached to Medical Colleges into Colleges of Nursing (iv) Establishment of College of Nursing at JIPMER, Puducherry. (v) Upgradation of Schools of Nursing into Colleges of Nursing attached to Dr. R.M.L. Hospital, S.J. Hospital and Lady Hardinge Medical College, New Delhi. (vi) National Florence Nightingale Award for Nursing Personnel. Training of Nurses: The pattern of assistance for conducting Continuing Nursing Education Programme on the following areas in order to update the knowledge and skills of the Nursing personnel has been revised from Rs. 75,000 /- to 1,65300/- A sum of Rs. 1.00 crore has been allocated for the year 2010-11 for conducting 60 courses to train 1800 Nursing personnel. Strengthening of Schools / Colleges of Nursing: In order to improve the quality of training imparted at the existing Schools and Colleges of Nursing, a sum of Rs.25.00 lakhs as revised pattern of assistance has been approved towards procurement of A.V Aids, improvement of library, additions and alterations of School/College/ Hostel building. A sum of Rs. 50.00 lakhs have been released during the year 2010-11 for strengthening two institution during the year 2010-11. Upgradation of Schools of Nursing attached to Medical Colleges into Colleges of Nursing: A revised one time assistance of Rs. 6.00 crores has been approved for upgrading a School of Nursing into College of Nursing in order to increase the availability of graduate nurses. The funds are released to the Institute subject to the condition that State Government/Institution Category of Nursing Area of continuing Personnel Education Staff Nurses - Different clinical specialty Nurse Administrators - Management Technique Nursing Educators - Educational Technology Duration of training - 7 days No. of Participants - 30 per training programme Annual Report 2010-11 208 will bear the recurring expenditure. The financial assistance is meant for civil works including addition and alteration of school and hostel building and for furniture, audio- visual aids. 20 institutions in the states of Rajasthan (5), Jharkhand (3) Gujarat (2). Tamil Nadu (2), West Bengal (2) Himachal Pradesh (1), Manipur (1) , Mizoram (1),& Uttar Pradesh (3) have been released grant-in aid during the year 2010-11. Establishment of College of Nursing at JIPMER, Puducherry and Upgradation of Schools of Nursing into Colleges of Nursing attached to Dr. R.M.L. Hospital, S.J. Hospital and Lady Hardinge Medical College, New Delhi: College of Nursing at JIPMER, Puducherry has been established during 2006-07 and the School of Nursing at Lady Hardinge Medical College, New Delhi has been upgraded into College of Nursing during 2007-08. The School of Nursing at Dr. RML Hospital and Safdarjung Hospital has bee upgraded during the year of 2008-09. National Florence Nightingale Award for Nursing Personnel: National Awards for Nurses are given as a mark of highest recognition for the meritorious services of the nurses and nursing profession in the country. From 2007 onwards this award has been revived with the consent of Hon,le President of India and named as National Florence Nightingale Award. 27 nursing personnel had been honored with this prestigious award. Each award carries a Certificate of Merit and Cash Award of Rs. 50,000/- . A sum of Rs. 80.00 lakhs has been earmarked during the year 2010-11. New scheme of strengthening/upgradation of nursing services under human resource: I. Opening of ANM /GNM Schools: A sum of Rs. 250.00 crore have been allocated for the year 201011 for implementing the new scheme. CCEA has approved this Ministrys proposal for opening of 132 ANM Schools and 137 GNM Schools in those districts of the states where there are no such schools. 154 districts in 23 High Focus States have been identified having no ANM and GNM schools. A Sum of Rs. 123.00 crore has been approved so far for release under the new Sl.No Name of the State No. of No. of Districts Districts for for opening opening ANM GNM Schools Schools I. Arunachal Pradesh 3 2 II. Bihar 9 5 III. Haryana - 1 IV. J&K 6 5 V. Manipur - 6 VI. Puducherry 2 - VII. Orissa 2 1 VIII. Rajasthan 1 1 IX. Sikkim 2 - X. Uttarakhand 5 4 Total 30 25 scheme of opening of ANM /GNM Schools to the states as per details given below :- II. Faculty Development Scheme: In order to meet the shortage of qualified Post Graduate teachers in nursing to improve the quality of nursing education in the high focused States, a faculty Development programme has been approved and 22 nominations have been received from 7 States for undergoing training in M.Sc (Nursing) at the identified Institutions wiz. SNDT College of Nursing, Mumbai, PGIMER, Chandigarh and Govt. College of Nursing, SSKM Hospital, Kolkata. 15.8. RAJKUMARI AMRIT KAUR COLLEGE OF NURSING The Rajkumari Amrit Kaur College of Nursing, New Delhi, a subordinate organization of the Ministry of Health and Family Welfare was established in 1946 with the object of developing and demonstrating model programmes in Nursing Education. The College works in close association with health centres, hospitals, medical centres and allied agencies for teaching undergraduates, post- graduates and also for continuing education of nursing personnel. The college provides advisory and consultative services on nursing education matters to the States, Union Territories and some developing countries. Annual Report 2010-11 209 The admissions & graduations to B.Sc. (Hons) Nursing, Master of Nursing and M.Phil in Nursing are made on the basis of merit in the selection test as laid down by the Academic Council of the University of Delhi. Total admissions made in July, 2010 = 92 B.Sc. (H) Nursing 1 st year = 68 Master of Nursing 1 st Semester = 24 No. of foreign students admitted during 2010-11: B.Sc. (H) Nursing = 02 Master of Nursing = Nil No. of participants in Short term courses: = 60 Community Services: During B.Sc. (Hons.) Nursing programme the major emphasis was to develop primary health care competencies in the family and community setting by utilizing local resources and achieve community participation. Students actively participated in the national health programmes. Continuing Education: During the period under review, continuing education courses were conducted for nursing personnel. One national level short-term course on Quality Assurance in Nursing was conducted during the year 2010-11. Rural Field Teaching Centre, Chhawla: The Rural Field Teaching Centre was established in 1950 for the purpose of providing objective oriented Rural Community Health Nursing experience to the students. It covers 7 villages with approximately population of 17000 and is situated 35 Kms. away from the College. The Centre provides an integrated comprehensive health and family welfare services to the community in MCH services, family planning, immunization, nutrition and health education programme. The Centre also has DOTS and Microscopic Centre for screening and treatment of T.B . Patients. Chief Medical Officer of the R.A.K. College of Nursing is the In-charge of the R.F.T.C. and DOTS Centre. In addition, the Centre provides mobile Van clinic services to seven villages with special emphasis on Primary, secondary and tertiary level. R.F.T.C. is a team movement point for Pulse Polio Programme. 15.9. ALL INDIA ENTRANCE EXAMINATION FOR ADMISSION TO MBBS/BDS COURSES, 2010 CONDUCTED BY CBSE The All India Pre-Medical/Pre-Dental Entrance Examination was conducted in two stages (Preliminary & Final) by Central Board of Secondary Education (CBSE) on 3.4.2010 and 16.5.2010 for 15% All India Quota seats in Medical/Dental courses all over the country. Total 1,46,230 candidates appeared for Preliminary Examination. On the basis of the result of Preliminary Entrance Examination, 14,218 candidates had been declared qualified for final stage examination. The final result was declared on 23.5.2010 and 2434 candidates were placed in the merit list and 2238 in waiting list. Allotment was made upto rank UR- 3467 in 120 Government Medical and 27 Dental Colleges on 2012 MBBS and 238 BDS courses seats respectively. Allotment of Colleges and courses to the successful candidates were made as per their rank by Video Conferencing at three centers AIIH&PH, Kolkata, AIIPMR, Mumbai, NIS, Chennai and CHEB Building, New Delhi in two rounds. The whole admission process for 15% All India Quota of MBBS/BDS seats was successfully completed by 11.8.2010. 15.10. ALL INDIA ENTRANCE EXAMINATION FOR ADMISSION TO 50% POST- GRADUATE SEATS-2010 CONDUCTED BY A.I.I.M.S. NEW DELHI. In compliance with directions of the Honble Supreme Court of India, the All India Institute of Medical Sciences, New Delhi conducted the All India Entrance Examination for admission to 50% All India Quota PG Medical/Dental courses on all India basis. The Entrance Examination was held at 126 Centers in 15 capital cities in the country on 10.1.2010. A total 62,161 candidates were registered and 56,826 candidates appeared in the examination for admission to MD/MS/ Diploma and MDS courses. The result was declared on 15.2.2010 for enabling the allotment of seats for the merit/ wait list candidates in 102 Medical and 24 Dental Colleges all over India. There were 3850 recognized/approved seats in MD/MS/Diploma Courses and 155 approved seats in MDS course under the 50% All India PG Quota for 2010. The allotments were made to the successful candidates by personal appearance from 23.2.2010 to 17.3.2010 (1 st round) & 22.4.2010 to 12.5.2010 (2 nd round for merit Annual Report 2010-11 210 and wait listed candidates for unallotted seats) and 2.6.2010 to 12.6.2010 (Extended 2 nd round). The whole admission process to All India Quota PG/Diploma seats was successfully completed by 12.6.2010. 15.11 ALLOCATION OF MEDICAL/DENTAL SEATS FROM CENTRAL POOL MBBS and BDS Seats: A Central Pool of MBBS and BDS is maintained by the Ministry of Health and Family Welfare by seeking voluntary contribution from the various States having medical colleges and certain other Medical Education Institutions. In the academic session 2010-11, 261 MBBS and 28 BDS seats were contributed by the States and medical institutions. These seats were allocated to the beneficiaries of the Central Pool, viz., States/Union Territories, which do not have medical/dental colleges of their own, Ministry of Defence (for the wards of Defence Personnel), Ministry of Home Affairs (for the children of para-military personnel and Civilian Terrorist Victims), Cabinet Secretariat, Ministry of External Affairs (for meeting diplomatic/ bilateral commitments and for the children of Indian staff serving in Indian Mission abroad), Ministry of Human Resource Development (for Tibetan Refugees) and Indian Council for Child Welfare (for National Bravery Award winning children). MDS Seats: There are 4 MDS seats in the Central Pool contributed by Government of Uttar Pradesh, which are allotted to the in-service doctors sponsored by the States/Union Territories without MDS teaching facility on a rotational basis. For the academic session 2010-11, in-service doctors sponsored by the States of Uttranchal, Tripura, Nagaland and Manipur were nominated against these seats. Post Graduate Medical Seats for Foreign Students: There are 5 P.G. medical seats in the Institute of Medical Sciences, Banaras Hindu University, Varanasi, reserved for foreign students in a calendar year. The foreign students against these seats are nominated by the Ministry of Health & Family Welfare on the advice of Ministry of External Affairs. During the year 2010, these seats were allocated to the candidates from Nepal (1 seat), Maldives (1 seat) and Mauritius (3 seats). 15.12 NATIONAL BOARD OF EXAMINATIONS The National Board of Examinations established in 1975, functioned as a wing of the National Academy of Medical Sciences upto 1982 Government of India, after a review, took a policy decision to make it an independent autonomous body with effect from March 1, 1982 under the Ministry of Health and Family Welfare. The Diplomate qualifications awarded by the National Board of Examinations have been equated with postgraduate degree and post-doctoral level qualifications of universities by the Government of India Ministry of Health and Family Welfare. Considering the fact that India has the expertise in various sub-specialty areas with centers having high tech equipment and trained manpower performing exceptional quality work and also keeping in mind the need to increase manpower that can render highest degree of professional work,the National Board is also conducting Fellowship programme in 16 sub- specialties. The 16 th Convocation of National Board of Examination was held on 5 th April 2010 at Vigyan Bhawan, Maulana Azad Road, New Delhi to confer the Prestigious Diplomate of National Board Degrees to the successful candidates during the session from Dec, 2008 to June 2009. On that occasion Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, would be the Guest of Honour. Prof. K Srinath Reddy, President of National Board of Examination presided the Ceremony. In the convocation, 1500 candidates were awarded Diplomate of National Board Degrees from December 2008 to June 2009 sessions. Approximately 700 candidates in 46 specialties were awarded the degrees in person and 800 candidates were awarded their degrees inabsentia. Dr. Montek Singh Ahluwalia awarded Gold Medals to the candidates for their outstanding performance in various broad and super specialities. Interactive teleconferencing sessions for DNB candidates using facilities of IGNOU are being done every Thursday from 2.30 PM to 7.30 PM at IGNOU. Interactive radio counseling sessions for DNB candidates using facilities of IGNOU are being done every Thursday from 5.00 PM to 6.00 PM at IGNOU. Annual Report 2010-11 211 The NBE conducted 33 CME programmes for DNB candidates and 5 CMEs for consultants during the year under report. 15.13. NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) The National Academy of Medical Sciences (India) established in 1961 is a unique institution which fosters and utilises academic excellence as its resource to meet the medical and social goals. Over the years, the Academy has recognized the outstanding achievements of Indian scientists in the field of medicine and allied sciences and conferred Fellowship and Memberships. Fellows and Members are chosen through a peer review process consisting of screening by the Advisory Panel of Experts and the Credentials Committee, election through voting by the Council and by all the Fellows. As on 31 st October, 2010, the Academy has on its roll, 6 Honorary Fellows, 830 Fellows and 4950 Members (including 1625 MAMS and 3325 MNAMS). The 50 th Annual Meeting of the Academy was held at the Govt. Medical College, Patiala on 29 th , 30 th and 31 st October, 2010. The Governor of Punjab, Shri Shivraj Patil was the Chief Guest. Professor J.S. Bajaj, Emeritus President and Chairman- Academic Committee, NAMS was the Guest of Honour. Seventy Five candidates were given Scrolls of Fellowship and Membership of the Academy at the ceremonial occasion of the Annual Convocation of the Academy held at Govt. Medical College, Patiala. The Annual General Body Meeting was held on 30 th October, 2010. Ten Orations and Six Awards were awarded to eminent Bio-medical Scientists of the Country for the year 2010-2011. The Academy has been recognized by the Government of India as Nodal Agency for Continuing Medical Education for medical and allied health professionals. Since 1982, CME programmes are an important activity of the NAMS to keep medical professionals abreast with newer/current medical problems of the country and to update their knowledge for better delivery of medical education, patient care and health care at large. In this financial year, financial assistance has been provided to various Medical Institutions to conduct seminars/workshops/CMEs on topics of interest and relevance to India. Emeritus Professors of NAMS: In order to strengthen the intramural CME Programmes, the Academy has appointed 43 eminent Fellows of the Academy for Emeritus Professorship. The Emeritus Professors have been assigned the responsibilities viz. (i) to identify one or more medical colleges where intramural CMEs of NAMS can be organized and where lectures can be given by designated emeritus Professors who will also strengthen the Postgraduate Medical Education through clinical rounds, case discussion or laboratory exercises, (ii) to suggest topics/subjects related to their expertise for intramural CME and would assist in organizing and conducting these with NAMS support, (iii) to undertake travel to any part of the country at least once a year and visit one or two medical institutions to deliver lectures, seminars and also contribute towards academic activities and training of Postgraduates. The Directory of the Emeritus Professors is being updated during the Golden Jubilee Year of the Academy. Intramural CME Programmes: The CME Programme Committee identifies, from time to time, topics of national and academic relevance for funding as intramural CME Programmes. The Academy provides TA/DA and honorarium to Fellows who attend the CME programmes as Observers. During the year 2010-2011, an intramural CME programme-NAMS-PGI National Symposium on Acute Coronary Syndromes is being held at the Postgraduate Inst itute of Medical Education and Research, Chandigarh. NAMS has made a major effort to improve the outreach of CME programme by establishing tele-linkages between medical colleges so that more medical colleges can participate and benefit from CME programmes. The NAMS-PGI Centre for Tele-education in the Health Sciences at Chandigarh was established in November 2005. The centre is connected to the medical colleges in Punjab, Haryana and Himachal Pradesh and also to some district hospitals in Punjab and Himachal Pradesh. Encouraged by these successful outcomes, NAMS proposes to intensify such tele-education activities by developing the NAMS JSB Centre for Multi-professional Education and Research at Delhi as the major in-house facility for tele-education. The Annals of National Academy of Medical Sciences (India), which is published quarterly, is the flagship publication of the NAMS and serves as an important tool for dissemination of recent advances to fellows and Annual Report 2010-11 212 members of the Academy. The NAMS web site http:// nams-india.in serves as the window to the global medical community and provides information on the major events at NAMS. A highlight of this years Annual Conference at Patiala has been the Continuing Medical Education Programme on Modern Multi-Disciplinary Care for Breast Cancer and the Scientific Symposium on High Altitude Medicine. The CME programme of NAMS (India) also covers Human Resource Development by sending Junior Scientists to Centres of Excellence for providing training in advanced methods and techniques. Twenty two Scientists/Teachers have been selected for advanced training at specialized centres during 2010-2011. During 2010-2011, the budget provision is 87.00 lakhs and 42.00 lakhs under Plan and Non-Plan respectively. 15.14. ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS) All India Institute of Medical Sciences (AIIMS) was established in 1956 by an Act of Parliament as an institution of national importance. The institute has been entrusted to develop patterns of teaching in undergraduate and postgraduate medical education in all its branches so as to demonstrate a high standard of medical education to all medical colleges and other allied institutions in India, to bring together at one place educational facilities of the highest order for the training of personnel in all important branches of health activity, and to attain self sufficiency in postgraduate medical education. For pursuing academic programmes, the AIIMS has been kept outside the purview of the Medical Council of India. The Institute awards its own degrees. The AIIMS continues to be a leader in the field of medical education, research and patient-care in keeping with the mandate of the Parliament. The Institute is fully funded by the Government of India. However, for research activities, grants are also received from various sources including national and international agencies. While the major part of the hospital services are highly subsidized for the patients coming to the AIIMS hospital, certain categories of patients are charged for treatment/services rendered to them. 15.14.1.Medical Education Undergraduate Medical Education This year the Institute has admitted 77 students to its MBBS course. 26 students to B.Sc Nursing (post- certificate) course, 62 students to B.Sc (Hons) in Nursing Course, 15 students to B.Sc. (Hons.) in Ophthalmic Techniques and 09 students to B.Sc (Hons.) in Medical Technology in Radiography. The MBBS course is spread over 5 years, dividing the period to 1 year for pre-clinical, 1 year for para-clinical, 2 year for clinical and 1 year rotating internship. Para- medical courses like B.Sc (Hons) in Nursing, Ophthalmic Techniques, Medical Technology in Radiography continued to be popular and attracted students from other countries also. The curricula of these courses are under constant scrutiny by the faculty of the Institute for purposes of improvement. This year AIIMS has admitted OBC seats in undergraduate courses as indicated against each: 19 seats in MBBS, 03 seats in B.Sc (H) Ophthalmic Techniques, 02 seats in B.Sc (H) Radiotherapy, 10 seats in B.Sc (H) Nursing, 06 seats in B.Sc (PC) Nursing. Post-Graduate Medical Education A total of 448 students, including 24 state-sponsored and 12 foreign nationals were admitted to the above- mentioned courses during the year under review. The total number of postgraduate and doctoral students on 31 March 2010 was 1134. A total of 294 postgraduate students MS/MS/MDS/DM/ MCh/PhD/MSc/M.Biotech passed out during the year 20092010. The Institute provide full time post-graduate and post- doctoral courses in 57 disciplines. In the year under review, many post-graduate students qualified for various degrees and qualified for various superspeciality degrees. The guiding principle in post-graduate training is to train them as teachers, researchers and above all as competent doctors to manage and treat the patients independently. Continuing Medical Education The institute organized a number of workshops, symposia, conferences and training programme in collaboration with various national and international agencies during the year. Professionals from various institutions all over the country Annual Report 2010-11 213 participated in these seminars and workshops and benefited with update knowledge. Guest and Public lectures were organized by visiting experts and faculty of AIIMS. Training for long term/short term, WHO-in-Country Fellowship and Elective Training to the Foreign Nationals Students: The institute is also providing short/long term training, WHO-in-Country Fellowship and Elective training to the Foreign Nationals students. Training for Scheduled Castes (SC) and the Scheduled Tribes (ST) Candidates: The SC and ST candidates are given due consideration and weightage in accordance with the Govt. of India guidelines in all selections. During this year 36 SC/ST candidates were selected for various undergraduate courses. 11 SC and 6 ST candidates were selected to the MBBS course, 2 SC and 1 ST candidates were admitted to B.Sc (Hons) Ophthalmic Technique, 2 SC and 3 ST candidates admitted to B.Sc Nursing (Post- certificate) course and 7 SC, 4 ST candidates have been selected for B.Sc (Hons) Nursing course. 15.14.2. International Role The Institute continued to provide consultancy services in several neighbouring countries under bilateral agreements or under the aegies or international agencies. During 2009-2010 the institute trained many WHO-Sponsored candidates to fulfill its international obligations. 15.14.3. Research As per the mandate given to the All India Institute of Medical Sciences, research forms an important component. AIIMS has been at the forefront of conducting high quality research, both in the fields of basic and applied sciences. During the year under review, the faculty of the AIIMS drew extramural grants for various research projects from national and international agencies. 15.14.4. Patient-Care Services The hospital has maintained its tradition of services and quality of patient care, in spite of ever increasing number of patients that come to this hospital from all over the country as well as from abroad. A total of 14,40,254 patients attended the general outpatient department and specialty clinics of the main hospital and other centres of AIIMS. A total of 88,486 patients were admitted during the year in the various clinical units of the Main Hospital and other centers at AIIMS. A total of 82,474 of surgical procedures performed during the year in different surgical disciplines at AIIMS from 01.04.2009 to 31.03.2010 15.14.5. Cardio-Thoracic Centre The Cardiothoracic Centre at AIIMS continued to be in the forefront in maintaining the tradition of patient care, teaching and research encompassing a wide range of surgical, interventional imaging and laboratory procedures, stem cell therapy and organ retrieval and banking in addition to medical therapy for a wide range of ailments related to disease of the cardiovascular system. New facilities were added to strengthen patient care including two new surgical operating rooms, one of which is a hybrid operating room which combines surgery and interventional therapy; A 10-bedded neonatal intensive care unit to take care of extremely small babies & a new CT6 ward. A new outpatient clinic (Aortic Clinic) has been started on Wednesday and Thursday morning to cater to patients suffering from diseases of the aorta under one roof. The faculty of the cardiothoracic center was actively involved in delivering lectures at national and international meetings and projecting AIIMS as a leader in this field. In addition several conferences were organized by the various departments of the center and many observers and specialists were imparted training. Important areas of continuing research include stem cell research, applications of advanced cardiovascular CT and MRI genetic polymorphism studies in coronary artery disease patients, nuclear cardiology studies related to stem cell labeling cardiac dyschrony evaluation, assessment of myocardial viability and various projects funded by ICMR. In addition to this, community health and stress management programs are being actively promoted. The stem cells facility at AIIMS has initiated clinical research in degenerative disorders like heart muscle cells regeneration, ocular surface reconstruction, peripheral vascular disease, stroke, myocardial infarction, dilated cardiomyopathy, non union of fracture, extrahepatic biliary atresia & spina bifida. The Organ Retrieval & Banking Organization (ORBO) has been instrumental in procuring organs and tissues for transplantation & in spreading the knowledge of importance of donating organs. Annual Report 2010-11 214 15.14.6. Dr. Rajendra Prasad Centre For Ophthalmic Sciences Dr. Rajendra Prasad Centre for Ophthalmic Sciences for now more than 43 years is the oldest Centre at the AIIMS functioning on the tenets and guidelines issued from the MHFW and the GB/ IB, on which norms all the subsequent superspeciality Centres here at AIIMS have been developed. The Centre carries about 25% of the total AIIMS patient care load. Dr. R.P. Centre is the first major continuously reaccredited WHO Collaborating Centre for Prevention of Blindness (PBL) in the South East Asian SEARO region since 1973. The Centre continues to be the initial member of INTERSUN (WHOs International Sun Monitoring Project) efforts are under way to set up the UV monitoring units with Project ISUVRA (Indian Solar Ultra-Violet Radiation Assessment). The Chief of the Centre is the Director of this WHO Collaborating Centre for PBL, & also continues to be the Honorary Advisor Ophthalmology to the Ministry of Health & Family Welfare, Govt. of India, the RPC remaining the Apex Centre under the NPCB, GOI. The Faculty of this premier Eye Centre have been honoured by several international and national awards and published numerous scientific works in international and national peer reviewed journals and, even residents and research associates have presented their research works in various international conferences, authored books and delivered lectures besides attending scientific meetings and providing specialized training and filing patents. Many such research projects in various fundamental aspects are ongoing at the Eye Centre. Efforts are under way to secure an upgraded and integrated 4-year programme for Bachelor of Optometry and Visual Sciences at RPC along with a 1-year internship, and also Fellowships for both this Course as well as in the specialities of Clinical Ophthalmology, etc. Over 110 junior and senior residents at any one time, constitutes the worlds largest ophthalmology residency training programme. Dr. R.P. Centre has 15 clinical and paraclinical departments with numerous state-of-the- art Investigative and Clinical Service labs. During this period, 113712 patients in OPD and 91165 in our Speciality Clinics were attended to [total 224375], 17512 indoor patients admitted, 13564 operations performed, and more than 200,000 laboratory and other investigations were carried out. The Centre also provides round-the-clock Eye Casualty services, with 19498 more patients registered in Eye Casualty alone during this period. Our workload continues to escalate. The Centre is providing eye care services to urban slum populations, including eye OPDs, provision of subsidized spectacles, free surgeries and investigations. Cataract surgery is being provided totally free of cost to patients identified and brought in from the rural areas. At the Centre several specialized procedures in ophthalmoplasty, corneal and refractive areas are being carried out, along with newer vitreoretinal and macular procedures including intravitreal drugs especially for ARMD and DR, and newer investigations and techniques in glaucoma, squint, and neuro-ophthalmic disorders being undertaken with gratifying results. For further upgradation of patient care services, newer facilities have been initiated in Ocular Biochemistry, Ocular Microbiology, Ocular Pathology, and Ocular Pharmacology. A DNA chip for diagnosis of eye infections has been developed and commercially launched by the Industrial partner of the recently concluded CSIR (NMTLI) multicentric project. Newly established Stem cell/ Tissue and Cell culture facility, PCR and Molecular Biology laboratories are fully functional. The advanced bioanalytical system with LC-MS/MS has completed installation at RPC. Community Ophthalmology services and projects continue to form a major part of the activities of RPC along with NPCB (National Programme for Control of Blindness) and WHO. Inculcating awareness of disease among the public has been given a suitable fillip with the recent ADR monitoring, Glaucoma Awareness, and Drug Monitoring programmes. Dr. R.P. Centre has extended its exemplary and unique Eye Centre services spread far afield, and continuing as in the North Eastern state of Meghalaya, with several speciality eye camps under the NRHM, and also closer to home as in the state of Uttarakhand. The Centre organized several conferences/ workshops/ symposia during this period including live surgeries in Ophthalmic superspecialities. The XXV th National Eye Donation Fortnight was held from 25 Aug 08 th Sep 2010 where Awareness Drive for Eye Donation was launched and charts and pamphlets distributed. Dr. R.P. Centre is in constant collaboration with ORBIS International and major INGOs especially with regard to childhood blindness activities, and the National Forum of Vision 2020: The Right to Sight-India. The Chief RPC continues as the active Vice President of Vision 2020: India. Annual Report 2010-11 215 CCTV in the OTs has been improved to long distance transmissions in the city Telemedicine is being augmented for better patient care, teaching and research. A newer Digital TV system with direct transmission has been initiated at RPC Private Wards etc. for the first time at AIIMS. The Centre has taken significant steps in improving the quality of services delivered to all patients (including Daycare services), despite several constraints. All our Investigative and Clinical Service Labs are being constantly upgraded as far as practicable. Various expansion plans for RPC are also under way, especially under the XI Five Year Plan. This is a nodal referral Centre for Tribunals, Commissions, all Courts, Consumer forum, etc. not to mention innumerable legal notices and RTI, which have all increased our multifarious workload tremendously. 15.14.7. Dr. BRA Institute Rotary Cancer Hospital Expansion project of Dr. BRA Institute Rotary Cancer Hospital has been completed, and the floor are functional. 15.14.8. National Drug Dependence Treatment Centre Besides the Professor and Chief, currently the Centre has 3 Professors, 2 Associate Professors and 1 Assistant Professor. During this period (2009-10), a total of 34570 (new and old) patients in the OPD, 20401 (old & new) in the Trilokpuri Community clinic, 8692 in Sundar Nagari mobile clinic, 72 patients in the Adolescent Drug Abuse clinic, and 791 patients in the Tobacco Use Cessation clinic and 251 patients in the Dual Diagnosis clinic were seen. A total of 957 patients were admitted in the ward. During this period, the following laboratory investigations were carried out: Drugs of abuse screened (20733), various biochemical tests to assess health damage (19739), haematology (5109), and HIV screening (340). Last 2 years (2008-09) activities supported by the Ministry and WHO-I supported were: Workshop: Revisiting the Current Situation and Planning Ahead Workshop: Curriculum Development on Agonist Maintenance Two Training Programmes on Agonist Maintenance Development of Minimum Standards of Care Managing of Alcohol and Drug Dependence in Primary Care Settings Assessment of substance use among out of school children Peer based Intervention in out of school children District based monitoring system Training by Trainers (TBT) Programme Drug Abuse Monitoring System-data on new treatment seekers in Govt. De-addiction Centres Collaboration with NACO and UNODC on starting OST and evaluation of Centres providing OST and their accreditation. Control of alcohol abuse and development of Policy, carried out with support from WHO-SEARO, WHO-HQ, Indo-Swedish collaboration and of course Indias /Ministrys contribution towards development of Global Strategy to Reduce Harmful Use of Alcohol (WHO-HQ activity). The current (2010-11) ongoing projects being supported by WHO-I are: Convergence of services with special emphasis on management of substance among adolescents Addressing alcohol use in diverse settings including E-health Developing a network of De-addiction services between the government, NGO and private sectors. The Chief of the Centre was nominated by the WHO as member of the International Narcotics Control Board (INCB), 2010-2015 and also appointed as Head and Member of the Expert Group to finalise National Policy on Prevention of Alcoholism and Substance Abuse and Rehabilitation, Ministry of Social Justice & Empowerment, Govt. of India, January 2010. In this period seven research projects on Substance Use Disorder are ongoing which is being funded by national and International agencies. Besides these, five funded research projects have been completed. The faculty published twelve research articles in indexed national and Annual Report 2010-11 216 international journals and seven chapters in books\manuals Reports\Proceedings\Manuals\monographs. Some faculty also received national as well as international awards in recognition. The faculty of the centre acted as a resource person in national and international meetings as well as in various training programmes held in Delhi as well as in various states of the country. The faculty of the department of Psychiatry and the centre jointly carry out post-graduate teaching that includes journal discussion, seminar, and case conference and research/academic presentations once every week. 15.14.9. Department Of Neurology The new imitates four the department of neurology is use of stem cells in Parkinsons disease, subacute stroke and chronic ischeamic cerebral damage. Pilot project in this area has been completed or going on a multi centre study is on going in patient with subacute stroke. 15.14.10. Centre for Community Medicine The Centre for Community Medicine carries out teaching training and research activities keeping in view the mandate of AIIMS. There are 20 post graduates and 2 PhD students. Currently, 11 research projects are underway through intra mural and extramural funding, and 26 papers were published. Rural Programme: The Comprehensive Rural Health Services Project, Ballabgarh Haryana which is the rural programme of the Centre provides secondary and primary level care through a 50 bedded hospital and 2 PHCs. About 138,894 patients are seen in various outpatient clinics in CRHSP Ballabgarh annually. Urban Health Programme: The UHP is located at Dakshinpuri Extension [Dr. Ambedkar Nagar] in South Delhi and apart from providing health care to the inhabitants, acts as a training & teaching centre for MBBS, MD, Nursing and other students. A mobile health clinic provides primary care daily, and about 23,712 patients are seen annually. The telephone helpline on HIV/AIDS, Sex related issues and contraception (Shubhchintak) and Internet based helpline E-shubhchintak continued to be operated with usual popularity, attracting a good number of calls and mails daily. Contribution to various National programmes: National Iodine Deficiency Disorders Control Programme; National Rural Health Mission; National AIDS Control Organization (NACO) for HIV sentinel surveillance Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, and Delhi; National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke; National Urban Health Mission and Revision of the Indian Public Health Standards (IPHS). New Initiatives: Started an innovative program Pre-Marriage Orientation & Counseling for Happy Married Life. Seven courses have been conducted so far with great success. Started a series of regular, monthly lecture discussions on health topics for general public HELPs (Health Education Lecture-discussions for Public) at AIIMS for important public health problems like Diabetes, Swine Flu etc. Setting up of delivery huts in the Primary Health Centres as recommended under the National Rural Health Mission where about 350 deliveries were conducted last year. 15.14.11. Department Of Nephrology Department of nephrology is providing integrated best care for nephrology patients in a government set-up in the country. Department has done 80 renal transplants during this period including cadaver transplants. Increasing chronic ambulatory peritoneal dialysis and hemodialysis facilities are being provided at cheapest cost. Department is providing bed side facility of hemodialysis to large number of departments within the institute inspite of limitation of staff. Nationally and internationally recognized work is being done on tuberculosis and hepatitis patients with kidney disease. Department is the only centre contributing to world largest transplant registry; Collaborative Transplant Study, Germany. Department faculty is awarded grant by the World Health Organization, International Society of Nephrology and Japanese Society of Dialysis Therapy. Faculty is regularly Annual Report 2010-11 217 invited for Guest Lectures at various meetings. Department has ten publication during this period. Dr. SK Agarwal, professor and head has been appointed chairman of nephrology specialty by MCI and National Board of Nephrology. Dr SK Agarwal is organizing secretary of 6 th World Organ Donation Day being observed at Vigyan Bhawan under Ministry of Health and Family Welfare on 27 th Nov 2010. Dr Agarwal is also coordinator for a multicentric study to find out prevalence of CKD being funded by ICMR. Faculty had regularly conducted patient education program in print and electronic media particularly in U.P. Sahara Samay on series of education program on chronic kidney disease for lay public. Department also had visiting faculty from USA and Australia during this period. 15.14.12. Department Of Urology The Department of Urology is equipped with the state- of-art devices and provides a wide range of services, specializing in minimally access techniques, microsurgery, robotics and oncology. It organized a Mock Examination for post graduate trainees (M Ch and DNB) in Urology for the Urological Society of India in March 2010. 80 PG students of urology attended this three day program and over 15 faculty members from all over the country conducted exams in the standard pattern. A live operative demonstration was also given on common urological procedures. The department of Urology, AIIMS jointly organized an International Uro-oncology Workshop with Rajiv Gandhi Cancer Institute & Research Centre and RML Hospital PGIMER, New Delhi on October 1- 3, 2010. During this Workshop a wide variety of surgical procedures (open, laparoscopic and robotic) were demonstrated by International and national faculty. The faculty of the department delivered numerous lectures and live operative demonstrations at various meetings nationally and abroad. It continues to conduct research in basic and clinical aspects of Urology in collaboration with various departments in the Institute with both intramural and extramural funding. The department published over 40 articles in peer reviewed journals over the last one year and the faculty received a number of awards and honors. Over 7500 surgical procedures including 130 robotic surgeries were performed during the last year. Major achievement and success of the department has been computerisation of discharge summaries and other related data.The Department of Urology has taken new initiatives in the field of Advanced Robotic Surgery and has done a pioneering work in establishing Pre Peritoneal approach for doing Radical Prostatectomy with the robot for the first time in the country besides other advanced procedures. 15.14.13. Department of Orthopaedics The Department of Orthopaedics at AIIMS continues to be the best in the country and occupies an eminent position in the field of Orthopaedics in the country. Newer and highly complex surgeries in the field of trauma, tumor, hand, spine, joint replacement, arthroscopic surgery and paediatric orthopaedics are done on a regular basis. The Department has facility for comprehensive physiotherapy and rehabilitation of the patients. We also have facility for Bone banking including cadaver bone banking. A number of research projects funded by ICMR, DST, DBT and CSIR are being carried out in the Department. The Department continues to publish articles in indexed journals of repute. The faculty members have actively contributed in many CMEs at national and international levels. The Department has also served the country at various health camps at far-flung remote areas. The department continues to enjoy the trust and faith of millions of countrymen and is the best testimony to its character. 15.14.14. Department of Forensic Medicine & Toxicology Routine Work:- The Department of Forensic Medicine & Toxicology continued to provide medicolegal services to the South Zone and South East Zone of Delhi along with round the clock coverage to the casualty. Department also provided consultation in complicated medicolegal cases to the CBI, NHRC, Crime Branch, Delhi Police and other investigating agencies. Forensic Pathology:- Total 1775 postmortems were performed during this period including at trauma centre. Department also participated in exhumation as ordered by competent authorities and guided the investigating agencies to arrive at logical conclusion. Casualty Services: About 500 calls were attended from casualty pertaining to cases of various natures. Department is also looking after medicolegal records of casualty. Clinical Forensic Medicine:- Clinical Forensic Medicine services were provided by the Department in cases of injury, age estimation, paternity dispute etc. 20 such cases were dealt during this period. Annual Report 2010-11 218 Expert Opinion: Department gave expert opinion in various cases referred by Honorable Courts, CBI and other investigating agencies. Court Summons: 380 summons were received by the Department to appear as an expert from various courts of law in Delhi and other states. DNA-Finger Printing: Department is running DNA- Fingerprinting Laboratory where training is provided to short term trainees referred from all over India. This laboratory of the Department performs tests for medicolegal cases referred by Delhi Police, SDM of neighboring States, CBI and Honourable Courts of India. Toxicology Laboratory: The Department provides only hospital services for toxicology analysis or cases referred by courts. Tests were done for various poisons and heavy metals in this laboratory. CME:- Departmental faculty and officers participated in various CME programmes. Lectures were delivered to the officers of CBI, Forensic Scientist, Judicial officers and medical officers. CME Programmes organized by the Department include Workshop on Crime Scene Investigation, DNA-Finger printing and International conference- INPALMS-2010 in collaboration with PGIMER, Chandigarh and Amity University, Noida (UP) Research Publications: 08 research papers have been published in various scientific journals during this period. 15.14.15. Department Of Biochemistry The Department has innovative teaching programs involving problem based learning and case oriented small group discussions for MBBS students. The Department has provided short-term research training to many post-graduate students. Provided research exposure to undergraduate students, leading to some of them being successful in obtaining KVPY fellowship of DST. Research grants/ funding amounting to Rs.3.57 crores obtained from DBT, DST, CSIR, DRDO, ICMR and Indo-US, Indo-Canadian collaborations. There are forty ongoing research projects with departmental faculty. Forty seven publications in indexed National and International Journals. Patient care laboratory of the department is providing clinical service for a number of tumor markers, free of cost. Have applied for two patents. Prof. N. Singh conferred fellowship of National Academy of Medical Sciences. 15.14.16. Department Of Cardiac Radiology During this year, the Department of cardiac radiology continued to be at the forefront of providing advanced cardiovascular imaging and vascular interventional services to the the Cardiothoracic center as well as other allied Departments within the AIIMS. These include cardiovascular CT and MRI, vascular Doppler and fluoroscopic procedures as well as percutaneous techniques for vascular recanalization, reconstruction and occlusion of diseased vessels for all organ systems. Among educational activities, the Department organized the Annual Registry meet cum CME of Indian Society of Vascular and Interventional Radiology on 17-18 th April, 2010. The Departmental faculty was also involved in delivering lectures, presenting papers and participating in workshops dealing with this subspecialty.at various national and international forums. Besides, the faculty members are also reviewers for many reputed cardiology/ radiology journals. On the research front, the department completed participation in 8 research projects, and initiated/contributed to starting 4 others, dealing with various diagnostic and interventional aspects of cardiovascular diseases. At the forefront are projects dealing with stem cell research and applications of advanced cardiovascular CT and MRI. There were 6 research papers and one book chapter that were published with the involvement of this Department. 15.14.17. Department Of Cardiology In the current year, the Department of Cardiology has catered to over 1,00,000 outpatients. Over 20,000 patients had undergone echocardiography, and over 4000 cardiac catheterizations were performed. Overall around 1000 patients had undergone interventional procedures including coronary angioplasty, balloon valvuloplasty and device implantations. Department of cardiology has been renovating its existing facilities to cope with its ever increasing demands. The Echo, Holter, and TMT have been renovated and started functioning with added capacity. A new state-of the art Annual Report 2010-11 219 Department is actively involved in many intramural and extramural research projects. Newer projects including stem cell research in dilated cardiomyopathy and ischemic heart disease are underway. Efforts have been made to refocus the educational activities of the Department to address the changing needs of current cardiology practice. The Department has organized a successful CME and Professor Philip Poole Wilson Heart Failure Research Symposium in collaboration with Imperial College /Royal Brompton Hospital London. The Faculty of our department has authored 60 papers in indexed medical journals and some prestigious books. They have participated and contributed in various national and International conferences/committees. 15.14.18. Department Of Physiology The Department provided about 400 hours of teaching to the first year MBBS students and about 60 hours of teaching to students of B.Sc. Nursing and allied courses, besides conducting M.Sc. (Physiology) and MD (Physiology) courses and guiding Ph.D. students. 15.14.19. Department Of Biostatistics The Department was actively involved in teaching Biostatistics and Essentials of Research Methods for the undergraduate, paramedical and postgraduate courses, viz. MBBS, BSc (Hons) in Medical Technology in Radiology, M. Biotech, B.Sc. & M.Sc. Nursing and MD Community Medicine. The Department organised a series of fourteen evening classes on Essentials of Biostatistical Methods and Research Methodology for the new residents, Ph.D. students and other researchers in the Institute. On request, for statistical methods in specific areas of medical research, Departmental faculty members delivered series of lectures for the residents, Ph.D. students and faculty members in several departments in the Institute. Also, departmental faculty and scientists delivered invited talks outside the institute throughout the country. On request, the faculty and scientists also participated in departmental scientific presentations in most of the departments in the Institute. Besides guiding Ph.D. students in the department, faculty members contributed to the academic activities of other departments in the Institute as Co-Guides and DC Members of Ph.D. students. Both faculty members and Scientists contributed to the academic activities of most of the departments as co-guides for MD/MS, DM, MCH students. 15.14.20. Department Of Gastroenterology And Human Nutrition Established a New Molecular Biology Laboratory In The Department With State Of Art Facility. Continuing Medical Education 1. The department organized an International Workshop on Micronutrients and Child Health held on October 20-23, 2009 at AIIMS, New Delhi. 2. The department organized a National Consensus Workshop on Management of SAM Children through Medical Nutrition Therapy on November 26-27, 2009. 3. The department organized Current perspective in Liver Diseases (Oct 14-15, 2010) Lectures delivered in CMEs, national and international conferences: All faculty members of the department delivered 42 lectures at the international and national meetings. 15.14.21. Department Of Pathology During the period of 01.04.2010 to 30.11.2010 the Faculty of the Department has published 64 publications in reputed national and international journals. Laboratory Services: Surgical Pathology Laboratory: No. of specimens processed 28,588 Cytopathology Laboratory: No. of specimens processed 15,449 Immunohistochemistry Laboratory: No. of cases processed 4,357 15.14.22. Department Of Cardiac-Anaesthesia Faculty & Residents of the Department of Cardiac-Anaesthesia are involved in providing Anaesthesia care in 7 operation theater, 5 catheterization labs, CT angiography and MRI Cardiac-Anaesthesia Department is also involved in resuscitation & ventilatory care in CTVS-ICU-A & B, ICCU, all the general wards and C.N.Tower. 9-DM-Candidates including two sponsored LT.Col. from Army and 8 other post MD-Senior resident doctor are undergoing superspeciality training in Cardiac-Thoracic- Annual Report 2010-11 220 Anaesthesia. Dr.Mulidharan from Shree Chitra Institute of Medical Sciences, Triventhapuram & 3 M.D.Candidates from Lady Hardinge Medical College were imparted short term training in the specialty of Cardiac-Anaesthesia. Researh: - The Departmental faculty is involved in 5 extramural 3 AIIMS funded research projects as chief investigator/co-investigators.The Departmental faculty is involved in 06 non-funded (Departmental) research projects as chief investigator/co-investigators. Scientific Presentation Faculty of the Department delivered twenty-nine lectures in different national & International forums and Resident doctors & DM students presented- Six papers in national conferences, topics:- Thalasamia & heart surgery, Chest trauma, aortic injury management, PDA ligation in 900gm child. Percardectomy management in 3mths old child. Post stent inschaenic TAPVC stent blocked. New Initiatives Taken & Community Progamme 1). Department is running stress management clinic for cardiac and neuro patient in CT5 meditation room. 2). Research initialed on sonoclot and pharmacological preconditioning youth. 3). Nine Community health programme, stress management and health awareness for children are conducted as part of the project My India, healthy India at GT Karnal Road, Industrial Area. Invited by Nepal, govt. for participation in Healthy Nepal a mega project. 4). Quit tobacco awareness programme for Rural area of Panipat. 5). Mind body intervention for heart patients and their attendants. 15.14.23. Department of Physical Medicine and Rehabilitation The Department of Physical Medicine and Rehabilation was actively involved in providing medical cover for Commonwealth Games 2010 held at Delhi Dr. U Singh, Professor and Head was Nodal Officer Incharge from AIIMS. AIIMS provided medical cover for the athletes, the teams and the VIPs at the medical centre located at the Jawaharlal Nehru Stadium and Thyagraj Stadium. Dr. Sanjay Wadhwa, Additional Professor, Department of Physical Medicine and Rehabilitation received the following awards during this period. 1. Distinguished Services Award by the Geriatric Society of India, New Delhi Dr. S.L. Yadav, Associate Professor of the Department was deputed as acting Venue Medical Officer for JLN Stadium Dr. Gita Handa, Associate Professor of the Department was awarded Standford India Biodesign fellowship (Pioneering initiative by Department of Biotechnology, Govt. of India in collaboration with IIT Delhi and AIIMS to promote Medtech Innovation) and worked as visiting Associate Professor at Standford University for 6 months from January to June 2010. 15.14.24. Department of Dermatology And Venereology Department Achievements 1. National CME Dermatology AIIMS, 2010 was organized on April 10-11, 2010. 2. Renovation of D-1 ward was undertaken. 3. Procurement of laswers (Pulsed dye laser, Diode Laser, Q-Switched Nd-YAG laser) was done. Laser OT was set up providing free laser services to the patients. Faculty Achievements Dr. M. Ramam elected as President, Indian Association of Dermatologists, Venereologists and Leprologists, Delhi State Branch, 2010. Dr. Sujay Khandpur award as ICMR International Fellowship for Biomedical Scientists 2010-2011. 15.14.25. Department of Paediatrics 1. A life saving drug for newborn babies, namely, pulmonary surfactant derived from goat lungs developed by the Department of Paediatrics has been licensed for clinical use. 2. The Department continues to provide technical support on child health in areas of IMNCI, ASHA Annual Report 2010-11 221 training, Neonatal resuscitation, Pediatric HIV and tuberculosis. 3. Department developed package for training of neonatal nurses working at district and sub-district hospitals. 4. The Department conducted telemedicine training with medical colleges at newborn health. It also established sub-speciality training knowledge exchange using telemedicine with the Department of Pediatrics at PGIMER, Chandigarh. 15.15JAWAHARLAL INSTITUTE OF POST GRADUATE MEDICAL EDUCATION AND RESEARCH (JIPMER) Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), was declared an Institution of National Importantance on 14.7.2008 through an Act of Parliament. The primary functions of this Institute are patient care, teaching, training and research. During the year under review, the Institute has made all round progress in all its activities. JIPMER Hospital has total bed strength of 1591. The daily average number of outpatients treated in the year 2009-2010 was 4,760 .Under the Rashtriya Arogaya Nidhi (RAN) 22 patients were benefited and Rs. 10,59,277/- was utilized during the year. Rs.10 Lakhs was allotted under special Rastriya Arogya Nidhi for the treatment of cancer patients. 09 patients were benefited by this scheme and one patient is under treatment. In the year 2009- 2010, a total of 14, 04,389 outpatients were treated in JIPMER Hospital. In the year 2009-2010, a total of 64,331 admission were made in the Hospital .A total of 19,48,543 investigation were carried out in the year 2009-2010. Total number of deliveries conducted was 16,363. Total numbers of operations perfomed were 35,195. The total attendances in Emergency Medical Service (Main Casualty) were 1,17,517 and the total attendance in OG (Obstetrics & Gynaecology) Casualty was 18,267. JIPMER caters to people from the states of Puducherry, Tamil Nadu, Andhra Pradesh, Karnataka and Kerala and other States. New Services Started: An Acute Stroke and Neuro Intensive Care Unit has been set up in the Nerurology department .Neuro Surgery department has started doing Stereo tatic biopsy for deep seated brain lesions. World Bank supported Regional Influenza Laboratory for the surveillance of human, avian and swine Influenza has been set up in Microbiology department. Orthopaedics Department has started doing Total Knee Replacement. Clinical Immunology has been made an independent division and diagnostic and therapeutic services are being offered by this division. Yoga therapy OPD has been started and generalized yoga therapy consultation is provided for diabetes mellitus, hypertension, respiratory disorders, and for other chronic ailment thereby providing holistic health care. Crisis Intervention Clinic has been started in the Psychiatry Department to cater to the needs of cases of attempted suicide. Academic Activities: The admission to first year MBBS course in JIPMER is through All India Entrance Examination. A total of 22,674 applications were received and 17,389 candidates appeared in the Entrance Examination for the first year MBBS Course, 2009-2010 session. Out of the 11,966 candidates who qualified in the Entrance Examination, 82 candidates were admitted based on their category merit rank. Eighteen candidates were nominated for the Academic Session 2009-2010 by the Government of India. College of Nursing was started by JIPMER during the year 2006 with an annual intake of 75 students. Admissions were made to the B.Sc (Nursing) course based on an Entrance Examination for 2009-10 session. Post graduate courses (M.D /M.S ) are conducted in 21 disciplines. A total of 88 seats are available for the 21 postgraduate courses. Thirty-four new PG seats will be added from the academic session 2011-12. At present, Super Specialty Programmes (D.M./M.Ch) are conducted in 7 disciplines. A total of 10 seats are available in these 7 Super Specialty Programmes. PhD programmes are conducted in 8 disciplines and a total of 18 seats are available for these 8 PhD programmes. JIPMER has been conducting M.Sc (Medical Biochemistry) course for the last 32 years. For the academic year 2009-2010, nine students were admitted on the basis of the entrance examination to this 3 years course. Annual Report 2010-11 222 New Courses: The Central Government has accorded its approval to the starting of the following courses from the academic year 2010-11: B.Sc (Dialysis Technology), B.Sc (Perfusion Technology), B.Sc (Medical Radiation Technology). B.Sc (Operation Theatre Technology) and M.Sc (Medical Lab Technology-Microbiology). Besides, several new courses such as D.M.in Clinical Pharmacology, Clinical Immunology, Neurology, Neonatology,MD Radiotherapy and post doctoral fellowship in Diabectology have been started. First Convocation: Besides awarding its own degrees, the Institute is now empowered to start various new courses and develop its own curriculum.The first Convocation of JIPMER as an Institute of National Importance was held under the Chancellorship of Prof. N.K. Ganguly, the president of the Institute on 22 nd March 2010 in which Shri. Ghulam Nabi Azad, Honble Union Minister of Health and Family Welfare was the Chief Guest and Shri V. Narayanasamy, Honble Union Minister of State for Planning, Parliamentary Affairs and Culture was the Guest of Honour. A total of 154 degrees were awarded to the MBBS, PG (MD/MS), B.Sc. (MLT) and Super Specialty students who had successfully completed the course. Faculty Recruitment: The Institute on becoming an autonomous body conducted the interviews and selected about 100 Assistant Professors in various disciplines and almost all of them have joined. Projects: Department of Radiotherapy got the status of Regional Cancer Centre in the year 2002.A new building has been constructed with bed strength of 82 .Medical Oncology, Radiation Oncology and Cancer Registry, Day Care Centre have been commissioned along with the Super specialty Block & Trauma Care Centre. A 360 bedded Super Specialty Block housing all the super specialty departments under one roof has been constructed at a cost of Rs.93.04 crores. A Trauma Care Centre has been constructed over the existing Emergency Medical Services Department at a cost of Rs.13 crores. This centre has state-of the art equipments such as Multi Slice CT Scanners, high profile Operating Tables, Micro- Vascular Instruments etc. and 2 high tech Ambulances. Medical Oncology, Surgical Oncology, Medical Gastroenterology, Surgical Gastroenterology, Nephrology, Neuro Surgery and Endocrinology Departments have started functioning in the new super specialty block. Efforts are being made to start post doctoral training programmes in all these Departments. Action has also been initiated for second phase of development which includes construction of a 400 bedded Women and Children hospital, a Teaching Block, Hostel Complex and upgradation of all the departments. The total budget provision as per BE 2010-11 is Rs.252 crores (Plan Rs.132.00 crore & Non-Plan Rs.120.00 crore). 15.16. POST GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH (PGIMER), CHANDIGARH The postgraduate Institute of Medical Education and Research, Chandigarh was declared as an Institute of National Importance and became an Autonomous Body by an Act of Parliament (Act 51 of 1966), on 1 st April, 1967. The Institute in fully funded by the Government of India. The main objectives of the Institute are:- o To develop pattern of teaching of undergraduate and postgraduate medical education in all its branches so as to demonstrate a high standard of medical education; o To bring together as far as may be in one place educational facilities of the highest order for training of personnel in important branches of health activity; and o The attain self-sufficiency in postgraduate medical education to meet the countrys need for specialists and medical teachers. Academic Activities Postgraduate Institute of Medical Education & Research, Chandigarh has been empowered to grant medical, dental and nursing degrees, diplomas and other academic distinctions and titles under the PGIMER, Chandigarh Act, 1966 (No.51 of 1966 and thereafter amended from time to time). For attaining self-sufficiency of postgraduate medical education and to meet the countrys needs to have highly qualified and skilled medical teachers in medical sciences and to undertake basic community based research, the Institute has been striving hard and achieving Annual Report 2010-11 223 the desired goals in this direction too. The Institute conducts various Postgraduate courses viz. MD/MS, DM/M.Ch, Ph.D. and other paramedical courses viz. B.Sc. MLT and M.Sc. etc. The number of candidates passing various courses is increasing day by day with the increase of new centres at the Institute. A total of 116 candidates passed the MD/MS examinations in 2010 97 in the June batch and 59 in the December batch, Similarly, 20 candidates passed their DM/M.Ch. examination in May 2010 whereas 29 candidates passed DM/M.Ch. examination in December 2010 session. A total number of 2994 candidates have passed their MD/ MS course and 1291 candidates have passed DM/M.Ch. Course upto 31.12.2010 and 30.06.2010 respectively. Apart from above, 56 candidates passed various other examinations viz. MHA, MPH (Part I & II), M.Sc. (Part I & II) and M.Sc. Nursing Part I examinations in May 2010 session whereas there were 65 candidates who passed out in December 2010 session. Similarly, in the examination held in August, 2010 for various paramedical courses like B.Sc. MLT, B.Ph., B.Sc.MT (OT) and B.Sc. Nursing etc., there were 261 candidates passing out above courses. Candidates for MD/MS courses come from all parts of the country and also from abroad. At present the number of such candidates is 549 as on 31.07.2010. Similarly, for DM/M.Ch. Courses, there were 194 candidates on roll as on 31.07.2010. Besides, there were 144 candidates on rolls of the Institute as on 31.07.2010 pursuing Ph.D. courses. Lists showing above position are attached for showing no. of candidates from different States pursuing different courses at PGI, Chandigarh. Since 2007, PGI has introduced three new courses in the super-specialties viz. D.M. (Paediatric Critical Care and Paediatric Haematology Oncology) in the Department of Paediatrics and D.M. in Neuro-Radiology in the Department of Radiodiagnosis. Besides, Postgraduate course of M.Sc. (Anatomy) has also been started. There are also other courses which are proposed in the near futute:- a) D.M. in Haemato-Pathology in Haematology Department. b) D.M. in Cardiac-Anaesthesia in Anaesthesia Department. c) D.M. in Clinical Haematology in Internal Medicine Department. d) D.M. in Paediatric Neurology in Paediatrics Department. e) M.Sc. in Respiratory course in Pulmonary Medicine Department. f) M.D.S. in Oral & Maxillofacial Surgery in Oral Health Sciences. g) A.P.G. Diploma in Public Health Management (PGDPHM) in the School of Public Health. Hosptial Services The Nehru Hospital attached to the Postgraduate Institute of Medical Education & Research, Chandigarh provides tertiary care in all the medical and surgical specialties to the patients, who came not only from the adjoining States but also from far off States like West Bengal and Bihar. The total bed strength of the PGI has increased to 1612 beds. The number of patients who attended the Outpatients Departments and those admitted during the last three years is as under:- 2007-08 2008-09 2009-10 OPD Attendance 13,19,973 14,13,796 15,46,639/- Admissions 56,078 58,496 62,330/- Emergency and critical patients were attended to round the clock. A total number of 50,943 patients were attended in the emergency and 30,845 were admitted. In the emergency operation theatres, a total of 10,766 operations were performed including 9,535 major operations (which includes Labour Room operations) and 1,231 minor operations. During the financial year 2009-10, 2,09,24,201/- was spent for subscription of 530 Journals Rs.23,23,1809 lacs was spent for online Medical Database and, Rs. 86543/- has been spent for the purchase of books. A new Central Animal House facility and clean room for Stem Cell Research have been established in the Institute during the year, 178 Research Schemes were completed and 324 Research Schemes funded by ICMR, DST.U.T., New Delhi, international agencies etc. were under progress. There were 569 publications in indexed and non indexed national and international journals, 10 visiting Professors, from all over the World, visited the Institute. 293 students were conferred various doctoral/post doctoral degrees. 29 faculties members were conferred various awards/honours during the year. Annual Report 2010-11 224 15.17 LADY HARDINGE MEDICAL COLLEGE & SMT. S. K. HOSPITAL NEW DELHI The Lady Hardinge Medical College (LHMC), New Delhi was established in the year 1916 with a modest beginning of just 14-16 students. Over the years, the Institute has matured as a pioneering Institute for Medical Education and now it has the existing strength of 150 admissions per year for MBBS girl students. The 95 th Academic Year (2009-10) of the College began with 724 undergraduates and 128 interns on the rolls. The College, which is affiliated to the University of Delhi since the year 1949, has continued to admit students from all over India, as well as from foreign countries. A separate out patient block was started in 1958 to cater the needs of ever increasing population of Delhi. The hospital statistics for the period 2008-09 is as under:- The necessary follow up action is going on to implement the comprehensive re-development plan of LHMC& Associated Hospitals approved by Cabinet Committee of Economic Affair at the total cost of Rs. 387.31 crore. A modern intensive Coronary unit has been established. Rheumatology Clinic and Adult Thalassemia Clinic have been started under the Deptt. of Medicine. H1N1 Infuenza screening OPD and in-patient ward have also been established under the Deptt. of Medicine. Voluntary Counseling Test Centre (VCTC) and Prevention of parent to child transfer (PTCT) for HIV patients under the supervision of National Aids Control Organization (NACO) are part of the Department of Microbiology. HIV DNA PCR Lab under National Pediatric HIV initiative to diagnose HIV infection in newborns up to 18 months has also started functioning in the Deptt. of Bed Strength 1247 OPD Attendance 541240 Indoor Admissions 31145 Sterilization 1295 Bed Occupancy 65.7% Surgeries performed:- Minor 6891 Major 8077 Total 14968 Microbiology. Surveillance facilities for meningococcal and Dengue fever are also in place in view of frequent occurrences of these diseases. Facilities for Advanced Laparoscorpic Surgery using High Definition Camera and 24 hours Ambulatory Esophageal PH Monitoring for diagnostic and research purpose are also available in the Deptt. Of Surgery a number of Rainwater harvesting wells have been constructed and Solar panels installed. Separation of Eye Operation Theatre and ENT Operation Theater is under process and is likely to be completed during the current financial year. A number of research projects have been going on in many Departments of the institution. The total numbers of papers published during the year are 131. The total budget provision as per BE 2010-11 is Rs.176 crores (Plan Rs.79.00 crore & Non-Plan Rs.97.00 crore). 15.18 KALAWATI SARAN CHILDRENS HOSPITAL, NEW DELHI Kalawati Saran Childrens Hospital (KSCH) is a premier referral Childrens Hospital of national importance. The Hospital started functioning in the year 1965 for imparting medical care service exclusively for Paediatrics patients upto 18 years of age. At present it has 370 beds. Under the (JICA) scheme for the improvement of KSCH, the bed strength of this Hospital is being increased to 500. Kalawati Saran Childrens Hospital is one of the busiest children hospitals in the country and caters to a daily OPD attendance of 800-1000 children, and 80-100 new admissions per day from Delhi and neighbouring states. The hospital is a Sentinel Centre for Poliomyelitis, Tetanus and Measles. It has the unique distinction of having a separate Pediatric Emergency with direct inflow of patients. It also houses the Diarrhoea Training and Treatment Unit, the first such unit in the country, which has also been recognized by WHO and Govt. of India as a training centre for diarrhoeal diseases. The hospital has also served as a training centre for ARI, UIP and other National Health Programmes. The Institution is a super speciality hospital in real sense with its fully developed subspecialities like Neurology, Nephrology, Gastroenterology & Nutrition, Hematology, Pulmonology and Endocrinology. Indo-Japan Friendship Block of Kalawati Saran Childrens Hospital has been constructed with an expenditure of over Rs.54 crores for the building and the latest equipment Annual Report 2010-11 225 for various sections of the Hospital which has been helpful in easing the problem of inadequate space and technological upgrading of the Institution. Kalawati Saran Childrens Hospital was designated as Nodal Centre for Pre-service IMNCI (Integral Management of Neonatal and Childhood Illness) implementation in NIPI States. The Hospital organized National Training of Trainers Course of IMNCI with support of Govt. of India/ WHO/UNICEF. Infant and Young Child Feeding (IYCF) Counseling Centre was started in Kalawati Saran Childrens Hospital to strengthen IYCF practices. Autism evaluation cell was started in the Hospital. Hemophilia follow-up clinic facilities are provided on first Wednesday (afternoon) of every month in the Department of Physical Medicine & Rehabilitation Department. Once a month After Completion of Therapy (ACT) clinic for follow-up of children treated for lymphoma and leukemia was started in the first Monday of every month. Kalawati Saran Childrens Hospital organized a sensitization workshop on Infant and Young Child Feeding in collaboration with Govt. of NCT Delhi from 24 th to 26 th March 2009. An advanced centre of pediatrics care has been set up at the Hospital. This Centre is poised to be one of the premier center of Paediatrics care in the country. The Hospital statics for 2009-10 are as under :- Total No. of sanctioned beds 370 (340 + 30 at Nursery Smt SK Hospital) Total OPD attendance 3,09,398 No. of admissions 27,951 Bed occupancy rate 110.6% Minor operations 1427 Major operations 2519 Casualty attendance 62,339 Neonatal & Nursery Care 7,200 No. of patients admitted in ICU 1228 Patients attended in PMR Deptt. 80,115 Gross Death Rate 9.0 Centre for adolescent Health was established in March 2009 with the objectives of providing special services to adolescents , to teach and train medical and nursing students, and to conduct research relevant to the needs of adolescents of India. Kalawati Saran Childrens Hospital has developed the training modules on Facility Based Care-Integrated Management of Neonatal and Childhood Illness (IMNCI). Kalawati Saran Childrens Hospital also developed training modules on Facility Based Care of Severe Acute Malnutrition. Clinical Epidemiology Unit was established in Lady Hardinge Medical College in November 2009 with the objectives of felicitating research activities, and for teaching and training of undergraduates, postgraduates and faculty in clinical epidemiology. The total budget provision as per BE 2010-11 is Rs 47.26 crore (Non-Plan-Rs 3.26 crore & Plan- Rs 24 crore. 15.19 MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES/KASTURBA HEALTH SOCIETY, SEVAGRAM, WARDHA The Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram is Indias first rural medical college. Nestled in the karmabhoomi of Mahatma Gandhi, in Sevagram, this Institute was founded by Dr Sushila Nayar. Started in the Gandhi Centenary Year 1969, it was designed to be an experimental model institute where medical education will be reoriented to meet the needs of the rural areas. In the spirit of its founder, the mission of MGIMS today continues to be committed to the pursuit of professional excellence by evolving an integrated pattern of medical education and seeks to provide accessible and affordable health care primarily to underprivileged rural communities. It has completed 41 successful years in the service of this mission and is now one among the best rated medical colleges in the country. The expenditure of MGIMS is shared by the Govt of India, Govt of Maharashtra and the Kasturba Health Society in the proportion of 50:25:25 as per the agreed pattern. This Government of India released the grant-in- aid of Rs.27.21 crores during the year 2009-10. The students at MGIMS are drawn from all parts of the country and come from all kinds of social backgrounds. Every effort is made to acquaint the medical student to the real rural India. The approach to medical education Annual Report 2010-11 226 with spotlight on rural community oriented education makes the doctors coming out of the Institute be sensitive to the felt needs of the underprivileged. The entrance examination to the MBBS course includes a separate qualifying paper on Gandhian Thought. The students and staff of the Institute adhere to a unique code of conduct, where they are expected to wear khadi, participate in shramdan, attend all-religion prayer and abstain from non- vegetarian food, alcohol and tobacco. The Institute offers degrees and diplomas in 19 postgraduate disciplines of which 18 are MCI recognized and 19 th in Skin and VD has just started this year. Seven of its Departments are recognized for PhD. It has a well equipped fully computerized digital library which is a recognized resource library for HELLIS network in Western India.Since 1991, the Institute follows a unique Rural Service Scheme through its graduates. The students are posted in these NGOs and regularly monitored. Two years rural service is mandatory eligibility criteria for admission to post-graduation and this is achieved through 96 non-governmental organizations who have joined hands with the institute to fulfill this dream. At present 95 extramural research projects are on going. Each year, the large numbers of national and international peer reviewed publications from this Institute provide evidence of excellence in research. Based on its recent research the Department of Forensic Medicine had submitted a 258 pages report to Union Ministry of Health and Law highlighting the lacunae in examination reports of victims of sexual assault resulting in the lack of documentary evidence to implicate the assaultees. Based on this report the Centre and State Governments have come up with various guidelines for medical officers to ensure proper forensic examination of victims of sexual assault. The Department Community Medicine has adopted many villages over 60 in number, where they have constituted number of Womens Self Help Groups in order to promote women to play pro-active role in health care delivery in their villages. A total of 149 Groups have been created and more than 98% of these groups are linked with banks and have updated account books. Hospital Services Kasturba Hospital of the Institute has the distinction of being the only hospital in the country which was started by the Father of the Nation himself. The patient load comes to us not only from Vidarbha in Maharashtra, but also from adjoining parts of Andhra Pradesh, Madhya Pradesh and Chhatisgarh. It acts as a tertiary care hospital with all the modern health care amenities but provides health services at affordable cost and with compassion. It has a unique insurance scheme in which 20345 families were insured this year. In 2009-10, 528184 patients attended the hospital as outpatients and 40256 patients were admitted for various ailments. The Hospital has state-of-the-art intensive care units in Medicine, Surgery, Obstetrics and Gynecology and Paediatrics which provide excellent critical care. A well equipped hemodialysis unit is available for patients of renal failure. The Sri Satya Sai Accident and Emergency Unit provides succour to patients of trauma. With the grant from Govt. of India for Emergency and Accident Ward the Institute has a fully equipped high tech Trauma Ambulance alongwith wireless system. The Institute has the only Blood Component Unit in the district which provides components not only to patients in Kasturba hospital, but also to private hospitals in the district. Facilities for MRI, CT scan and Mammography are available. The Alcohol and Drug De-addiction centre seeks to rehabilitate patients who are addicted to drugs and alcohol. The Hospital has also been providing Geriatric services to address to the needs of older people. Its Radiation Oncology Department has received a grant- in-aid of Rs. 2 crore from the Govt of India to develop the Oncology wing under the National Cancer Control Programme and the Department is fully equipped with state of the art radiotherapy equipments including Linear Accelerator, HDR Brachytherapy Machine, 3D treatment Planning system and Simulator. The Pathology, Microbiology and Biochemistry laboratories have in- house facilities and automation to conduct a battery of diagnostic tests. All Departments of the hospital are connected by an advanced Hospital Information System. The Govt. of India has sanctioned grant-in-aid for infrastructural facility to accommodate additional 192 indoor patients to Kasturba Health Society at MGIMS, Sewagram. The building is under construction. The Department of Obstetrics and Gynaecology offers expert obstetric care to the unwed, the divorced, and the widowed women with advanced pregnancy and ensures that they deliver safely in the hospital. Till date 289 women have been helped under this project. This year eight unwed mothers have availed themselves of this assistance. The project also supports babies born out of such pregnancies and keeps them in Aakanksha till they Annual Report 2010-11 227 can be legally adopted. This year legal adoption of 10 babies has been facilitated. The total budget provision as per BE 2010-11 is Rs 27.00 crore. 15.20 NATIONAL CENTRE FOR DISEASE CONTROL (NCDC) The Institute in under administrative control of the Director General of Health Services, Ministry of Health and Family Welfare, Govt. of India. The Director, an officer of the Public Health subcadry of Central Health Services, is the administrative and technical head of the institute. The Institute has its headquarters in Delhi and had 8 branches located at Alwar (Rajasthan), Bengaluru (Karnataka), Kozhikode (Kerala), Coonoor (TamilNadu), Jagdalpur (Chattisgarh), Patna (Bihar), Rajahmundry (Andhra Pradesh) and Varanasi (Uttar Pradesh). There are several technical Divisions at the headquarters of the institute i.e. Centre for Epidemiology and Parasitic Diseases (Dept. of Epidemiology, Dept. Parasitic Disease), Division of Microbiology, Division of Zoonosis, Centre for HIV/ AIDS and related diseases, Centre for Medical Entomology and Vector Management, Division of Malariology and Coordination, Division of Biochemistry and Biotechnology. In each division there are several sections and laboratories dealing with different communicable diseases. The divisions have well equipped laboratories with modern equipments, capable of undertaking tests using latest technology. The activities of each division are supervised by an officer in charge, supported by medical and non- medical scientists, research officers and other technical and paramedical staffs. The branches are also well equipped and staffed to carry out field studies, training activities and research. 15.20.1. Integrated Disease Surveillance Project Background: Integrated Disease Surveillance Project (IDSP) was launched by Honble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The Project has been extended for two years up to March 2012 by Government of India. A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established. Objectives: To strengthen the disease surveillance in the country by establishing a decentralized State based surveillance system for epidemic prone diseases to detect the early warning signals, so that timely and effective public health actions can be initiated in response to health challenges in the country at the Districts, State and National level. Project Components: Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level. Human Resource Development Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance. Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data. Strengthening of public health laboratories. Data Management: Under IDSP data is collected on epidemic prone diseases on weekly basis (MondaySunday). The information is collected on three specified reporting formats, namely S (suspected cases), P (presumptive cases) and L (laboratory confirmed cases) filled by Health Workers, Clinicians and Laboratory staff respectively. The weekly data gives information on the disease trends and seasonality of diseases. Whenever there is a rising trend of illnesses in any area, it is investigated by the Rapid Response Teams (RRT) to diagnose and control the outbreak. Data analysis and actions are being undertaken by respective State/District Surveillance Units. Emphasis is now being laid on reporting of surveillance data from Major Hospitals and also from Infectious Disease Hospitals. Overall 85% Districts are reporting weekly disease surveillance data under IDSP. Outbreak Surveillance and Response: CSU, IDSP receives disease outbreak reports from the States/UTs on weekly basis. Even NIL weekly reporting is mandated and compilation of disease outbreaks/alerts Annual Report 2010-11 228 is done on weekly basis. On an average 10-20 outbreaks are reported to CSU weekly. A total of 553 outbreaks were reported in 2008 and 799 outbreaks in 2009. In 2010, 871 outbreaks have been reported from January to October 2010. Majority of the reported outbreaks were of Acute Diarrhoeal diseases, Food poisoning, Measles and Chickenpox. Contribution of IDSP in Influenza A H1N1 Outbreak Monitoring Cell on 24x7 basis has been established at National Centre for Disease Control (NCDC) for monitoring the situation. Community, Private Practitioners, Nursing homes and Hospitals have been requested to report to IDSP Call Centre on 1075 (Toll free number) in case of any occurrence of clusters of Influenza like illness in the community. 12 Laboratories are strengthened out of which 10 laboratories are functional and 2 are in process of strengthening under IDSP for testing clinical samples of Influenza A H1N1 in different regions of the country. 11 strains have been sequenced at NCDC Laboratory. State and District RRTs have been alerted to investigate and manage suspected outbreaks. Media Scanning and Verification Cell: Media scanning is an important component of surveillance to detect the early warning signals. Media scanning and verification cell daily receives an average of 4-5 media alerts of unusual health events which are detected and verified. A total of 1298 health alerts have been detected since its establishment in July 2008. In 2010, 388 media alerts were reported from January to October 2010; majority of them were Acute Diarrhoeal diseases, Food poisoning and Malaria. Information & Communication Technology Network (ICT): ICT plays an integral and most powerful role in implementing IDSP across the country. One of the important components of the project is data management, analysis and rapid communication in case of outbreaks. Data Centre: National Informatics Centre (NIC) has installed Data Centre Equipment at 776 out of 800 sites. The objective of Data Centre is online data entry for speedy data transmission. Training Centre (NIC): Training Centre Equipments have been installed at 378 out of 400 sites. State to District communication is possible by NICs E-Learning Portal (http://e-learning.nic.in/lms), which has facility in managing live virtual classrooms for training (State/Area specific discussion on disease surveillance activities), e-learning, interactive electronic discussion (Chat rooms, Boards, Mailing Lists) and reviewing and monitoring project related activities. Training Centre (ISRO): Indian Space Research Organization (ISRO) has installed training centre at 367 out of 400 sites (EDUSAT/VSAT). Call Centre: A 24X7 call centre has been established to receive disease alerts from anywhere across the country on a toll free number 1075 for verification and initiating appropriate public health actions. The call centre has a response mechanism by informing respective health officials at concerned Districts for early response. A total of 51496 calls were received from January - October 2010, out of which 3663 calls were related to Influenza A H1N1. IDSP Portal: The IDSP portal is a one stop portal (www.idsp.nic.in) which has facilities for data entry, view reports, outbreak reporting, data analysis, training modules and resources related to disease surveillance. Overall 55% of Districts reported in the portal from January to October 2010. Training: The training in IDSP is three-tiered: Master Trainers State and District Surveillance Officers and RRT members are trained at identified 9 National level institutes. The Medical Officers and District Lab Technicians are trained by Master Trainers at State level. Health Workers & Lab Technician/Assistants at peripheral institutions are trained by District officers/Medical Officers at District level. Training of State/District Surveillance Teams has been completed for 27 States/UTS and partially completed in 4 States. Annual Report 2010-11 229 The main focus of training for State level participants is on basics of disease surveillance, concepts of epidemiology and data management, whereas the District training focuses on correct procedures of data collection, compilation and reporting and outbreak response. A need based special two-week Disease Surveillance and Field Epidemiology Training Programme (FETP) have been initiated for the District Surveillance officers. A total of 288 District Surveillance Officers have been trained for 2- week FETP in which 44 District Surveillance Officers were trained from January to October 2010. State Health Societies were requested in May 2010 to recruit technical manpower under IDSP. 246 Epidemiologist, 34 Microbiologists and 16 Entomologists have joined in States and Districts till October 2010. States has been requested to expedite the filling up the remaining contractual positions at the State/Districts levels. Induction training to 191 Epidemiologists, 15 Microbiologists and 7 Entomologists has been completed. Infectious Disease Hospital Surveillance Network: 7 Infectious Disease Hospitals, one each in Delhi, Mumbai, Chennai, Kolkata, Bangaluru, Ahmedabad and Hyderabad have been given funds for strengthening epidemic-prone disease surveillance under IDSP. EDUSAT network has been installed at these Hospitals. Infectious Disease Hospitals of Mumbai, Chennai, Delhi, Ahmedabad and Kolkata have started reporting weekly disease surveillance data. Strengthening of Laboratories: 50 priority District laboratories are being strengthened in the country for diagnosis of epidemic prone diseases. The guidelines and procurement of certain deficient lab equipment were communicated to the States in February 2009. Till date 18 States i.e. 26 labs have completed the process of procurement. These labs are also being supported by a trained manpower to mange the lab and an annual grant of Rs 2 lakhs per annum per lab for reagents and consumables. 13 laboratories are functional at present. In 9 States, a referral lab network is being established by utilizing the existing functional labs in the medical colleges and various other major centers in the States and linking them with adjoining Districts for providing diagnostic services for epidemic prone diseases during outbreaks. The plan for all 9 States has been finalized through State level meetings and the network is functional in 3 States namely Gujarat, Punjab and Rajasthan. The network plan is in process of implementation in the remaining 6 States. Entomological Surveillance on Vector Borne Diseases: Vector borne diseases like Malaria, Japanese Encephalitis, Dengue, Kala-azar etc. are of major public health concern. Every year outbreaks/ epidemics occur in different parts of the country leading to high morbidity and mortality. Entomologists have joined in 16 out of 35 States/UTs. Entomological surveillance and monitoring of vector borne diseases are being carried out by the Entomologists. Tribal and Social Plan: Gujarat, Maharashtra and Karnataka are piloting community surveillance as part of the Tribal Action Plan. West Bengal is planning to prepare a community surveillance strategy involving Panchayat representatives and community volunteers. Gujarat has started planning the tribal action plan (TAP) (community surveillance among tribal communities) in two Taluks of the Nizar block of the Tapi district, where over 90 percent are tribal and live in remote locations. The Gujarat TAP pilot will involve participation of community volunteers, health workers, and NGOs. The Tapi DSU is collecting baseline data on health service, access, disease incidence and outbreak reporting patterns so as to be able to prioritize outreach and monitor outcomes. Karnataka and Maharashtra have started working on their TAP pilots in two select blocks each involving community health workers and volunteers. Maharashtra is piloting community surveillance as part of the TAP in Taloda and Akkalkowa blocks of Nadurbar district; and Karnataka in Gundulpet and Kollegal blocks of Chamrajnagar district. Prevention and Control of Avian/H1N1 Influenza: A networking model has been developed with 12 laboratories, out of which 10 labs are functional. The Animal Component of Avian Influenza is being looked after by Ministry of Agriculture (Dept. of Animal Husbandry). Annual Report 2010-11 230 Finance: Budget and Expenditure for IDSP is as under: Achievements of Integrated Disease Surveillance Project (IDSP) A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established. Central Surveillance Unit, IDSP presently receives weekly disease surveillance data from 527 districts (85%) in the country. A total of 335 (55%) districts are accessing one stop portal for data transmission, trend analysis and resources like guidelines, advisories for health personnel related to disease surveillance, etc. On an average, 10-20 outbreaks are reported to CSU weekly by States. In 2010, 871 outbreaks have been reported from January to October 2010. Majority of the reported outbreaks were of Acute Diarrhoeal diseases, Food poisoning, Measles and Chickenpox. Media scanning and verification cell detects an average of 4-5 media alerts of unusual health events daily. In 2010, 388 media alerts were reported from January to October 2010; majority of them were Acute Diarrhoeal diseases, Food poisoning and Malaria. IT network has been established for data entry, training, video conferencing and outbreak discussions. Data centre has been established in 776 out of 800 sites, and training centre has been established in 745 out of 800 sites with video conference facility. A 24X7 call center has been established to receive disease alerts from across the country on a Toll free number 1075. A total of 51496 calls were received from January - October 2010 out of which 3663 calls were related to Influenza A H1N1. Sl. No. Year Budget Estimates Expenditure % of expenditure (Rs. in crores) (Rs. in crores) w.r.t. BE 1 2009-10 48.50 39.95 82.37 2 2010-11(upto October 2010) 35.00 27.24 77.82 Outbreak Monitoring Cell on 24x7 basis has been established at National Centre for Disease Control (NCDC) for monitoring the situation. Community, Private Practitioners, Nursing homes and Hospitals have been requested to report to IDSP Call Centre on 1075 (Toll free number) in case of any occurrence of clusters of Influenza like illness in the community. 12 Laboratories are strengthened out of which 10 laboratories are functional and 2 are in process of strengthening under IDSP for testing clinical samples of Influenza A H1N1 in different regions of the country. 11 strains have been sequenced at NCDC Laboratory. State and District RRTs have been alerted to investigate and manage suspected outbreaks. Training of State/District Surveillance Teams has been completed for 27 States/UTS and partially completed in 4 States. A total of 288 District Surveillance Officers have been trained in special 2- week FETP of which 44 District Surveillance Officers were trained from January to October 2010. State Health Societies were requested in May 2010 to recruit technical manpower under IDSP. 246 Epidemiologist, 34 Microbiologists and 16 Entomologists have joined in States and Districts till October 2010. States has been requested to expedite the filling up the remaining contractual positions at the State/Districts levels. Induction training to 191 Epidemiologists, 15 Microbiologists and 7 Entomologists has been completed. Procurements of deficient equipments completed in 9 more Sates (16 labs); making it a total of 18 States (26 labs). Expenditure guidelines for the annual grant of Rs. 2 Lakhs per District priority lab communicated to the States. Hand holding of the States via video conferencing and on site lab Annual Report 2010-11 231 visits for making the District lab functional. 13 laboratories are functional at present. Referral lab network plans were finalized through State level meetings with the stakeholders for remaining 3 States namely Maharashtra, Andhra Pradesh and Rajasthan. Implementation guidelines, prototype MoU for the referral lab network and expenditure guidelines for the grant for the referral labs under the network communicated to the States. Specimen collection and transport guidelines for use at the district level during outbreaks communicated to the States for further communication to the Districts. Entomology unit has been established with the objective of updating the entomological surveillance of vector borne diseases in the country. Integrated Disease Surveillance Project - North Eastern States:- Background: Integrated Disease Surveillance Project (IDSP) is a decentralized State based programme to strengthen surveillance system for epidemic prone diseases for early detection and control of outbreaks. As on date, all States and Union Territories including North Eastern States are implementing IDSP. The component wise details of status / achievements in North East states are as under: IT Networking: In N.E States, IDSP has established linkages with all States/Districts HQ & all Govt. Medical colleges on a Satellite Broadband hybrid network. The State wise details are as under: Sl. No. State Data Broadband Video Conference Centre Connectivity Facility 1. Arunachal Pradesh 14/14 11/14 13/14 2 Assam 27/27 27/27 26/27 3. Manipur 11/11 4/11 11/11 4. Meghalaya 9/9 7/9 9/9 5. Mizoram 10/10 4/10 10/10 6. Nagaland 12/12 9/12 12/12 7. Sikkim 6/6 6/6 4/6 8. Tripura 6/6 5/6 4/6 Total 95/95 73/95 89/95 Manpower status: Since July 2010, manpower recruitment has been decentralized and State wise break up of technical manpower is as under. Sl. No. States Epidemiologists Microbiologists Entomologist in position in position in position i) Arunachal Pradesh 15/17 1/2 1/1 ii) Assam 4/24 2/2 0/1 iii) Manipur 7/10 1/2 0/1 iv) Meghalya 0/8 2/2 1/1 v) Mizoram 0/9 1/3 0/1 vi) Nagaland 0/12 0/3 0/1 vii) Sikkim 1/4 1/2 0/1 viii) Tripura 0/5 0/2 0/1 Total 27 / 90 8/18 1/8 Annual Report 2010-11 232 Training Status: Training of Trainers (ToT) of State and District Rapid Response teams (RRT) has been completed for eight North Eastern States. State wise details are as under: Data Management Status: IDSP presently receives weekly disease surveillance reports from about 96% of the Districts of NE region (80 out of 83 districts). Data analysis and action are being taken by respective Districts. Strengthening of Laboratories: In North East States, strengthening of 10 identified district laboratories for diagnosis of epidemic prone diseases is in progress. These labs are being supported under IDSP for procurement of certain deficient equipments and posting of a trained Microbiologist to manage the lab. In addition these labs have been allocated Rs 2 Lakhs per annum per lab for reagents and consumables. Guidelines related to procurements, manpower recruitment and expenditure guidelines for Rs 2 Lakhs per annum have already been communicated to the States. Outbreaks detected: The major component of the project is to detect and respond to outbreaks in the early rising phase. In 2010, Sl. No. States Master Medical Health District Peripheral Trainers Officers Workers Laboratory Laboratory Trained Technicians Technicians in ToT i) Arunachal Pradesh 61 Trainings to be initiated ii) Assam 85 1792 1032 iii) Manipur 41 300 0 0 0 iv) Meghalya 38 123 515 17 102 v) Mizoram 43 106 767 34 8 vi) Nagaland 20 158 683 159 35 vii) Sikkim 29 43 380 33 5 viii) Tripura 20 131 658 14 36 Total 337 2653 4035 257 186 the State has detected a total of 57 outbreaks till October 2010 which is as follows: Finance: The Grants-in-aid released and expenditure incurred in Sl.No. States No. of Outbreaks in 2010(up to October) i) Arunachal Pradesh 5 ii) Assam 44 iii) Manipur 2 iv) Meghalaya 2 v) Mizoram 0 vi) Nagaland 2 vii) Sikkim 1 viii) Tripura 1 Total 57 Annual Report 2010-11 233 last 5 years i.e starting from the year 2003-04 of the project till 24 November 2010 is as under: 15.20.2. Division of Parasitic Diseases The Department is a nodal agency for planning, implementation, monitoring and evaluation of Yaws Eradication Programme (YEP) and Guinea Worm Eradication Programme (GWEP) in the country. It undertakes surveys, manpower development and research. On request, it also provides teaching materials like filarial slides to various colleges in the country and contributes to training of post graduate, undergraduate and nursing medical students who visit NCDC. The department also provides advice to states and districts in the control of parasitic diseases. A. Yaws Eradication Programme (YEP) in India Yaws Eradication Programme (YEP) was launched as a centrally sponsored scheme in 1996-97 in Koraput district of Orissa, which was subsequently expanded to cover all the 51 Yaws endemic districts in ten states (Andhra Pradesh, Orissa, Maharashtra, Madhya Pradesh, Chhattisgarh, Tamil Nadu, Uttar Pradesh, Jharkhand, Assam and Gujarat). The programme aimed to reach the un-reached tribal areas of the country. National Centre for Disease Control has been identified as the nodal agency for the planning, monitoring and evaluation of the Programme. The Programme is implemented by the State Health Directorates through Sl. States Amount Amount No. released expenditure (In Lakhs) (In Lakhs) i) Arunachal Pradesh 282.08 244.44 ii) Assam 295.39 288.99 iii) Manipur 94.20 22.28 iv) Meghalaya 162.63 120.72 v) Mizoram 358.49 375.91 vi) Nagaland 365.31 321.71 vii) Sikkim 96.20 67.8 viii) Tripura 113.39 86.2 Total 1767.69 1528.05 the existing health care system. The number of reported cases has come down from 3751 to nil during the period from 1996 to 2004 and subsequently no case has been reported from any of the states till October, 2010. The programme envisages achieving its objective through adoption of following strategies: Case finding: active case search, passve surveillance, rumour reporting; Treatment of cases and contacts; Manpower development; IEC activities and Multisectoral approach. Around 10000 sera samples collected from 1-5 years children till October, 2010 tested negative for Yaws by RPR/TPHA test. Funds in the form of Grant-in-aid are being provided to the states for operational cost to undertake activities under YEP. B. Guinea Worm Eradication Programme (GWEP) in India In 1983-84, National Centre for Disease Control was made the nodal agency by the Minsitry of Health & Family Welfare, Govt. of India for planning, co-ordination, guidance and evaluation of Guinea Worm Eradication Programme (GWEP). At the beginning of the Programme i.e. in 1984, about 40,000 GW cases were reported in 12,840 guinea worm endemic villages 89 districts of seven endemic states, viz. Andhra Pradesh, Gujarat, Karnataka, Madhya Pradesh, Maharashtra and Rajasthan. The State of Tamil Nadu remained free from GW disease since 1982. The last guinea worm case in India was reported in July 1996 in Jodhpur district of Rajasthan. World Health Organization certified India as guinea worm disease free country in February 2000. However, routine surveillance continues till the disease is eradicated from the globe. C. Lymphatic Filariasis: Manpower Development The Department is imparting training course on lymphatic filariasis at its three Regional Filaria Training and Reseach Centres (RFT&RC) functioning at Kozhikode in Kerala, Rajahmundry in Andhra Pradesh and Varanasi in Uttar Pradesh. Training courses for Medical Officers/Biologist/ Programme Officers for 5 days on lymphatic Filariasis organized during the reported period at NCDC branches Annual Report 2010-11 234 Varanasi from 23-27 August, 25-29 September, Kozhikode 19-23 July, 4-8 October and Rajahmundry 6-10 September 2010. Training course on filariology for Fialria Inspectors/ Technicians for 10 days organized during the reported period at NCDC branch Varanasi 12-23 April, 13-14 Sepember, Kozhikode 2-13 August and Rajahmundry 15- 26 November 2010. 15.20.3. Microbiology Division Coxsackie B Virus: To find out the association between myocarditis and Coxsackie B virus, paired serum samples from 36 cases from different hospitals were received and tested. All the samples were found negative to Coxsackie B group (B1-B6) virus infection. Measles: Sixty-two (62) clinically suspected cases of SSPE were reported to the laboratory. Twenty-four (24) of these cases were confirmed by laboratory tests showing of high titre anti measles antibodies in serum and CSF samples. No such case, so far, is reported following measles vaccination. Twenty-four (24) serum samples from suspected measles cases were received. Thirteen (13) were positive for anti measles IgM antibodies. Viral Hepatitis A total of 1216 serum samples were received and tested for various markers of viral hepatitis. 28 cases showed evidence of hepatitis A, 32 of hepatitis E and 148 of acute and chronic hepatitis B. Congenital Viruses: These viral infections result in abortions and congenital malformation in infants. A total of 495 samples from women having bad obstetric history and congenitally malformed babies and viral encephalitic cases were tested for antibodies against Rubella, Cytomegalo virus & Herpes simplex virus infections. 229 serum and 203 CSF were tested for HSV encephalitis. Viral Encephalitis: 26 cases from viral encephalitis from Delhi hospitals were received and tested for anti-measles anti HSV, anti Rubella, Vericella, mumps, EBV IgM and EV-71 antibodies. ILI Surveillance A total of 879 ILI Surveillance samples have been processed by Multiplex PCR from May, 2008 to till date out of which 31 are positive for Influenza A, 10 positive for influenza B, 8 for Influenza A H1N1 and 5 for para Influenza. Viral Conjunctivitis: Twenty-five (25) eye swab were tested for enteroviruses. Four were found positive for Coxsackie A24 and EV-71 viruses. National Polio Surveillance: AFP Surveillance: The Virology laboratory of NCDC has been accredited as WHO National Polio Lab to assist NPSP on lab based surveillance of Acute Flaccid Paralysis. In this regard, 3000 stool specimens, 1500 cases were received and tested. 150 isolates found positive for polio virus were sent to ERC, Mumbai for further typing and intratyping characterization. Supplementary Environmental Surveillance: As per Govt. of India, Ministry of Health & FW, NCDC has been selected to carry out supplementary surveillance by collecting sewage samples on weekly basis from 7 sites selected by NPSP to see the presence of any wild poliovirus in the sewage. In this regard, 118 sewage samples have been collected and tested at NCDC and ERC, Mumbai in parallel. 18 samples were found to be positive for wild polio virus (P1-5. P3-7 and P1+P3 46) indicating that the wild virus is still circulating in the community. Tuberculosis: A total of 731 clinical samples (mainly serum samples and a few other samples like CSF pleural, other fluids, obtained from suspected cases of tuberculosis were tested for the presence of anti A60 mycobacterial antibodies by ELISA test. 287 samples were found to be positive. In addition, 150 clinical samples obtained from suspected cases of tuberculosis were subjected to mycobacterial culture 6 mycobacterial isolates were subjected to drug sensitivity test using BACTEC as well as Conventional method. Bacteriology 148 samples (including CSF, blood and slides) obtained from suspected cases of pyogenic meningitis were subjected to culture examination and rapid latex agglutination test for antigen detection. 365 clinical samples from suspected diphtheria cases in Delhi were processed for diphtheria cases in Delhi were processed for diphtheria culture. 347 urine samples were subjected to culture examination. Blood culture was carried out in 98 samples from cases of enteric fever. 89 pus, throat swabs and other samples were subjected to culture examination. 15 samples were processed for Legionella culture and IFA test. Annual Report 2010-11 235 Diarrheoal Diseases Laboratory A total No. of 642 rectal swab/stool samples from gastroenteritis cases in and around Delhi from Infectious Diseases Hospital, and Aruna Asaf Ali Hospital, Delhi processed for the presence of enteropathogens Vibrio cholerae 01 and non-agglutinating cholera, Shigella and Salmonella sp. Out of 642 samples, 187 positive for V.cholerae 01, 3 NAG, 8 Shigella, 31 Salmonella, 6, E.coli pure culture, 1 Clostridium difficile and 3 Rota virus. Twenty-nine (29) referral diagnostic samples were received, out of which 2 VCO1, 2 Shigella, 4 Clostridium difficile were diagnosed. A total No. of 31 samples received from various parts of India, as pert of outbreak investigation, 9 positive for VCO1, 5 EFC 1 Rota virus. 100 isolates processed for Antimicrobial sensitivity. Following new diagnostic services are added during the reporting year. i. Diagnosis of viral diarrheoa: Rotavirus and Norovirus detection by ELISA test. ii. Diagnosis of antibiotic associated diarrheoa: Clostridium difficile toxin detection by ELISA test. iii. Molecular diagnosis of Travellers diarrheoa: Enterotoxigenic E.coli (ETEC); Enteropathogenic E. coli (EPEC) and Enteroaggresive E.coli (EAEC) detection by multiplex PCR. Environmental Laboratory: A total of 351 (Three hundred and fifty-one) drinking water samples belonging to different drinking water sources (collected during outbreak investigations of water borne diseases, samples from air-line caterers serving VVIP flights, referred samples from schools, hospitals, domestic sources etc.) were tested for bacteriological standards by the MPN Coliform method. 233 (66.38%) of these were found satisfactory, while the remaining 118 (33.6%) were unsatisfactory. Other than this, 123 sewage water samples were collected and processed for polio virus surveillance in Delhi. Concentrated samples were sent to ERC, Mumbai for polio virus isolation. 2500 H2S strip bottles prepared were supplied for polio surveillance in other outbreaks. Media Room Approximately 4000 plates of routine plate media (Blood agar, MacConkey agar, Chocolate agar, MH agar etc.) were supplied in this period. 2000 plates of specialized/ selective media (e.g. XLD, SSA, TCBS, etc) were supplied. Around 5000 tubes, 550 vials and 300 flasks of liquid media (e.g. Peptone water, Selenite broth, McConkey broth etc.) were supplied. 600 vials of transport media eg (Cary-Blair medium were supplied by Media room. 1000 nutrient agar stabs were supplied as preservative media. 5000 tubes of biochemical test media (e.g. PPA, TSI Agar, Simmons citrate, RCUT media etc.) were supplied. Mycology Laboratory It provides Diagnostic mycology services to the referred cases from Delhi Hospitals. The important mycotic infections that were diagnosed: Cryptococcusis- 6, Aspergillusis - 9 Candida albicans 2, Candida sp.p-1, Alternaria spp.-1, Nocardia spp-1. This involved processing of 105 clinical specimens such as CSF, sputum, blood, serum, skin scrapings and tissue biopsies. In addition assisted in disease outbreaks and carried out teaching and training activities. 15.20.4. Centre for Medical Entomology and Vector Management Centre for Medical Entomology and Vector Management is reorganized to develop it as a National Centre par excellence for undertaking research, providing technical support and to develop trained manpower in the field of vector-borne diseases and their control. The centre provides technical guidance, support and advice to various states and organizations on outbreak investigations and entomological surveillance of vector-borne diseases and their control. Major achievements are highlighted below: Major achievements 1. Based on the detection of Dengue virus antibodies in vector mosquitoes early warning signals were issued to Municipal Health Officer, MCD, Delhi, Chief Medical Officers of district Sonipat & Panipat (Haryana) for possible outbreak of Dengue. 2. Officers and staff members of CME&VM monitored dengue surveillance activities in Central Zone, Shahadra Zone & South Zone of Delhi during current Dengue/Chikungunya epidemic. 3. Laboratory evaluation of two Transfluthrin based mosquito repellent liquid (RDE/LV/A-165) and 1.6% Transfluthrin (RDE/LV/A-166) vaporizer was Annual Report 2010-11 236 carried out in Peet Grady chamber against Culex quinquefasciatus mosquitoes and house flies (Musca domestica). 4. Field evaluation of six insecticide compounds in respect of its residual efficacy under field condition is being carried out in Bastar district, Chhattisgarh state. Ongoing Research Projects 1. Studies on the presence of Dengue/JE Virus in vector mosquitoes. 2. Japanese Encephalitis /Dengue virus detection in mosquitoes of some endemic areas. 3. Entomological surveillance of vector of Yellow Fever, dengue and chickungunya mosquitoes in and around international airports and sea ports and vector control measures thereof. 4. Studies on rodent-flea association at major Sea Ports of India. 5. Studies on the role of certain anophelines in the transmission of malaria in Arunachal Pradesh and other parts of the country. 6. Entomological surveillance of vectors of Scrub typhus in selected urban, peri-urban and rural set up of Delhi, NCR and other parts of the country. Research abstracts submitted & accepted for presentation: Title Malaria in rural foot hill of Aravali hill mountain range, India submitted to DRDO for conference on International Symposium on Recent Advances in Ecology & Management of Vector Born Disease at Gwalior (M.P.), w.e.f. 1 st to 3 rd December 2010. Title Prevalence of different species of Aedes mosquitoes in urban localities of National Capital Territory of Delhi, India and detection of Dengue virus. submitted to DRDO for conference on International Symposium on Recent Advances in Ecology & Management of Vector Born Disease at Gwalior (M.P.), w.e.f. 1 st to 3 rd December 2010. Title Effectiveness of Diflubezuron (IGR) formulations against four vector species of mosquitoes. submitted to DRDO for conference on International Symposium on Recent Advances in Ecology & Management of Vector Born Disease at Gwalior (M.P.), w.e.f. 1 st to 3 rd December 2010. 15.20.5. Division of Malariology & Coordination A. The division has a malaria clinic to check/cross check blood smears of clinically diagnosed cases for the presence of malarial parasites, referred by various hospitals of Delhi and surrounding districts of Uttar Pradesh and Haryana state. During the year 2010 upto 31 st October,10 a total of 1227 blood smears were examined, of which 91 were found to be positive. 72 for P vivax and 19 for P falciparum. Clinic also checks the slides brought from field by various divisions during Research & survey. A total of 11 blood smears were examined and all were found negative. B. A total of 582 students from different institutes were given short term training as follows: S.No Month Institutions No. of participants 1 18-1-10 to MD Microbiology students of Delhi University of MAMC, LHMC, 20-1-10 UCMS & VPCI 6 2 4-2-10 to 5-2-10 5 senior veterinary Army officers of RVC Centre and College Meerut under the aegis of Indian Vet. Research Institute, Izatnagar, Bareilly 5 3 05-2-10 B.Sc Nursing Students of St. Anns group of Institutions, Mulki, Mangalore 37 4 8-2-10 to 12-2-10 Post Graduate students from Department of Community Medicine of MAMC, LHMC, UCMS New Delhi 5 Annual Report 2010-11 237 S.No Month Institutions No. of participants 5 15-2- 10 Trainees of diploma in health promotion Education & PG Diploma in community Health care (PG- DCHC) from Health & Family Welfare Training and Research centre, Mumbai 30 6 17-2-2010 Medical officers of Himachal Pradesh under going Professional Development Course in Management public health & Health sector reforms for the mid level Medical Officers at State Health and Family Welfare Training Centre, Pari Mahal, Shimla 17 7 18-2-2010 B.Sc III yr life science students of Sri Aurobindo College(University of Delhi), Malviya Nagar, New Delhi 9 8 23-2-2010 Newly appointed CGHS and CHS officers undergoing induction training course at NIHFW, Munirka 22 9 11-3-2010 BHMS students of Dr. Padiar Memorial Hoemopathic Medical college, Ernakulum, Kerala 38 10 22& 23-3-10 DNB Students 3 11 27-4-10 2 nd year MBBS students of Army college of medical sciences, Delhi cantt. 19 12 11-5-10 2 nd year MBBS students of Army college of medical sciences, Delhi cantt 9 13 13-5-10 4 th year B.Sc Nursing students of Vidyarathana college of Nursing, Udupi 34 14 25-5-10 2 nd year MBBS students of Army college of medical sciences, Delhi cantt 14 15 28-5-10 Visit of 4 th year B.Sc Nursing students of VidyarathanaNitte Usha Institute of Nursing Sciences, Deralakatte, Karnataka 102 16 8-6-10 2 nd year MBBS students of Army college of medical sciences, Delhi cantt 14 17 15-6-10 MD (CHA) & DHA Final Year students from National Institute of Health & Family Welfare, Munirka 12 18 23-6-10 Senior Medical officers of BSF Academy, Tekanpur, Gwalior 11 19 13-7-10 Visit of 2 nd year M.Sc Nursing students of K. Pandyarajah Ballal Nursing Institute , Ullal, Karnataka 27 20 19-8-10 Visit of Class XIIth students of lady Irwin Senior Secondary school Shrimant Madhav Rao Scindia Marg, New Delhi 34 21 13-9-10 Medical officers of Department of community medicine, AFMC, Pune 10 22 239-10 Visit of M.Sc Nursing students of Bombay Hospital College of Nursing, Bombay 32 23 5
-10-106- 10-10 7-10-10 Visit of Final year BHMS students of Nehru Homeopathic Medical College and Hospital, Defence Colony, New Delhi 92 582 Annual Report 2010-11 238 15.20.6. Centre for AIDS & Related Diseases Introduction The Division of AIDS was established at National Centre for Disease Control (NCDC) in the year 1995. Prior to this it had existed as AIDS Reference Laboratory in Division of Microbiology (since 1985), one of the first reference centers in India, which initiated surveillance of HIV-infection in the country. In December 2004, it was upgraded as Centre for AIDS & Related Diseases. The Centre has the following laboratories/units i. National Reference Laboratory ii. HIV Serology Laboratory iii. Quality Control Laboratory iv. Immunology Laboratory v. STI and Opportunistic Infections Laboratory vi. Molecular Virology Laboratory vii. Integrated Counselling and Testing Centre (ICTC) viii. HIV Test Kits Distribution Unit ix. Central Blood Collection Unit Brief overview of the activities of the Centre Serological testing and confirmation of HIV infection for referred samples. Counselling and HIV testing for direct walk-in clients Panel preparation and delivery of EQAS to SRLs of 4 linked states i.e. Delhi, Haryana, Rajasthan and J&K. Quality Control of HIV testing performed by linked state reference laboratories (SRLs) and linked sentinel surveillance centres in four states viz. Delhi, Haryana, Rajasthan and J&K Preparation and characterization of panel for kit evaluation (HIV, HBV & HCV) HIV, HBV and HCV test kits evaluation. Testing of blood products referred by DCGI for various infectious markers (HIV, HBV and HCV) CD4 cell estimation for samples referred from linked ART and PPTCT centers Diagnosis of common opportunistic infections i.e. Cryptosporidium spp. Microsporidium spp. and P. jeroveci in stool and sputum respectively. Serological diagnosis of syphilis Participation in EQAS for CD4 cell estimation conducted by National AIDS Research Institute (NARI), Pune in collaboration with QASI, Canada. Participation in EQAS for HIV serology conducted by the National AIDS Research Institute, Pune. Participation in EQAS for VDRL/RPR testing conducted by Regional STD Teaching, Training & Research Center, VM Medical college & Safdarjung Hospital, New Delhi. Manpower development for 1. Laboratory investigations for HIV/AIDS 2. Development of Quality management System in HIV testing laboratories Centralized sample collection for different Divisions of NCDC. HIV test kits storage facility to DSACS. Activities performed in various laboratories/units of the Centre A. Participation in International and National EQAS This Center regularly participates in an EQAS for HIV serology conducted by National AIDS Research Institute, Pune. The Centre has consistently given 100% concordant results as part of the proficiency testing programme. Centre regularly participates in EQAS for CD4 cell estimation conducted by National AIDS Research Annual Report 2010-11 239 Institute, Pune in collaboration with QASI, Canada. The Centre has consistently performed satisfactorily during the period. This centre regularly participates in External Quality Assessment Scheme (EQAS) for VDRL/ RPR test conducted by Regional STD Teaching, Training & Research Centre, VMM College & Safdarjung Hospital. The centre has consistently given 100% concordant results for qualitative RPR. B. National Reference Laboratory A total of 52 blood products referred from Drugs Controller General of India (DCGI), Govt. of India have been tested for various infectious markers i.e. HIV, HBV and HCV (a total of 624 tests were performed during the testing of these blood products). A total of 05 HIV kits were evaluated at NRL (a total of 2500 tests were performed during the evaluation of these kits). A total of 272 samples have been tested for HIV as part of Quality Control of HIV testing performed by liked SRLs (a total of 408 tests performed) . EQAS programme was conducted twice in this year for all the 13 SRLs and their associated ICTCs o A panel comprising of 08 members for each of the SRLs and a bulk panel comprising of 04 members for ICTCs was sent after getting them validated from NARI, Pune. o Report of testing conducted on panel by SRLs was compiled and feedback was given to the respective SRLs. C. Serology / Quality Control Laboratory A total of 609 serum samples were tested for diagnosis and conformation of HIV infection. A total of 2186 samples were tested during last round of HIV Sentinel surveillance as part of Quality Control of HIV testing performed linked sentinel surveillance centers in four states viz. Delhi, Haryana, Rajasthan and J&K. A total of 6325 Dried Blood Spot (DBS) specimens received from Twenty eight high risk group (HRG) sentinel sites spread across four states namely Jammu & Kashmir, Haryana, Rajasthan & Delhi were tested for anti-HIV antibodies. D. Immunology Laboratory CD4/CD3 cell estimation was performed on 1148 samples referred from anti retroviral treatment (ART) centre, Deen Dayal Upadhyay Hospital, New Delhi and 08 PPTCT centers of Delhi. E. Molecular Virology Laboratory HIV viral load assay by quantitative RT-PCR performed on 200 samples as part of collaborative research project entitled Comparative study on HIV/AIDS with anti-retroviral and add on Homoeopathy drugs with Central Council for Research in Homoeopathy, Department of AYUSH, MoH&FW, GoI. F. Opportunistic Infections/STI Laboratory A total of 359 sera samples from suspected cases of Syphilis were tested by RPR card test and TPHA test (A total of 779 tests performed). Annual Report 2010-11 240 A total of 10 samples were tested for various opportunistic infections. G. Integrated Counselling & Testing Centre (ICTC) A total of 293 direct walk-in-clients were provided pre test counseling while 260 subjects were given post test counselling. H. Central Blood Collection Unit This unit acts as a central sample collection facility for the institute. During the period a total of 2262 samples were collected and distributed to the respective laboratories for testing. I. Kits Distribution Unit A total of 8843 HIV, HBV and HCV kits were received and distributed by DSACS to various Centers of Delhi. J. On going Research Projects 1. Collaborative research project Comparative study on HIV/AIDS with anti retroviral and add on Homoeopathy drugs with CCRH, New Delhi. K. Training Activities 1. Organized two days workshop on External Quality Assessment Scheme (EQAS) for HIV testing for Officers of the linked State Reference Laboratories from 16th - 17th March 2010. 2. Organized two days workshop on External Quality Assessment Scheme (EQAS) for HIV testing for Laboratory Technicians of the linked State Reference Laboratories from 18th - 19th March 2010. 3. Practical demonstration of HIV Testing Methodologies to 25 participants from South East Asia Region during the 3 months FETP Programme on 20th August, 2010, at NRL (CA&RD) of NCDC, Delhi. 15.20.7. Epidemiology Division:- A. Activities of the Division Organization and coordination of training courses in Epidemiology to develop trained health manpower. Development of teaching materials such as Modules, Manuals etc. on disease surveillance and outbreak investigation of epidemic prone communicable diseases. Investigation of outbreak of diseases of known / unknown etiology and recommend measures for its prevention and control to the States / UTs of the country. Provision of technical support to State government for investigation and control of disease outbreaks. Provision of administrative and technical supervision to three branches of the Institute viz., Alwar (Rajasthan), Jagdalpur (Chhattisgarh) and Conoor (Tamil Nadu). Provision of technical support to various National Health Programmes in the form of developing guidelines for control, manpower development, evaluation of different components / indicators. Assisting the Director for publication of monthly Bulletin CD Alert. Carry out field research on different aspects of communicable diseases. B. Outbreaks Investigated/ Rapid Health Assessment. During the period, officers from the division of Epidemiology carried out investigations of outbreaks in the country and suggested containment measures to the Annual Report 2010-11 241 authorities. Some of the outbreak investigations are as follows: Avian Influenza in Murshidabad district of West Bengal. Reported wild polio virus cases in Ghaziabad district of Uttar Pradesh on 9th Feb. 2010 Reported cases of blindness among infants and children in village Shivpur of Gauri bazaar, Deoria district of Uttar Pradesh from 12 14 May 2010. Dengue outbreak in the districts of Idukki, Kottayam, Pathanamthitta and Thiruvuanan thapuram in Kerela state from 20 24 July 2010 . Malaria in Mumbai (Maharashtra) from 29 30 July, 2010. After cloud burst leading to flash floods causing damage to human life and provided Disease control facilities in Leh from 7- 15 August and from 13- 28 August. Reported cases of wild poliovirus in Motihari (East Champaran) District of Bihar from 13-17 October 2010. Reported cases of wild poliovirus in Beed district of Maharashtra from 12-25 October 2010. C. Manpower Development National Centre for Disease Control (NCDC), Delhi is a WHO Collaborating Center for Epidemiology and training. The division of Epidemiology conducts regular training programmes and numerous other short-term training activities every year. The course curricula of these training programmes are designed and tailor-made to develop the necessary need-based skills for the health professionals. The participants to these courses come from different States/ Union Territories of India. In addition, trainees from some of the neighbouring countries like Bangladesh, Bhutan, Sri Lanka, Myanmar and Nepal also participate in some of the training programmes. D. The Training Courses Organized 15th Regional Field Epidemiology Training Programme (FETP) from 2nd August 2010 to 29 th October 2010. A total of 25 participants from 10 countries participated in this training. Four week Regional Training Programme on Prevention and Control of Communicable Diseases from 9th November 2010 to 6th December 2010. A total of seven participants from Maldives, Bhutan and Nepal attended the said training. E. Training/ Meetings & Workshops Attended Meeting on Public Health Bill 2009 in the Ministry of Law and Justice at New Delhi on 22.1.10. Meeting on South-East Asia Regional conference on Epidemiology organized by WHO and IAE at Hotel Taj, New Delhi from 8 10 March 2010. Ethical Committee meeting at NCDC on 25.05.2010 to look for the ethical issues of the long projects of MPH Scholars. Meeting for revision of Indian Public Health Standards held at NCDC on 5 6 May 2010. Expert Group Meeting on Firming of Sentinel Surveillance for Vaccine Preventable Diseases under the chairmanship of Dr. L.M. Nath at N.C.D.C., Delhi on 28 th June, 2010. Sixth World Organ Donation Day on 27 28 November 2010 at Vigyan Bhawan, New Delhi 15.20.8. Zoonosis Division The objectives of the division is to provide technical support for outbreak investigations, conduct operational research and trained manpower development in the field of zoonotic diseases and their control in the country. Diagnostic support is provided to State Governments for laboratory diagnosis of zoonotic infections of public health importance. The Division has Reference Laboratory for Plague. It has also been recognized by the World Health Organisation as WHO Collaborative Centre for Rabies. Currently the work is being carried out on following Zoonotic diseases: Plague, Rabies, Kala-azar, Arboviral infections (Dengue, JE & Chikungunya), Toxoplasmosis, Brucellosis, Leptospirosis, Rickettsiosis, Hydatidosis, Neurocysticercosis and Anthrax. The Central Animal Facility for breeding & maintenance of different species of laboratory animals is being supervised by the Division. Annual Report 2010-11 242 Major Role and Activities of Division during 2010 are as follows: A. Referral diagnostic services for the years 2010 (01.01.2010 30.11.2010) Rabies (a) Post-mortem diagnosis in animal brain samples by Negri body, FAT, BT 15 (b) Diagnosis in hydrophobia cases by 16 (c) Assessment of antibodies by ELISA test (i) Human 617 (ii) Animal 28 Kala-azar (a) Parasitological diagnosis by smear examination and culture 96 (b) Serological diagnosis by IFA test 228 Toxoplasma Serological and diagnosis by IFA test 390 Brucellosis Serological diagnosis by tube agglutination test 76 Rickettsiosis Serological diagnosis by Weil Felix test 156 Hydatidosis Serological diagnosis by ELISA 32 Arboviral diseases Serological diagnosis by IgM ELISA test for Japanese Encephalitis. (i) Human sera samples 29 (ii) Human CSF 72 IgM ELISA test for Dengue 742 IgM ELISA test for Chikungunya 292 Plague Serological diagnosis by PHA and PHI in rodent Sera 1204 Culture for isolation of Y.pestis from rodent organs 846 Neurocysticercosis Serological diagnosis by ELISA 187 Annual Report 2010-11 243 2010 (01.01.2010 30.11.2010) Leptospirosis Serological diagnosis by ELISA 292 Anthrax Nil Viral isolation Chikungunya 60 Dengue 280 JE Nil Rabies 4 Lymes Disease Nil Hanta virus Nil B Training courses/Expert group meetings Joint Orientation Workshop on Zoonotic infections for medial and veterinary professionals from 17 th to 21 st May, 2010 Training Course on laboratory diagnosis of Dengue & Chikungunya for doctors & paramedicals of sentinel hospitals of Delhi from 8 th to 11 th June 2010. Training of core trainers in appropriate animal bite management including intra-dermal inoculation of cell culture anti-rabies vaccine, August, 2010. C (1). Research projects undertaken To study the epidemiological profile of Kala-azar patients in Delhi Serological studies in Toxoplasmosis in different Delhi Hospitals. Comparative analysis of various serological tests in diagnosis of Toxoplasmosis. Surveillance of Plague in different parts of the country. Specificity of Passive haemagglutination Test for Y.pestis. Use of ELISA in serological diagnosis of Neurocysticercosis. Molecular characterisation of strains of Leishmania. Sero-epidemiology of Brucellosis in high risk population in Delhi Standardization of appropriate diagnostic methods for sero-diagnosis and sero-epidemiology of human and animal leptospirosis Surveillance of arboviral infections in man and animals Isolation of rabies virus in-vitro (Neuroblastoma 2A cell lines). Study of prevalence of Rabies in peridomestic and wild rodents. Standardization of Rapid Fluorescent Focus Inhibition Test (RFFIT) for rabies antibody titer. Isolation of Chikungunya virus in mouse neuroblastoma cell lines. Serological studies in clinically suspected cases of hydatid disease Sero-epidemiological studies for rickettsial diseases (scrub typhus & Indian tick typhus) in patient with pyrexia of unknown origin. C (2) Pilot Projects on Prevention and Control of Human Rabies and Control of Leptospirosis. Annual Report 2010-11 244 The Zoonosis division is presently undertaking two projects as New initiative under 11 th five year plan namely:- o Pilot Project on Prevention and Control of Human Rabies o Pilot Project on Control of Leptospirosis. Pilot project on Prevention and Control of Human Rabies To prevent human deaths due to rabies a pilot project has been initiated as a New Initiative in the 11 th Five Year Plan since March 2008, to be completed by March 2010. NICD is the nodal agency to coordinate various activities under the project. It is being carried out in five cities viz: Ahemdabad, Bangaluru, Delhi, Pune & Madurai. The focus of the pilot project is on training of health professionals about rabies and animal bite management, ensuring timely and adequate post-exposure treatment to all animal bite victims, creating awareness in the community regarding rabies, animal bites and its prevention, strengthening laboratory diagnostic capabilities, facilitating introduction of intradermal route of vaccination and sensitizing veterinarians. A total amount of Rs. 3.26 crore has been allocated for the project. An amount of Rs. 1.81 crore was released during 2008-2009 to pilot project cities to carry out various activities. Pilot Project on Control of Leptospirosis To prevent morbidity and mortality due to Leptospirosis in human a pilot project has been initiated as a New Initiative in the 11 th Five Year Plan for two years (March 2008 to March 2010). NCDC is the nodal agency and the three states under the project are Gujarat, Kerala and Tamil Nadu. The focus of the project is on early diagnosis and treatment of Leptospirosis cases, Strengthening of Laboratory and patient management facilities, trained manpower, awareness in the community and inter-sectoral co-ordination. A total amount of Rs. 2.05 crore has been allocated for the project. An amount of Rs 99 Lakhs was released during the year 2008-09. Rs 95.50 lakhs was allocated to pilot project states to carry out various activities. Utilization Certificate and Statement of expenditure of Tamil Nadu (Rs 30.00 Lakhs) and Gujarat (Rs 35.50 lakhs) has been obtained. In the current financial year 2009-10, a sum of Rs. 80.00 Lakhs has been allocated. 15.20.9.Division of Biochemistry & Biotechnology:- The division is actively involved in disease diagnosis during various epidemics and outbreak, operational research, manpower development, advisory role and other multifarious activities towards prevention and control of a cascade of epidemic-prone diseases of larger public health importance. The division provides laboratory support to epidemiological studies, surveys and outbreaks and also participates in teaching, training, conference, workshops, seminar, symposia and other academic related activities organized by the Institute from time to time. The division conducts applied research activities leading to Ph.D degree from GGSIP University, Delhi. It also imparts project training to M.Sc/B.Tech students from different Universities and Institutes. The division has two laboratory wings: A. Biotechnology/ Molecular Biology Wing i) Biotechnology & Molecular Biology Laboratory ii) Molecular Diagnostics & Gene Cloning Laboratory Molecular Diagnosis & Molecular Epidemiology of over 25 epidemic-prone diseases viz. Polio, Dengue, Hepatitis, HIV, SARS, Avian influenza,Swine flu, Anthrax, MDR TB, Malaria, Kala-azar etc of greater public health importance. PCR/RT-PCR & DNA Fingerprinting/Gene Sequencing for ultimate diagnosis of pathogens. Tracking the source of infection of emerging/re- emerging diseases. Molecular differentiation of strains, detection of virulent/drug resistant forms. Genotyping and Sub-typing of strains. Maintenance of Gene Bank of important disease pathogens. Molecular typing of drug resistant M. tuberculosis, S.aureaus and K.pneumoniae. B. Biochemistry & Environmental Biochemistry Wing Annual Report 2010-11 245 i) Clinical Biochemistry & Toxicology Laboratory ii) National Reference Lab for Iodine Deficiency Disorders Referral services/support to outbreak investigations. Analysis of iodine in salt and urine samples in Iodine deficiency disorders (IDD) analysis. Thyroid function test (FT3, FT4 & TSH) in referred serum samples. Chemical analysis of water for fluoride toxicity, Imparts training under NIDDCP for manpower development. Significant achievements: Department of Biotechnology, NCDC has been recognized as Regional Reference Laboratory of NACO for DBS-based HIV-DNA PCR for early infant diagnosis (EID). MOU between NACO and NCDC signed by Director, NCDC on 27.11.2010. Four Ph.D students of the division have been awarded Ph.D. Degree from GGSIP University, Delhi. Research Projects: Genomic characterization of circulating strains of Influenza A Virus including H5N1/H1N1. Molecular characterization of Dengue virus isolates in the Cpre-M, M and Env/NS1 gene of region of the virus isolates from DF outbreaks. Genotyping of HBV Strains from Gujarat HBV outbreak and typing of HCV from Delhi isolates. Molecular typing of HIV-1 subtype-C and drug resistance gene in Indian strains. Molecular characterization of M.tuberculosis in endometrium obtained from infertile women undergoing infertility management. Studies on drug resistance gene(s) in Salmonella species. 7. Characterization of DNA repair enzymes in MDR and XDR M. tuberculosis and their role in drug resistance. Molecular studies of Chikungunya virus isolates in different parts of the country. Monitoring of thyroid hormones in sera from suspected cases and iodine levels in urine and salt samples under NIDDCP. Outbreak Investigations Pandemic Influenza A (H1N1) : In view of the major pandemic Influenza A (H1N1) virus outbreak in the country, clinical samples of more than 34285 suspected cases of swine flu were tested at NCDC, Delhi using CDC recommended protocol for Real Time RT-PCR, alongwith PCR and gene sequencing. Till date, over 7966 confirmed cases of Influenza A (H1N1) were reported by NCDC alone. Further regular lab-testing is going on to detect new cases of pandemic Influenza A (H1N1). 15.20.10. Proposed upgradation of NICD to NCDC NICD, a premier public health institute in the country tasked to meet the challenges of emerging and re- emerging diseases. The upgradation was considered essential as no major upgradation had taken place since long. The institute got its independent appraisal done as advised by the Planning Commission in July, 2007. The Department of Management Studies, IIT Delhi carried out evaluation during November 2007 and submitted its report in May 2008. M/s. HSCC was appointed as Consultant for preparing Detailed Project Report (DPR). They submitted the DPR. Based on the above inputs and also detailed consultations at different levels, including with technical officers, a draft Memo for Expenditure Finance Committee (EFC) was prepared and circulated in December 2009. EFC Memo was finalized after incorporating response from the concerned Ministries/ Departments. The estimated cost includes capital cost for civil and services works, furniture, equipment and additional manpower. EFC has since recommended the project at a total cost estimates of Rs.382.41 crore. A draft note for Cabinet Committee on Economic Affairs (CCEA) was prepared and sent to MOH&FW for further necessary action. In addition, it has since been decided to engage National Building Construction Corporation (NBCC) as an agency for construction works. Further action to execute an MoU with them is being taken. Simultaneously approvals from local authorities on the site plan and master plan are also being taken. Annual Report 2010-11 246 15.21 LADY READING HEALTH SCHOOL (LRHS), DELHI Lady Reading Health School, Delhi is established in 1918 ,is imparting the following courses:- I. Diploma in Nursing Education and Administration (Elective in Community Health Nursing). II. Certificate Course for Health Workers (Female) under Multipurpose Workers Scheme. III. Auxiliary Nurse-cum-Midwife Course under (10+2) Vocational Scheme. Ram Chand Lohia Infant Welfare Centre, under Lady Reading Health School provides field practice area for Urban Health experience for the students and gives integrated M.C.H. Family Welfare Services to over 39,000 populations. Staff and students actively participated in Pulse Polio Programme, Reproductive Child Health Programme and Perfect Health Mela etc. during the year. 15.22 PASTEUR INSTITUTE OF INDIA (PII) COONOOR The Institute registered as Society under the Societies Registration Act, 1960, started functioning as Pasteur Institute of Southern India, on 6 th April 1907 and the Institute took a new birth as the Pasteur Institute of India and started functioning as an autonomous body under the Ministry of Health and Family Welfare, Government of India, New Delhi from the 10 th of February, 1977. Activities undertaken during 2010-11 were:- Institute has a Rabies Diagnostic Lab and treatment center to cater the need of the general public. Clinical Laboratory service Present Activities Production of DPT vaccine and TCAR vaccine keeping in view of Supply Order received from the Ministry. Training Programmes to Post-Graduate and Graduate students. Academic programmes like Ph. D. (Microbiology Part time & Full time) affiliated to Bharathiar University, Coimbatore and M.D (Microbiology) affiliated to Tamilnadu Dr. M. G. R Medical University, Chennai. Breeding of Mice and Guinea pigs for Experimental purpose like Quality Control of DPT and TCAR vaccine and stability study of such vaccines. Quality Control Division The Quality Control Division comprises the following divisions. 1. Quality Control Department 2. Rabies Diagnostic Laboratory 3. Sterility Media Section The following processes were carried out in Quality Control Division. a) Quality Control Tests on Bacterial Vaccines ( DPT group of vaccines) and Tissue Culture Anti Rabies Vaccines b) Sterility media preparation c) Rabies Diagnostic Tests a. Quality Control Tests IPQC tests for 9 batches BPDT, 7 batches of BPTT and 13 batches of B.P. pool samples were carried out in QCD. Aluminium Phosphate Gel samples (63 Nos) were tested for Aluminium Phosphate content and the Sterility test was conducted for 40 samples. Estimated Thiomersal content for 3 samples and 1 batch of 5 ml tubular glass vials tested for measurement and hydrolytic resistance (Raw Material Testing). Growth Promotion Test was carried out for 1 batch of FTM. Analysed 40 water samples and performed Lf test for 20 samples. The Standard Microbial ATCC Strains and SP2/O Ag 14 Mouse Myeloma cell line have been received and stored. b. Sterility Media Preparation Division During this period the Sterility Media section was engaged in the preparation of sterility media to rule out the microbial contamination on various samples and also for the checking of microbes in the classified sterile area in vaccine production. The following table shows the figures of various bacteriological media prepared and utilized. Annual Report 2010-11 247 Nutrient Agar 42 Litres Prepared in Petri dishes and used for various testings Sabourauds Agar 32 Litres Prepared in Petri dishes and used for various testings Alternate Thioglycollate broth fluid medium 795 Litres Used in the sterility testings as per I.P. Soyabean Casein Digest broth 840 Litres Used in the sterility testings as per I.P. Fluid Thioglycollate Broth 85 Litres To use in the sterility test as per I.P. Nutrient Broth 15 Litres Used in various tests c. Rabies Diagnostic Lab 48 sera samples both from Human, Domestic animals were subjected to Rapid Fluorescent Focus Inhibition Test (RFFIT) for the detection and quantification of Rabies Neutralizing Antibodies using Murine Neuroblastoma-2A cells and 96 well flat bottom Micro titre plates. This includes the samples received from our Dispensary from the Patients reporting for consultation and to assess the post vaccination sero conversion for the protection against rabies infection. Laboratory Animal Division Number of animal weaned: Mice : 14091 Nos Guinea pig : 468 Nos Number of animal supplied to internal users: Mice : 3386 Nos Guinea Pig : 159 Nos Number of Animals Supplied to neighbouring Institute: Mice : 2350 Nos Guinea pig : 25 Nos. Details of grant-in-aid received from the Ministry of Health and Family Welfare, and the expenditure incurred, etc., during 2010-11: The Ministry of Health and Family Welfare, New Delhi, out of the annual budget of Rs.20.00 Crores has released a total sum of Rs.5.00 Crores to this Institute during the financial year 2010-11 vide the Sanction Order No.V.11011/12/2010/V-I dated 02.08.2010- As against the Grant-in-Aid amount of 9.91 Crores (i.e., 5.00 crores + 4.91 crores unutilized Grant-in-Aid available as on 01.04.2010), this Institute has already spent a sum of Rs.7.46 crores during the financial year 2010-11 under Plan scheme upto October, 2010. While releasing the Grant-in-Aid, the Ministry has, vide above letter informed that the normal expenditure of the Plan scheme including the administrative expenses of grantee institutions may be met from the above amount. Academic activities: The Industrial visit of Graduate and Post Graduate students of different college/universities were discontinued due to the revival of vaccine production. Two students underwent training for 15 days during May 2010. The Institute has a well stocked library with 4183 books and 12414 bound volumes, 4 International journals, 13 Indian Journals and WHO publication (Global subscription). The Library is connected with 31 E-books (Print form) and rest of the E-Books are stored in the CD. The Library is connected with internet to utilize the E-journal service to the maximum. Journal Club activities are revived and decided to have two scientific presentation per month. Quality Assurance Quality Assurance is a wide ranging concept covering all matters that individually or collectively influence the quality of a product. It is the totality of the arrangements made with the object of enduring that pharmaceutical products are of the quality required for their intended use. Quality Assurance therefore incorporated GMP and other factors, including those outside the scope of this guide such as product design and development. The following activities were carried out in Quality Assurance Section. Regular monitoring of cold storage of bacterial seed copies (DTP group of vaccine) and issued to concerned section for vaccine production purpose based on their request. Annual Report 2010-11 248 Issuing of approved and Authorized copies of BPR to the concerned section (DTP production, formulation & Sterility Media Section) based on their request and reviewed the same when their submitted to quality Assurance Section. Organogram and Responsibilities prepared for all the sections of this organization based on source data from the respective section and issued back the approved copies. SOP revision work carried out for the following sections : Tetanus Section, Diphtheria Section, pertussis Section, gel and mixing section, DTP Containerization and filling section, labeling and packing Section, sterility media Section, Quality control section, Administration section, Account Section, purchase and Stores section, Library, Dispensary, laboratory Animal division, Quality Assurance Section and TCARV section. Preparation of site master file completed. Viable and non viable particle count as part of environmental monitoring carried at Gel and Mixing Section, DTP Filling Section, TC ARV Section, Quality Control Section, Sterility Media and report generated and issued to concern section. Verification of In-house training records and documentation of the reports from all the sections is being carried out periodically. Revocation of suspension of licence: The Drugs Controller General (India), Central Licence approving Authority, Drugs Control Division, DGHS, New Delhi has vide Office Memorandum No.X-11026/1/06-D dated 15.01.2008 informed that the Drug Licence has been suspended till such time all the deficiencies pointed out by the Inspection team of NRA Assessment are rectified. Accordingly, the production of all vaccines stopped since January 2008 in this Institute. However, Central Government vide order numbers V.12011/1/2009- VI/DFQC dated 12.02.2010 and F.No.X.11035/2/2010- DFQC dated 26.02.2010 revoked the suspension to the above licence. DPT production: To comply with the Ministrys order the production activity initiated and different components like Diphtheria Toxoid, Pertussis component and Tetanus Toxoid are at different stages of preparation. The tentative schedule of supply is as follows: January, 2011 50.00 LDs February, 2011 50.00 LDs March, 2011 50.00 LDs April, 2011 50.00 LDs May, 2011 60.00 LDs June, 2011 60.00 LDs TOTAL 320.00 LDs 15.23 ALL INDIA INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION (AIIPMR), MUMBAI 15.23.1 About the Institute The All India Institute of Physical Medicine and Rehabilitation, Mumbai, established in the year 1955 is an apex Institute in the field of Rehabilitation Medicine under DGHS. Objectives To provide need based Medical Rehabilitation Services including provision of Prosthetic & Orthotic appliances for persons with neuro-musculo-skeletal (locomotor) disorders. To provide training at Under Graduate and Post Graduate level to all categories of Rehabilitation professionals. To conduct research in the field of Physical Medicine and Rehabilitation (P.M.R.). To provide and promote community based programmes of Disability Prevention & Rehabilitation for the rural disabled. 15.23.2. The Institute has initiated several steps for commencing new service lines to meet the challenges arising from increasing incidence of disability due to non communicable disorders. Rehabilitation team meets periodically and confer on rehabilitation management in the following special clinics for the PWD. CP Clinics 295, Prosthetic & Orthotic Clinics 208, Case Conference 103, Disability Certificate Evaluation 1585. Annual Report 2010-11 249 Types of disability managing in the Institute. Birth anomalies affecting musculo-skeletal system,Post Polio Residual Paralysis, Cerebral Palsy, Stroke, Amputee, Spinal Cord Injury , Neuropathies, Myopathies, Occupational Disability. 15.23.3.a Community Based Rehabilitation Projects (CBR): Following project is now completed by this Institute and report is submitted to WHO A Pilot Project on CBR, in Mumbai urban slum of S-Ward, Bhandup, sponsored by WHO (Country office, India) in- collaboration with Municipal Corporation of Greater Mumbai. 15.23.4.b Mobile Domiciliary Rehabilitation Project in collaboration with Rotary Club of Mumbai- Worli in H ward of Municipal Corporation of Greater Mumbai. This project is ongoing project for last Five years, which represents exemplary collaboration between Government of India, NGO and MCGM i.e. local self Government. Highlights: - Persons with disability belonging to below poverty line living in the urban slums are targets for intervention under this project. Population living in Santacruz belongs to H (East) ward, Mumbai are being covered by outreach services. Those who require referral services to the Institute are provided transport facilities which are modified to ease the boarding and the alighting of the individual by customized hoist attachable to the entrance. Schools children in the locality are periodically screened and provided counseling and intervention services. During this period 161 PWDs have been screened in the urban slums. 15.23.4.c Intervention-wise distribution (Under the Project) Therapeutic intervention Exs Therapy - 128 Electrotherapy - 26 Referrals visit to AIIPMR for reconstructive surgeries - 13 No of Aids & Appliances delivered - 7 15.23.4.d Post-graduate students were conducted following projects in the Department of P & O. Gait Evaluation of a Swing Phase Assist Orhtotic Knee Joint in Patients with Poliomyelitis. Performance study of anatomic versus Quadrilateral socket design Design and evaluation of multi purpose walker for Elderly people A comparative study between supracondylar socket and Anatomical Contoured Socket for Trans-Radial Amputee. 15.23.5. Academic Activities The institute had received permission to start MD (Physical Medicine & Rehabilitation) course from the academic year 2010-11 from Ministry of Health & Family Welfare, Government of Maharashtra, Maharashtra University of Health Sciences, Nashik. Sr. No. Name of Courses Intake Capacity 1 MD (Physical Medicine & Rehabilitation) 2 Under graduate and post graduate counselling centre - Institute is recognized as one of the center for UG & PG counseling for admission to MBBS, MD, Dental Courses through Video Conference Mode. Counselling was held during the month of February and March. Diploma in Hearing Languages and Speech Programme is ongoing training programme on video conference mode. 14 students enrolled for the Academic year 2009-10. All the passed out students have obtained jobs at various organizations. 15.23.6. Implementation of Right to Information Act. (RTI) Institute is responding to information sought by the applicants. Nominated Central Public Information Officer (CPIO) duly assisted by the committee members provides such information. Annual Report 2010-11 250 15.24 All India Institute of Speech and Hearing (AIISH), Mysore The All India institute of Speech and Hearing is a pioneer institute in the country imparting professional training, clinical services, conduct of research and education of the public on various communication disorders. 15.24.1.Academic Issues AIISH has been conducting courses in the area of communication disorders from its inception. The institute which started offering one PG course in 1965 is now offering 14 courses. The student strength has increased from 15 in 1965 to 583 as on today. The admission to all the courses is made on All India basis duly following reservation policies of Government of India. Besides one certificate course, AIISH conducts 14 Academic courses, which include, three Diploma, UG / PG programs of B.Sc (Speech and Hearing), B.S.Ed (Hearing Impairment), M.Sc (Audiology), M.Sc (Speech- Language Pathology), and M.S.Ed (Hearing Impairment). It has Ph.D and Post-doctoral fellowship programs both in Audiology and Speech Language Pathology. In addition to the existing two post graduate diploma programs Viz., PG Diploma in Clinical Linguistics for Speech Language Pathologist and Forensic Speech Sciences and Technology, a new Post-graduate Diploma Program in Neuro-Audiology has been introduced at this institute from this academic year 2010-11. On 1 st Oct. 2010, this program was launched by Sri V G Talwar, Vice Chancellor, University of Mysore and Dr. Mewasingh, Professor and Dean, Dept. of Psychology, University of Mysore was the guest of honour on this occasion. DHLS Program: This Diploma program introduced through quasi distance mode in the year 2007-08 has been continued. At present, the institute has 11 study centers spread over 11 different states covering all the zones in the country, as follows, with AIISH, Mysore as nodal center ; Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipal, Dr. Ram Manohar Lohia Hospital, New Delhi, All India Institute of Physical Medicine and Rehabilitation (AIIPMR), Haji Ali, Mumbai, Indira Gandhi Medical College, Himachal Pradesh University, Shimla, Himachal Pradesh, Shri Chathrapathi Sahuji Maharaj Medical College, Lucknow University Chowk, Lucknow, Uttar Pradesh, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, Srirama Chandra Bhanj Medical College, Cuttack, Orissa, Dr. Rajendra Institute of Medical Sciences, Baritayu, Ranchi, Jharkand, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, Jawaharlal Nehru Medical College and Hospital, Mayaganj, Bhagalpur, Bihar. An annual meet of the All India DHLS Coordinators was held on 1 st and 2 nd July, 2010 at the institute. The coordinators of the 12 DHLS centers from all over India participated in the meeting along with their counterparts from AIISH. Courses conducted and admission details: The admission details for different courses conducted at the institute for the academic year 2010-11 are as follows: Sl Name of the course Nos. No. 1 Diploma in Hearing Aid and Earmold Technology 04 2 Diploma in Hearing, Language and Speech (DHLS) at AIISH, Mysore 06 3 DHLS at other 11 study centres (through quasi distance mode) 182 4 DTYHI (Diploma in Training Young Hearing Impaired) 08 5 BASLP (Bachelors in Audiology & Speech Language Pathology) I Year - 61 II Year - 62 III Year - 44 Internship - 36 203 6 B.S.Ed (Hearing Impairment) 03 7 M.S.Ed (Hearing Impairment) 03 8 M.Sc (Speech-Language Pathology) I Year 36 II Year 35 71 9 M.Sc (Audiology) I Year 36 II Year 35 71 10 Ph.D 15 11 Post-doctoral fellowship 01 12 P.G. Diploma in Forensic Speech Sciences & Technology (PGDFSST) 04 13 P.G. Diploma in Clinical Linguistic for Speech Language Pathologists (PGDCLSLP) 03 14 P.G Diploma in Neuro Audiology(PGDNA) 08 Total 583 Annual Report 2010-11 251 Short-term Training Program Short term training programs were conducted on the following topics: a. Assessment of Communication Disorders on 20.4.2010 b. Identification of language problems in school children on 6.5.2010, 10.6.2010 and 16.7.2010 c. Speech and language disorders on 9.6.2010 Workshops/ Semi nars/ Symposi a/ Ori entati on Programs Ten workshops/orientation programs were conducted in these seven months on the following topics: a. A program on Communication Disorders: Early Identification and Prevention held on 18.5.2010 and 19.5.2010 to Social workers and Health workers. b. A program on practical observation of pre-school training for children with communication disorders was held on 4.6.2010 to 30.6.2010 to 14 trainees of C4D2 batch. c. Orientation regarding activities of speech language sciences and its activities to nurses on 14.6.10 d. An orientation program on Speech, Hearing and Language Disorders and Training on Survey for Early Identification and Prevention Communication Disorders held on 2.9.2010 to AHSA Workers of Gumballi and Volunteers of Home Makers from Hullahalli and Akkihebbal. e. A workshop on Fine tuning of digital hearing aids Individuals with hearing impairment was conducted on 2.9.2010. f. Workshop on Preparing young children with Autism to learn language on 10.9.2010 g. Orientation program on Professional Voice Care causes and management of voice disorders to students BGS Apollo Hospital on 14.9.2010. h. A program on Staff enrichment on application MATLAB held on 15.9.2010. i. An orientation program on use of Hearing Aid analyzers and tester by Special Educator. Library and Information Center A total of 210 books were procured during the year making the total number of books to 17045. Besides this, 69 Journals are being subscribed, out of which 13 are e- journals. 15.24.2.Research: Five research projects with extra mural funding (WHO, DST, CIIL, SBMT and Society of Bio Medical Technology) and 6 projects from AIISH Research Fund are in progress. Additionally, 36 research projects were approved under AIISH Research Fund during the report period. A collaborative project on Design and Development of Speech Enhancer with Vellore Institute of Technology sponsored by Society for Biomedical Technology, Bangalore is being carried out at the institute. Publications / Releases: 29 th Volume (No.1 2010) of Journal of All India Institute of Speech and Hearing (JAIISH) was released on 9th August 2010 on the 45 th Anniversary Day of the institute. Proceedings of the International Symposium on Bilingual Aphasia, Seminar on Cochlear Dead Regions and Auditory Dys-Synchrony were released during the period under report. A book on Train Your Child Level I was also released for Care-givers of children with hearing impairment during the period 15.24.3. Clinical Services: The institute continued to provide clinical services for clients with communication disorders through the Departments of Audiology and Clinical Services with its specialized clinical units and Department of Prevention of Communication disorders. A total of 11,912 new clients and 19,176 repeat clients registered during the period from 1.4.2010 to 31.10.2010. Annual Report 2010-11 252 Details of clinical services provided at AIISH, Mysore Total Hearing Evaluation 6408 Hearing Aid Trial 4994 Ear Mould Impression 1902 Clients provided with Speech, Language Therapy 4227 Clinical Psychology 3174 ENT cases evaluated at AIISH and KR Hospital 26201 Major and Minor operations conducted 183 Physiotherapy 489 Occupational Therapy 516 Special Clinics Augmentative and Alternative Communication Unit: Evaluation 11 Therapy 108 Autism Spectrum Disorders Unit: Evaluation 103 Therapy 178 Craniofacial Unit 45 Listening Training Unit 877 Professional Voice Care centre 01 Tele-diagnosis and Tele-Rehabilitation to DHLS study centers No. of Clients provided Tele-diagnosis and Tele-intervention 16 Clients attended Educational Guidance 126 Preschool Training Center Total No. of groups 42 Total No. of languages 04 Total No. of children 1224 Hearing Aid dispensing: Under ADIP Scheme of Ministry of Social Justice and Empowerment, 3055 Govt. of India Issued at Camps 257 Issued under AIISH Hearing aid dispensing scheme 596 Hearing Aid Repaired 612 Annual Report 2010-11 253 Outreach Services I. Hearing Screening: Hearing Screening at the Hospitals at Mysore, wherein new born and infant hearing screening was carried out on 7577 babies during the period from 1.4.2010 to 31.10.2010. The babies were referred for confirmation of hearing loss, if any, to AIISH. The babies with confirmed hearing loss were taken for management intervention. II. Outreach Service Centers: All India Institute of Speech and Hearing has established Outreach Service centers at Akkihebbal, Hullahalli and Gumballi, wherein a speech and hearing unit has been established at the Public Health Centers. Between 1 st April 2010 and 31.10.2010, 161 cases were seen at Akkihebbal, 274 at Hullahalli and 192 at Gumballi villages. III. Camps Five camps were conducted in Karnataka and Kerala where 1242 were examined, 112 hearing aids were issued and 164 certificates were provided. IV. AIISH-SSA Project A collaborative project with Govt. of Karnataka under Sarva Shikshana Abhiyaan was continued and around 95 teachers underwent training in the detection of academic difficulties of school children in the report period. Two New Special units were launched namely: 1. Fluency Unit. On 9 th August 2010, Prof. V N Rajashekaran Pillai, Vice- Chancellor, Indira Gandhi National Open University (IGNOU), New Delhi, inaugurated the Fluency Unit. Fluency unit cater to the academic, clinical and research and public education needs. Clients with stuttering, neurogenic stuttering, cluttering, and fast rate of speech are offered clinical services. Approximately 40 to 50 persons with stuttering avail the therapeutic services and 250 number of therapy sessions are provided in a month in this unit. 2. Vertigo Clinic Vertigo Clinic was inaugurated in the Department of ENT at the institute on 22.10.2010. This clinic was launched to benefit the patients with peripheral and central vertigo problems. The Multidisciplinary team comprises of ENT surgeons, Neurologists, Audiologists and Nurses. The facilities available in the Vertigo Clinic are Microscopic examination of the ear, Electro Nystagmography, Vestibulo Spinal tests, neurological evaluation, Audiological tests for Cochlear and Retrocochlear Pathology. 15.24.4. Public Education (i) Public Lecture Series: The monthly lecture series was continued and seven lectures on various topics related to communication disorders were conducted on the following topics during the period. a. Public lecture on identification of hearing problems in school going children on 24.4.2010. b. Physiotherapeutic Aspects in Communication disorders on 29.5.2010. c. Inclusive Education for Children with hearing impairment on 26.6.2010. d. Early Identification and Intervention of Hearing Impairment on 31.7.2010. e. Stuttering in Children on 28.8.2010. f. Hearing Aids Care and Maintenance on 25.9.2010. g. Augmentative and Alternative Communication on 30.10.2010. Inaugurations: Bodhi, the New Mens Hostel was and this new hostel situated at Panchavati Campus of the institute accommodates 94 number of students. Ashoka, the newly constructed International Guest House with 15 number of guest faculty suites recently started with a total living area of 63 sq. mtrs. and parking space with a lounge. Financial Achievements: Funds from the Ministry (` in crores) Grants for the Grants received Internal year 2010-11 April-October Revenue 2010 Plan 21.85 9.70 Non-Plan 8.00 5.64 1.67 Annual Report 2010-11 254 15.25. CENTRAL INSTITUTE OF PSYCHIATRY, KANKE, RANCHI The Central Institute of Psychiatry, Ranchi covers a sprawling area of about 210 acres and has the bed capacity of 643. All beds in this hospital are paying. Some beds are reserved for the patients sponsored by the Central Government, Railways, Coal India and some for the state Governments. There are 17 Wards, Nine wards for the Male and six for the Female patients, one Family Unit and one Emergency Ward. Each ward is at some distance from other wards. Each ward has well laid out roads and lawns around it. Male and Female sections are separated by a high wall. All the wards are named after eminent psychiatrists. It may be worth noting that unlike other mental hospitals, CIP, Ranchi has never been a custodial care facility. It has always been an open hospital and the patients are never confined to rooms. They are free to roam within the hospital. Apart from drug therapy various psychotherapies, behavior therapy, group therapy and family therapy are routinely employed. A milieu therapy approach exists where patients participate in running the ward and help in looking after other patients. Regular physical exercise, outdoor and indoor games and Yoga are available for the patients. A very well stacked library having books in English, Hindi, Urdu and Bengali as well as a number of newspapers and magazines is freely accessible to the patients. Main objectives of CIP have been Patient care, Manpower development and Research for which the institute has the facilities of: 15.25.1. Adult Inpatient Services: The Inpatient Psychiatry Unit provides services for acutely ill psychiatric patients, including those requiring extensive care for concurrent medical disorders. The entire gambit of mental health expertise is available for the care of in-patients. 15.25.2. Patient OPD- Attendance, Admission and Discharge: During the period from January -October 2010 the total number of OPD cases was 55334 (20478 New and 34856 Old) [including Psychiatric Cases (Adult & Child), Staff OPD, Clinical Psychiatry, Extension Clinics, Skin Clinics & School Mental Health Programme, Epilepsy Camps]. New Cases (Psychiatry) were 9730 (6647 Male, 3083 Female); old cases were 32900 (23669 Male, 9231 Female); 3864 (3045 Male, 805 Female) patients were admitted, 3822 (3015 Male, 807 Female) discharged and only Three (03) deaths occurred during the period. The average bed occupancy rate was 87%. 15.25.3. Special Clinics: Special clinics include chronic Schizophrenia Clinic, Skin & Sex Clinic, Neurology Clinic, Sleep Clinic, Epilepsy Clinic, Staff OPD, Headache Clinic, De-addiction Clinic, Child Guidance Clinic; Mood Clinic, OCD Clinic etc. are also run here. Attendance of patients in Special Clinics during the period from January -October 2010 was 16413 which is given below: 15.25.4. Centre for Addiction Psychiatry: This is a new and modern De-addiction Center with capacity of 30 patient beds for the treatment of the person suffering from problems of alcohol & drugs addiction. It is also the nodal Center for the eastern India for the manpower training and research in the field of alcohol and drugs abuse. During the period from January -October 2010, 531 patients suffering from the problem of Alcohol and Drug addiction were seen in the OPD in De-addiction Clinic, 539 patients were admitted, 526 discharged. 15.25.5. Centre for Child & Adolescent Psychiatry: Child psychiatry has been an important discipline at CIP, Ranchi. A child guidance clinic was started in 1950 and an independent 50-bed child psychiatry unit in 1975. This unit also imparts training to resident doctors and postgraduate students in the field of child and adolescent Clinics No. of Patients Epilepsy clinic 2435 Emergency service 2268 Sleep clinic 58 Skin clinic 2102 Headache clinic 169 Staff OPD 7534 Mood clinic 601 De-addiction 531 Chr. Schiz. Clinic 456 Ocd clinic 212 Neurology 40 Sex clinic 7 Total 16413 Annual Report 2010-11 255 mental health. It caters the needs of grossly psychotic children, children with development disorders and mental retardation. The parents are required to stay with their children for the duration of the treatment. During the period from January -October 2010, 5150 (New-1286, Follow-up-3864) patients attended OPD for treatment. 15.25.6. Department of Clinical Psychology The Clinical Psychology Department at the Central Institute of Psychiatry was established in 1948 and is the oldest independent Department of Clinical Psychology in India. Over a period of years the Department has gained excellence in the field of teaching, training, research and clinical services. 15.25.7. Teaching and Training Initially, the Department was involved in the patient care only; however, later in the year 1962 a teaching course in Clinical Psychology was also started. The course was known as Diploma in Medical and Social Psychology (now known as M.Phil in Medical and Social Psychology). In 1972 Ph.D. in Clinical Psychology was started. Presently, there are 18 seats in M.Phil. (M&SP) and 04 seats are in Ph.D. (Clinical Psychology). Our faculty includes 2 assistant professor, 2 assistant psychologists and 1 lab assistant. 15.25.8. Clinical Services The Department provides non-pharmacological management for the patients of wide ranging psychiatric problems with the help of psychotherapy, counseling, group meetings, psycho-education, psycho-diagnostic testing, intelligence testing and so forth. Apart from the patients coming to the hospital, the Department is also involved in providing services at various extension clinics as well as schools. There is a separate out-patient unit of the Department. The out-patient unit either gets referral from the general OPD of the hospital or people can directly come and seek help for their psychological problems. The psychosocial OPD, as it is called, caters to the needs of those patients who suffer from minor psychological problems and who can be below exclusively by psychological methods viz counseling, behaviour therapy or biofeedback or relaxation therapy. 15.25.9. Psychology Labaratory The clinical psychology lab was established for the first time in India in 1949. It has various psychological tests, rating scales, instruments and apparatus which aid in the management of the patients. The lab has these tests designed for use with both children as well as adult population. There are in total 13 equipments and apparatuses, 43 tests for the assessment of cognitive functions, 19 tests for the assessment of personality which includes projective and objective tests and there are 44 various scales. These tests are for use with both child- hood as well as adult population. There are also 66 new tests which the lab has acquired which assess various domains of personality and cognition. Departmental Activities Apart from management of the patients, the Department holds weekly academic exercises in the form of departmental seminars and psychotherapy meetings. Further, regular classes are taken for M.Phil and Ph.D. students as well as for the students of other disciplines such as Psychiatry, Psychiatric Social Work and Nursing. Research Activities Research is an integral part of the Department. Faculty members and the students of the Department are involved in research activities on a regular basis. Major focus of the current research is psychological assessment, cognitive neurosciences and psychotherapy. Research papers have been published in various international and national journals. The Department is growing every year and is contributing significantly to the field of mental health. 15.25.10. Department of Psychiatric Social Work The Department of psychiatric social work came into existence in the decade of 1950s although the family psychiatry can be dated back to 1922 when patients were admitted in specially made cottages with their family members for multi-dimensional treatment. Training of the students and professionals who were aspiring to be trained psychiatric social worker started in the year 1970. Since then various achievements have been attained by this Department. Training of psychiatric social work started as the Diploma in Psychiatric Social Work (DPSW) firstly and in the year 1985 it was upgraded to M.Phil. Presently, 12 seats are available for M. Phil trainees. 15.25.11. Outreach Program: Extension Clinics include General Psychiatry Clinic at West Bokaro, Hazaribagh and CCL Gandhi Nagar Clinic, Ranchi and Epilepsy Clinic at Deepshikha, Ranchi. These Units are conducting these programmes regularly. We also arrange regular Camps for awareness program, workshop with teachers, parents Annual Report 2010-11 256 etc. School mental health programme also runs in two schools details of which have been shared in the table below: 15.25.12.Centre for Cognitive Neurosciences The Centre for Cognitive Neurosciences had its humble beginning as Electro-encephalography (EEG) Department in 1948 with 6 channels and then 8 channels EEG equipment. The Department was rechristened as Psychophysiology and Neurophysiology Labs in 1995 and recently as the Centre for Cognitive Neurosciences; each new name representing the phenomenal growth that this department has witnessed. Presently the centre has two sections; a clinical section and a research section. The clinical section contains a 21 channels paper EEG, 32 channels QEEG and 40 channels video EEG. The research section includes Dense array EEG acquisition systems (64, 128 and 192 channels), ERP acquisition units (40 channels), a polysomnography unit (40 channels) and a repetitive Transcranial Magnetic Stimulation (rTMS) unit. The centre has acquired advanced signal processing softwares like ASA, BESA, Neuroscan, Curry, Matlab and Mathematica. The Centre runs a weekly Epilepsy Clinic in the Outpatient Department of the institute (Thursdays) and at Deepshikha, Ranchi (Wednesdays). 25.15.13 Department of Pathology and Biochemistry Department of Pathology and Biochemistry performs number of pathological test in clinical pathology, microbiology, bacteriology and biochemistry, serology and immunology. The Department has innumerable Total No. of Patients Clinics No of Patients West Bokaro 328 CCL Gandhi Nagar 74 Hazaribagh Clinic 731 Deepshikha Epilepsy Clinic 173 Deepshika, ICD & H 212 Epilepsy Camp Baripada, Orissa 84 Total 1602 pathological specimens of rare cerebral disease. This Department is also engaged in high level of research. 15.25.14. Emergency Services: A 24 hours emergency service is available in the OPD of the institute with bed strength of 16 patients (8 for male and 8 for female patients). 15.25.15. 24 Hours Services of Telephonic Helpline & E-Mail Helpline: During January October 2010, 761 helpline calls and 124 e-mails were attended. 15.25.16. Training Programme: In the training program, Case conference, Seminar, journal clubs were regularly held every week. Seminar-27 (1284 participants), Case Conference-29 (1283 participants), Journal Club-20 (626 participants) Visiting Nursing Students from other centers (402 participants). 15.25.17. Medical Library In accordance with the objectives of the institute to become a Centre of Excellence Medical Library is to provide the information services and access to bibliographic and full text digital and printed resources in the field of Mental Health and Allied Sciences to the scholarly and informational needs to the institute community. It also support the educational and research programme of the institute by providing physical and intellectual access to information, consistent with the present and anticipated educational and research programmes of the institute. Library provide a wide range of current , accurate and authoritative information from a vast selection of print and electronic resources using State of the art technology at its newly constructed three storied building. The library collection focused primarily on Psychiatry, Psychology, Neurosciences, Psychiatric Social Work and Psychiatric Nursing. The collection of the library which includes Books, Journals, Weekly Magazines, Newspapers, VHS, VCDs, Reports, Dissertation, Thesis, WHO publication, Microfilms, Atlas and electronic databases is regarded one of the richest collection of its kind in the country. It has some rarest collection of reference materials dating back from pre independent (1910) and onwards. It has collection of nearly 55,000 books, bound volumes of journals and WHO publication. Nearly 2000 books from different world wide publishers have been added every year to make the library collection richer. The library currently subscribes 318 print journals and has access of Annual Report 2010-11 257 almost more than 2000 e-journals by using different platform such as Science Direct, Wileys Online Library, OvidSP, Cambridge Online, Sage Online, Springer link etc. Library is also a member of the ERMED India consortia which is run by National Medical Library, New Delhi. ERMED provides full text access of almost 1800 journals on its platform. It is no exaggeration to state that the CIP Library is the largest and finest of its kind in the country. The library has been using the KOHA an Integrated Library Management Software package for library housekeeping operations. All the holdings of the library have been indexed and users can search the database by using KOHA OPAC online from any computer in the institutes LAN and from anywhere of the world by using Web OPAC as usual. All the holdings of the library are equipped with RFID Tags which help the users in Self Issue and renewal of the library holdings by using Bio- Metric system based Self Issue KIOSK and also help in finding any books on the self by using Handheld Reader. RFID tags also helps in librarys self management and security of the library holdings. Apart from the above library offers Reference Services, Photocopying, User Guiding Services, Display of New Arrivals, Document Delivery Service, Current Awareness Service etc. Library is well connected with institutes LAN and has 10 Mbps Leased Line connectivity. Library is equipped with Wi-Fi to provide Internet access to its users on their own Laptops. Anyone can contact the library for any type of information needed in their academic/research work by using the e-mail address ciplibrary@hotmail.com. 15.25.18. Homoeopathy Interventional Research Project in CIP On 17 September 2007 CIP launched two Homoeopathic interventional Research Projects entitled To Assess the Feasibility of Add on Homeopathic Therapeutic Intervention in Schizophrenia: an Open Trial and To Assess the Feasibility of Add on Homeopathic Therapeutic Intervention in Depression: an Open Trial. These projects are funded by Central Council for Research in Homoeopathy, Ministry of Health and Family Welfare New Delhi. The launch of this project widened the horizon in the mental health intervention. This project gave an impetus to the general belief toward alternative therapy and thus opened new avenues for the treatment of mental health problems. The joint venture of homeopathy and modern approach to mental health generated new knowledge that is useful for the field of mental health. 15.25.19. The 36th Annual Conference of Indian Psychiatric Society, Eastern Zone Branch (CEZIPS 2010) & World Mental Health Day The 36th Annual Conference of Indian Psychiatric Society, Eastern Zonal Branch (CEZIPS 2010) was held at Central Institute of Psychiatry (CIP) on 8th and 9th October, 2010 which was jointly organized by Central Institute of Psychiatry and Indian Psychiatric Society, Jharkhand State Branch. The theme of the conference was Child and Adolescent Mental Health. Over 350 delegates and accompanying persons were registered who attended the conference. 15.25.20. Major Achievement Centre for Cognitive Neurosciences Block, Central Store Building, 16 nos. of Type IV and 8 nos. of Type V residential quarters are at the verge of completion and will be handed over to CIP shortly. Construction of new boundary wall in place of old damaged boundary wall is in progress. 50 candidates out of total 79 seats were admitted for the various courses conducted by CIP, Ranchi in the session starting from 1st May, 2010 Digtal X-ray, Haematology Analyzer, Bio Chemistry auto analyzer, Coils for Magnetic Stimulator Machine, Radio Frequency identification system for Books & Journals for Medical Library, Digitization of Medical Records, EEG Records, Office Records, Fiber-Optic networking of the Campus and heavy duty switches for Campus Server have been added to the Institute. Installation of 380 KVA DG set, 400 KVA transformer & underground electric cabling and development of lawns in the hospital. Chapatti making machine, Flour kneading machine, Steam cooking system, 150 ltrs. cooker, Three burner and Two burner Gas Chulha, Potato Piller and Veg. cutting machine have been added to the kitchen. Annual Report 2010-11 258 15.25.21. Clinical & Research Marked increase in the number of cases attending OPD, inpatient admission and sharp decline in mortality rates, expansion of community outreach programme, increase in the number of research paper publication, publication of research journal- Indian Journal of Social Psychiatry (Official Journal of Indian Association of Social Psychiatry), increase in the number of students admitted to various courses, conversion of microfilms into digital formats. 15.5.22. Budgetary Provision FINANCIAL YEAR PLAN NON-PLAN BUDGET REVISED FINAL EXPENDITURE BUDGET REVISED FINAL EXPENDITURE ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE 2009-10 Revenue 100000 72300 74092 73858 262000 266600 273700 272537 Capital 50000 144100 139600 135800 Total 150000 216400 216392 209658 262000 266600 273700 272537 2010-11 (Up to Oct. 10) Revenue 120000 53767 241800 153351 Capital 152500 103500 Total 272500 157267 241800 153351 (Rs. in thousand) 15.25.23. Workshop on the Amendments to the Mental Health Act. A workshop was held in the Central Institute of Psychiatry on 17th July, 2010 to discuss the proposed amendments to the Mental Health Act, 1987.This workshop was a part of several regional workshops organized by the Ministry of Health and Family Welfare across the country to gather opinion regarding the proposed amendments to the Act. The Central Institute of Psychiatry was the venue for eastern India. Annual Report 2010-11 259 15.26. CENTRAL RESEARCH INSTITUTE (CRI) KASAULI Central Research Institute was established on 3 rd May, 1905 as Pasteur Institute for North India. It is a subordinate office of Directorate general of Health Services, under the Ministry of Health & F.W. Govt. of India. The Institute has a huge complex which divided in seven sub-sections i.e. Establishment, Academic, Auxiliary Facilities, Production Division, Quality Control Division, Animal House and Research & Surveillance Division. It has a network of large number of laboratories engaged in manufacturing vaccines/sera and research activities. Central Research Institute is engaged in production of (i) Bacterial and Viral Vaccines & Sera on large scale. (ii) Production & Supply of diagnostic reagents. (iii) Research and Development in the field of immunology and vaccinology. (iv) Teaching and training in vaccinology and Microbiology. (v) Quality Control of immunologicals. Staff Strength: There are 725 sanctioned posts in CRI-Kasauli. The number of sanction posts of group A,B, C and D are 50,32,213 and 430 respectively. The total staff in Position is 577. The staff in-position of group A,B,Cand D is 16,24,186 and 351 respectively. Total Vacant posts are 148. The Vacant position of group A,B,Cand D are 34,8,27and 79 respectively. Budget Provisions 2010-11 (Rs. in Lakh) Budget Provisions Plan Non Plan Total BE 2010-11 1200.00 2812.00 4012.00 Expenditure Oct, 2010 234.00 1313.00 1547.00 RE 2010-11 3232.00 2589.00 5821.00 BE 2011-12 4568.00 3312.00 7880.00 Manufacturing Demand and Supply of Vaccine and anti-sera : Since its inception the institute has developed into a premier institute in research and production of a number immunobiologicals. The order suspending the production license was revoked by the Govt. of India in February, 2010. Production has been restarted and work on upgrading all the facilities to meet cGMP standards is underway. The quantity of vaccines and anti-sera supplied during the last three years is given in the table No. 1. Sl . Vaccines and Anti Sera Installed 2008-2009 2009-2010 2010-2011 Balance Stock No. Capacity Demand Supply Demand Supply Demand Supply as on (31.10.2010) 1 DPT(Doses) 312 260 206.23 00 00 53.50 53.50 16.84 2 DT(Doses) 144 140 37.49 00 00 0.006 00 00 3 TT(Doses) 264 400 116.08 300.00 0.33 1.94 3.98 0.0018 4 Typhoid (AKD) (Doses) 20 20 1.96 1.42 00 00 00 00 5 J.E. (doses) Not Definite 4.00 00 00 00 0.0011 00 2.91 6 Yellow Fever (Doses) 0.40 1.32 0.84 1.07 1.06 0.75 0.75 0.89 Quantity in lakh of ml 7 ARS 2.00 0.38 0.38 0.1 00 1.52 0.22 0.0125 8 ASVS 3.00 0.04 0.04 0.0006 00 1.20 1.20 0.53 9 DATS(Lakh Vials) 0.10 00 00 0.01 00 0.03734 0.00054 0.00013 10 NHS As per Demand 00 00 0.279 0.253 0.035 0.035 0.05 11 Diag. AG. 2.50 0.243 0.243 0.714 0.714 0.443 0.443 0.07 Table No.1 Details of vaccine supplied during the period:- (Quantity in lakh of doses) Annual Report 2010-11 260 Other activities of the institute: In addition to manufacturing of the vaccine and sera the Institute is engaged in a large number of the activities such as : Quality Assurance and Quality control National Salmonella and Escherichia Coli Center. National influenza surveillance center Rabies research center National Polio laboratory for surveillance Experimental animal House Medical treatment Centre & Diagnostic section Academic & Research Activities For developing DPT group of vaccine manufacturing facility at CRI, Kasauli, Ministry has engaged M/s HLL Life care Limited, a Public Sector Enterprises under the Ministry as Project management Consultant and to utilize the services of M/s NNE Pharmaplan as their Detailed Engineering Consultant for revival of CRI Kasauli. Conceptual layout plan of the project has been approved by WHO and DCG (I) and further activities are also being undertaken. The project is likely to be completed by May-June, 2011. 15.27. VALLABHBHAI PATEL CHEST INSTITUTE (VPCI), UNIVERSITY OF DELHI, DELHI Brief Background The Vallabhbhai Patel Chest Institute (VPCI) is a unique post graduate medical institution devoted to the study of chest diseases. It is a University of Delhi maintained institution under ordinance XX (ii). The Institute is administered by a Governing Body constituted by Executive Council of the University and is funded entirely by Grants-in-Aid from the Ministry of Health and Family Welfare, Government of India. The Institute fulfills the national need for providing relief to large number of patients in the community suffering from chest diseases. It has eminently discharged its role and has earned a unique place in the field of Chest Medicine. Main Objectives The main objectives of VPCI are to conduct research on basic and clinical aspects of Chest Medicine, to train post graduates (D.T.C.D., M.D., Ph.D.) in Pulmonary Medicine and allied subjects, to develop new diagnostic technology and disseminate scientific knowledge related to Chest Medicine to other institutions in the country and to provide specialized clinical and investigative services to patients. Patient Management Services The Viswanathan Chest Hospital (VCH), is the hospital wing of the Institute which provides the patient management services with the following facilities; Outpatient Department, Inpatient Facility with 60 beds, 24 hours Respiratory Emergency, 8 bedded Respiratory Intensive Care Unit (with facilities of 7 ventilators), Sleep Laboratory, Tobacco Cessation Clinic, National Yoga Therapy Centre, Cardio-pulmonary Rehabilitation Clinic, Picture Archiving and Communication Systems (PACS), Medical Records Section, Oxygen Plant. During the year 2009-10 the VCH enrolled 10426 new patients, 54386 old patients. A total number of 3956 patients were admitted as Indoor cases. A total number of 19531 were provided 24 hours Respiratory Emergency Services and 429 patients were provided ventilator (invasive and non-invasive) treatment in ICU. A number of specialized investigations done were as follows; Pulmonary function tests: 20444, Arterial blood gases: 2046, Bronchoscopy: 261, Bronchoalveolar lavage: 28, CT scans: 2462, Ultrasound examinations: 569, X-rays: 20834, Electrocardiograms: 5919, Polysomnograms: 67, HIV testing: 218, Serum IgE tests: 622, Skin tests: 758, Clinical biochemistry: 26742. During the year under review, the Institute has played a vital role in conducting investigations for the pandemic influenza H1N1 virus as per the directive of the Government of India. Research Activities The Institute continued its thirst for research in Respiratory Diseases and allied sciences. These research projects were sponsored by different agencies of Government of India, World Health Organization, etc. The notable contributions during the period on research include: Development of novel therapeutics based upon natural products from Indian Medicinal plants, Pulmonary function in normal children in Delhi region: development of reference standards for spirometry, Heart rate variability in chronic obstructive pulmonary disease: associations with systemic inflammation and clinical implications, Annual Report 2010-11 261 Systemic mycoses in HIV positive patients: a study of species spectrum of etiologic agents, antifungal susceptibility pattern and epidemiologic aspects, Functional characterisation of lspA gene of Mycobacterium tuberculosis: cloning, expression and its role during pathogenesis, Prospects for the development of anti-tubercular drugs based on transacetylase function of glutamine synthase, Studies on the possible mechanisms involved in the effects of UNIM-352, a polyherbal, anti-asthmatic unani preparation in experimental animals, Brain nitric oxide and high altitude stress, To study the prevalence of obstructive sleep apnoea amongst middle aged chronic obstructive airway disease (COPD and asthma) patients by a home based sleep study and atopy, and Multi-site epidemiological and virological monitoring of human influenza virus surveillance network in India Phase II. Post Graduate Teaching and Training A total of 9 MD students for academic year 2008-11 and 10 DTCD students for academic year 2008-10 were enrolled. In addition, 48 students were given training under the MD and DTCD programmes. Sixteen research scholars pursued their PhD programmes. As a part of imparting updated knowledge regarding various developments in respiratory diseases, the Institute had conducted 9 th CME course on, Pneumonia on 13 th , February 2010 and the 35 th Workshop on Respiratory Allergy: Diagnosis and Management, Delhi on March 8 th -12 th March 2010. Training in Behavioural Counselling Tobacco Cessation on 22 nd July 2010. An important milestone during this year is the approval to start DM course in Pulmonary and Critical Care Medicine with an intake of two students every year by the University of Delhi. Conferences/ Workshops during the year National Symposium on Sleep Apnea: An Update, held on 5 th - 6 th April 2010 on the occasion of the 61 st Foundation Day Celebrations of the VPCI, Delhi. The 12 th Prof. R. Viswanathan-VPCI Oration was delivered by Prof. M.K. Bhan, Secretary, Government of India, Department of Biotechnology, New Delhi, on 6 th April 2010. The 6 th Prof. A.S. Paintal Memorial Oration was delivered by Prof. Chulani Tissa Kappagoda, Professor of Medicine, University of California, Davis, U.S.A., on 24 th September 2010. Publication The Institute has been publishing a quarterly periodical, The Indian Journal of Chest Diseases and Allied Sciences and continues its effort to disseminate the recent advances in Chest Diseases and allied sciences. It is available online at the website address; <http://www.vpci.org.in>. Further, 46 research papers authored by Institutes faculty members were published in reputed national and international journals and book chapters. Budget During the Year 2009-10 Plan Rs. 12.00 crores Non Plan Rs. 17.00 crores Infrastructure Development As part of continuing efforts in upgrading and modernization of the Institute, various equipments relating to patient care and diagnostic and for research and development were procured. Major equipments added are: Whole Body Multi Slice Helical CT Scanner (64 Slices/Rotation), CCTV, Non Invasive Ventilator UV-VIS Double Beam Spectrophotometer, Spectrum Monitor, Hardware & Software for Archiving & Networking System, HPLC System, Body Composition Analyzer, Portable Aerosol Spectrometer, Nikon Ten Header Trinocular Microscope, Electrophoresis & Trans Blot Unit, Biosafety Cabinet, Nikon Trinocular Research Microscope, Refrigerated Incubator cum Shaker, NIBP Recording System, Blood Gas Analyser, Biosafety Cabinet, Whole Body Plethysmograph, Water Purification System, etc. In addition, most of the renovation works are done with an eye on Persons with Disabilities (PWD). Ramps are provided for easy access to OPD, Doctors Room, ICU, Medical Investigation Rooms, Wards, Parking places, etc. Exclusive parking places are provided (with proper signage markings) for PWD. In the Auditorium of our Institute, special toilets have been provided exclusively for PWD. Ramps are also provided for easy access for PWD to enter the Auditorium seats and stage. Renovations/upgradations of Biochemistry, Physiology, Pharmacology and Respiratory Allergy and Applied Immunology Departments of the Institute were completed. Renovations/upgradations of Microbiology, Medical Mycology, Clinical Biochemistry Departments as well as Staff Quarters are going on. Annual Report 2010-11 262 15.28. CENTRAL BUREAU OF HEALTH INTELLIGENCE (CBHI) 15.28.1. Introduction Established in 1961, CBHI is the National Nodal Institution for Health Intelligence in India, with the broad objectives to: (1) Maintain and Disseminate the (i) National Health Profile (NHP) of India, (ii) Health Sector Policy Reform Options Database (HS-PROD), (iii) Inventory and GIS Mapping of Govt. Health Facilities in India, etc. (2) Review the Progress of Health Sector Millennium Development Goal (MDG) in India, (3) Annual Road Safety Profile of India, (4) Facilitate Capacity Building & Human Resource Development, (5) Need Based Operational Research for Efficient Health Information System (HIS) as well as use of Family of International Classification(FIC- ICD-10 & ICF) in India and (6) Function as WHO-CC on FIC in India, closely links with WHO CCs on FIC in the World, Asia Pacific FIC Network & South East Asian Countries. 15.28.2. Organization (a) In Dte. GHS / GOI, the CBHI headed by Dy. Director General & Director has four divisions viz. (i) Policy & Infrastructure, (ii) Training, Collaboration & Research, (iii) Information & Evaluation, and (iv) Administration. (b) Six Health Information Field Survey Units (FSUs) of CBHI are located in different Regional Offices of Health and Family Welfare (ROHFW) of GOI at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna; each headed by a Dy. Director with Technical & Support staff, who function under the supervision of Sr. / Regional Director (HFW/GOI). (c) Regional Health Statistics Training Center (RHSTC) of CBHI at Mohali, Punjab (near Chandigarh), CBHI-FSUs and Medical Record Department & Training Centers (MRDTC) of Safdarjung Hospital New Delhi & JIPMER Puduchery; conduct various CBHI In-service Training Courses. 15.28.3. Major Activities of CBHI 15.28.3.a Maintain and Disseminate the National Health Profile of India on Annual Report 2010-11 263 Demography Population Statistics Vital Statistics Socio-Economic Education, Social Indicators, Economic Indicators, Employment, Housing & Amenities, Drinking water & Sanitation, Health Legislation in India, Survey on Morbidity, Health Care and Condition of the Aged. Health Status Morbidity & Mortality i. Communicable Diseases ii. Non Communicable Diseases Incidents of Deaths due to Accidents, Major Outbreaks Investigated by NICD , Reproductive & Child Health, Disability, Mental Health Health Finance Five Year Plan Outlays Health Expenditure & Financing Agents Human Resources in Health Sector, including AYUSH Health Infrastructure, including AYUSH Education Infrastructure (Medical, Nursing & Paramedical) Service Infrastructure Vaccine-wise and Institution-wise status of production, demand and supply Directory of Health Research Institution in India 15.28.3.b. Health Sector Policy Reform Option Database (HS-PROD) of India. Though States / UTs of India have undertaken reforms in the health sector, a lot of this goes unnoticed and hence not documented. Thus,MOHFW/GOI under its Sector Investment Programme (SIP) funded by European Commission, entrusted CBHI to develop and maintain HS-PROD. It is a web-enabled database that documents and further creates a platform for sharing of information on good practices, innovations in health services management while also highlighting their failures that are very important for the success of NRHM. The HS-PROD website (www.hsprodindia.nic.in) till date has documented more then 260 reform options from a varied range of fields and stakeholders like the States/UT governments, development partners, non-government organizations and categorized them under 16 key management areas. 15.28.3.c.Inventory & GIS Mapping of Government Health Facilities in India: For creation of an electronic database of government health facilities, educational institutions, training centres, and other health care establishments in India, CBHI has prepared a database of the Govt. health facilities for their mapping using Geographical Information System (GIS) for its wider dissemination through the CBHI website. It is an ICT based approach to strengthen the health care resources management and planning for efficient health services delivery as envisaged under NRHM. Data has been collected from all the 35 States/UTs from the periphery and other source agencies including Statutory Councils and GIS mapping of the Govt. health facilities uploaded on the national website www.cbhighf.nic.in during February 2008. All the States/UTs are in process of data validation & updating the Govt. health facilities online. Keeping in view the census 2011 village/area codes. Once the updation is done, the GIS view will be opened for web surfers access for public. 15.28.3.d. Millennium Development Goals. The Millennium Declaration adopted by the General Assembly of the United Nations in its Fifty-fifth session during September 2000 reaffirmed its commitment to the right to development, peace, security and gender equality, to the eradication of many dimensions of poverty and to overall sustainable development. These are intended for the Member Countries to take efforts in the fight against poverty, illiteracy, hunger, lack of education, gender inequality, infant and maternal mortality, diseases and environmental degradation. The Millennium Declaration adopted 8 development goals, 18 time-bound targets and 48 indicators to be achieved by 2015, of which 3 MDGs are directly related to health sector viz. reduce child mortality, improve maternal health and combat HIV/ AIDS, malaria and other diseases; for which CBHI is responsible for compilation in Dte.GHS/MOHFW/GOI. 15.28.3.e.National Level In-service Man-power Development Training Programs per year: Annual Report 2010-11 264 Training Course (and Batch size) Duration and Frequency CBHI Training Center (Details Over-leaf) Medical Record Officers (15) One Year Medical Record Department & 02 batches a year Training Centers at Medical Record Technicians (15) 6 months 4 batches a year (i) Safdarjung Hospital, New Delhi Training Course of Master Trainers on (ii) JIPMER, Puduchery Family of International Classification One week (5 days) (ICD-10 & ICF), 9 States/UTs per batch 2 batches in a financial year CBHI/RHSTC, Mohali (Near Chandigarh) Orientation Training Course on One week (5 days) Health Information Management for Officers (15) 2 batches in a financial year CBHI/RHSTC, Mohali Orientation Training Course on Health Information One week (5 days) Management for Non-medical Personnel (20) 14 batches in a financial year (i) CBHI/RHSTC, Mohali, and (ii) CBHI/FSUs at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna Orientation Training Course on Medical Record & One week (5 days) (i) CBHI/RHSTC Mohali, and International Management (20) 14 batches in a financial year (ii) CBHI-FSUs at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna. Orientation Training course on Medical Record & One Week (5 Days) (i)CBHI/ RHSTC, Mohal Information Management (20) 8 batches in a financial year. (ii)CBHI,FSUs Bangaluru Bhopal Bhubaneswar, Jaipur Lucknow & Patna On regular basis more than 40 batches of training courses covering more than 800 candidates are held every financial year. Training Calendar, Eligibility Criteria, Guidelines and Application Forms for all the above courses can be downloaded from the CBHI website www.cbhidghs.nic.in During 2010-11 (up to 10.12.2010), 521 Personnel from all over the country have been trained in various in-service training courses viz. Medical Record Officer, Medical Record Technician, Health Information Management for Officers, Health Information Management for Non- medical Personnel, Family of International Classification (ICD-10 & ICF) for Non-medical Personnel, Master Trainers on Family of International Classification (ICD- 10 & ICF) and Medical Records and Information Management through CBHI Training Centres and 13 batches of trainings are still to be conducted up to 31 st March, 2011. In 2011-12, 46 batches of in-service training courses are expected to train more than 900 functionaries. 15.28.3.f. Capacity Building, Operational Research & Reviews CBHI FSUs located in Regional Offices of Health & FW/GOI at Bangalore, Bhubaneswar, Bhopal, Jaipur, Lucknow and Patna help CBHI in getting the validated health information from States/UTs and facilitate in capacity building of health care delivery functionaries as well as operational research keeping in view the objectives of CBHI. The CBHI regularly undertakes half yearly meetings to review functioning of all the FSUs and Training Centres and during 2010-11, 12 th & 13 th half yearly review meeting was held during 7-8 July 2010 at FSU Lucknow and 14 th such meeting is tentatively scheduled during January 2011 in Rajasthan. The Multicentric Study on the Organisation & Functioning of Medical Record Department and use of ICD 10 in Secondary and Tertiary Level Allopathic Hospitals in Different Regions of India has been undertaken during 2010-11 in 12 State/UTs including 72 hospitals with the following objectives: (1) Situation Analysis of infrastructure in terms of the organisation, functioning, logistics and human resources along with their training & skills in a Medical Record Departments/Units in the hospital from CHC through tertiary level. (2) To study the present system of record generation, compilation, analysis, storage and retrieval of medical records in the hospitals. Annual Report 2010-11 265 (3) To study the usage of ICD-10 for morbidity & mortality coding along with major constraints and feasible solutions. (4) To recommend the improvisation and strengthening of Medical Record Department (MRD) and use of FIC (ICD-10 & ICF), in terms of optimal requirement on the: (a) Functions, (b) Organisation with regard to human resources and their training as well skill needs (c) Logistics including physical space and ICT and (d) Development of pool of trained manpower for efficient functioning of MRD. 15.28.3.g. CBHI As WHO Collaborating Centre on Family of International Classification (FIC) CBHI with due approval by MOHFW the Dte. GHS/ MOHFW, GOI has been (Sept., 2008) officially declared to function as WHO Collaborating Centre on Family of International Classifications (ICD-10, ICF & ICHI) for coding morbidities, mortality, related health aspects, function and disabilities in India, while closely, linking with South East Asia Pacific network on FIC. 15.28.3.h. CBHI Functions as WHO Collaborating Centre on Family of International Classifications (ICD-10 & ICF) in India, with major Terms of References to: (1) Promote the development & use of the WHO Family of International Classifications (WHO- FIC) including the International Statistical Classification of Diseases and Related Health Problems (ICD), the International Classification of Functioning, Disability and Health (ICF), and other derived and related classifications and to contribute to their implementation and improvement in the light of the empirical experience by multiple parties as a common language. (2) Contribute to the development of methodologies for the use of the WHO-FIC to facilitate the measurement of health states, interventions and outcomes on a sufficiently consistent and reliable basis to permit comparisons within and between countries at the same point in time by: (a) Supporting the work of the various committees and work groups established to assist WHO in the development, testing, implementation, use, improvement, updating and revision of the member components of the WHO-FIC. (b) Studying aspects related to the structure, interpretation and application of contents those concerning taxonomy, linguistics, terminologies and nomenclatures. (c) Participating in the quality assurance procedures of the WHO-FIC classifications regarding norms of use, training and data collection and application rules. (3) Network with current and potential users of the WHI-FIC and act a reference centre (e.g. clearinghouse for good practice guidelines and the resolution of problems) by: (a) assisting WHO Headquarters and the Regional Offices in the preparation of member components of the WHO-FIC and other relevant materials. (b) Participating actively in updating and revising the member components of the WHO-FIC. (c) Providing support to existing and potential users of the WHO-FIC and of the data derived in India and SEARO Region. Linkage will also be made with other countries of Asian pacific Region for seeking status on FIC implementation. (4) Work in at least one related and / or derived area of the WHO-FIC: Specialty based adaptations, primary care adaptations, interventions/ procedures, injury classification (ICECI), and (5) Present periodic reports of the centres activities to the annual meetings of heads of WHO Collaborating Centres for the WHO Family of International Classifications (WHO-FIC). i. Director (CBHI) attended WHO FIC Network Annual Meetings, 16-22 Oct. 2010 at Toronto, Canada. 15.28.3.i. Maintenance of Three CBHI National Web Sites. CBHI with the assistance of NIC, has recently (2008- 09) redesigned & reformatted its three websites viz. (i) www.cbhidghs.nic.in (ii) www.hsprodindia.nic.in (iii) www.cbhighf.nic.in, for online data transmission and public viewing. Annual Report 2010-11 266 (i) CBHI website www.cbhidghs.nic.in contains general information about CBHI, National Health Profile, Mortality Statistics in India (2006), Right to Information Act, National Recommendations on improving and strengthening Health Information System, as well as use of ICD 10 in country, CBHI case study & recommendations on human health resource requirement, CBHI in-service training programmes/ calendar along with application forms, Module & Work Book on ICD 10, Reporting formats for health data from States/UTs to CBHI, etc., (ii) CBHI Website www.hsprodindia.nic.in contain entries related to Health Sector Policy Reform Data Base of India and being updated from time to time. (iii) CBHIs third website www.cbhighf.nic.in containing inventory & GIS mapping of the Govt. health facilities, was launched by DGHS/GOI. 15.28.3.j. Major Publications of CBHI (2010) (1) Trained Manpower Document on Family of International Classification Cation (ICD-10 & ICF): Indian Experiences (2004-2010),October, 2010 (2) National Health Profile (NHP) 2009, March20, 2010. 15.28.3.k.CBHI Activities under WHO/GOI, (Biennium 2010 & 2011) are as under 1. National Review on the use of ICD-10 in 6 different Regions of India & to recommend on further improvisation and strengthening. (1) Development of Advocacy & Training kit well as Simplified coding manual for family of International classifications (ICD-10 & ICF) (2) National consultation to update the framework and guidelines for disability certification to principles of ICF in India, (3) National Review on updation of data on GIS mapping of all the Government Health Facilities in all the 35 States/Uts. 15.28.3.l. CBHI On Line Data Entry System through website www.cbhidghs.nic.in. State/UT HFW directorates are responsible for punctually and regularly furnishing the (i) Monthly Communicable Diseases (ii) Monthly Non-Communicable Diseases, and (iii) Annual Data on Medical/Nursing/Para-Medical education & infrastructure in the prescribed formats to CBHI/ Dte.GHS. Based on this information from all the States/UTs and other reporting agencies, provide up-to- date data related to morbidity & medical/health infrastructure for framing reply to the Parliament Questions. CBHI also brings out annual publication National Health Profile which serves as National Reference Document for policy, planning and evaluation now of health related activities in the country. The above requisite health information are being sent by the States / UTs On-line through CBHI webside www.cbhidghs. nic.in. 15.28.4.CBHI Linkages and Coordination 1. All 35 States/UTs of India 2. All 20 Regional Offices of Health & FW of GOI 3. National Rural Health Mission (NRHM) and National Health Programmes in India 4. Medical, Nursing & Paramedical Councils & Educational Institutions 5. Public Health/Medical Care Organizations and Research Institutions under Department of Health Research including ICMR and Various other Ministries 6. Census Commissioner & Registrar General of India 7. Planning Commission, Government of India 8. Union M/o Statistics & Programme Implementation 9. Union Ministries of Railways, Labour, HRD, Rural Development, Communication & Information Technology, Shipping Road Transport & Highways, Home Affairs, Defence, Social Justice & Empowerment etc. 10. Non-Government Organizations in Health & related sector s in India 11. WHO and other UN Agencies Concerned with Health and Socio-economic Development 12. European Commission Annual Report 2010-11 267 13. All the WHO Collaborating Centres on Family of International Classification (FIC) in the world, Asia Pacific Network on FIC and countries of South East Asia Region 15.28.5. Budget CBHI under this budget head Health Information and Monitoring System has been allocated an amount of Rs.16850000 BE Rs.15770000 RE Rs 15000000 BE for 2011-12 proposed in plan for the financial year 2011-12. 15.29.NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES (NEIGRIHMS), SHILLONG North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) has been established in Shillong, on the lines of AIIMS, New Delhi, and PGIMER, Chandigarh, with the objective of providing advanced specialized Health-care to the people of North East Region. An amount of Rs. 1266.38 crore has been allocated for the Institute in the 11 th Plan. This Institute has been planned to include a 500 bedded referral hospital with 35 teaching departments at postgraduate level in various specialties and super- specialties. A fifty seat Nursing College and Under Graduate MBBS College has already started functioning from the Institute. PG Courses in Anesthesiology, Obst. & Gynecology, Microbiology and Pathology have started in 2009-10 Total staff strength in the Institute Budget Allocation & Expenditure for the years 2010-11 is indicated below:- Sl. Total Staff Post Filled Vacancy No. sanctioned up position 1 NEIGRIHMS 1524 850 674 Name of the Institute Allocation Amount 2010-11 released as on 17.01.2011 NEIGRIHMS 102.85 67.85 15.30. NATIONAL INSTITUTE OF BIOLOGICALS (NIB), NOIDA The Ministry of Health & Family Welfare has established the National Institute of Biologicals (NIB) as an Apex Scientific institution in the country at an estimated cost of Rs. 269.24 crores. The Institute shall be a National Control Laboratory (NCL) for assuring availability of high standards and good quality of biological products namely Vaccines, Blood products, Recombinant DNA products, Reagents, Immunodiagnostic kits, Therapeutic Enzymes & Hormones, Glucometers, Allergens, etc. that are manufactured indigenously or imported into the country. The scientific activities of the Institute are performed by Laboratories carrying out the Quality Control Evaluation/ testing of different batches of various types of Biologicals as under : a) Critical immunodiagnostic kits (ELISA, rapid, confirmatory and automated kits) for diagnosis of HIV, HCV and HBsAg & Syphilis. (b) All categories of Blood Grouping Reagents like Monoclonal, Polyclonal, blend and type like Anti- A, Anti-B, Anti-AB, Anti-D (lgM), Anti-D (igM+igG), Anti-D(lgG), Anti-C, Anti-c, Anti-E, Anti-e, Anti-H (Lectin), Anti Human Globulin (AHG) and Bovine Serum Albumin (BSA), Anti- K, etc. In addition evaluation of Blood Grouping kits are also done. (c) Blood Products like Human albumin, normal and specific immunoglobulin, coagulation factors (factor-VIII & IX), Plasma Protein fraction & Fibrin Sealent. (d) Biotherapeutics Enzyme and Hormones like Streptokinase, hCG&FSH (e) Viral and Bacterial Vaccines OPV, MMR, CCRV, HRIg, TAT, Alib, Meningococcal, etc. (f) Recombinant products like Insulin Analogs, Interferon and Erythropoietin. (g) Biochemical test kits like for Glucose, Cholesterol, Triglycerides, HDL & LDL (h) Allergens like House dust mites & cockroaches (i) Preparation of National Reference Standards and well characterized Sera Panels with traceability. Annual Report 2010-11 268 In addition to the above mentioned main laboratories, there are other supporting laboratories/units like the Bioassay, animal facility, Sample Receipt & Report Despatch Section, Quality Management Unit, etc. Performance Report (a) Since 1997, NIB has been doing Quality Control Evaluation of various batches of critical immunodiagnostic kits for HIV, HCV, HBsAg and Syphilis. The main functions of the Diagnostic Division is to certify the quality of diagnostic kits for assuring the safety of blood from the viral diseases at blood banks resulting in Safe Blood Transfusion. The types of kits evaluated are Enzyme Linked Immunosorbant Assay (ELISA), Enzyme Immunofluorescent Assay (ELFA), Chemi Lumniescence Immuno Assay (CLIA), Rapid & Confirmatory (Western Blot, RIBA & Neutralization antibody). These kits are either indigenously manufactured or imported, and referred by the port offices and CDSCO offices of DCG(I). The total number of kits evaluated during the year was 177 out of which 55 kits were for HIV, 53 kits for HBsAg, 60 kits for HCV & 4 each for Syphilis and HIV-HCV combo kits. Evaluation was done as per Standard Operating Procedures based on WHO guidelines. The Laboratory has prepared characterized sera panel for evaluation of HIV, HCV and HBsAg and have been supplied to indigenous licensed diagnostic kits manufacturing 165 Laboratory Technicians from CHCs, PHCs, IECS, Blood Banks, District & Private Hospitals and Medical Colleges from various districts of U.P. and Uttarakhand have been trained in HIV testing. The lab has participated in International and External Quality Assessment Programme (EQAS) for HIV & HCV with National Serology Reference Laboratory Australia. The lab has also conducted EQAS for NACO State Reference Laboratories of Uttar Pradesh and Uttarakhand. Under NACOs HIV Sentinal Surveillance (HSS) in 45 Targeted Interventure (T.I.) based high risk group based in the States of U.P., Bihar and Assam. 12000 dried blood spot (DBS) testing was done. In addition to Evaluation of kits for its quality, a total number of 60 batches of Blood Products, Human albumin Immunoglobulin Factor VIII Fibrin Sealant, Hepatitis B Immunoglobulin were tested for Transfusion Transmitted Infection (TTI). (b) The Blood Grouping Reagents Laboratory is a notified CDL under the Drugs & Cosmetics Act for Quality Control Evaluation and Batch Release Certification of Blood Grouping Reagents. The Institute, besides dealing with legal samples referred by CDSCO, also certifies the quality of Blood Grouping Reagents for safe blood transfusion services. The Institute during the year tested and reported 55 batches of Blood Grouping reagents (c) The Blood Products samples in the Institute are received from and through the Port Offices of the DCG (I) for Quality Control Evaluation and pre-release certification. A total of 53 batches of such blood products received for evaluation during the year were Human Albumin, Coagulation Factor (Factor VIII & IX), Fibrin Sealant Kit, Plasma Protein, Plasma Protein Fraction, and human normal IgG (Immunoglobulin) IV & IM, Specific Immunoglobulin (Anti D IgG). (d) The Enzymes and Hormones Laboratory has been set up to evaluate the Quality Control testing of Biotherapeutic Enzymes and Hormones namely Streptokinase, Urokinase. The work has been initiated on Human Chorionic Gonadotropin. During the year 3 batches of streptokinase were tested and reported. Standardization of parameters for Q.C. evaluation of heparin is also in progress. (e) The Bacterial Vaccine Laboratory was established to initiate the Quality Control Testing of Bacterial Vaccines for pre-release certification. The laboratory have standardized quality control test parameters to take up the testing of BCG vaccine (live attenuated) and polysaccharide vaccine viz. Haemophilus Influenza type b conjugate vaccine. The viral Vaccine Laboratory of the Institute, during the year, have (i) standardized the quality control parameter of Live Attenuated MMR Vaccine and Cell culture Rabies Vaccine. 6 batches of MMR and 4 batches of Rabies vaccine have been tested. The approval for the safety test has been taken up. The testing of Rabies Immune-globulin and Tetanus Antitoxin is ready to be taken up. (f) Recombinant Products Laboratory has been established for Quality Evaluation of Annual Report 2010-11 269 Recombinant Products derived by recombinant DNA technology. Laboratory has standardized 12 parameters for testing of rh-Insulin and Insulin analog formulations and during the year 86 batches from 11 different formulations of Insulin and Analogs have been tested and reported upon. This includes Insulin formulations namely Regular. NPH, biphasic (50:50, 25:75, 30:70), Lispro, Aspart, glargine, Glucagon like peptide. Developed Pharmacopoeia specifications for Human Insulin to be incorporated as addendum in insulin monograph. Preparation of National Reference Standard for Insulin Human was taken up by Inter- laboratory collaboration at National & International level. Newer products are ready to be taken up are hematopoiteic factors, and Analogs Detemir, Glulisine. (g) Biochemical laboratory for evaluation of test kits is in the initial phase of its establishment to develop methodology for routine biochemical kits for Glucose by collection of fresh left over blood samples from various reputed hospitals. Similarly Glucometers and test strips have been studied as per the method developed for it. The process of standardization of the other biochemical kits viz., Cholesterol, Triglycerides, HDL & LDL have been initiated. (h) Bioassay Lab for Sterility test has performed the test as per Pharmacopoeia requirements given in USP, BP and IP by 3 methods viz., direct inoculation, membrane filtration and closed system membrane. Total of 134 samples have been tested for sterility test on samples of insulin formulations and blood products referred by respective laboratories. (i) Animal Facility registered with CPCSEA in 2004 is fully functional to perform mandatory in vivo tests for the Quality Control Evaluation of Biologicals as given in Pharmacopoeia. During the pre-view period, IAEC approval has been taken for mandatory regulatory tests on Human Albumin, Streptokinase, Immunoglobulin, hCG Hormone, live attenuated Measles Vaccine, Cell Culture Rabies Vaccine and Hyperimmune Rabies serum. Abnormal toxicity assay has been performed on 21 batches of Human Albumin, 2 batches of Plasma and 3 batches of Streptokinase. Potency Assay for LCG Hormone and abnormal toxicity assay for polysacctraride vaccine viz. Haemophilies influenza type B conjugate vaccine has been standardized and Progen test on rabbies is under standardization. (j) Nucleic acid testing laboratory has been established for Nucleic acid based detection of Transfusion Transmitted Viruses (HBV, HCV, and HIV1) in human plasma samples. During the year 07 samples were tested on plasma and albumin for HBV, 02 samples for HIV and 06 samples for HCV by viral RNA extraction. (k) Reference standard Unit maintains a repository of traceable Standards procured from NIBSC, USP, EDQM, BBI, Paul Ehrlich and WHO. These are for diagnostic Kit, blood grouping reagents, blood products, enzymes and hormones, recombinant products, bacterial and viral vaccines. (l) Quality Management Unit has prepared the quality manual document as per requirements of ISO 17025. It has taken up the process of filing application to NABL for accreditation of laboratories as per chemical and biological tests. To include in the 1 st phase testing of various Biologicals like Immunodiagnostic Kits, Blood Products, Blood Grouping Reagents, Enzyme & Hormones and Recombinant products, sterility tests and Animal tests were included. The unit conducted an Internal Quality Audit Management Review Meetings for compliance of actions and the pre- inspection by the NABL Lead Auditor for the same was held in April 2010. BUDGET The funds of the Institute are received as Grant-in-aid from the Ministry of Health & Family Welfare. The B.E. & R.E. of the Institute are as under: Year B.E. R.E. Expenditure 09-10 15.00 11.00 10.98 10-11 17.25 15.00* 8.38 # 11-12 17.80 * - * proposed # up to Nov. 2010 Rs. in crore Annual Report 2010-11 270 15.31. BCG VACCINE LABORATORY, (BCGVL) GUINDY Activities The BCG Vaccine Laboratory was engaged in the following activities : Production of BCG Vaccine (10 doses per vial) for control of childhood Tuberculosis and supply to Expanded Programme of Immunization (EPI) since 1948. Production of BCG Therapeutic (40 mg.) for use in Chemotherapy of Carcinoma Urinary Bladder since 1993. Performance of Laboratory at Present: After revocation of suspension of manufacturing licence vide Ministry of Health & Family Welfare Order No.X.11035/2/2010-DFQC dated 26.2.2010, the manufacturing of BCG Vaccine 10 doses has started. BCG Cancer Vaccine (40mg): Production of BCG Vaccine (40 doses) has yet to start. Total Revenue Earned: Total revenue earned is Rs.2,73,233 from Sale of Guinea Pigs, Sale of condemned items, Licence fee for Community Hall and Guest House. Important Achievements during 2010-11: After the revocation of suspension of manufacturing licenses, production process has been initiated. Sl. Sub-head Budget Grant 2010-11 Expenditure Balance available No. incurred from 1.4.2010 to 31.10.2010 1 Salaries 6,00,00,000 2,39,29,527 3,60,70,473 2 Medical Treatment 12,00,000 1,12,660 10,87,340 3 Overtime Allowance 20,000 14,667 5,333 4 D.T. E 5,00,000 99,001 4,00,999 5 Office Expenses 37,00,000 20,57,564 16,42,436 6 Supplies & Materials 3,00,00,000 1,07,87,656 1,92,12,344 7 Advt. & Publicity 2,50,000 81,718 1,68,282 8 Minor Works 35,00,000 12,10,456 22,89,544 9 Mach. & Equipment 2,58,30,000 31,42,859 2,26,87,141 TOTAL 12,50,00,000 4,14,36,108 8,35,63,892 Budgetary Details: Budget Grant- 2010-11-Non-Plan (Actual Expenditure as on 31.10.2010) Budget grant 2010-11- Plan (Revenue) Sl. Sub-head Budget Grant 2010-11 Expenditure Balance available No. incurred from 1.4.2010 to 31.10.2010 1 Office Expenses 50,00,000 18,83,419 31,16,581 2 Materials & Supplies 1,40,00,000 4,94,910 1,35,05,090 3 Machinery & Equipment 2,85,00,000 2,00,226 2,82,99,774 TOTAL 4,75,00,000 25,78,555 4,49,21,445 Annual Report 2010-11 271 Budget Grant-2010-11-4210 Capital Outlay on medical and Public Health (Major Head) Sl. No. Sub-head Budget Expenditure Balance grant 2010-11 incurred from Available 1.4.2010 to 31.10.2010 1 Motor Vehicles 1000000 0 1000000 2 Machinery & Equipment 4000000 0 4000000 3 Major Works 5000000 0 5000000 TOTAL 1,00,00,000 0 1,00,00,000 Group Wise Staff Position of BCG Vaccine Laboratory, Guindy, Chennai Group Sanctioned Abolished Present Filled Vacant Excess Strength Strength Incumbent Group-A 3 - 3 2 1 - Group-B Gazetted 4 - 4 - 4 - Group B Non-Gazetted 14 5 9 5 4 - Group-C 160 63 97 122 3 28 Total 181 68 113 129** 12 28 ** The filled posts include excess incumbents whose appointments were made after receipt of various recommendations of MHFW for abolition of posts/abolition orders under optimization Scheme/IWSU. 15.32 ALL INDIA INSTITUTE OF HYGIENE AND PUBLIC HEALTH (AIIH & PH), KOLKATA Background The All Institute of Hygiene and Public Health (AIIH&PH), Kolkata was established on 1932 with the assistance of Rockefeller Foundation. This institute is pioneering in Post-Graduate Teaching and Research in various disciplines of health intelligence and health services. The Institute continues to pursue with its mandate for development of human resources in the field of Public Health since its inception. The primary objectives of the Institute are: To develop health manpower by providing post-graduate training facilities of the highest order; To conduct research directed towards the solution of various problems of health and diseases in the community; To undertake fundamental and operational research to develop methods for optimum utilization of health resources and application of the findings for protection and promotion of health care services. Institutional set up The Institute has eleven academic Departments and two (2) field practice areas, one at Urban Health Centre, Chetla, Kolkata and the other at Rural Health Unit & Training Centre, Singur, Dist. Hooghly. Under the aegis of these departments and field practice units, various teaching/ training courses, field programs and workshops are conducted. The Institute also houses a reference Annual Report 2010-11 272 library especially on health sciences to cater to the needs of the students, faculty and other users. Two hostels, one for men and another for women, are located in the vicinity of the main building of the Institute to accommodatre students and guests. Hostel facilities are also available at Rural Unit & Training Centre, Singur. Work on construction of the Institutional Block in the Bidhan Nagar campus of the Institute coming up at Salt Lake, Kolkata is almost complete. Construction of 44 residential quarters, substation building, international hostel and guest house along with associated services has already been completed. Budget Allocation The Institute has been allocated the following Budget Grant during the financial year 2010-11: Budget Head Plan Non-Plan Total Grant(Rs. Crores) 7.22 16.87 24.09 Besides, international agencies like WHO, UNICEF etc. Other central and state agencies also provided funds to this Institute to carryout various projects/research activities in Public Health & Hygiene. Teaching and Training Activities During the year 2010-11, the Institute conducted MD/ Community Medicine and Masters degree Course in Veterinary Public Health, Post Graduate Diploma Courses viz., DPH, DMCW, DIH, DHE, Dip- Diet, DPHM, DNEA, DHS, M. Sc. in Applied Nutrition , MPH and MEPH. The Institute organized the following courses: Training on Trainers in Immunization for MOs For NE States supported by NIHFW, New Delhi FETP course for District Surveillance Officers of the IDSP of Nagaland, Mizoram, Tripura and West Bengal. Communicable Disease Epidemiology & its application in Health Promotion Prevention and Control Advance Methods in Epidemiology, Bio-Statistics and Research PLA for Health Promotion & Education Health Risk Behavior, Surveillance & Promotion for NCOs Life skill education for Adolescent health Institutional Capacity Enhancement Training in Health Promoyion to train a group of master trainers from Bhutan in collaboration with WHO SEARO, August 09. Behavioral change in Public Health. Important Projects/Research Activities Public Health Problems Particularly on Public Nutrition , Community Nutrition , Micronutrients, Malnutrition & street food. Prevalence of Arsenicosis in West Bengal. Monitoring & surveillance activities in HIV / AIDS surveillance in West Bengal & North Eastern States supported by NACO. Conducted WHO (FIP) on Epidemiological concepts in Malariology and its prevention and control & Epidemiology of Comuincable/Non- communicable Diseases. Other Important Activities a. The Department of PHA, as the Nodal department, has conducted Professional Development Course (PDC) for District level officers, which is sponsored by Govt. of India and European Commission. b. The Department of Epidemiology organized two Pre-Surveillance Training Workshops for the participants from 11 States under HIV Sentinel Surveillance (HSS). c. The Department of Microbiology along with the Department of Epidemiology of this Institute has been identified by NACO as the Departments of Regional Institute (RI) for the HIV Sentinel Surveillance Programme. d. The Department of Sanitary Engineering Provides services of water/ waste water analysis to various Government organizations, municipal authorities, NGOs etc. e. The Sanitary Engineering Department, Govt, of West Bengal & UNICEF in various ways for the mitigation of arsenic problems in West Bengal. f. 30 trainees have so far been nominated by WHO for training in different courses in the biennium 2009-10. Annual Report 2010-11 273 g. The Department of Microbiology is conducting IDSP training programmes for District Medical Officers for the 3 rd phase of the training in the North Eastern States of India. h. Counseling through video-conferening of MBBS/ BDS(15%) seats, MD, MS/MDS (50%) under ALL India UG/PG quota, AIIH&PH has been one of the counselling venue. Field Practice Units: Two Field Practice Units viz. Urban Health Centre, Chetla, Kolkata and Rural Health Unit & Training Centre, Singur, Hooghly (West. Bengal) are operating smoothly under the direct control of AIIH & PH. Besides the field Practice services offered to the students of the Institute, the field units are also providing excellent clinic based preventive, promotive & curative services to the community. Library Services: The Institute has a large reference library, offering excellent services on health information and other related matters to various users. The Library is having about 65000 (approx) books and Journals. The stock of the library is constantly being enlarged and enriched every year through acquisition of latest books & journals, periodicals, etc. Implementation of official language policy The Praveen / Pragya training under Hindi Teaching Scheme has been started in the Institute itself. Staff and officers nominated for Prveen /Pragya. Officers/staff successfully completed the Praveen / Pragya training under Hindi teaching Scheme. Details of the courses are being conducted at AIIH&PH, Kolkata are given below. SI. Name of Course Session Duration Sanctioned Student Vacant No strength admitted 1. Doctor of Medicine (Community Medicine) 2010-13 3 years 11 06 05 2. Diploma In Public Health 2010-12 2 years 92 71 21 3. Diploma in Maternal & Child Welfare 2010-12 2 years 46 45 01 4. Diploma in Industrial Health 2010-12 2 years 15 11 14 5. Master of Veterinary Public Health 2010-12 2 years 15 02 13 6. Master in Public Health 2010-12 2 years 31 18 13 7. Diploma In Nursing Education & Admn. (Child Health) 2010-11 1 years 62 08 54 8. Diploma in Public Health Management 2010-11 1 years 25 04 16 9. Diploma in Dietetics 2010-11 1 years 31 09 22 10. Diploma in Health Education 2010-11 1 years 46 39 07 11. M.Sc(Applied Nutrition) 2010-12 2 years 31 16 15 12. Master of Engineering Public Health 2010-12 2 years 23 00 23 13. Diploma in Health Statistics 2010-11 1 years 08 00 08 15.33. CENTRAL LEPROSY TRAINING AND RESEARCH INSTITUTE, CHENGALPATTU, TAMIL NADU Introduction: The Central Leprosy Teaching and Research Institute (CLT&RI), Chengalpattu was originally established in 1955 by the Government of India under a Governing Body by taking over Lady Wellington Leprosy Sanatorium established in 1924. Later, in 1974, Govt. of India had made CLT&RI as a subordinate office of Directorate General of Health Services, Ministry of Health & Family Welfare with an objective to provide diagnostic, treatment and referral services to leprosy patients, trained Annual Report 2010-11 274 manpower development for leprosy, control / elimination besides, research on various aspects of leprosy and its control. It has separate wings of Epidemiology and Statistics, Clinical, Medicine, Microbiology and Bio- chemistry laboratories with Animal House facilities, Surgery and Physiotherapy. This institute caters to both indoor and outdoor patients. The hospital has bed capacity of 124 patients. This Institute is also recognized as one of the nodal centers by Central Bureau of Health Intelligence (CBHI), Dte.GHS, Govt. of India for conducting Health Statistics training course for Medical Officers. During 2010-11 till 30 th November, 2010 following activities were carried out in the Institute. Inpatients services Total patients treated = 554 Total Discharges = 399 Patients remain at the end of the year = 37 Out patients: Total patients treated = 5541 Physiotherapy Section: New Case Registration : 40 Surgery 2010-2011 (till 30-11-2010) Reconstructive Surgery: Claw finger correction 11 Claw thumb correction 6 Wrist Correction 1 Drop Foot Correction 3 Surgical Decompression of Nerves: Ulnar Nerve 3 Ulcer Surgery 5 Miscellaneous like ear lobe repair, Biopsy, SSG Knee disorganization, MTH resection, Calcaneal shaving etc 5 Total 34 Total number of cases (for Exercise, Therapy, etc) : 4110 Radiography Section: Total Number of Ski grams taken = 168 (as on 30-11- 2010) Micro-Cellular Rubber Mill: MCR Sheet Production = 920 (as on 30-11- 2010) Division of Laboratories Clinical pathology & Skin Smear 831 Haematology & Serology 3000 Microbiology 100 Histopathology & Molecular Biology 71 Bio Chemistry 3130 Training Section All four Divisions, Clinical, Surgical, Epidemiology & Statistics & Laboratories are actively taking part in the various teaching and training programmes conducted by the Institute. The details of the programmes are as on 30-11-2010 follows:- S.No Category of service Number of participants attended the training 1 Non Medical Health Supervisors Training Course 83 2 Medical Officer Skin Smear Training (10 days) 1 3 PG Medical students from CMC & CRRI 53 4 Lab technician Skin smear raining (5 days ) 5 Annual Report 2010-11 275 15.34. REGIONAL LEPROSY TRAINING AND RESEARCH INSTITUTE, RAIPUR, CHHATTISGARH RLTRI, Raipur is under the DGHS, continuously serving is having 75 beded indoor patient services and is providing daily OPD services. It is also having well equipped Laboratory and well trained technical manpower in the laboratory for skin smear examination and other laboratory investigation. The Institute has well equipped Operation Theatre and an expert Orthopaedic Surgeon to undertake various kind of Re-constructive surgery for leprosy related deformity. As per the existing guidelines of the Government of India, the treatment of Leprosy is now available in every health facilities and in the changed scenario after integration the Institute provides only technical guidance as and when required. Need based training program for all categories of medical personnel in the field of leprosy are organised. Condensed training program for Medical Officers as well as for the field level workers has been developed. The Institute has all the facilities and expertise to conduct the training program. The Institute is also having well equipped indoor facility. A total of 356 cases were admitted in the indoor wards which includes 116 patients having ulcers, 58 patients having ENL reaction. The average monthly bed occupancy ratio of indoor wards during the year 2009- 2010 was 50% and average duration of stay of the patient was 38 days. Leave against Medical Advice (LAMA) rate was less than 1%. 118 new and old RCS cases were also admitted in the indoor wards for Physiotherapy and treatment. 15.35. REGIONAL LEPROSY TRAINING & RESEARCH INSTITUTE ASKA, ORISSA This institute was established in the year 1977. At present there is 47(Gr.A-2, Gr.C-23, Gr.D-20) staff in position out of 67 sanctioned posts. It has a 50 beds hospital and average bed occupancy is about 52%. The institute provides both Outdoor and Indoor services to leprosy patients. The institute also works as a referral center for management difficult to diagnose leprosy cases, Skin smear examination and problematic, complicated and intractable cases of reaction and ulcers. Physiotherapy measures and MCR chapples are provided to the needy patients. Amputation and various other surgical procedures are carried out regularly and RCS (Reconstructive Surgery) camps have been done in the past. It also works as a nodal training and research center for the cause of leprosy elimination. Brief activities performed by this Institution 1. OPD Attendance - 954 (Leprosy -728 , Non-Leprosy -226 ). 2) Indoor - Total admission -280 3) Reaction cases Managed -63 with Thalidomides 5. 4. Major Surgeries :- 41 5) DPMR - 153 ( exercise, POP-37, splint-Nil, Crape Bandage -03) MCR Chappals -436) Lab:- Total Inv. - 1426 ( Clinical - 740, Microbiology (Skin Smear ex).- :- 80, Parasitology & haematology :- 588 Bio- Chem.-18) 7) Training: Faculty of this institute is going as resource person to impart modular trg. in NLEP to doctors and Paramedical staffs of state and also participate in NLEP review and planning meeting of states. 15.36. REGIONAL LEPROSY TRAINING AND RESEARCH INSTITUTE, GOURIPUR, BANKURA, WEST BENGAL Regional Leprosy Training and Research Institute, Gouripur, Bankura, a 50 bedded leprosy hospital set up by Central Govt. in 1984. The performance report up to 31 st October, 2010 during the year 2010-11 is as detailed below- i. One day orientation training given to Homeopathy Student nos. 45 ii. Admission-97 Discharge-100, New Case-35 Other case-1916 MDT given-314, Staff Treatment- Other cases attended-2551 iii. Group Discussion- 249 Leaflet distribution-699, School Survey-0 nos., Student exanubed-0, Suspected Case-0, Film Show 0, IEC programme-47 iv. Plastering 19 pts, Ray-220 pts, Wax Therapy- 325 pts, Exercise and massage for indoor pts averagely 8 pts daily v. 140 nos exposure vi. Slit Skin Smear 571, Bio-chemistry-184, Clinical Pathology-235. 15.37.NATIONAL MEDICAL LIBRARY Introduction National Medical Library (NML) provide valuable library information services to support the academic, research Annual Report 2010-11 276 and clinical work Health science professionals in the country. It occupies important position in countrys health care information delivery system. Some of the significant services provided by NML are: 15.37.1. Reference services & collection building One of the greatest strengths of NML is its richest collection of books, reports, serials, bound volumes of journals and computer databases. This invaluable treasure of biomedical and health science information, which is often the only source,is widely used by professionals from all parts of the country. It has collection of over 1.35 lakhs books and over 5.2 lakhs bound journals. The Library subscribed 1510 print journals worth Rs. 7.44 crore in 2010. Library follows Open-Access system for shelf arrangement. Library added 390 volumes (books purchased 1035+ serials purchased 90+Gift books 30) by spending over 34.57 lakhs in the year 2010. The books and journals acquired during the year have been classified and catalogued by using LIBSYS library software package. 15.37.2. Local Area Network (LAN) and Online Public Access Catalogue (OPAC): Servers and computers in the library are networked to form a LAN having an integrated Library Management Software Package LIBSYS. About 40,500 records of books are now available through OPAC computer search by library users. Leased lines of (100 mbps) and broad band internet facilityis available to provide Internet services including access to full-text of the journals. Information Retrieval Services NML has been offering the service using MEDLINE since 1990. Besides, it has about 500 CDs on different subjects. The biomedical information sources available on Internet, namely PUBMED, PUBMED Central, ERMED etc. were also accessed to meet the requirement of library users. Many articles were searched through MEDLINE service for getting references and abstracts for research scholars during the year. A Work station having the facility of 10 terminals fitted with CD writer is being developed for on-line access of foreign medical journals. Scheme to Inter-linking of Government Medical College Libraries with the NML. Government colleges are provided with financial assistance to acquire hardware, software, Internet connectivity and to hire contractual staff. This scheme has already covered 78 medical college libraries. The project aims to develop information communication technology capability among the participating colleges to be able to access the online information resources available in NML. Reference and Documentation Services The library remains open on 359 days of the year from 0900 - 2000 hrs on weekdays and from 0930 - 1800 hrs on holidays. Over 150 users visit the library every day for reference, consultation, obtaining photocopies of required articles and information retrieval service. Library has been visited by information seekers to avail following services: Queries answered 4798 New Membership 74 Issue/return of documents 1270 Inter Library loan (Print documents) 14 Library developed database of over 6000 medical thesis/ dissertation submitted to medical colleges across the country. The same is available at<Search Medthes> at www.nml.nic.in. The library also developed a database of over 4000 medical articles published in Indian Medical journals in the country in MARC21 software under the Index Medicus-India project. The library also developed the database of over 6000 medical thesis submitted to different medical colleges across the country. The database is widely used through the NML website. Library brings out a quarterly List of New books Added to NML. It is also bringing out a weekly Indian Press Index on Health which covers important press release on topics related to health science in prominent Indian newspapers. Document Delivery Service The Document Delivery Service provides access to the full text of documents needed by various medical specialists. This service is in fact used more widely than any other service of the library and caters predominantly to requests for copies of articles in journals (current as well as back files). A large number of request for photocopy of articles are received from outside Delhi by post, e-mail and fax through Government as well as private photocopy counters. Photocopies of about 7089 (approx.) articles per month are provided to medical research scholars across the country, in which postal charges are free for delivery of articles to outside Delhi states. Annual Report 2010-11 277 ERMED-India e-journal consortium Over the years the National Medical Library (NML) has been providing a wide variety of Health Information dissemination activities focused on reaching out Health Care Professionals of the country. NML disseminates over 8000 ( 8000 x 5 =40,000 pages) photocopy of articles from medical journals per month to medical scholars across the country. The system involves sizeable photocopy machines + man power + maintenance of back ,volumes of medical journals, their shelving and repeated binding due to extensive use of journals.Despite above tedious efforts the end user does not get efficient document delivery service due to delay in postal services and human handling. In 2010 ERMED purchased 1180 e-journals at the cost of Rs 10.20 crores for 98 members (2 private members have made their own payment for per site e-journals). The consortium recorded over 1,92,082 download of full text of articles from Jan- Jun 2010, which shows optimum utilization of ERMED resources . NML envisions that the availability of latest knowledge and skills through global Medical Literature to Indian Medical Fraternity will be able to improve Medical Research output of the country and ensure effective Health Care System for All. Training: The Training cum Orientation programme for ERMED at National/Regional/State level has been conducted to create awareness and make the system more user friendly at the following Institutions mentioned below: (i) For Chandigarh, Haryana and Himanchal Pradesh, at PGIMER, Chandigarh, on 9 th April 2010. (ii) For Gujrat and Madhya Pradesh, at BJMC, Ahmedabad on 20 th April 2010. (iii) For Tamil Nadu, Puducherry and Port Blair at Dr.MGRMU on 27 th April 2010. (iv) For Uttar Pradesh, at SGPIMS, on 21 st May 2010 (v) For West Bengal, at PGMER & SSKM on 19 th April 2010. NML also provided sufficient number of Users Manuals and Posters to each participant to enhance awareness for ERMED. It is expected that the search skill of the users will be more efficient in future to make use of the ERMED resources. Consultancy services provide to followingHospitals/ Institutes: National Institute of Health & Family Welfare, New Delhi Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi. Safdarjung Hospital, New Delhi. Branch Library: National Medical Library maintains a branch library in the Nirman Bhawan to cater to the library and information needs of staff and officers in the Directorate General of Health Services and the Ministry of Health and Family Welfare. Steps are being taken to renovate the present library set up and to improve library collection and services at Branch Library. 15.38. LALA RAM SARUP TB HOSPITAL LRS Institute of Tuberculosis (TB) & Respiratory Diseases has been engaged in the service of the Nation since 1952. From a TB Hospital, It became an autonomous Institute in 1991 with specific objectives of developing tertiary care facilities for patients suffering from respiratory diseases and for supporting the National Tuberculosis Control Programme (NTCP). The Institute is engaged in the management of patients through its state of the art Out Patient Department (OPD), Indoor wards, Operation Theatre, Respiratory Intensive Care Unit, Emergency Ward and quality assured Lab. Diagnostic facilities. The institute has various departments and sections which are as follows:- Departments: Department of Anaesthesia, Department of Bio- Chemistry, Department of Epidemiology & Public Health, Department of Hospital Administration, Department of Internal Medicine, Department of Microbiology, Department of Molecular Medicine & Bio-technology, Department of Paediatrics, Department of Pathology, Department of Physiology ,Department of Radiology, Department of TB & Respiratory Diseases, Department of TB Control & Training, Department of Thoracic Surgery and Surgical Anatomy. Sections Respiratory intensive care unit (ICU), Sleep lab, Health education section, Biostatistics section, Voluntary Annual Report 2010-11 278 Counselling and Testing Centre (VCTC), Fibre-optic Bronchoscopy Unit , Lung Cancer section , Physiotherapy section, Library, Computer section , ART Centre, Yoga Centre, Allergy and Immunotherapy Clinic. The sanctioned staff of the Institute is 610 and present staff strength is 495. Out Patient Management: A total of 28438 patients were registered in OPD registration counter. These are considered as chest symptomatic at the LRS-OPD. Out of these 6384 (22.4%) came from the LRS RNTCP specified area, 14218 (50.0%) from Non-Area and 7836 ( 27.6%) from outside Delhi. A total of 20469 patients were diagnosed. Out of them 12971 (63.4%) were diagnosed as TB cases and 7498 (36.6%) were diagnosed as Non TB cases. After diagnosis, a total of 5682 TB cases were referred out from LRS to LRS DOTS centres / other chest clinics in Delhi or outside Delhi for further treatment from DOTS centres. The total number of patients who attend the LRS OPD constitute mainly four groups (i)New registration (ii) Subsequent visits for diagnosis (iii) Follow up visits of TB cases and (iv) Follow up Visits of Non-TB patients. During the period, a total of 83561 patients attended the OPD with an average of total 373 patients per day including 128 per day as new registrations. A total of 5119 chest symptomatic directly attended the DOTS centres under the specified area of the LRS institute. Besides these, 6384 symptomatic came directly at LRS OPD from the RNTCP area of the institute. This comprised a total of 11503 symptomatic under RNTCP. Out of these, a total of 1405 TB cases were registered under RNTCP for DOTS treatment. All of them were put on DOTS treatment with none on conventional. A daily OPD for children is being carried out in the morning. A total of 2551 children were newly registered in the OPD. 213 were diagnosed as suffering from tuberculosis and referred to respective DOTS centres. A centre for Integrated counselling for HIV testing has been operational in the institute. During the period, a total of 3122 patients were imparted counseling and tested for HIV. A total of 130 (4.2%) cases were found HIV positive during this period. Comprehensive HIV care facilities are provided at the ART centre. These include free of cost antiretroviral therapy, free CD4 testing, treatment and prophylaxis of opportunistic infections, patients and family counseling as well as pre ART support and care services. As on 31 st December-2010, a total of 855 patients are on HIV care and 523 patients are on ART treatment. Surgical Clinic is held on Tuesday/Friday afternoon for patients requiring surgical treatment and follow up post- operative patients. A total of 424 Major and 2850 minor procedures were done during this period. The Institute runs various specialised clinics, which are held periodically. A total of 4303 patients attended these clinics during this period. Indoor Management: A total of 4114 patients were admitted. They included 482 patients admitted to Respiratory Intensive Care Unit. Of these, 4027 (98%) were admitted on free and 87 (2%) on paid beds. Many patients who were admitted came at terminal stage. A total of 3816 patients were treated and 708 died during this period. Training of Medical & Paramedical personal: Several training programmes have already being conducted by the institute for Doctors, paramedical personnel (Lab Tech.,Sr. Lab Tech., Treatment organisers, Sr.Treatment supervisors and programme officers, Administrators) of several states. The training is also imparted in the management of tuberculosis to the nursing students from Rajkumari Amrit Kaur College of Nursing and the trainee health visitors from New Delhi TB Centre every year. A total of 762 trainees were imparted training during this period. DNB course: The Institute is recognized centre for post-graduate DNB (Respiratory Diseases) degree course since 1999. Now, w.e.f. 2009, the institute has been accredited for ten DNB seats per year. Regular teaching activities such as seminars, journal club, faculty lectures, grand case presentation, mortality meetings, pathological conference, radiological conference, bed-side clinical round are routinely carried out. Organising the CME & Conferences: The institute is actively involved in organising Continuing Medical Education programme (CME) on different aspects of diagnosis and management of tuberculosis and respiratory diseases. Annual Report 2010-11 279 Research Activities: In addition to 20 on going DNB researches, 10 more were under taken during the period. Similarly in addition to 43 ongoing other than DNB researches, 18 more were undertaken during the period. Publications: During the period 11 faculty members of the Institute contributed chapters in the recently released NCCP Text Book of Respiratory Medicine(Editor in chief Dr. D. Behera) under the aegis of National College of Chest Physicians, India. In addition to this, there were 10 publications by the faculty in renowned National and International Journals. Achievements: A new diagnostic facility called Line Probe Assay (LPA) has been established in new research block to detect resistance to Rifampicin in 48 hours. This is likely to help in rapid diagnosis of TB Patients. A training was conducted under FIND project in this regard following which internal proficiency test has been completed. Institute facilitated the process of the National DOTS-PLUS guidelines for programmatic management of MDR-TB patients. A first of its kind in the country, New MDR-TB wards have been constructed with latest technology and have started functioning. The Institute has now become a regular DOTS- Plus site for the state of Delhi under the National Programme. The Institute is extending its services and activities to become one of the four DOTS- Plus sites under RNTCP that will cover nearly 40 lakh population of Delhi and the national reference laboratory of the Institute will extend logistic support for the culture and DST facilities for half of the population of Delhi to detect MDR TB patients. The Institute, being one of the NRLs, is supervising the IRL activities over 8 states of India that includes areas in the North East. Under its guidance, the NDTB center was accredited as an IRL. A state of art BSL-III laboratory, MGIT system and RT-PCR machine have been functioning. A newsletter of the Institute is being published regularly every three months for circulation among the professional colleagues. A number of high end equipments for patient care and research were procured for various departments. Institute is now admitting 10 students for DNB degree course following approval as against the 6 students earlier. Emergency services have been functioning round the clock now along with facilities for X-ray, ECG and laboratory services. Digital X-ray is being provided free of cost to the patients through computed radiography system installed in Radiology Department. Institute is responsible for conducting the national Annual Risk of T.B. infection Survey in eastern region of the country. A block of 30 staff quarters (Type-A) has been constructed. 15.39. NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SECIENCES, (NIMHANS), BANGALURU The National Institute of Mental Health and Neurosciences, a multidisciplinary Institute for patient care and academic pursuit in the frontier areas of Mental Health and Neurosciences has strived too hard to maintain the mission of delivering prompt and appropriate patient care, develop man power and carryout the research in areas of natural relevance in behavioral, clinical and basic neuroscience. During this period of review from April 2009 to 31 st March 2010, Dr.D.Nagaraja was the Director/Vice Chancellor till 31 st January 2010. After completing his terms of appointment, Ministry of Health and Family Welfare, Govt. of India has appointed Dr.S.K.Shankar, Dean Clinical Neurosciences as In- charge Director/Vice Chancellor, till the appointment of full time Director/Vice Chancellor. Dr.Shankar ensured continuity of service, academic and scientific philosophy of the Institute with equal opportunity to all. Hospital Services NIMHANS as a secondary and tertiary care hospital in the fields of Psychiatry, Neurology and Neurosurgery and allied diagnostic specialities, rendered service to the patients from all over the country as well as neighbouring developing SAARC, Arabic and African Countries. During the year 2009-10, patients numbering 3,97,666 have been treated. Annual Report 2010-11 280 YEAR 2009-2010 Summary of patient care and hospital statistics Screening 89,498 Registrations Psychiatry 11,291 Neurology 17,095 Neurosurgery 14,470 Follow Ups Psychiatry 105,045 Neurology 50,359 Neurosurgery 23,921 Admissions Psychiatry 5,216 Neurology 3,098 Neurosurgery 4,182 Salient services provided by various departments during the year 2009-10 are reflected below. Department of Psychiatry Six specialty clinics are run for the evaluation and management of patients. De-addiction Centre - New cases 2231 Follow up cases 5430 During the year the De-addiction Centre services have moved to an out patient facility. Three training programme for medical officer in the field (110 medical officers) and one month orientation programme on Substance Abuse management conducted for medical and non medical professionals and lay counselors. During the current year the centre trained 320 professionals. A toxicology laboratory to monitor the drug levels is functioning clearing out 20 different screening tests. Employment assistance is provided for patients with work related problems through vocational counseling and placement referrals. The centre developed a manual for people who want to start a Tobacco Cessation Centre. Obsessive Compulsive Disorder Clinic New Cases 257: Follow up cases 1288. Geriatric Clinic (elderly above age of 60 with Neuropsychiatric disorders, Dementia, Late onset Psychosis and Depression) New cases 200, screened 3010. Schizophrenia clinic 1800 patients were treated and Integration of Yoga therapy for patient attending for schizophrenia clinic was initiated. Metabolic Clinic 400 patients were comprehensively assessed in the metabolic clinical of Psychiatry. Discharges Psychiatry 4,896 Neurology 2,841 Neurosurgery 3,864 Emergencies Psychiatry 2,229 Neurology 13,037 Neurosurgery 14,871 Extension Services Gunjur 2,620 Gouribidnur 10,414 Maddur 3,181 Kanakapura 2,762 Madhugiri 2,794 Sakalawara 8,910 Turuvekere 180 Annual Report 2010-11 281 Pre-natal and Post natal psychiatry clinic This clinic is devoted to women in the reproductive age group with psychiatric problem related to pregnancy and post partum. Intervention procedure is carried out for training mothers to improve mother infant bonding, infant stimulation and psychological education. Yoga Services An advance centre for Yoga offer yoga therapy for the patient suffering from psychiatric and neurological disorders and their care givers. The total 692 new and 9284 old patients were treated. The centre conducted 4 workshops and came out with a quarterly news letter. Psychiatric Neurological Rehabilitation New cases 5869, follow up 425 Departments of Neuropathology Neuromicrobiology, Neurovirology, and Neurochemistry have provided comprehensive diagnostic facilities to the patients. Department of Mental Health and Social Psychology continued psychological evaluation, behavioral/cognitive therapy, mentally handicapped counseling, family and marital therapy, learning and disability treatment. Department of Psychiatric Social Work carried out regular rehabilitation and placement services. The faculty is actively involved in psychosocial rehabilitation as a part of disaster management and training of the manpower from time to time. Department of Neurosurgery has round the clock emergency surgical team to treat trauma. The department is conducting special clinics like Post Trauma Clinic, Spinal Clinic, Spina Bifida, Gamma Knife Radiosurgery and Functional Neurosurgery. During the year more than 5000 neurosurgical procedures have been conducted. Department of Neuroanaesthesia assisted in carrying out 3623 neurosurgical operations and managed 1200 cases in medical ICU. The department has acute shortage of faculty thus hampering service delivery from time to time. Department of Neurology in addition to routine patient care has been conducting Refractory Epilepsy Clinic, Neuromuscular Clinic and Movement Disorder Clinic. The department has been managing state of the art Stroke unit. Department of Health Education has developed a range of education materials to educate the public about H1N1 epidemic and preventive strategies. Department of Epidemiology has been managing helpline to prevent suicide and is active in policy planning related to road traffic accidents. Department of Neuropathology continued round the clock autopsy services and has co-ordinated the work at Human Brain Tissue Repository (Human Brain Bank). Transfusion Medicine Centre has been offering plasma pheresis facility all the days including holidays. During the year more than 1200 plasma pheresis procedure has been carried out. The Transfusion Medicine Centre has provided 4110 blood and blood products to other hospitals in the city. The work load in all the laboratory section has increased significantly. Department of Neurovirology department was recognized as nodal centre for H1N1 testing by the Ministry of Health and Family Welfare, Govt. of India for the state of Karnataka. During the outbreak of H1N1, Dept of Neurovirology under the leadership of Prof V.Ravi conducted testing round the clock to meet the crisis for the management of the patients. Prof Ravi has been called upon by the Govt. of Karnataka as an expert to plan, assist and direct the outbreak management services for the entire state of Karnataka. The department continues to be WHO referral centre for the diagnosis of rabies. Manpower Development NIMHANS has 23 departments in various specialties. The Institute is offering PhD Courses in Clinical Psychology, Neurophysiology, Psychiatry Social Work, Speech Pathology & Audiology, Clinical Neurosciences (ICMR Fellowships), DM degree in Neuroradiology, DM degree in Neurology, M.Ch degree in Neurosurgery,MD degree in Psychiatry, Diploma in Psychiatry, Post doctoral fellowship in Neuropathology, Neuroanesthesiology and Neuroinfections and Child and Adolescence Psychiatry, M.phil in Biophysics, Clinical Psychology, Psychiatric Social Work, Neurophysiology and Neurosciences. NIMHANS has pioneered in Psychiatric nursing, neurological and neurosurgical nursing with enhanced intake of students to meet the requirements. These services need further augmentation to meet the national needs. To enhance the services NIMHANS is planning to commence new courses Post doctoral fellowship in movement disorder, epilepsy, Post Certificate Course B.Sc Nursing. For the first time in the country NIMHANS is imitating a new course DM Child Psychiatry in an Annual Report 2010-11 282 effort to enhance positive mental health in children and also offered and evolved treatment modalities for psychiatric disorders in children. This is in line with the philosophy of enhancing trained manpower in specialized areas in the country. Degrees awarded Ph.D 26, DM Neurology and Neuroimaging 10, M.Ch 6, M.phil 35, MD-Psychiatry 16, Post Doctoral Fellow -3. Research Various Basic Sciences Departments are actively investigating genetic basis of Stroke, advanced methodologies in Neuroimaging, proteomic and genomic studies in Neuropsychiatric disorders, Neuroinfections, Brain plasticity following stimulation of cutaneous nerves, neural correlates behavior, high altitude physiology, physiological basis of stress, behavioral alterations in fear learning and memory following early maternal separation in rats, biology of Schizophrenia, analysis of metabolic disorders in Neuromuscular disorders with special references to mitochondrial genome. Genetic basis of Epilepsy has been described in collaboration with Jawaharlal Nehru Centre for Advanced Scientific Research and National Brain Research Centre. 15.40. NATIONAL TUBERCULOSIS INSTITUTE, BANGALURU Introduction National Tuberculosis Institute (NTI), Bangalore, under DGHS, is involved in carrying out Operational Research Particulars Total 1 Students joined for various post graduate degree/diploma, undergraduate courses and certificate courses during 2009-10 219 2 No. of Trainees undergone training at this Institute from April 2009 to March 2010 3535 3 Total number of projects: -Ongoing 87 -Completed 4 -Sanctioned 2 on various components of TB Control, mainly carried out by the Epidemiology and Control Sections. The Bacteriological Wing of the Institute has been recognised as a National Reference Laboratory for External Quality Assessment in the TB Control activity. It also assists in establishing Intermediate Reference Laboratory for Culture and Drug Sensitivity tests, across the country. Major Activities Undertaken During the Year A. Research The research studies/projects taken up by the institute were Nodal centre for carrying TB Disease Prevalence Survey under RNTCP, Nodal Centre for Repeat Zonal ARTI Surveys, Study on Routine Referral of TB patients to integrated Counselling & Testing Centre, Tobacco Cessation Intervention among the Pulmonary TB cases in selected treatment units of Bangalore District, Assessment of documentation of HIV related information on TB treatment card & relevant records, Review of Articles for journals 10Nos, Prospective Multi-centric cohort study to asses risk factors for unfavourable treatment outcomes, including recurrent TB, among sputum positive Pulmonary Tuberculosis Patients treated with CAT-1 regimen of RNTCP, Disease Prevalence Survey in Nelamangala Taluk. B. Training The Institute has pioneered in the field of Human Resources Development. It is involved in conducting the following training programmes to the TB Programme Managers positioned at different parts of the country. Five (5) RNTCP & TB-HIV Modular training Programme were conducted at NTI where STDCs, STOs, DTOs, MO-TCs and faculty of Medical Colleges participated. Managing Information for Action (MIFA) Training - One. Training in Preventive maintenance and minor repairs of Binocular Microscopes One.EPI Centre Training Workshop One.Workshop for Microbiologist for updating training material guidelines for National Reference Laboratories - One. SAARC Regional Training of Microbiologist on Culture & DST of MTB One. TB Operational Research Workshop One. PCR based LPA Training One. Thirty (30) orientation programme of one day duration were organized for about 1181 undergraduate Medical, Microbiology and Nursing and Pharmacy students sponsored by different Institute across the country.External Quality Assessment (EQA) has been given importance under RNTCP in the recent Annual Report 2010-11 283 years. One training on the procedures of EQA was imparted to the Laboratory personnel of different parts of the country. Three training in Culture & DST / Smear Microscopy were imparted to Microbiologists/Lab technicians. C. Bacteriology Section I. Operationalise the EQA for sputum smear microscopy network in the states in conjunction with /STDCs or IRLSs. Carry out NRL responsibilities of EQA such as Onsite Evaluation (OSE). Panel testing (proficiency testing of lab staff) to ten states at least once in a year for 3-4 days (including one to two districts visits), and make visits as and when required depending on the priorities /necessity to improve and help the performance of labs. Eight visits of EQA on site evaluation were undertaken to five states. Prepared slides were used for panel testing during the visits. II. Conducting quality improvement workshops for the state level programme managers with a view to find solutions to EQA related operational and technical problems faced in the field. III. To implement and verify Random Blinded Rechecking (RBRC) producers and improve the performance of labs based on analysis of the RBRC data in conjunction with STDCs. IV. Capacity building and strengthening the ten state level TB laboratories (STDCs) with respect to proficiency in culture and Drug Susceptibly Testing including second line drugs. V. Conducting Anti-TB Drug rsistance surveillances of priority states involving processing of representative sample of the states to obtain information of prevalence of drug resistance, with a view to support logistics of DOTS Plus programme under expansion of DOTS and RNTCP and conduct/participate in National Level disease prevalence studies/surveys. VI. The Lab team of the Institute carries out on site evaluation of STDC laboratories of different states and provides necessary guidelines to establish quality laboratory to undertake EQA and DRS studies. D. Monitoring Section With full coverage of RNTCP in the country, the Institute is not compiling the reports on NTP. At present, the monitoring activity is being carried out by the Central TB Division under DGHS. E. Publication Activities The faculty of the Institute published about 5 research papers in the leading journals on TB. Five presentations and two poster sessions on the basis of the research studies conducted by the institute were presented in the National Conference on TB and Chest Disease, held at Bangaluru during 10 th , 11 th & 12 th January 2011.The in- house publications, NTI Bulletin of Volume 43-1 & 2 and Volume 3 & 4 have been released F. Other Activities I. The Faculty and the technical staff participated in the appraisal and Central Evaluation of RNTCP districts as and when called upon to do so and given the technical support for implementation of RNTCP. II. The Scientific Gallery was established to disseminate the general information on TB the evolution of the programme and achievements of the Institute since its inception. Considering the needs of various categories of trainees, two methods of display units vis., Photo Display and Projection facility and Information Kiosk are available. The Director, faculty and the technical staff participated in about 23 Meetings/Seminars conducted by Central TB Division and other TB related activities. Up-gradation of Infrastructure On a proposal submitted by FIND on behalf of UNIT AID the Govt. of India decided to establish an International Centre for Excellence in Laboratory Training (ICELT) at the National Tuberculosis Institute, Bangalore with the following Vision and Mission. Vision: Establish a state of the art teaching and training facility for imparting quality laboratory practices for tuberculosis and other opportunistic infections and promote a healthier India and Asia. Mission: To support the scaling up of laboratory capacity building in India and Asia by providing hands-on training courses in the diagnosis and monitoring of major infectious diseases such as TB, HIV/AIDS and Malaria. Annual Report 2010-11 284 International Centre for Excellence in Laboratory Training (ICELT) will provide Training to the personnel who are working in about 43 Culture Laboratories in different parts of the Country in Newer Diagnostic Tools for Diagnosing TB & Drug resistant TB. The ICELT was inaugurated on 20 th January 2011. Two training programme of five days each was held from 24 th January 4 th February 2011. F. Financial Outlay & Expenditure The details of budget allocation for NTI during the year 2010-11 and 2011-12 are as follows: 15.41. HOSPITAL SERVICES CONSULTANCY CORPORATION (HSCC) Background HSCC was set up in March 1983 as Public Sector Enterprise under the administrative control of Ministry of Health & Family Welfare. As on 31.03.2010, the Authorised Capital of the Company was Rs. 500 Lakhs (divided into 5,00,000 equity shares of Rs. 100/- each) and the Paid-up Capital of the Company was Rs.240.018 Lakhs (including Bonus Shares of Rs. 200 Lakhs). Since inception the total business of the Company has been managed without any borrowing either from the Government or from other sources. HSCC has been declared Mini Ratna Company in September 2002. Service Spectrum HSCC is a multi-disciplinary renowned consultancy and procurement management service organization in the health care and other social infrastructure development sectors. Its service spectrum covers feasibility studies, design engineering, detailed tender documentation, construction supervision, comprehensive project management, procurement support services in all areas Category 2010-2011 2011-12 Budget Revised (Rs. in crore ) estimate estimate (Rs. in crore ) (Rs. in crore ) Non-Plan 5.66 6.16 6.83 Plan Revenue 0.50 0.48 0.50 Capital 1.45 1.45 1.45 Total 7.61 8.09 8.78 of civil, electrical, mechanical, information technology and auxiliary medical service areas. Its important clients include: Ministry of Health & Family Welfare and its Hospitals / Institutes, Ministry of External Affairs and other Ministries, State Governments and their Hospitals / Institutes, PSUs / Other Institutes. Financial Performance During the Year 2009-10 the Company has attained the highest ever total income of Rs. 3355.77 Lakhs in its existence. The Company has declared a dividend of @ 72% of the paid-up share capital amounting to Rs. 172.81 Lakhs. This was the 25 th consecutive year in which the Company has paid dividend and with this the cumulative dividend till 2009-10 stands at Rs. 2117.33 lakhs. Over the years, HSCCs net worth has grown to Rs.7238.87 lakhs as on 31 st March 2010 which is more than 30 times of its paid-up capital. Quality System The Company is an ISO 9001 accredited Company. The Company has from time to time, taken steps to upgrade quality assurance system and degree of clients satisfaction. The Company is ISO 9001:2008 certified Company and has internal quality control as required for its various projects and assignments. Corporate Governance Corporate Governance Practices in the Company focus on transparency, integrity, professionalism, accountability and proper disclosure. Recognition HSCC has been signing MOU with the Ministry of Health & Family Welfare and rated Excellent for the year 2009-10. Annual Report 2010-11 285 Companys Affairs HSCC had adopted an integrated approach to projects, drawing on its pool of expertise to provide the best combination to evolve client specific, cost effective and innovative solutions. HSCC being the knowledge based Company, its real strength lies in its manpower. The Company employs competitive and highly skilled cadre of architects, engineers, Chartered Accountants, Cost Accountants, MBAs and a pool of Consultants in the areas of medicines and corporate planning etc. The employee management relationship was excellent throughout the year. In line with changing market requirements, the knowledge and skill of HSCC employees are continuously upgraded. A list of the major on-going projects where HSCC is rendering Consultancy Services is as under: A. Architectural Planning, Design Engineering & Project Management Services Consultancy Services Up gradation and development of Government Medical College and associate hospitals consisting of Bebe Nanki Mother & Child Health Care Centre, Diagnostic Block, Drug Dependence Centre, Nursing College and Service Block at Amritsar Design Engineering for the construction of Academic Block, Senate Campus and Guru Gobind Singh Medical College for Baba Farid University of Medical Sciences, Faridkot North Eastern Institute of Ayurveda & Homoeopathy (NEIAH), Shillong Up gradation of Lokpriya Gopinath Bardoloi Regional Institute of Mental Health, Tezpur Nurses Hostel and other works / services for North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya Comprehensive Redevelopment Plan for Lady Hardinge Medical College, New Delhi Up gradation of Health Care facilities in the State of Punjab Prime Minister s Swasthay Suraksha Yojna (PMSSY) for:- - Nizam Institute of Medical Sciences (NIMS), Hyderabad 300 Bed Super Specialty Block and 50 Bed Emergency & Trauma Block - Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGI), Lucknow 160 bed Super Specialty Block - Kolkata Medical College, Kolkata OPD & Academic Block and Super Specialty Block Residential Complex for AIIMS like institutes at :- - Raipur - Bhubaneshwar DPR for Chitaranjan National Cancer Institution, Kolkata Project Management Consultancy for All India Institute of Ayurveda, Department of Ayush, New Delhi Veterinary Ayurveda Research Institute, Deptt. of Ayush, Lucknow. Regional Institute of Medical Sciences (RIMS), Imphal Master Plan and Renovation & Repair of existing Laundry and OPD and associated Works at AIIMS, New Delhi Sports Injury Centre at Safdarjung Hospital, New Delhi Design & Engineering of New Hospital Building at Oil India Ltd. Hospital, Duliajan, Assam BSL 4 Lab for MCC, ICMR, Pune Lab & Animal House Regional Medical Research Centre, Dibrugarh Indian Institute of Chemical Biology, Kolkata BSL-3 Lab for NRCE, Ministry of Agriculture. Hissar NARI-Bhosari, ICMR, Pune Animal BSL-3 facility at ICPO, Noida Science Centre & National Institute of Medical Statistics (NIMS) under ICMR at ICPO Campus, Noida Annual Report 2010-11 286 ABROAD 200 bedded Emergency and Trauma Centre for Bir Hospital, Kathmandu, Nepal District General Hospital at Dickoya, Sri Lanka B. Procurement Management Services Medical Equipment for NEIGRIHMS, Shillong Drugs and Equipments for Central Government Health Scheme Medical Equipments for ONGC Medical Equipments for Ethiopia, MEA Medical Equipments Liberia, MEA Medical Equipments for Bir Hospital, Kathmandu, MEA Lab Equipments for CDSCO Medical Equipments for Sports Injury Centre, Safdarjung Hospital, New Delhi. C. Studies and Training Services Feasibility Reports for the Super Specialty Hospitals at Sibasagar, Assam and Ankleshwar, Gujarat for ONGC Detailed Project Report for up gradation of National Institute of Communicable Diseases (NICD) to National Centre for Disease Control (NCDC), Delhi Detailed Project Report for the Proposed Medical College at Thimpu, Bhutan for Bhutan Institute of Medical Sciences (BIMS) 15.42. PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA Government of India has approved the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) in March, 2006 with the objective of correcting regional imbalance in the availability of affordable/reliable tertiary healthcare services and also to augment facilities for quality medical education in the country. I. PMSSY 1 ST PHASE PMSSY has two components in its first phase - (i) setting up of six AIIMS-like institutions and (ii) upgradation of 13 existing Government medical college institutions. It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chhattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneshwar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 Crores per institution. These States have been identified on the basis of various socio-economic indicators like human development index, literacy rate, population below poverty line and per capital income and health indicators like population to bed ratio, prevalence rate of serious communicable diseases, infant mortality rate etc. Each institution will have a 960 bedded hospital (500 beds for the medial college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for Ayush ) intended to provide healthcare facilities in 42 speciality/super-speciality disciplines. Medical College will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms and also nursing college conforming to Nursing Council norms. In addition, it has also been decided to upgrade the 13 existing medical institutions spread over in 10 States, with an outlay of Rs.120 crores (Rs.100 Crores from Government of India and Rs.20 crores from State Government) for each institution. In so far as SVIMS, Tirupati, Government of India share is limited to Rs.60 crores and Rs.60 crores would be borne by the TTD Trust. The medical college institutions being upgraded under PMSSY Phase-I are as under:- 1. Govt. Medical College, Jammu (J&K) 2. Govt. Medical College, Srinagar (J&K) 3. Kolkata Medical College, Kolkata (W.B.) 4. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (U.P) 5. Institute of Medical Sciences, BHU, Varanasi (UP), 6. Nizam Institute of Medical Sciences, Hyderabad(A.P) 7. Sri Venkateshwara Institute of Medical Sciences,Tirupati (A.P) (50% cost of upgradation will be borne by the TTD Trust) 8. Govt. Medical College, Salem (T.N.) Annual Report 2010-11 287 9. B.J. Medical College, Ahmedabad (Gujarat) 10. Bangalore Medical College, Bangaluru(Karnataka) 11. Medical College, Thrivananthapuram, (Kerala) 12. Rajendra Institute of Medical Sciences (RIMS), Ranchi 13. Grants Medical College & Sir J.J. Group Of Hospitals, Mumbai, (Maharashtra ) A. STATUS (i) Setting up of six AIIMS-like institutions (a) Package-I - Medical College/Hostel :Civil work for construction of medical college/hostel was awarded in April, 2010 and work started the last week of May, 2010. Completion period of the work is 15
months in all sites except Patna where duration is 18 months. The site-wise progress is as under:- (b) Package-II Hospital Complex Tenders floated earlier were rejected due to exorbitant price offered by the bidders. Retender issued on 30.5.2010. Closing date for receipt of tender was 15.7.2010. Contractors were selected for construction of hospital complex at all the six sites. Letters of Intent were issued to all the six selected contractors on 23.7.2010. On receipt of confirmation from contractors, work for Bhopal, Patna, Raipur and Rishikesh sites has been awarded on 28.7.2010 and for Bhubaneswar and Jodhpur on 2.8.2010. The civil work is expected to start by end of August, 2010 and is scheduled to be completed in 24 months. S.No Name of site Percentage of Progress 1. Bhopal 15.86% 2. Bhubaneswar 12.03% 3 Jodhpur 22.0% 4. Patna 22.04% 5. Raipur 10.46% 6. Rishikesh 17.86% S.No Name of site Progress of work(%) 1. Bhopal 3.64% 2. Bhubaneswar 5.56% 3 Jodhpur 8.0% 4. Patna 8.0% 5. Raipur 7.05% 6. Rishikesh 10.0% (c) Construction of residential complex Construction of residential complexes has been taken up separately. The civil work at Jodhpur has been completed in April, 2010 and at Raipur in June, 2010. The progress of civil work at the 4 remaining sites is as under:- (d) Human Resource Planning for the six AIIMS- like institutions Manpower requirement for medical college, hospital complex and nursing college for the AIIMS-like institutions has been worked out by a Committee headed by Dr. K.K. Talwar, Director, PGIMER, Chandigarh and got vetted further by premier medical institutions in the country, e.g. AIIMS, PGIMER, JIPMER, Tata Memorial Hospital etc. Proposal for creation of 4047 posts for each of the six AIIMS-like institutions to be recruited in three phases has been submitted to Ministry of Finance. Ministry of Finance has approved creation of 1145 posts for each AIIMS-like institution to be filled up in first phase of recruitment. (e) Formation of society for each of the AIIMS- like institutions Cabinet approved the proposal for formation of a society for each of the AIIMS-like institutions to facilitate faster execution and expeditious implementation of the projects, till the institutions are brought under an Act of Parliament. Society has been registered for all the six AIIMS. 2. Strengthening and up-gradation of medical college institutions (a) 13 existing Government medical college institutions were taken up for up-gradation in Phase I of S.No Name of site % of work Likely date completed of completion 1 Rishikesh 81 March, 2011 2 Patna 67.50 June, 2011 3 Bhopal 48 June, 2011 4 Bhubaneshwar 18 September, 2011 Annual Report 2010-11 288 PMSSY. Out of this, 10 institutions involve both civil work and procurement of medical equipment and the remaining 3 involve mainly procurement of equipment. Status of civil work in the 10 medical college institutions are as under:- Progress of other 3 medical colleges which involve mainly procurement of equipment is as under:- S. Name of medical college Name of Project Percentage of Likely date of No Consultant Progress completion 1. Trivandrum Medical College HLL 100% Completed 2. Govt. Mohan Kumaramangalam Medical College, Salem HLL 100% Completed 3. Bangaluru Medical College HLL 100% Completed 4. SGPGIMS, Lucknow HSCC 100% Completed 5. NIMS, Hyderabad HSCC 100% Completed 6. Kolkata Medical College HSCC OPD completed Academic Block - 68% Mar., 2011 7. Jammu Medical College CPWD 97.5% Mar., 2011 8. IMS, BHU, Varanasi CPWD 60% June, 2011 9. Srinagar Medical College CPWD 42% Dec., 2011 10. RIMS, Ranchi CPWD 40% June, 2011 S.No Name of medical college Percentage of Likely date of Progress completion 1. SVIMS, Tirupati 70% May, 2011 2. B.J. Medical College, Ahmedabad 70% May, 2011 3. Grants Medical College, Mumbai 84% May, 2011 (a) Procurement of equipments Low end and uncommon equipment would be procured by the beneficiary institutions/State Governments. About Rs.100 Cr has also been released to State Governments/ medical college institutions for purchase of low end and uncommon equipment. In the case of procurement of common and high end equipment, MoHFW, through Hindustan Latex Ltd. is doing central procurement of equipment. An amount of Rs.351.51 Crore has been earmarked for high end equipments and out of this, equipment worth Rs. 289.65 Crore has been procured. Procurement of balance equipment worth Rs.61.86 Crore is under process and it will be completed by March, 2011. Annual Report 2010-11 289 II. Phase-II Government has approved setting up of two more AIIMS- like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of following six medical college institutions in the second phase of PMSSY. - Government Medical College, Amritsar, Punjab; - Government Medical College, Tanda, Himachal Pradesh; - Government Medical College, Madurai, Tamil Nadu; - Government Medical College, Nagpur, Maharashtra - Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh and - Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. The estimated cost for each AIIMS-like institution is Rs.823 Crore. For upgradation of medical college institution, Central Government will contribute Rs.125 Crore each. Status (a) AIIMS-like institutions Government of West Bengal has identified land at Raiganj, Uttar Dinajpur District for the proposed institution in the State. Central team visited the site on 12.10.2010 to ascertain suitability of the land and submitted an inspection report. State Government of Uttar Pradesh has been requested to identify land at Lalganj, Raebareli District for the proposed institution in the State of UP. Communication from the State Government is yet to be received in the matter. (b) Up- gradation of six medical college institutions 5 institutions involve both civil work and procurement of equipments except Nagpur Medical College which involves procurement of equipments only. Concept plans/Detailed Project Reports (DPR-I) for Government Medical College, Nagpur and Government Medical College, Amritsar were approved by Project Management Committee (PMC) of PMSSY on 6.8.2009. Rs. 40 Crore has been released to Nagpur Medical College/State Government for procurement of medical equipments. They are in the process of procurement of equipments. Tenders for civil work at Government medical college, Amritsar is under finalizaation. DPRs for Rajendra Prasad Government Medical College, Tanda and Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh have been approved by PMC on 25.10.2010. DPRs of Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak and Government Medical College, Madurai were discussed in the PMC meeting held on 25.10.2010 and the State Governments have been asked to provide clarifications on the up- gradation plan submitted by them. 15.43. INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES (IIPS) MUMBAI 15.43.1. Introduction: International Institute for Population Sciences, Mumbai, was established in 1956 as the Demographic Training and Research Centre. The Institute is a Deemed University functioning under the administrative control of the Ministry of Health and Family Welfare, to impart training, conduct research and provide consultancy services in the field of Population Studies. The Institute has six departments viz. Department of Mathematical Demography and Statistics, Department of Fertility Studies, Department of Public Health and Mortality Studies, Department of Migration and Urban Studies, Department of Population Policies and Programmes, and Department of Development Studies. In addition, Department of Extra Mural Studies is functioning since August 1993 on yearly project basis. Apart from the Director & Senior Professor, the faculty consists of 33 members, who are engaged in both teaching and research. 15.43.2.Training: During the year 2009-10, the Institute offered the following four regular courses:- (a) Diploma in Health Promotion Education (DHPE), (b) Post Graduate Diploma in Community Healthcare (PGDCH), (c) Master of Population Studies (MPS), and (d) Master of Philosophy in Population Studies (M.Phil.). The courses (a) and (c) are of one year duration, the course (b) is of fifteen months duration, and the course (d) is of eighteen months duration. Apart from the above regular courses, the Institute also offers Master of Population Studies (MPS) and Diploma in Population Studies (DPS) through correspondence. Annual Report 2010-11 290 During 2009-2010, 23 students qualified for award of Diploma in Health Promotion Education, 19 students qualified for award of degree in Master of Population Studies (MPS), 13 students qualified for the award of M.Phil degree, 20 students had qualified for the award of Ph.D degree, 6 students qualified for the award of the degree of DPS (Distance Learning) and 18 students had qualified for the award of the degree of MPS (Distance Learning). Short-term training/instructional courses The following seven short-term training programmes were organized at the institute during the year 2009-2010. These short-term training programmes are conducted either at the request of funding institutions or as part of resource mobilisation academic activities: (i) One month training on Demography, Gender and Reproductive Health was conducted for 15 students from Nordic countries, from 12 July to 8 August 2009 at the request of Nordic center. (ii) Training on Demographic Techniques and Application of Software Packages was conducted during 7-25 December, 2009. Of the four participants, three were from Myanmar and one from Malawi. (iii) Training on Application of SPSS for Data Analysis was conducted during 14-18 December, 2009 for eight participants. (iv) A Refresher Course on Demography was conducted for fifteen Senior level ISS officers during 4-8 January 2010. (v) A Training Programme on Large Scale Sample Survey (LSSS) in Demographic and Health Research was conducted during 18-29 January, 2010 for eight participants. (vi) Training on Application of SPSS for Data Analysis was conducted during 22-26 February, 2010 for twenty participants. (vii) Training on Application of Qualitative Methods of Data Collection in Population Research was conducted from 22 March to 2 April, 2010 for twelve participants. 15.43.3. Study Tour: Every year as a part of the academic programme, all the students of Master of Population Studies are taken for a study tour to different parts of the country. This years study tour was undertaken from 21 st March to 1 st April 2010.This tour provided an opportunity to the students to have direct interaction and exposure to two premier social science research institutions Insitute for Social and Economic Changes (ISEC), Bangalore and Center for Development Studies, Thiruvananthapuram, two Population Research Centers, one social action Institute, Indian Social Institute (ISI), Demography department in Kerala University and three NGOs working in the areas of health, HIV prevention, tribal welfare and social development. Apart from this, the students were given an opportunity to actively participate in the National Conference on Demographic Dividend and Fertility Transitions held at Chennai, which had many scientific sessions and deliberations on demographic issues. Besides participating in this conference, the students had interaction with a large number of demographers and social scientists who attended the national conference. 15.43.4. Research Consultancy Services: The Institute had completed 6 Research Projects during 2009- 2010. There are 13 on-going research projects funded by the Institute which are at different stages of completion. Also, 3 new research projects are being taken up during the year 2009-2010. There are 6 on-going research project funded by external agencies, and 4 new projects have been undertaken funded by external agencies. During the year the Institute provided consultancy services to various institutions in India in the field of Population. 15.43.6. Publications The Institute brings out quarterly Newsletter, which publishes information about various ongoing activities of the Institute. During the year 2009-10, the Institute published two issues covering four numbers of IIPS News- Letter. In addition Publication Unit brings out research briefs and working paper series based on different research projects completed by the Institute as part of dissemination of IIPS research findings. 15.43.7. Library The Institute maintains an excellent library with most recent books on population and related topics. There are 78,855 books, 13,794 bound volumes of periodicals, 16,157 reprints and 170 CDs in the library. The library receives about 325 Indian as well as foreign journals, out of which 175 are received by way of subscription and another 150 are received by gift/exchange. More than 20,000 journal Annual Report 2010-11 291 articles have been indexed and added in the library operation software. The library has books on different disciplines such as Demography, Statistics, Public Health, Family Planning, Anthropology, Mathematics, Economics, Sociology, Psychology, Health Education, Political Science, Geography, Computer Programming, etc. published by the Union Government, State Governments, Corporate Bodies, International Agencies and Commercial Publishers of India as well as abroad. The library provides abstracts and current awareness services, documentation, reference, inter-library loan and Xeroxing facilities. The library has a special collection of all the census publications of India and other countries, indexed journals/edited books articles which are made available through OPAC. The Institutes library provides bibliographic and reference services to other libraries, organizations and researchers and also fulfils information requests from libraries outside India. The library is fully automated with the help of SLIM-21 software which offers Online Public Access Catalogue (OPAC) through a network of computers. The databases offered in the library are POPLINE, JSTOR, INDIASTAT.COM, SCIENCE DIRECT (Social Sciences) and SCOPUS. Digital conversion of Census of India 1881-1941, 1991-2001 is special collection and made available in the library. All these databases are accessible through all the computers on the campus. Metadata access work is in progress. Mapping module has been introduced and integrated with OPAC to provide easy library access. Each title of the online database has weblinked with OPAC too. To promote the National Language Hindi, a bibliographical database has been made available in Devnagiri script, and is accessible through OPAC. 15.43.8. Computer Centre The Computer Centre of the institute is well equipped with the latest computers and statistical software required for data analysis. The computer center is having one main classroom/lab room with 37 Pentium IV and higher generation computers. The software packages installed on these computers are SPSS, STATA, Spectrum, Mortpac and GIS and are used by the research scholars and students for analyzing their data. Of the 37 computers, 12 computers are configured for internet access. The computer center has a network attached storage ( Nasstor ) server which stores the data from Census, NFHS, RCH etc. and one email server for providing the internal email facility to the institute. The computer center has a 2 Mbps Leased Line connection which is distributed among the different users through Local Area Network. Another 2 Mbps backup line to provide wireless internet facilities is being established. To secure the internet access Fortigate Firewall is installed in the computer centre. There are a total 260 desktop computers in the institute and the computer center looks after providing the services like installation of software, configuration for the internet and local mail access and giving the technical support as and when required. Recently a second classroom has been established in computer center with 14 computers to meet the requirement to run the Short Term courses and regular classes simultaneously. This second class room can also be used by students and research scholars for their research data entry and analysis. 15.43.9.Data Centre The Data Center of the institute acquired the data set of Census of 1991 and 2001, National Family Health Survey 1, 2 and 3, DLHS (RCH) 1, 2 and 3, Demographic Health Survey (DHS) and National Sample Survey (NSS) data on CD-ROM media, which are available to the researchers. An E-book in the CD-ROM media containing the full papers of DPS/MPS/M.Phill students seminar has been prepared and six e-books on topic related to the reproductive health, child and maternal mortality are also prepared. Data sets from National Family Health Survey and DLHS are provided to researchers who request them. At present, the users are directly accessing resources such as Demographic data sets and databases, which are stored on the server. Further, server based software like GIS and OPAC (Library Information) can be accessed through campus network including the internet. The users can also access Bibliographic Data Bases such as Popline, Jstor, Science Direct, Scopus, etc. The Institute has a website :http://www.iipsindia.org having a storage capacity of 10 GB which has recently been upgraded and redesigned. Information regarding the institute as per UGC norms is being updated regularly on the website and is in the process of being uploaded in Hindi. Efforts are also on to make the website interactive. 15.43.14. Notable achievements of the institute: I. District level household project under Reproductive and Child Health (RCH) project & Facility survey-3, India Annual Report 2010-11 292 Introduction: The District Level Household and Facility Survey (DLHS) was initiated in 2007 with a view to assess the utilization of services provided by government health care facilities and peoples perception about the quality of services. The DLHS-3 is the third in the series of district surveys, preceded by DLHS-1 in 1998-99 and DLHS-2 in 2002-04. The sample size among the districts in the country varies according to their performance in terms of Ante-Natal Care (ANC), institutional delivery, immunization, etc. and it was fixed based on information related to such indicators from DLHS-2. For low performing districts, 1500 Households (HHs), for medium performing districts, 1200 HHs and for good performing districts, 1000 HHs were fixed as sample size. The survey used two-stage stratified random sampling in rural and three-stage stratified sampling in urban areas of each district. The information from 2001 Census was used as sampling frame for selecting primary sampling units (PSUs). In rural areas, all the villages in the district were stratified into different strata based on population / HH size, percentage of SC/ ST population, female literacy (7+), etc. The required number of villages from each strata were selected with probability proportional to size (PPS). In selected primary sampling units (villages), household listing was done and required numbers of households were selected using systematic random sampling. For larger villages (more than 300 HHs) segmentation was carried out. In case of 300 to 600 HHs, two segments of equal size were made and one was selected using PPS. For PSUs having more than 600 HHs, segments of 150 HHs were created depending on the size and then two segments were selected using PPS. In case of urban areas, numbers of wards were selected using PPS at first stage. In a selected ward, one enumeration block from 2001 census was selected again using PPS. Procedure for segmentation, household selection, etc., was same as in the case of rural PSUs. The uniform bilingual questionnaires, both in English and in local language, were used in DLHS-3 viz., Household, Ever Married Women (age 15-49), Unmarried Women (age 15-24), Village and Health facility questionnaires. For the first time, population-linked facility survey has been conducted in DLHS-3. In a district, all Community Health Centres (CHCs) and District Hospital (DH) were covered. Further, all Sub-centres (SC) and Primary Health Centres (PHC) which were expected to serve the population of the selected PSU were also covered. There were separate questionnaires for SC, PHC, CHC and DH. They broadly include questions on infrastructure, human resources, supply of drugs & instruments, and performance. DLHS-3 covered about seven lakh sample households from 612 districts of the country. Progress:- The progress of DLHS-3 is listed below:- i) The data collection work for 601 districts of 34 States & Union territories in DLHS-3 have already completed in 2008. ii) State Fact Sheets of all 34 States of DLHS-3 have been printed & dispatched to the concerned officials as well as to Ministry. iii) District Facts Sheets of 599 districts of 34 States of DLHS-3 have been printed & dispatched to the concerned officials as well as to Ministry. The printing work of remaining 2 districts of Andaman & Nicobar Island is under progress. iv) Reports containing fact sheet of India & 34 States and Union Territories have been printed. v) DLHS-3 data are ready for use. vi) All key indicators of district, state and national level are ready. vii) State Level Report of Punjab, Haryana, Andhra Pradesh, Madhya Pradesh, Jharkhand, Chhattisgarh have been printed. State Level Report of Bihar, Uttarakhand and Jammu & Kashmir are in the press for printing. viii) One national seminar on preliminary results of DLHS-3 had been conducted on 8th December 2008 at New Delhi. One State Level Dissemination Workshop for Andhra Pradesh of DLHS-3 had been conducted on 4th November 2009 at Tirupati during IASP Conference. One more State Level Dissemination Workshop for Punjab & Chandigarh of DLHS-3 had been conducted on 27th November 2009 at Chandigarh. The DLHS-3 dissemination for remaining states will be conduct after printing of State Reports respectively. Annual Report 2010-11 293 Expected date of completion: - State wise compendium will be completed before 31 st March 2011. The draft National Report, hard copies of 6 State Reports (Punjab, Haryana, Andhra Pradesh, Madhya Pradesh, Jharkhand, Chhattisgarh) sent to Ministry. The State Report of remaining states will be ready by March 2011. II. Youth in India: situation and needs study The Institute is collaboration with the Population Council has undertaken a pioneering research to document young peoples transition to adulthood in six states namely Maharashtra, Andhra Pradesh, Tamil Nadu, Rajasthan, Jharkhand and Bihar. Both qualitative and quantitative approaches are used covering behaviors and experiences ranging from schooling to marriage and sexual behavior. Gender role attitudes and relations with parents will also be studied. The MacArthur and Packard Foundations provide the funding for this project. Publication and dissemination of fact Sheet: The key indicators of the study are being prepared in a fact sheet for the states. The fact sheets for all six states have been printed and disseminated. Some of the findings have been widely disseminated in various news papers and television programs. Dissemination Seminars of Youth in India: Situation and Needs Study The Youth in India: Situation and Needs study is a sub- nationally representative study undertaken for the first time in India to understand the key transitions experienced by young people in six states of India. With the funding of Packard and MacArthur Foundation, IIPS & Population Council conducted this study. The findings of this study for India and the states of Jharkhand, Tamil Nadu, Bihar, Rajasthan and Andhra Pradesh were released during the dissemination seminars held in their respective states. IV. Global Adult Tobacco Survey (GATS) The main aim of the Global Adult Tobacco Survey (GATS) is to establish systematic surveys to monitor adult tobacco use and to evaluate progress in implementing tobacco control interventions under the Bloomberg Global Initiative to reduce tobacco use. Since there is no standard global adult tobacco survey that consistently tracks prevalence of tobacco use (smoking and smokeless as well), exposure to secondhand smoke, cessation, risk perceptions, knowledge and attitudes, exposure to media and price and taxation issues, which are critical measures for tobacco control program and policy development. The project is sponsored by the Ministry of Health and Family Welfare, Government of India and WHO SEARO, New Delhi with technical support from CDC, Atlanta, U.S.A and Research Triangle Institute (RTI), North Carolina. Under the overall umbrella of the GATS project mentioned above, the main aim of the GATS-India is to carry out an Adult Tobacco Survey in India at regional levels which include all the 29 states and union territories of Chandigarh and Puducherry covering about 99.92 percent of the total population according to the 2001 Census of India. The major objectives of the survey are to obtain sufficiently reliable estimates of prevalence of tobacco use (smoking and smokeless tobacco as well), exposure to secondhand smoke, cessation etc., for both males and females at the national level and for each of the six regions classified by place of residence of the respondents (urban/rural). The specific objectives of GATS-India are as follows: Provide estimates of the levels of tobacco use, and smoking, second hand exposure, and cessation attempts among men and women separately for urban and rural areas of India, a country as a whole. Provide estimates of the levels of tobacco use, and smoking, second hand exposure, cessation attempts among men and women in each geographical region for urban and rural areas. Provide estimates of the levels of tobacco use, and smoking, second hand exposure, cessation attempts among men and women for all 29 States and two Union Territories. Provide estimates of the levels of tobacco use, and smoking, second hand exposure, cessation attempts among men and women by selected background characteristics at national, and regional level Like other large scale surveys conducted in India, entire country has been grouped in the following 16 groups. Each group will be assigned to one Research Agency for conducting fieldwork. In addition, keeping in view the weather condition prevailing during the data collection (October 2008 to February 2009), fieldwork has been phased out. Around 17 States/UTs will be included in first phase and around 16 States/UTs to be covered in second Phase. It may be mentioned that Uttar Pradesh and Assam which a sample size of around 5000 in each state will be covered in two phases, an identified portion in each phase. Annual Report 2010-11 294 The total target sample size at national level is 70,802, including 42,647 in rural areas and 28,155 in urban areas. With the assumption of target sample size of average 30 completed interviews per Primary Sampling Unit (PSU), GATS-India will cover 2,366 PSUs nationwide (1,423 rural and 943 urban). It has been decided that this survey would be conducted on digital formats through HP iPAQs handheld devices. It has been considered by the Government and agreed that though handheld devices are being used for the first time on large scale surveys in India, it would have several advantages. Data collection work for GATS-India is already completed in all the 31 States/UTS. The National fact sheet and national report and dissemination already completed. Five zonal dissemination to be completed before March 31, 2011. V. ENVIS Centre on Population and Environment The Ministry of Environment and Forests, Government of India under the Environmental Information System (ENVIS) Centre on population and Environment at IIPS. The centre collects, collates and disseminates data on various aspects of population and environment relationship such as population growth and land use, urbanisation and air pollution, household environment and morbidity and mortality etc. The centre maintains a website http:// www.iipsenvis.nic.in connected to NIC server. It also brings out a quarterly bulletin on population and environment. The centre is in existence since 2004. Apart from regular activities of web based dissemination and publishing of bulletins, the centre has published a book on Population and Environment Linkages and an e- book containing extensive abstracts for about 500 research articles in the areas of population and environment. ENVIS Publications o ENVIS Newsletter ENVIS newsletter is being published regularly on quarterly basis since 2004 which provides information on population and environment related issues. o Books/ Bibliography The ENVIS Centre has published a book and compiled a bibliography of research articles in the areas on Population and Environment. IIPS ENVIS Website (http://www.iipsenvis.nic.in) o The Website contains Newsletters and archives back issues from 2004, along with Database, Publications of the Centre, Picture Gallery, Query Form, Web Links etc. I. Longitudinal Ageing Study in India (LASI Pilot) Project The International Institute for Population Sciences, Mumbai and the Harvard School of Public Health are undertaking a collaborative study entitled, Longitudinal Ageing Study in India (LASI).The short-term goal of LASI is to carry out a pilot survey to assess the health and wellbeing of the elderly population in Karnataka, Kerala, Punjab and Rajasthan in India. The timeline for pilot survey is October 2008-December 2010. A full-scale nationally representative LASI is envisioned with the first wave starting from 2011. The full-scale LASI is expected to cover a national sample of 30,000 elderly persons in age45+ and to follow them every two years for up to 25 years. No thorough study of this type has ever been carried out in India. LASI is modelled on similar surveys carried out in china, Korea, several European countries and the United States. These Health and Retirement Studies (HRSs) provide longitudinal data for researchers, policy analysts and program planners making policy decisions related to labor supply and savings behavior, the disease burden and demand for health and utilization and social and economic well-being of the elderly and their families. The HRSs are collectively designed to facilitate direct and close comparisons of the health and the retirement behavior of relatively old populations in d i f f e r e n t countries. With the percentage of individuals over the age of 50 in India projected to grow at a 2.7% compound annual growth rate over the next 45 years, an understanding of health, retirement and population aging is a matter of critical policy importance. The sampling plan and survey instrument are currently being developed. LASI-pilot fieldwork is expected to be undertaken during March-April, 2010. LASI-pilot is funded by the National Institute on Aging of the United States National Institutes of Health and National Institute of Ageing (NIA) of the national Institute of Health, USA. Annual Report 2010-11 295 VII. Study of global Ageing and Adult (SAGE) - India 2007 The International Institute for Population Sciences, Mumbai in collaboration with the World Health organization, Geneva is undertaking the Study on Global Ageing and Adult Health (SAGE), 2007 in India. SAGE is part of global longitudinal study implemented in six countries China, India, Ghana, Mexico, Russia and South Africa. In India, SAGE is being conducted in six states Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal. SAGE will cover a sample of 10600 households across the six states. SAGE will follow-up the same PSUs and the sample households covered across these six states in the World Health Survey (WHS), India, 2003. SAGE is expected to run for up to 10 years with follow-up waves for every two years. The primary objective of SAGE is to assess health and well-being of the elderly persons in age 50 and above and their social determinants. SAGE aims to gather evidence base on socioeconomic background, health state description, burden of disease, health care utilization, quality of life and well-being. Besides these self-reported information based on interview, SAGE adopt improved health measurement techniques by using a range of biomarkers-blood pressure, lung-function, vision, grip strength, time walk, a battery of cognitive tests, anthropometry and blood test for anaemia, diabetes, heart disease, and hepatitis-B. SAGE Field work and data entry have been completed during 2007-08. Currently, data processing is underway and the report for first wave is expected to be completed by June 2011. Funding for SAGE is being provided by the World Health Organization, Geneva and USAID, New Delhi. VIII Concurrent evaluation of NRHM Results were disseminated/presented to Ministry of Health & Family Welfare chaired by Secretary, MOHFW on 25 th October 2010. 15.44. FAMILY WELFARE TRAINING & RESEARCH CENTRE (FWTRC), MUMBAI. 15.44.1 Family Welfare Training & Research Centre (F.W.T. & R.C.), Mumbai, is a Central Training Institute, responsible for the in-service training in the key health areas for different categories of health personnel all over the country. Training related to Primary Health Care, Family Welfare, R.C.H., HIV/AIDS and other integrated National Health Programmes are imparted to various categories of health professionals of state and district levels, i.e. DHOs, DEMOs, Key-trainers etc. from Health & F.W. Training Centres. Centre is also conducting a one year academic Post-graduate Diploma in Health Education (Renamed as Diploma in Health Promotion Education) for the candidates deputed from all-over-the country and also for candidates sponsored by WHO/UNICEF/UNDP/DANIDA etc. The first course of D.H.P.E. was started in the year 1987-88. At present the 24 th course is in progress, with 23 trainees. 15.44.2. With the launch of Government of Indias National Rural Health Mission and the present health care services, FWTRC Mumbai is also conducting a Post-graduate Diploma in Community Health Care, for the para-medicals working in family welfare in Health Departments, NGOs and Private Sectors to improve their efficiency to cope up with the work under the NRHM for better delivery of health care services. The first course of this has been started at F.W.T. & R.C., Mumbai from October 2007. The duration of the course is 15 months. The third batch of P.G. D.C.H.C. is in progress. At present a total of 8 trainees are undergoing the above course. 15.44.3. Apart from training, Centre is also involved in Community-based Research work in the field of Health & F.W., Population, AIDS etc. in rural as well as in the urban areas. Institute is also conducting training programmes, workshops and seminars in the key health areas like RCH, HIV/AIDS, Population, Immunization and Communication for the medical and para-medical personnel from the Governmental and Non-governmental Organizations, including Fellows sponsored by international organizations like UNFPA/UNDP, WHO etc. 15.44.4.Looking towards the future developments of the Institute and organizing more and more training programmes for medical and para-medical personnel to deliver better health care services, it has been proposed to shift this Institute to a new Institutional premises at New Panvel, Navi Mumbai. With this view, a piece of land admeasuring 5000 Sq.Mtrs. for the construction of Annual Report 2010-11 296 office premises, with training infrastructure including hostel has been purchased to shift the activities of the Institute to a new premises. Apart from this, land of area 1700 sq.mtrs. has also been purchased for residential purpose, near the Institutional complex at Navi Mumbai. The Institute is having the vision to develop it as one of the leading Central Training Institutes (CTIs) for training, operational research and policy decision for the medical and para-medical personnel to meet the goal under the National Health Policy, National Rural Health Mission and RCH. The construction of the new Institutional premises of FWTRC, Mumbai at New Panvel, Navi Mumbai is progressing well and likely to be completed. 15.44.5.During the year 2010-2011, training, education, research and clinic services of the institute were continued and expanded in accordance with its objectives. The activities of the Centre for the year 2010-11 are as follows:- Contact Classes:- Centre has been identified by NIHFW, New Delhi for conducting two (2) Contact classes for the students of the Post-graduate Certificate Course in Health & F.W. Management and Hospital Management through distance learning (conducted by NIHFW, New Delhi). During the year Contact Classes programme on Hospital Management from 29-11-10 to 3-12-10, for 28 participants has been conducted by FWTRC. W.H.O. Fellowship Programmes:- Centre has been identified by WHO and Ministry of Health & F.W., New Delhi, as a Collaborative Institute for conducting training programmes for international Students under the WHO Fellowship programme. Research/Evaluation Activities:- The regular Evaluation activities and research work has been continued during the year 2010-11. During the year under report, routine activities were conducted at the FPDA area, i.e. Khumbarwada area, which is half Km. away from the Centre, by the DHPE as well as PGCHC trainees. The students undergoing the formal training courses of the Institute regularly visit F.P.D.A. area for training purposes and health educational activities/concurrent field work activities.The students also conducted field activities in their respective districts, namely Satara, Aurangabad ,Latur, Beed, Barshi, Solapur and Thane in Maharashtra and East Godawari, Nellore, Warangal, Kadappa, West Godawari, Karnool and Shrikakulam in Andhra Pradesh as part of Field Training. Seminars/Workshops An Audio-visual Workshop was organized during Jan. 2011, at the Institute for the DHPE and PGCHC students for preparation of Audio-visual material in collaboration with J.J. School of Architecture, Mumbai, so that the specialized input of artistic Communication could be integrated to enhance the impact of health Education material. Trainees prepared the audio-visuals and later on they used the same for organizing the health exhibition in the FPDA. 15.44.6. Education: Diploma in health promotion education: Centre is conducting its 24 th course of Diploma in Health Promotion Education Course, which is a one academic year Post-graduate Diploma course, with a total strength of 23 students from Maharashtra and Andhra Pradesh and Madhya Pradesh. The 1 st Semester Examination is conducted in the month of Nov.-Dec. 2010. The observational tour to Delhi is being scheduled for this month. A work-shop on preparation of Audio- visual Aids was organized at the Centre. The trainees have already started their assigned concurrent field work in the field area, i.e. Kendriya Vidyalaya, Antop Hill. A health exhibition and medical camp was also organized at Kendriya Vidyalaya on 24 th and 25 th Jan. 2010. All the trainees were actively involved in the above activity. The Second Semester examination will be conducted in March 2011. Later on the students will be posted/placed for Supervisory Field Training (SFT) in their respective states. Post Graduate Diploma in Community Health Care: With the launch of Government of Indias National Rural Health Mission and the present health care services, FWTRC Mumbai started a Post-graduate Diploma in Community Health Care, for the para-medicals working in family welfare in Health Departments, NGOs and Private Sectors to improve their efficiency to cope up with the work under the NRHM for better delivery of health care services. The first course of this has been started at FWTRC, Mumbai from October 2007. The duration of the course is 15 months, which includes 3 months field placement. At present the 3 rd course is going Annual Report 2010-11 297 on with a total of 8 trainees. All the trainees were actively involved in the health exhibition and medical camp was organized at Kendriya Vidyalaya on 24 th and 25 th Jan. 2010. I.E.C. Training/Programmes in The Community: Organized audio-visual aids workshop for D.P.H.E .and PGCHC trainees, wherein trainees prepared projected and non-projected aids and utilized them during their field placement; Organized Health Exhibitions and Health Education meetings in urban slums of Mumbai for creating awareness amongst people, on various topics related to health and Family Welfare, HIV/AIDS, R.C.H. etc; Organized Health Camp at Kendriya Vidyalaya, Antop Hill for the school children on 24 th & 25 th Jan. 2011. Clinical and Laboratory Services: Service delivery to mothers and children continued at the Centre during the year 2010-2011, through its Clinic and Laboratory. Medical and Health Care services were delivered to the patients attended the Clinic during the year. Along with MCH services, counseling in Family Welfare is also done by this institute. Apart from this, Centre is also running an Immunization Centre/Clinic (once in a week) for the infants/children and a daily Dispensary/OPD for the community. The institute has a patient attendance of approximately around 100/per month including immunization beneficiaries. 15.44.7. Research: The Officers participated in the discussions of the Consultative Group of I.I.P.S. to Finalize around 10 Research Projects and also reviewed the progressive projects. 15.44.8. Out-Reach Activities: A Medical Check-up Camp in collaboration with the, CGHS, was conducted Mumbai for approximately 2500 children comprising of Medical Officers from FWTRC, CGHS and other Hospitals. 15.45. NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE (NIHFW), NEW DELHI The National Institute of Health and Family Welfare (NIHFW) is an autonomous, apex technical institute under Ministry of Health and Family Welfare, Government of India working for the promotion of Public Health in the country. 15.45.2. Educational Activities Teaching Activities: The educational activities of the Institute are planned to impart basic education and promote academic excellence in the areas having a bearing on the health and family welfare programmes in the country. M.D. (Community Health Administration) NIHFW conducts a three year Post-graduate Degree Course in Community Health Administration. This course is recognised by MCI and affiliated to University of Delhi. Sixteen students are undergoing the M.D. (CHA) course during the year 2010-2011. Six (6) students are in final year; three (3) in second year and seven (7) in the first year. Diploma in Health Administration (DHA) NIHFW conducts two years Post Graduate Diploma in Health Administration and this course is recognised by MCI and affiliated to University of Delhi. Seven (7) students are undergoing the DHA course during the year 2010-2011. Two (2) students are in first year and five (5) in the final year. Post Graduate Diploma in Public Health Management (PGDPHM) This course, in collaboration with Public Health Foundation of India and supported by MoHFW under NRHM is being run by nine reputed Institutions in the country. The said course started in the year 2008, with the objective to enhance the capacity of Public Health managerial workforce through conduct of a specially designed course. Total 30 seats are allotted to NIHFW. In the year 2010- 2011, which started from 2 nd August 2010, 29 students are enrolled, out of which 9 students are international students facilitated by Partners in Population Development (PPD). The International students are from Bangladesh (2), China (2), Gambia (1), Nigeria (1), Thailand (1), Tunisia (1), and Vietnam (1). The course fee of this programme is Rs.2.50 lakh per candidate and is met from NRHM funds of the respective State Governments. Students from Uttar Pradesh, Uttarakhand, Rajasthan, Jammu & Kashmir and Haryana are also attending this course. Distance Learning Courses One year Certificate Course in Health and Family Welfare Management through distance learning. In the Annual Report 2010-11 298 year 2010-2011, 181 students have been enrolled for the course. One year Certificate Course in Hospital Management through distance learning. In the year 2010-2011, 403 students have been enrolled for the course. One year Certificate Course in Health Promotion. This is the new course in Distance Learning mode started with the approval of Directorate General of Health Services, Govt. of India. 235 students have already been enrolled for the course. A graduate in any discipline can be enrolled in this course. Ph.D. Programme Under the Ph.D. programme, 8 students are pursuing their Doctoral work from different Universities. The Institute has became the approved Research Centre affiliated with Chhatrapati Shahuji Maharaj Medical University, Lucknow, U.P. and 7 students are pursuing their Doctoral work. 15 students are pursuing their Doctorate in various disciplines like - Social Sciences, Demography, Public Health and Reproductive Biomedicine. Summer Training: A total of 14 students from different Universities of the Country completed Summer Training Course. Four students from National Institute of Epidemiology, Chennai, have also joined recently. 15.45.3. Training Activities and Workshops NIHFW conducts various short term training courses, ranging from one to ten weeks duration.From April 2010 till 20 th November, 70 training courses were held and 3383 participants were trained. Professional Development Course (PDC) in Management, Public Health and Health Sector Reforms for District Medical Officers It was started with the objective of training middle level medical officers with 12-16 years of service, to be able to function effectively for service delivery. This integrated training incorporates management, public health and ongoing reforms in the country including NRHM in a ten weeks programme. The course has been evaluated twice. The course was started by NIHFW (Nodal Institute) in 2001 and has been rolled out to 17 CTIs of which three are in the private sector - IIHMR, Jaipur, IISW&BM, Kolkata & AMCHSS Trivandrum, Kerala. During the year 2010-11 (till 15 th Nov, 10), a total of 118 and a cumulative total of 1671 officers have been trained from various states. Immunization Training NIHFW has been designated as the apex nodal agency for Immunization Training for Medical Officers, Vaccine and Cold Chain Handlers and for states conducting Measles SIA catch-up rounds. Immunization Training for Medical Officers In 2010-11, 27 trainers from 4 states were trained. NIHFW is also tracking the progress of immunization training of Medical Officers in the states. As on 1 st November 2010, 16665 (27.5%) of Medical Officers have been trained across the country. Training of Vaccine and Cold Chain Handlers During June 2010, two national trainings (one for State Immunization Officers and one for regional master trainers) were conducted by NIHFW. Following this, two regional level TOTs for training teams from 6 states have been conducted. During 2010, 105 national and state trainers have been trained for further trainings in the regions and states. Measles SIA Trainers NIHFW has conducted a National Measles SIA TOT in August 2010 to train 44 master trainers. During August and September, 2010, 284 district trainers were further trained directly by NIHFW through 9 states/regional level TOTs for 13 states conducting Measles SIA catch up rounds. Training on Stress and Conflict Management for Health Professionals. Sensitivity Training of the Health Professionals posted at the Common Wealth Games. Foundation Courses for Basic Emergency Medical Obstetrics Care (BEmOC) in Collaboration with the Government of India, Liverpool School of Tropical Medicine (LSTM) and the Royal College of Obstetricians and Gynaecologists, UK. This training package named Prasuta is initially being piloted in seven states. In two rounds of training, 390 doctors and staff nurses have been trained along with 46 Master trainers. Uttarakhand BPMU training - On the request of government of Uttarakhand, NIHFW had taken up the responsibility of training of Block Public Health managers Annual Report 2010-11 299 in Uttarakhand. Six courses of two days were organised at Almora, Dehradun, Pauri and Nainital for the BPHMs and Block level Accountants. A total of 198 participants were trained. The first course in Asia on Managing Programme to Improve Child Health was organized at NIHFW by the faculty from WHO Headquarter, Geneva. Data Analysis Using SPSS for Health and Demographic Research. Training for Health Care Providers of Uttar Pradesh On request of Uttar Pradesh Govt., NIHFW conducted the following training courses for their health care providers: Enhancing Capacity of District Project Officer (DPOs) of Uttar Pradesh under NRHM - thirty three (33) participants attended the training. During the training, a field visit was conducted at Udaipur, Rajasthan, to give the participants first hand information regarding the District Health System, Basic Laparoscopic Skill Training (BLSP) 12 Medical Officers posted at various District Hospitals were trained on Basic Laparoscopic Skill Training at Surgery Department of AIIMS, New Delhi, Advance Life Support Training 32 Doctors and 31 Staff Nurses of Uttar Pradesh were trained in three days on Advance Life Support at Trauma Centre of AIIMS, New Delhi, Training Courses on Hospital Administration for Chief Medical Superintendents (CMS) Working in Hospitals under Govt. of Uttar Pradesh. Total 78 CMSs were trained ,Role of NGOs in National Rural Health Mission. 15.45.4. Workshops Indo-US Workshops in Partnership With ICMR Indo-US workshops were organised in partnership with Indian Council of Medical Research on: Workshop on Maternal & Neonatal Sepsis on 25-26 Oct.,2010, Workshop to develop a social and behavioural research agenda to prevent spread of HIV/STD in India on 27-28 Oct.,2010, A Grantsmanship and Peer review workshop on 29-30 Oct.,2010. 15.45.5. Conferences 28 th Annual Conference of Indian Society for Medical Statistics (ISMS) The conference was jointly organized by NIHFW and National Institute of Medical Statistics (NIMS), New Delhi during November 11-13, 2010. More than 200 participants attended and total of 132 papers were presented in 15 scientific sessions along with 7 invited talks. Research Studies The Rapid Appraisal of Health Interventions (RAHI-III) The Rapid Appraisal of Health Interventions, a collaborative activity with the United Nations Population Fund (UNFPA), has been a unique initiative taken under the wider umbrella of the Public Health Education and Research Consortium (PHERC) of NIHFW. The first phase with 12 health system research projects on various components of NRHM in five low-performing states and second phase, RAHI-2, again, 12 health system research projects on various components of NRHM in 6 low- performing states were completed and published. The third phase of RAHI has three research projects cleared by the Institutional Review Board. The research projects are mainly for the EAG states and are funded by NIHFW. Ongoing WHO-CONRAD funded multi-country, multicentric project on Sperm suppression and contraceptive protection provided by norethisterone enantate (Net-en) combined with testosterone undecanoate (TU) in healthy men. The study is in progress. A Study on Integration of PPTCT Services with RCH and Other Components of Primary Health Care System in States of Andhra Pradesh and Karnataka. The data collection is completed. Approved Evaluation of National Cancer Control Programme. The study is approved by the MoHFW. MD-CHA Thesis Six(6) MD-CHA thesis have been completed and three (3) are ongoing studies. Health Financing Unit Research study This unit was established in the Institute with financial support from WHO in the year 2009. The Institute has continued this unit with its internal funding. The ICMR has sponsored Research Study on Evaluation of Rashtriya Annual Report 2010-11 300 Suraksha Bima Yojana (RSBY) in Delhi which will be conducted by Health Financing Unit. 15.45.6. National Child Health Resource Centre (NCHRC) The centre established aims at strengthening the focus on child health and related maternal health, mainstreaming child health agenda in public health. Ongoing tasks include analysis of the data collected from the field on Home- based care of newborns and mothers by ASHAs, development of digital gallery of IEC/BCC materials, and holding national workshop on prioritizing areas of operational research in maternal, newborn and child health. 15.45.7. Public Health Education & Research Consortium (PHERC) Network and Partnership 638 institutions are the members in this consortium which includes 179 Medical Colleges, 173 Nursing Colleges, 51 SIHFWs/CTIs, and 214 NGOs and 21 other institutes/ organizations. CDs along with relevant material has been distributed to them for information sharing. They are working in collaboration with NIHFW in studies on health system research. Twenty four studies had been conducted by the Partner Institutions and three are in progress. This is helping in the capacity building of the partner institutions. 15.45.8. NIHFW: A Part of Global Development Learning Network NIHFW has now become a part of the Global Development Learning Network (GDLN), initiated by the World Bank. The GDLN is a global partnership consisting of more than 100 learning centres (GDLN Affiliates) that offer the use of advanced information and communication technologies to the people working in development sectors around the world. Through videoconferencing, high-speed internet resources, and interactive facilitation and learning techniques, GDLN enables their members to hold co- ordination, consultation, and training events in a timely and cost-effective manner. GDLN clients include academic institutions offering distance learning courses on development issues; development agencies seeking dialogue with key partners across the globe; and non- governmental organizations co-ordinating with their partners world-wide. 15.45.9. Clinical Services The Institute is providing clinical services on infertility management along with adequate laboratory support. The clinic also providing family planning services , MCH services, conducting adolescents and youth clinic. 15.45.10. NRHM/RCH-II Project MOHFW has given an approval for extension to National Institute of Health & Family Welfare to act as the Nodal Agency for training under the RCH programme and NRHM till the year 2012. It has been pursuing the responsibility of coordinating and monitoring the training activities under both RCH & Diseases Control Programme, with the help of 18 collaborating training institutions (CTIs) in various parts of the country: RCH Unit Central Training Plan (CTP) A Central Training Plan has been developed by NIHFW on the six thematic areas - Maternal Health, Child Health, Family Planning, ARSH, Disease Control and other Programmes based on the states PIPs & ROPs. The CTPs has been developed for the purpose of development of training curriculum, monitoring of trainings and data analysis under NRHM and is available on the Website www.nihfw.org. MCH Centres Mapping Consultants from RCH unit, NIHFW participated in mapping of MCH centres in 261 high focuss districts around 22 states of India along with representatives of MOHFW & NHSRC. The exercise was undertaken with the objective of upgrading & strengthening the identified facilities, to provide maternal and neonatal care services round the clock to improve maternal and child health status of the district. The teams did the gap analysis in terms of infrastructure, human Resources, equipments & Instruments and training status of health personnel and prepared the plan for additional inputs including budget for developing these centres as L-1, L-2 and L-3 centres. Monitoring Visit Ten different checklists have been developed by NIHFW in consultation with MOHFW for monitoring the health facilities, trainings and identifying the gaps at state, district and block level. NIHFWs RCH consultants visited 60 districts in the 9 High Focus States with the aim of monitoring and mid course correction. Navjat Shishu Suraksha Karyakaram (NSSK) Annual Report 2010-11 301 NIHFW assisted MOHFW, GoI in developing module for NSSK training. So far 135 participants have been trained in 4 batches in collaboration with Indian Academy of Paediatrics (IAP). 15.45.11. National Nodal Agency for Specialized Projects Annual Sentinel Surveillance for HIV Infection NIHFW is coordinating and supervising the Annual Sentinel Surveillance for HIV Infection in the country in 2010 through identified Regional Institutes, Central team members and SACS. NIHFW have been involved in doing data triangulation exercise assigned by NACO, for the states of Gujarat and Jharkhand. District wise reports were prepared about the vulnerability of HIV for 25 Districts and 2 Municipalities of Gujarat. Reports are under preparation for the 25 districts of Jharkhand. 15.45.13. National Health Information Collaboration The National Health Information Collaboration (NHIC) is a National Health Information Repository, designed to serve as a one-point source for authentic and relevant health information on all health topics. It is targeted to serve health professionals viz. health service providers, researchers and policy makers. The portal has been facilitated by WHO which jointly with Indian Council of Medical Research is hosted at www.nhicindia.org and is being administered by the National Institute of Health and Family Welfare, New Delhi. 15.45.14. Publications During the year, the Institute has come up with publications, such as: National Iodine Deficiency Disorders Control Programme National leprosy Eradication Programme National Mental Health Programme Modules of Health Promotion Course. The Institute has made efforts for digitization of various Committtees Reports in Health Sector and uploaded on its Website. 15.45.15. Journals of Institute The Institute like every year published its quarterly journal, Health and Population: Perspectives and Issues, with articles on research studies conducted all over the country and it has been abstracted/indexed by national and international abstracting agencies. The Journal is indexed/ abstracted by 9 National and International abstracting agencies. The journal is also available on the Institutes web site i.e., www.nihfw.org. The Institute published the quarterly Journal - Indian Journal of Community Medicine (IJCM), an official publication of Indian Association of Preventive & Social Medicine, on line with articles on research studies on Public Health and it has been abstracted/indexed with Pubmed. Prof. Deoki Nandan, Director, NIHFW is the Chief Editor of the Journal. Dhaarna the Hindi Publication of the Institute which continues with articles contributed by faculty and staff members of the Institute on the issues related to Health & Family Welfare. Now it will be published half-yearly. 15.45.17. The Transcendence: The quarterly newsletter is informative, educative and useful to the readers. Recently, NIHFW has published quarterly Newsletter Vol.XII No.3, July-September, 2010. Also available on the Institutes website i.e. www.nihfw.org. 15.45.18. Upgraded Facilities in the Institute Computer Facilities The Institute has provided computer access to all its faculty, research staff, students and administrative staff. About 250 Pentium IV Desktops and 50 Laptops are provided to staff of the Institute. The Institute has a computer lab facility. 15.45.19. National Documentation Centre NDC has developed a computerised, well balanced and up-to-date collection of over 60,000 documents; including books, periodicals, technical reports, annual reports, statistical reports, conference proceedings, modules, non- book materials i.e. CD-ROM, online databases etc. 15.46. RURAL HEALTH TRAINING CENTRE, NAJAFGARH, NEW DELHI Rural Health Training Centre, Najafgarh, New Delhi was set up as a health unit in 1937 and evolved for the next 50 years to become a national Scientific institute. The Major Activities of RHTC Najafgarh are as follows: Training Activities:- There are a number of training activities going on RHTC, Najafgarh i.e. Training to Medical Interns under ROME Scheme. Around 350 unpaid Medical Interns undergone Annual Report 2010-11 302 rural posting from this Centre. Training to ANM 10+2 (Voc.) Students is with intake capacity of 40 students per academic session. Community Health Nursing Training to BSc/MSc/GNM students of various Nursing Institutions like College of Nursing, Safdarjung Hospital, RML Hospital, Lady Hardinge Medical College, Holy Family Hospital, Batra Hospital, Apollo Hospital and various other Govt./State Govt./Pvt. Institutions. Nearly 1000 trainees were trained during the period, Promotional Training for Nursing Personnel, Health Education to the PGDHE Students & One Day Observation Visit. RHTC Najafgarh has been providing Health Services to the low socio-economic group of people of 64 villages and 9 town of Najafgarh through its three Primary Health Centre and 16 Sub-Centre including 24x7 Emergency Services in PHC Najafgarh. It conducts field studies aspects of Health & Family Welfare, RCH, Nutrition, Health Education and Communicable Diseases and also provides field services for research work to the various health institutions, i.e. NIHAI, AIIMS in public health. There are a number of additional programme under NRHM implemented by RHTC, Najafgarh. RHTC Najafgarh has implemented the NRHM in its three PHCs and 16 sub-centres in collaboration with CDMO (South-West), Govt. of NCT Delhi. The following programmes had organized/conducted in RHTC Najafgarh. Village Health Nutrition Days were organized in different sub-centres under PHC Najafgarh and PHC Ujwa. VHNDs were organized with the help of Anganwari workers at Sub-centre level. Key services provided by RHTC Najafgarh in the VHND: (i) Maternal Health check up, (ii) Check up of Child Health Infant upto 1 year, Children aged 1-3 yrs. and all children below 5 yrs. (iii) Family Planning, RTI/STDs, (iv) Sanitation (v) Communicable Disease (vi) Health Promotion (vii) special emphasis on Nutritional Demonstration-Diseases due to malnutrition and its precaution (viii) Hygienic & correct cooking practice (ix) weighing of infants & children and (x) Importance of nutritional supplement. Nutritious food items also demonstrated to the community keeping in view the above points. So far 21 VHND camps have been organised. 15.47. GANDHIGRAM INSTITUTE OF RURAL HEALTH AND FAMILY WELFARE TRUST (GIRHFWT) Established in 1964 the Health and Family Welfare Training Centre at GIRHFWT is one of 49 such training centres in the country. It trains Health and Health related functionaries working in Primary Health Centres, Corporations / Municipalities, Tamil Nadu Integrated Nutrition Projects. The type of training programmes included orientation training, refresher training, skill training on different Health & Family Welfare issues for various categories of health personnel which is affiliated to Tamil Nadu Dr. M.G.R Medical University. 15.48. HINDUSTAN LATEX LTD (HLL) Introduction HLL Lifecare Ltd. (formerly Hindustan Latex Ltd.) is a Mini Ratna (Category I-PSE) Schedule B enterprise under the Ministry of Health and Family Welfare Government of India, operating in the area of Contraceptives, Hospital products and Healthcare services. Capital Structure The issued and paid-up share capital of the Company was Rs. 15.53 Crore as on 31 st March 2010. The reserves and surplus of the Company as on that date was Rs. 124.71 Crore and the capital employed Rs. 221.08 Crore. Marketing and Exports Revenue from direct marketing (excluding Govt. sales) was Rs.200.68 cr contributing to 45% of the total turnover and achieved 22% growth compared to last year. Consumer Business Division: Divisions flagship brand MOODS is now one of the strongest consumer brands in India and contributes to 55% of the total revenue. The consumer business division also launched Herbs & Berries Chyavanules (granular chyavanprash) in Kerala and Delhi. Hicare Division: HCD has achieved sales revenue of Rs. 336.36million of which Blood bag contributed to 67% of the total revenue .Blood bag achieved a value growth of 27% and unit growth of 11%.Surgical sutures registered revenue of Rs.44.51million. Traded products contributed 64.14 million of total Turnover. Annual Report 2010-11 303 International Business Division: International Business Division has achieved sales revenue of Rs. 582.86 million contributing 13% of the companys turnover. Consultancy Services Procurement Consultancy Services: HLL is acting as Procurement Consultant in the field of medical equipment, analytical & research equipment, insecticides, larvicides, drugs, vaccines, hospital furniture etc. with reputation and satisfaction to our esteemed group of clients from the government sector. Research & Development The R&D projects are carried out as stand-alone projects at HLL, or as collaborative projects with institutions of repute. HLL R&D is presently engaged in researches that range from novel and path breaking to incremental progression in nature. Projects are also in progress to improve existing product lines such as condoms, blood bags and diagnostic kits. Modernisation of Blood Bag manufacturing unit: The capacity of blood bag production increased to 11.75 M. Pcs from the present 6 M. Pcs. New projects Medipark - an exclusive industrial park for the medical technology sector Integrated Vaccine Complex Revival of DPT Vaccine manufacturing facility at Central Research Institute, Kasauli, Himachal Pradesh Sanitary Napkin (SN) Manufacturing Project HINDLABS -Diagnostic Services Hindlabs MRI Scan Centres HLL had set up Hindlabs MRI Scan Centre in three Medical College Hospitals at Thrissur, Kottayam and Alappuzha in accordance with a MoU inked with Government of Kerala. Joint Venture Company LifeSpring Hospitals Pvt. Ltd. During year 2009-10, LifeSpring Hospitals Private Limited the 50:50 joint venture company formed by HLL and Acumen Fund Inc., USA had set up three more hospitals, one each at Boduppal (Hyderabad), Bowenpally and Chilkalguda (both in Secunderabad) raising the total number of LifeSpring Hospitals to nine (9). The present paid up capital of the company is Rs.15.67 Cr held equally between HLL and Acumen Fund Inc. Hindustan Latex Family Planning Promotion Trust (HLFPPT) A not-for profit organisation promoted by HLL, HLLPPT has been supporting implementation of reproductive and child health and HIV/AIDS prevention and care programmes in partnership with international development agencies, state governments and MOHFW. 15.49. REGIONAL OFFICES There are 19 Regional Offices of Health & Family Welfare functioning under the DGHS. Located in various State Capitals and headed by a Regional Director. The essential units of the ROH & FW are: (i) Malaria operation field Research Scheme (MOFRS), (ii) Entomological Section, (iii) Malaria Section, (iv) Health Information Field Unit (HIFW) and (v) Regional Evaluation Team (RET). Roles and Responsibilities of ROH & FW: Liaison of Centre-State activates in the implementation of National Health Programme. Cross-Checking of the quality of the Malaria work, Maintenance of free Malaria Clinic in the Office Premises and review/analysis of the technical reports related to NVBDCP. Checking of the Records in respect of Family Welfare Acceptors and other registers maintained during the tour and provide feed back related to Family Welfare Programme activities. Organizing training for laboratory technicians, medical and Para-medical Staff as well as other categories of staff on Orientation in various National Health Programmes. Specified responsibilities are undertaken by Regional Evaluation Team (RET), Health Information Field Unit (HIFU) Malaria Operational Field Research Scheme (MOFRS). Annual Report 2010-11 305 Chapter 16 16.1 INTRODUCTION The Scheduled Castes and Scheduled Tribes Cell in the Ministry continued to look after the service-interests of these categories of employees during 2010-2011. The Cell assisted the Liaison Officer in the Ministry to ensure that representation from Scheduled Castes/Scheduled Tribe, OBCs and Physically Handicapped Persons in the establishment/services under this Ministry received proper consideration. The Cell circulated various instructions/orders received from the Department of Personnel and Training on the subject to the peripheral units of the Ministry for guidance and necessary compliance. It also collected various types of statistical data on the representation of Scheduled Castes/Scheduled Tribes/OBCs/Physically Handicapped Persons from the Subordinate Offices/Autonomous/ Statutory Bodies of Deptt. of Health & Family Welfare as required by the Department of Personnel and Training, National Commission for Scheduled Castes and Scheduled Tribes etc. The Cell also rendered advice on reservation procedures and maintenance of reservation particularly post based rosters. During 2010-2011 inspection of rosters was carried out in respect of thirteen offices namely:- 1. Central Government Health Scheme Jaipur 2. Regional Office for Health & F.W, Jaipur 3. Port Health Organisation Kolkata 4. Airport Health Organisation Kolkata 5. Government Medical Store Organisation Kolkata 6. Central Drugs Standard Control Organisation Kolkata 7. All India Institute of Hygiene & Public Health Kolkata Facilities For Scheduled Castes Facilities For Scheduled Castes Facilities For Scheduled Castes Facilities For Scheduled Castes Facilities For Scheduled Castes And Scheduled Tribes And Scheduled Tribes And Scheduled Tribes And Scheduled Tribes And Scheduled Tribes 8. Assistant Drugs Controller (I) Kolkata 9. Central Drugs Laboratory Kolkata 10. Serologist & Chemical Examiner Kolkata 11. Central Food Laboratory Kolkata 12. Central Government Health Scheme Kolkata 13. Chittaranjan National Cancer Institute Kolkata The salient aspects of the scheme of reservation were emphasised to the participating units/offices. Suggestions were made to streamline the maintenance and operation of rosters in these Institutes/Organizations. The defects and procedural lapses noticed were brought to the attention of the concerned authorities, for immediate rectification. The representation of Scheduled Castes, Scheduled Tribes and Other Backward Classes in (i) the Central Health Services Cadre (administered by Deptt. of Health & Family Welfare) and (ii) the Department of Health & FW its Attached and Subordinate Offices as on 1.1.2010 is as follows:- 16.2. PRIMARY HEALTH CARE INFRASTRUCTURE: 16.2.1 Given the concentration of Tribal inhabitation in far-flung areas, forest lands, hills and remote villages, Name of Cadre Total SC ST OBC Employees (i) Central Health Services : (All Group A Posts) 3610 358 134 218 (ii) Deptt. of Health &FW- its Attached and Subordinate Offices. 16350 5468 1023 1344 Note: This statement relates to persons and not to posts. Posts vacant etc. have not, therefore, been taken into account. Annual Report 2010-11 306 the population norms have been relaxed at different levels of health facilities for better support infrastructure development as under: 16.2.2: Under the Minimum Needs Programme: 24952 Sub Centres, 3504 Primary Health Centres and 750 Community Health Centres have been established in tribal areas as on 31.03.2009. 16.3 NATIONAL RURAL HEALTH MISSION (NRHM) 16.3.1 In order to provide effective health care to the rural population throughout the country with special focus on 18 States with poor health indicators and weak health infrastructure, the Government launched the National Rural Health Mission (NRHM) in April, 2005. The Mission adopts a synergistic approach by relating health to determinants of good health.The Mission seeks to establish functional health facilities in the public domain through revitalization of the existing infrastructure and fresh construction or renovation wherever required. The Mission also seeks to improve service delivery by putting in place enabling systems at all levels addressing issues relating to manpower planning as well as infrastructure strengthening. 16.3.2 The Mission also aims at bridging the gap in Rural Health care services through a cadre of Accredited Social Health Activists (ASHA) and improved hospital care, decentralization of programme to district level to improve intra and inter-sectoral convergence and effective utilization of resources. The ASHA would reinforce community action for universal immunization, safe delivery, newborn care, and prevention of water-borne and other communicable diseases, nutrition and sanitation. ASHA is provided in each village in the ratio of one per 1000 population. For tribal, hilly, desert areas, the norm could be relaxed for one ASHA per habitation depending on the workload. 16.3.3 The NRHM also provides an overreaching umbrella to the existing programmes of Health & Family Welfare including RCH-II, Vector Borne Disease Control Programme, Blindness, Iodine deficiency, Leprosy and Integrated Disease Surveillance Programme. It addresses the issue of health in the context of sector-wide approach with focus on sanitation and hygiene, nutrition and safe drinking water. 16.3.4 The Primary Health care Services in Primary Rural Health Care Services are provided through a network of 145920 Sub Centres, 23391 Primary Health Centres, 4510 Community Health Centres across the country as on September, 2010. The services being provided through the above centres are available to all sections of population including SC/ST. 16.4. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP): Under National Vector Borne Disease Control Programme, the service for prevention and control of Malaria, Kala-Azar, Filaria, Japanese Encephalitis, Dengue/Dengue Hemorrhagic Fever (DHF) and Chikungunya are provided to all sections of the community without any discrimination, however, since vector borne diseases are more prevalent in low social economic group , the focused attention is given to areas dominated by the tribal population in North Eastern states and some parts of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra Orissa & Karnataka. The additional inputs under externally assisted projects from Global Fund to N.E states and World Bank to other States especially for control of malaria is provided. For Kala-azar elimination in the states of Bihar, Jharkhand and West Bengal World Bank support is also being provided. In addition, the N.E. states are being provided 100% central assistance for implementation of the programme from domestic budget. 16.5. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP): 16.5.1 Under the NLEP, free leprosy diagnosis and treatment services are provided uniformly to all sections of the society irrespective of caste and religion including Scheduled Castes and Schedules Tribes population. Intensified IEC activities are carried out through the rural media to cover population residing in remote, inaccessible and tribal areas as one of the target Groups where awareness generation activities are more focused. Centre Population Norms Plain Areas Hilly/Tribal/ Difficult Areas Sub- Centre 5, 000 3, 000 Primary Health Centre 30, 000 20, 000 Community Health Centre 1, 20, 000 80, 000 Annual Report 2010-11 307 Dressing material, supportive medicines and Micro- Cellular Rubber (MCR) footwear are provided for prevention of disability among persons with insensitive hands and feet. Re-constructive Surgery (RCS) services are being provided for correction of disability in leprosy affected persons. An amount of Rs. 5000/- is also provided as incentive to each leprosy affected persons from BPL families for undergoing re-constructive surgery in identified Govt./NGO institutions to compensate loss of wages during their stay in hospital. Medical facilities are provided to leprosy affected persons throughout the country residing in self settled colonies. Funds are also allocated to NGOs under Survey Education Treatment (SET) scheme, most of which are working in tribal areas for providing services like IEC, prevention of disability and follow up of cases for treatment completion. 16.5.2 Disaggregates data on SC and ST population is also collected under the programme through monthly reports from States/UTs. During the year 2009-10, the population of SC and ST cases among newly detected cases was 18.54% and 13.33% respectively at national level. During the year 2010-11 (up to Sept., 2010) SC 18.88% and ST 13.71% cases were detected among the new cases. 16.6. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) 16.6.1 Under RNTCP, the benefits of the programme are available to all sections of the society on a uniform basis irrespective of caste, gender, religion. etc. The sputum microscopy and treatment services including supply of anti TB drugs are provided free of cost to all for full course of treatment. However, in large proportion of tribal and hard to reach areas, the norms for establishing Microscopy centres has been relaxed from 1 per 100,000 population to 50,000 and the TB Units for every 250,000 (as against 500,000). To improve access to tribal and other marginalized groups, there is also provision for: Additional TB Units and DMCs in tribal/difficult areas Compensation for transportation of patient & attendant in tribal areas Higher rate of salary to contractual staff posted in tribal areas Enhanced vehicle maintenance and travel allowance in tribal areas Provision of TBHVs for urban areas 16.7. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) 16.7.1 The NPCB was launched in the year 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3% by 2020. The Scheme is being implemented uniformly throughout the country. However, following initiatives have been introduced under the programme during the 11th Five Year Plan, keeping in view NE States, which are tribal predominate. Construction of dedicated Eye Wards & Eye OTs in District Hospitals in North-Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttarakhand and few other States where dedicated Operation Theaters are not available as per demand. Appointment of Ophthalmic manpower (Ophthalmic Surgeons, Ophthalmic Assistants and Eye Donation Counsellors on contractual basis) to meet shortage of ophthalmic manpower. Development of Mobile Ophthalmic Units with tele- network in NE Stats, Hilly States & difficult Terrains for diagnosis and medical management of eye diseases. Grant-in-aid to NGOs for management of other Eye diseases (other than Cataract) like Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of childhood blindness etc. The reimbursement would be up to Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases. Involvement of Private Practitioners in Sub-District, Blocks and Village level. 16.8. BUDGET ALLOCATION Allocations are made for implementation of health programmes across all segments of the society. However, Programme Officers have been directed to ensure allocation of funds to an extent of 8.2% and 16.2% towards Tribal Sub-Plan (TSP) and Scheduled Caste Sub-Plan (SCSP) respectively. Under NRHM, State Governments have been advised to earmark certain percentage of allocation to districts with SC/ST population above 35% and propose the same in the Programme Implementation Plan (PIP) of 2011-12. Annual Report 2010-11 308 The allocation under Scheduled Caste Sub-Plan (SCSP) and Tribal Sub-Plan (TSP) for the year 2010-11 in respect of major health schemes / programmes is given in the table below. Sl. Name of the Scheme SCSP TSP No. 1 National Vector Borne Diseases Control Programme 67.72 34.28 2 National Programme for Control of Blindness 42.12 21.32 3 Revised National TB Control Programme 56.70 28.70 4 National Leprosy Eradication Programmme 7.34 3.72 5 Infrastructure Maintenance 612.62 310.09 6 Supply of Drugs & Contraceptive 47.79 24.19 7 Immunization 245.77 124.40 8 IEC 33.20 16.81 9 Area Projects 5.13 2.60 10 Flexible Pool for State PIPs 1279.96 647.88 Total 2398.35 1213.98 (Rs. in crores) Annual Report 2010-11 309 Chapter 17 The Ministry of Health and Family Welfare is also taking necessary steps for promoting the use of Hindi in Offical Work. There is arrangement in the Ministry for undertaking translation work relating to Department of Health and Family Welfare and Department of Ayurved, Yoga & Naturopathy, Unani, Sidha & Homoeopathy (AYUSH). Steps are taken for implemetation of official language policy of the Union in the Ministry and its attached/ subordinate offices, public sector undertakings and other institutions under the Ministry. More than 95 percent officers and employees of the Ministry possess working knowledge of Hindi and the Ministry is notified under rule 10(4) of the Official Language Rule, 1976. During the year, a number of officials have been imparted training in Hindi under Hindi Teaching Scheme in order to see that they possess working knowledge of Hindi. Letters received in Hindi were replied to in Hindi and directions were issued to make maximum use of Hindi in official correspondence. Efforts were made to achieve the targerts set in the Annual Progremme of the year 2010-11 issued by the Department of Official Language. An incentive scheme for providing cash prizes for writing original noting and drafting in Hindi is in operation. Hindi fortnight was organised in the Ministry and its attached and subordinate offices during September, 2010. The messages from Secretary, Health & Family Welfare and Minister of Home Affairs were circulated. A number of steps were taken to promote the use of Hindi during the fortnight. Hindi competitions were organized in which a number of officers/employees participated. Hindi Fortnight was also organized in AYUSH Vibhag whereas Hindi fortnight was observed from 14.9.2010 to 28.9.2010 in the Department of Health and Family Welfare. Use of Hindi In Official Work Use of Hindi In Official Work Use of Hindi In Official Work Use of Hindi In Official Work Use of Hindi In Official Work A scheme for promotion of the books, orginally written in Hindi or translated into Hindi on various medical and public health subjects is in operation under which the authors and translators of such books are awarded cash prizes by the Ministry. The following prizes are provided under the scheme for useful books originally written in Hindi in the field of medical science and public health, a first prize of Rs. 25,000/-, a second prize of Rs. 20,000/-, a third prize of Rs. 15,000/-, a fourth prize of Rs. 10,000/- and three consolation prizes of Rs. 5,000/- each are given. For Hindi translation of medical text books written in English or in any Indian Language by eminent doctors/authors, there are three prizes viz. a first prize of Rs. 20,000/-, a second prize of Rs. 15,000/- and a third prize of Rs. 10,000/-. The books should be any one of the following subjects :- (1) Primary Health Care (2) Community Medicine (3) Maternity and Child Health (4) Public Health (5) Hygiene and Sanitation (6) Prevention of Communicable Diseases (7) Manuals/Text books for Para Medical Workers (8) Nutrition (9) Prevention of Disabilities (10) Mental Health (11) Indian Systems of Medicine (12) Population Control (13) Immunization Programme (14) AIDS Control Programme On Expiry of its term of three years, the Hindi Salahkar Samiti of the Ministry is being reconstituted and after reconstitution its meeting will be convened. Annual Report 2010-11 310 As far as use of Hindi in the attached/subordinate offices, public sector undrtakings and autonomous institutions etc. under the Ministry is concerned, the Hindi Division of the Ministry monitors the progress by reviewing the quarterly progress reports of these offices. After reviews of quarterly reports, shortcomings found therein are brought to the notice of the concerned offices and institutions. 25 offices falling under the control of Ministry of Health and Family Welfare were inspected up to December, 2010 to find out the position of the use of Hindi. The Committee of Parliament on Official Language conducted inspection of 3 offices under the Ministry of Health & Family Welfare. Annual Report 2010-11 311 Chapter 18 18.1 INTRODUCTION A separate North East Division in the Ministry and a Regional Resource Centre at Guwahati, to provide capacity building support to the NE States, has been set up. NACO has also opened NERO for the NE States. Flexibilities have been provided under the RCH and NRHM Flexi pools to take care of the specific developmental requirements of the NE Region while ensuring that the national framework is also kept in view. A scheme under the nomenclature Forward Linkages for NRHM in NE has been specifically launched to take care of the tertiary care, infrastructure requirements of the NE. Problems in the Health Sector in the North East States. Shortage of trained medical manpower, Providing access to sparsely populated, remote, far flung areas, Improvement of Governance in the Health sector, Need for improved quality of health services rendered, Making effective and full utilization of existing facilities, Effective and timely utilization of financial resources available, Morbidity and Mortality due to Malaria, High level of tobacco consumption and the associated high risk to cancer and High incidence of HIV/AIDS in Nagaland, Manipur and the increasing incidence in Mizoram and Meghalaya. Activities In North Activities In North Activities In North Activities In North Activities In North East Region East Region East Region East Region East Region 18.2. NATIONAL RURAL HEALTH MISSION (NRHM) IN NORTH EAST The National Rural Health Mission (NRHM) has been launched with a view to bringing about dramatic improvement in the health system and the health status of the people, especially those who live in the rural areas of the country. The Mission provides special focus to 18 states, which include the 8 North Eastern states, which have weak public health indicators and/or weak infrastructure. The Mission seeks to provide universal access to equitable, affordable and quality health carewhich is accountable at the same time responsive to the needs of the people, reduction of child and maternal deaths as well as population stabilization, gender and demographic balance. In this process, the Mission would help achieve goals set under the National Health Policy and the Millennium Development Goals. Achievements under NRHM (2010-11): Total number of ASHAs selected in the NE States comes to 53237 (2005-06 -10673, 2006-07-29639, 2007-08-5677, 2008-09-3323, 2009-10- 3925). 551 PHCs functioning as 24X7 basis in the NE States. 206 CHCs functioning as 24X7 basis in the NE States. 59 District Hospitals (DH) taken up for upgradation. 99 centres operational as First Referral Units (FRU), including DHs, SDHs, CHCs & other levels. 87 Districts are having working Mobile Medical Unit(MMU). Annual Report 2010-11 312 Ayush facilities is available in 402 Centres, including DHs, CHCs, PHCs and other health facilities above SCs but below block level. 2.39 Lakh Institutional Deliveries done. 1.94 Lakh beneficiaries of JSY recorded. 3.95 Lakh Children fully immunized. Initiatives under NRHM for the Year 2010-11 An amount of Rs.1838.37 crores has been approved for the State PIPs of all the eight NE States for various activities under NRHM. State-wise & programme wise details of funds approved under NRHM State PIP is given below:- The approvals include, broadly the following interventions. 1. ASHAs. 2. Untied Funds at the VHSC and PHSC levels. 3. Fund transfer to Rogi Kalyan Samitis at PHC, CHC, SDH and DH levels. 4. Annual Maintenance Grants for PHSC, PHCs and CHCs. (Rs. in crores) Sl. No. Component/Scheme Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland SikkimTripura 1 Part A: RCH Flexible Pool (incl. JSY, FP) 19.47 317.39 25.20 27.16 16.04 32.34 6.76 30.11 2 Part B: NRHM Flexible Pool 30.23 734.12 42.69 72.34 24.23 40.86 15.63 54.30 3 Part C: Immunization 1.78 11.67 1.19 2.04 0.99 1.27 0.36 0.36 4 NVBDCP(incl. kind grants) 6.3 14.20 3.97 4.18 4.37 5.53 0.17 4.46 5 RNTCP 3.13 8.82 2.91 2.10 1.30 3.03 0.93 1.38 6 NPCB 2.44 13.32 0.72 1.75 3.76 1.68 1.15 1.34 7 NLEP 0.65 1.20 0.46 0.41 0.42 0.52 0.33 0.31 8 NIDDCP 0.38 0.42 0.36 0.36 0.36 0.36 0.38 0.38 9 IDSP 1.27 1.77 0.81 0.67 0.85 0.98 0.48 0.48 10 Infrastructure Maintenance 8.44 107.91 17.65 10.77 16.86 11.53 10.04 22.01 11 PPI operation cost 0.81 10.67 1.18 1.48 0.45 0.87 0.23 1.40 Total 74.9 1221.49 97.13 123.26 69.63 98.97 36.46 116.53 5. Janani Suraksha Yojana (JSY). 6. Innovative interventions including Public Private Partnerships, Incentives, etc. 7. Infrastructure strengthening, including for PHSCs, PHCs, CHCs, DHs and Drug Warehouses. This includes construction of new facilities also. 8. Procurement of drugs and equipments and improvement of logistics. 9. Training and Orientation of Medical Personnel as well as other stakeholders. 10. Mobile Medical Units. 11. Contractual employment and co-location of AYUSH. 12. Specific Disease Control Programme interventions. 13. Strengthening of Programme Management. Forward Linkages to NRHM in the NE for the Year 2010-11 With a view to complement the initiatives under the NRHM Programme, the Scheme for Forward Linkages to NRHM in NE has been introduced during the 11 th Plan with an outlay of Rs. 900 crore, to be financed from likely Annual Report 2010-11 313 savings from other Health Schemes. This aims at improving the Tertiary and Secondary level Health Infrastructure of the region in a comprehensive manner. During 2010-11, Rs.60.00 crore has been allocated under Forward Linkages Scheme to NRHM in NE States and Rs. 26.82 crore has been released to Government of Nagaland for up-gradation of District Hospital at Phek and Kiphire. An amount of Rs.9.96 crore has been released for the up-gradation of Koloriang CHC to 50 bedded FRU to the State Government of Arunachal Pradesh and also an amount of Rs. 86.03 lakhs has been released to M/s HSCC for the consultancy fees for preparation of DPR of Naharlagun Civil Hospital in Arunachal Pradesh. 18.3. NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES (NEIGRIHMS) North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) has been established in Shillong, on the lines of AIIMS, New Delhi, and PGIMER, Chandigarh, with the objective of providing advanced specialized Health- care to the people of North East Region. An amount of Rs. 1266.38 crore has been allocated for the Institute in the 11 th Plan. This Institute has been planned to include a 500 bedded referral hospital with 35 teaching departments at postgraduate level in various specialties and super-specialties. A fifty seat Nursing College and Under Graduate MBBS College has already started functioning from the Institute. PG courses in Anesthesiology, Obst. & Gynecology, Microbiology and Pathology have started in 2009-10 Total staff strength in the Institute is as under: Budget Allocation & Expenditure for the years 2010-11 is indicated below:- Name of the Post Filled Vacancy Institute sanctioned up position NEIGRIHMS 1524 850 674 (Rs. In crore) Name of the Allocation released as Institute 2010-11 on 17.01.2011 NEIGRIHMS 102.85 67.85 18.4. REGIONAL INSTITUTE OF MEDICAL SCIENCE (RIMS) Regional Institute of Medical Science, Imphal, has been taken over by the Ministry of Health and Family Welfare from North Eastern Council in 2007. The Institute has an intake capacity of 100 undergraduate and 73 + 77 post graduate Degree/ Diploma seats. The 11 th Plan Allocation for this Institute is Rs. 589.92 crore. This Institute has a 1074 bedded teaching hospital with 104 graduates, 67 specialists, 4 M.Phil and 1 Ph.D scholar were produced. The Institute has so far produced 2394 medical graduates and 630 specialists therby richly contributing in bridging the gap of health manpower in the region. The Phase II project for Up-gradation of RIMS at an estimated cost of Rs.129.36 crores has been approved by the Expenditure Finance Committee (EFC) Department of Transfusion Medicine has been set up in the Institute and two posts of Professor and Associate Professor have been sanctioned. PG course in Transfusion Medicine has started. Total staff strength in the Institute is as under: The Annual Plan Allocation and expenditure for the current financial year 2010-11 is indicated below:- Name of the Post Filled up Vacancy Institute sanctioned position RIMS 1050 795 255 Name of the Allocation Amount Institute 2010-11 released as on 17.01.2011 RIMS 130.50 80.50 Annual Report 2010-11 314 18.5. LOKOPRIYA GOPINATH BORDOLOI REGIONAL INSTITUTE OF MENTAL HEALTH, TEZPUR, ASSAM Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH) is a premier tertiary mental health care facility in Northeast India. It was established in the year 1876 under the imperial British rule. This hospital has been particularly serving the entire Northeast region since its inception. After the Institute was taken over by the Government of India in 1999, new developments in the form of academic and research activities were initiated. One of the primary agenda of the Institute is to undertake research activities with special emphasis in mental health issues prevalent in the Northeast region. Over the years the Institute has received wide recognition in provision of mental health services across the country. During the year 2010-11, an amount Rs. 46.40 crores has been allocated of which an amount of Rs. 20.70 crores has been released. 18.6. REGIONAL INSTITUTE OF PARAMEDICAL AND NURSING SCIENCES (RIPANS). Regional Institute of Paramedical and Nursing Sciences (RIPANS), Aizwal was set up by the Government of India, Ministry of Home Affairs in 199293 to develop adequate paramedical manpower to provide the much needed basic paramedical health care facilities in the health institutions of the North Eastern Regions. The Institute came under the administrative control of Ministry of Health and Family Welfare w.e.f. Name of the Post Filled Vacancy Institute sanctioned up position RIPANS 85 79 6 01.04.2007. The 11 th Plan Allocation for this Institute is Rs. 69.62 Crore. The Institute is having 162 seats each year with total strength of 479 students during the academic year of 2009-10 for the following different courses B.Sc(N), B.Sc(MLT), B.Pharm, Diploma in Opthalmic Technology and Radio Imaging and Cardio Instrumentation Technology (RICIT)). Total staff strength in the Institute is as under: The Annual Plan Allocation and expenditure for the current financial year 2010-11 is indicated below:- 18.7. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) IN NORTH EAST STATES National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3% by 2020. NE States including Sikkim has remained a focus area for development of eye care infrastructure and coverage of eye care services under the Programme. Performance of Cataract Surgeries in NE States during 11 th Plan Name of the Allocation Amount released Institute 2010-11 as on 17.01.2011 RIPANS 29.50 5.00 State 2007-08 2008-09 2009-10 2009-10 (as on 30.11.2010) Tar. Ac. Tar. Ach. Tar. Ach. Tar. Ach. Arunachal Pradesh 2000 1364 2000 1172 2000 1578 2000 391 Assam 47000 43490 50000 47749 50000 50426 50000 26787 Manipur 1200 642 2000 1744 2000 2,393 2000 494 Meghalaya 2000 1064 2000 2308 2000 1936 2000 576 Mizoram 2000 1739 3000 2397 3000 2156 3000 1027 Nagaland 2000 823 1500 1048 1500 1046 1500 400 Sikkim 600 530 800 690 800 609 800 231 Tripura 8000 6732 7000 8429 7000 6316 7000 2980 Total 64800 56384 68300 65537 68300 66460 68300 32886 Annual Report 2010-11 315 New Initiatives introduced during 11 th Plan keeping in view NE Region: Various new initiatives have been introduced under the National Programme for Control of Blindness during 11 th Five Year Plan. The following schemes have been introduced mainly keeping in view NE States including Sikkim and other hilly States:- 1. Assistance for construction of dedicated Eye Wards & Eye OTs in District Hospitals in North- Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttarakhand and few other States where dedicated eye OTs are not available as per demand. 2. Assistance for appointment of Ophthalmic manpower on contractual basis (Ophthalmic Surgeons, Ophthalmic Assistants and Eye Donation Counsellors) to meet shortage of ophthalmic manpower. 3. Assistance for grant-in-aid to NGOs for management of other Eye diseases (other than Cataract) like Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, treatment of Childhood Bindness etc. The grant-in-aid would be upto Rs. 750 per case for Cataract/IOL Implantation Surgery and upto Rs.1000 per case for other major Eye Diseases as mentioned above. 4. Development of Mobile Ophthalmic Units with Tele-network in NE States, Hilly States & difficult Terrains for diagnosis and medical management of eye diseases. 18.8. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME IN NORTH EASTERN STATES Malaria situation in Northeastern States The North-Eastern region is prone to malaria transmission mainly due to topography and climatic conditions that largely facilitate perennial malaria transmission, prevalence of highly efficient malaria vectors, pre-dominance of Pf as well as prevalence of chloroquine resistant pf malaria. The North-Eastern states namely Arunachal Pradesh, Assam, Meghalaya, Mizoram, Manipur, Nagaland, Sikkim and Tripura together contribute about 4% of the countrys population 15% of malaria cases, 22% of Pf cases and 43% of malaria deaths reported in the country in the year 2009. The epidemiological and malario-metric indicators for the last 13 years are given at Table-A. TABLE-A Malaria Situation in the NE States during 1996-2009 Year Cases (in million) Deaths API Total Pf 1996 0.28 0.14 142 8.01 1997 0.23 0.12 93 6.51 1998 0.19 0.09 100 5.12 1999 0.24 0.13 221 6.40 2000 0.17 0.08 93 4.49 2001 0.21 0.11 211 5.29 2002 0.18 0.09 162 4.57 2003 0.16 0.08 169 3.93 2004 0.14 0.08 183 3.36 2005 0.15 0.09 251 3.64 2006 0.24 0.15 901 5.67 2007 0.19 0.12 581 4.58 2008 0.19 0.13 349 4.38 2009 0.23 0.18 488 5.19 Annual Report 2010-11 316 The state-wise situation of malaria in year 2009 is given at Table B. State-wise situation of Malaria in NE states-2009 TABLE- B. SN STATES/UTS Pop. B.S.C. B.S.E. Positive P.f. P.f.% ABER API SPR SfR Deaths (in 000) Cases Cases 1 Arunachal Pradesh 1238 213893 213893 22066 6602 29.92 17.28 17.82 10.32 3.09 15 2 Assam 31274 3021920 3021920 91413 66557 72.81 9.66 2.92 3.02 2.20 63 3 Manipur 2953 114720 114720 1069 620 58.00 3.88 0.36 0.93 0.54 1 4 Meghalaya 2734 501419 501419 76759 74251 96.73 18.34 28.08 15.31 14.81 192 5 Mizoram 874 171793 171793 9399 7387 78.59 19.66 10.75 5.47 4.30 119 6 Nagaland 1981 156259 156259 8489 2893 34.08 7.89 4.29 5.43 1.85 35 7 Sikkim 180 6688 6688 42 16 38.10 3.72 0.23 0.63 0.24 1 8 Tripura 3812 361848 361848 24430 22952 93.95 9.49 6.41 6.75 6.34 62 Total 45046 4548540 4548540 233667 181278 77.58 10.10 5.19 5.14 3.99 488 The table shows that Arunachal Pradesh, Meghalaya, Mizoram and Tripura are having API more than 5. Assistance to States: Government of India provides 100% central assistance for programme implementation to the Northeastern States including Sikkim. The Govt. of India also supply commodities like drugs, LLINs, insecticides/ larvicides as per approved norms to all NE States as per their technical requirements. The assistance provided since 2007-08 is at Table-C & Table-D. The additional support under Global Fund for AIDS, Tuberculosis and Malaria (GFATM) is provided to all NE States except Sikkim for implementation of intensified Malaria Control Project (IMCP), with following the objectives: (i) to increase access to rapid diagnosis and treatment in remote and inaccessible areas through community participation, (ii) malaria transmission risk reduction by use of insecticide treated bed nets (ITNs/LLINs) and (iii) to enhance awareness about malaria control and promote community, NGO and private sector participation. For strengthening early case detection and prompt treatment more than 53454 ASHAs are engaged in these areas. Out of them, 43517 have been trained and involved in high malaria endemic areas along with Fever Treatment Depots (FTDs) and Malaria clinics. This is in addition to the treatment facilities available at the health facilities and hospitals. Anti malaria drugs and funds for training are provided by Gol under the programme. As per the National Drug Policy, Cholorquine is used for treatment of all P.vivax cases. However, at present Artemesinin Combination Therapy (ACT) with Sulfadoxine Pyrimethamine (AS+SP) combination is being implemented for the treatment all Pf cases. Indoor Residual Spraying (IRS): Under integrated vector control initiative, IRS is implemented selectively Annual Report 2010-11 317 only in high risk pockets as per district-wise Micro Action Plans from domestic budget. The Directorate has issued Guidelines on IRS to the States for technical guidance. Guidelines on uniform evaluation of insecticides have also been developed in collaboration with National Institute of Malaria Research (NIMR), Delhi. Over the years, there is a reduction in IRS covered population in view of paradigm shift to alternative vector control measures such as extensive use of Insecticide Treated Nets (ITNs) and Long Lasing Insecticide Treated Nets (LLINs). The strategies of the project are: (i) Early diagnosis and prompt treatment with special reference to the drug resistant pockets, (ii) integrated vector control, including promotion of ITN/LLINs, intensive IEC and capacity building and efficient public-private partnership among, CBO, NGO, and other voluntary sectors and (iii) Training the health workers and community volunteers The GFATM has been supporting the programme under round - 4 (2005-06 to 2009-10). Inputs under Project is provided by the Global Fund in the form of financial support for drugs like artemisinine injections, Sulpha- pyrimethamine Artesunate Combination Therapy (SP- ACT) and rapid diagnostic kits (RDKs), and other materials for vector control such as bed nets (LLINs), insecticide for the treatment of bed nets (ITNs). The support for enhancing supervision and monitoring by providing consultants at the state and national level is also provided under the project. GFATM Round 9 project for malaria control in seven north eastern states has been approved as a continuation of Round 4 project. The EFC of the same has been prepared and circulated. Japanese Encephalitis(JE) is mainly endemic in Assam which is regularly reporting JE/AES cases. The state has reported, 424 cases and 133 deaths in 2007, 319 cases and 99 deaths in 2008, 462 cases and 92 deaths in 2009. However in 2010 (upto November) 562 cases and 125 deaths have been reported. Manipur reported only 2 cases and 1 death in 2002 and only 1 case of suspected JE during 2003 followed by 65 cases of AES in 2007, 4 in 2008 and 6 in 2009. However in 2010 (upto November) 116 cases and 14 deaths have been reported. Nagaland reported only 7 cases and 1 death in 2007 and 9 cases and 2 deaths in 2009. However in 2010 (upto November) 11 cases and 6 deaths have been reported. For control of J.E., Government of India has identified five sentinel sites in Assam and one in Manipur for diagnosis of J.E. cases. Besides, nine districts in Assam have been covered under J.E. vaccination programme since 2006. Two additional districts in Assam and four in Manipur have been identified for J.E. immunization during 2010. Dengue: NE States till few years back did not have problem of Dengue. Manipur has reported for the 1 st time in 2007 followed by Nagaland in 2009, Assam and Meghalaya in 2010 as detailed below: Assam:- The state has reported Dengue cases since July 2010. Till November 158 cases and 2 deaths have been reported. Total 20 districts are affected. Maximum cases were reported from Kamrup (Metro) district. Manipur:- In the year 2007, 51 dengue cases and 1 death was reported. In the year 2008 and 2009 no case had been reported. During 2010 till November 2010, 5 cases and no death have been reported from Imphal district. Meghalaya:- The state has reported only 1 case and no death have been reported from West Garo Hills district till November 2010. Nagaland:- In the year 2009, 25 dengue cases and no death was reported. During 2010 till November no case has been reported. Annual Report 2010-11 318 Arunachal Pradesh, Mizaoram, and Tripura are not endemic for Dengue. Chikungunya : Assam, Arunachal Pradesh, Manipur, Mizaoram, Nagaland, and Tripura are not endemic for Chikungunya. However in Meghalaya for the first time, the state has reported 16 Clinically Suspected Chikungunya cases from West Garo Hills district till November 2010. No death has been reported due to Chickungunya. Lymphatic Filariasis is endemic in 7 districts of Assam, whereas other states in NE region are not reported to be filaria endemic. The strategy of Elimination of Lymphatic Filariasis with annual single dose Mass administration of DEC is being implemented since 2004. The coverage of population is 25.42% in 2004, 42.94% in 2005, 67.33% in 2006, 78.32% in 2007 and 81.34% in 2008. The microfilaria rate in the state has come down from 1.46 in 2007 to 0.88 in 2008. MDA could not be observed during 2009 in Assam. However, during 2010, MDA has been observed on 11 th November and the reports on coverage is awaited from the state. TABLE-C Statement Showing Central Assistance provided to North Eastern States Under NVBDCP (Rs in lakhs) State 2007-08 2008-09 2009-10 Cash Kind Total Cash Kind Total Cash Kind Total Arunachal Pradesh 306.20 260.79 566.99 647.21 237.36 884.57 742.05 221.19 963.24 Assam 1042.00 2540.09 3582.09 910.87 2724.21 3635.08 700.16 2505.90 3206.06 Manipur 133.18 235.95 369.13 238.05 85.8 323.85 195.31 44.44 239.75 Meghalaya 142.91 399.60 542.51 229.86 267.77 497.63 96.36 514.93 611.29 Mizoram 138.73 359.79 498.52 276.56 142.22 418.78 316.52 310.60 627.12 Nagaland 214.28 334.99 549.27 381.15 228.89 610.04 434.45 238.12 675.57 Tripura 138.97 766.68 905.65 319.88 307.43 627.31 238.23 526.92 765.15 Sikkim 4.00 0.98 4.98 6.5 4.27 10.77 7.97 3.86 11.83 Total 2120.27 4898.87 7019.14 3014.08 3997.95 7008.03 2731.05 4365.96 7100.01 TABLE-D Allocation and Releases made to N.E. States during 2010-11 (Rs in lakhs) State Allocation Releases (as on 30.11.10) Cash Kind Total Cash Kind Total Arunachal Pradesh 502.17 256.75 758.92 347.35 166.16 513.51 Assam 1238.92 3155.69 4394.61 817.00 619.04 1436.04 Manipur 353.63 154.15 507.78 256.55 55.08 311.63 Meghalaya 352.20 507.76 859.96 150.88 153.56 304.44 Mizoram 396.35 280.28 676.63 252.23 75.55 327.78 Nagaland 479.97 314.19 794.16 345.39 130.92 476.31 Tripura 370.68 960.49 1331.17 173.85 230.30 404.15 Sikkim 16.23 5.12 21.35 10.91 126.80 137.71 Total:- 3710.15 5634.43 9344.58 2354.16 1557.41 3911.57 Annual Report 2010-11 319 18.9. REVISED NATIONAL TB CONTROL PROGRAMME (RNTCP) IN NORTH EASTERN STATES The entire population of the North Eastern states including Sikkim has been covered under the Revised National TB Control Programme (RNTCP). o Over the years, a strong network of RNTCP diagnostic and treatment services has been established in NE States through the general health system. 136 sub-district TB Units and 601 RNTCP Designated Microscopy centres have been upgraded till date. As the NE region has large proportion of tribal and hard to reach areas, the norms for establishing Microscopy centres has been relaxed from 1 per 100,000 population to 50,000 and the TB Units for every 250,000 (as against 500,000). o The states have shown considerable improvement in programme performance, and in 2010, the new smear positive case detection rate for the region was 79%, treatment success rate has been consistently maintained over 86%. o RNTCP has initiated over 61 thousand patients on treatment in 2009, thus saving over 13 thousand additional lives in the North East Region. o The programme has collaborated with private and public sector health institutions in the area. Innovative methods have been successfully implemented with the tea gardens in Assam. Collaboration with the defence health services has also been achieved in some of the states. o HIV-TB coordination activities have been implemented in all the North Eastern states. Cross referral activities are being reported by all the states. o New activities under RNTCP are: o Procurement and distribution of paediatric drug boxes for improved care of paediatric cases is currently in progress. o Quality sputum microscopy is an important component of RNTCP. All the states in North East have implemented the External Quality Assurance (EQA) protocol. Scaling up of the State-level Intermediate Referral Laboratories (IRL) capacity for implementation of External Quality Assessment (EQA) of sputum smear microscopy services and provision of culture and drug sensitivity testing: Guwahati, Assam, Sikkim and Manipur o Implementation of DOTS-Plus for multi-drug resistant TB cases will occur in a phased manner Involvement of Medical Colleges: All medical colleges in the NE have been involved in the programme. A separate Zonal Task Force has been established for the NE region, which holds regular annual meetings. To improve access to tribal and other marginalized groups, there is also provision for: I. Compensation for transportation of patient & attendant in tribal areas. II. Higher rate of salary to contractual staff posted in tribal areas. III. Enhanced vehicle maintenance and travel allowance in tribal areas. As a special case, transportation of drugs by air from GMSDs to the North Eastern states is allowed under the programme, full requirement of anti TB drugs of the States and Binocular Microscopes for quality diagnosis are provided by the Centre as commodity grant. For undertaking various activities for implementation of the RNTCP, cash assistance as grants-in-aid is released to the State TB Societies for onward transmission to the District TB Societies. Funds are provided for purchase of four wheelers and two wheelers for effective supervision; computer with internet facility; fax and photocopier for each district for facilitation of work and for information storage, retrieval and quick communication. All the districts have been electronically connected and reports are received through email. The manpower has been strengthened by providing essential staff on contractual basis. The performance of the States is also monitored regularly at CTD through analysis of quarterly performance reports from the districts and addl. feedback is given for necessary corrective action, if required. For assisting the States in implementation and supervision of the programme, technical assistance is provided by way of appointment of WHO consultants in the North Eastern States. The programme is also monitored at the state level meetings and meetings at the Centre from time to time. Annual Report 2010-11 320 Funds Status Funds released and utilized by NE States are as follows: State-wise statement of NE States for the financial year 2009-10 is as follows Performance Performance of the programme in the region based on the quarterly reports of 3 rd quarter of 2010 is as below: Overall performance of the programme in Aunachal Pradesh, Assam, Nagaland, Meghalaya and Sikkim is good. In other States (Manipur, Mizoram and Tripura) also the programme performance is gradually improving. State Population Total patients Annualized New smear Annualized 3 month conversion Success rate (in lakh) registered for total case positive patients new smear rate of newof new smear covered by treatment detection registered positive case smear positive positive RNTCP rate for treatment detection patients patients rate (%) Arunachal Pradesh 12 644 210 177 58 77% 93% 88% Assam 302 10435 138 4462 59 79% 87% 83% Manipur 24 1098 181 291 48 64% 88% 86% Meghalaya 26 1421 219 436 67 90% 82% 82% Mizoram 10 584 235 102 41 55% 90% 90% Nagaland 22 1010 182 373 67 89% 93% 93% Sikkim 6 430 284 125 83 110% 90% 86% Tripura 36 745 83 409 46 61% 89% 91% 2010-11 Sl.No. Name of the Op. Bal. Cash Expenditure Unspent State / UT 01.04.2010 Release as Reported Balance (as per SOE) till 30.09.2010 by States As 30.09.2010 on 30.09.2010 High Focus States - NE 1 Arunachal Pradesh 14.44 145.00 83.99 75.45 2 Assam 35.40 550.00 353.56 231.84 3 Manipur * 9.86 140.00 7.52 142.34 4 Meghalaya * 27.53 140.00 22.85 144.68 5 Mizoram 1.99 60.00 60.86 1.13 6 Nagaland 12.22 140.00 123.86 28.36 7 Sikkim 1.93 46.00 32.28 15.65 8 Tripura 20.05 65.00 37.97 47.08 Total 123.42 1286.00 722.89 686.53 (Rs. in lakhs) SOE from the State of Manipur and Meghalaya received only for the Qtr. April June 2010. Annual Report 2010-11 321 18.10 NATIONAL LEPROSY ERADICATION PROGRAMME IN NORTH EASTERN STATES The States of north east region have achieved leprosy elimination. The region contributed to 3.83% of countrys population and only 1.06% of countrys new cases detected in 2009-10. At the end of December 2010, there were 1605 leprosy cases on record in these states and 1135 new leprosy cases were detected from April to December, 2010. Leprosy services have already been integrated with General Health Care system in all NE states and leprosy diagnosis and treatment (MDT) services are available in all the PHCs and Government hospitals/dispensaries free of cost. All the Medical Officers and GHC staff have been trained in leprosy. The district nucleus teams are being actively involved in programme monitoring and supervision. Medical College Guwahati in Assam and RIMS Imphal have been identified for conducting Reconstructive Surgery in person affected with leprosy disability. 18.11 NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP) IN NORTH EASTERN STATES The National Iodine Deficiency Disorders Control Programme (NIDDCP) is being implemented in all the North Eastern States. IDD prevalence surveys have been conducted in all the states. State level IDD Control Cell has been set up, in all the NE States. However, IDD monitoring laboratory is yet to be set up in the state of Assam. Resurveys done in the State of Arunachal Pradesh, Manipur and Mizoram have indicated a decline in the prevalence of IDD as a result of iodated salt consumption. 18.12. DEVELOPMENT OF NURSING SERVICE & UP-GRADATION/STRENGTHENING OF NURSING SERVICES IN NORTH EASTERN STATES Development of Nursing Service & Up-gradation/ Strengthening of Nursing Services under Human Resource (Health): Under the Programme of Development of Nursing Services following schemes are implemented. 1) Training of Nurses 2) Strengthening / Up gradation of Existing Schools/Colleges of Nursing 3) Providing recurring assistance to Schools of Nursing that were opened during XIth plan period Training of Nurses: In order to update the knowledge and skills of the nursing personnel, Continuing Nursing Education Programme was started in the area of Nursing Specialty for the Staff Nurses, Education Technology for the faculty of the Schools and Colleges of Nursing, Management Techniques for the Nursing Administrators. The pattern of assistance for conducting Continuing Nursing Education Programme has been revised from Rs. 75,000 /- to 1,65300/ per course with a duration of 7 days to train 30 Nurses. A sum of Rs. 23.142 lakhs has been released during the year 2010-11 to conduct 14 courses to train 420 nursing personnel in NE Regions. Up gradation of Schools of Nursing into Colleges of Nursing: It is proposed to upgrade Schools of Nursing, which are attached to the Medical Colleges into Colleges of Nursing. The objective of the scheme is to train more Graduate Nurses. One time assistance of Rs. 6.00 crores is provided to the State Govt/Institution subject to the condition that State Govt. gives an undertaking that they will bear the recurring assistance of the College of Nursing. So far a grant of Rs. 6.75 crores has been released to 2 institutions in the N.E. States for upgrading School of Nursing into College of Nursing at Aizwal, Mizoram and School of Nursing at Manipur. Strengthening of Existing Schools/Colleges of Nursing: In order to improve the quality of training imparted at the existing Schools and Colleges of Nursing grant is released towards procurement of A.V Aids, furniture, improvement of library, additions/alterations of building and transport. it has been proposed to strengthen 2 Institutions in NE regions during the year 2009-10. A grant of Rs. 50.00 lakhs is being proposed for the year 2009-10. Annual Report 2010-11 322 details given below :- Faculty Development Scheme: 6 candidates have been nominated for undergoing M.Sc in (N) under the scheme of Faculty Development Scheme. New Scheme: Strengthening /Upgradation of Nursing Services: Opening of ANM /GNM Schools: A sum of Rs. 25.00 crore have been allocated for the year 201011 for implementing the new scheme. CCEA has approved this Ministrys proposal for opening of 132 ANM Schools and 137 GNM Schools in those districts of the states where there are no such schools. 154 districts in 23 High Focus States have been identified having no ANM and GNM schools. A Sum of Rs. 47.50 crore has been approved so far for release under the new scheme of Opening of ANM /GNM Schools to the states as per Sl.No Name of No. of Districts No. of Districts the State for opening for opening ANM Schools GNM Schools I. Arunachal Pradesh 3 2 II. Manipur - 6 III. Sikkim 2 - Total 5 8 Annual Report 2010-11 323 Chapter 19 19.1 INTRODUCTION Major component of Health & Family Welfare Programme is related to Health problems of women and children, as they are more vulnerable to ill health and diseases. Since women folk constitute about half of population, it is essential to health status of women so that the causes of ill health are identified, discussed and misconceptions removed. Ill health of women is mainly due to poor nutrition due to gender discrimination, low age at marriage, risk factors during pregnancy, unsafe, unplanned and multiple deliveries, limited access to family planning methods and unsafe abortion services. In order to overcome these problems, the women need to be educated, motivate/persuaded to accept the Family Welfare Programme to increase demand for services. Accordingly, the Government seeks to provide services in a life cycle approach, under the RCH Programme the need for improving women health in general and bringing down maternal mortality rate has been strongly stressed in the National Population Policy 2000. This policy recommends a holistic strategy for bringing about total intersectoral coordination at the grass root level and involving the NGOs, Civil Societies, Panchayati Raj Institutions and Womens Group in bringing down Maternal Mortality Rate and Infant Mortality Rate. In order to improve maternal health at the community level a cadre of community level skilled birth attendant to attend to the pregnant women in the community is also bring considered. The Maternal Health Programme, which is a component of the Reproductive and Child Health Programme, aims at reducing maternal mortality to less than 100 by 2010. The Development of Health & FW has taken several new initiatives to make the maternal health programme broad based and client friendly to reduce maternal mortality. The major interventions include provisioning of additional ANMs and Public Health/Staff Nurses in certain sub-centres, PHCs/CHCs, Laboratory Technicians, Referral Transport, 24-Hours Delivery Gender Issues Gender Issues Gender Issues Gender Issues Gender Issues Services at PHCs/CHCs, safe Motherhood Consultants, Safe Abortion Services, Essential Obsetetric Care, emergency Obstetric Care, skilled manpower on contractual and hiring basis, Training of Dais, Training of MBBS doctors in Anesthetic Skills for Emergency Obstetric Care at FRUs, operationalisation of FRUs through supply of drugs in the form of emergency obstetric drug kits, Blood Storage Centers (BSC) at FRUs and Prevention and management of RTI/STI. Details of these interventions are given in the Maternal Health Chapter of this Report. However some points on these Programme is given below: 19.2 JANANI SURAKSHA YOJANA (JSY) Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of promoting institutional delivery among the poor pregnant women. Launched on 12th April 2005, JSY is being implemented in all states and UTs and integrates JSY benefits with delivery and post-delivery care. The scheme focuses on poor pregnant woman with special dispensation for states having low institutional delivery rate namely, the states of Uttar Pradesh, Uttrakhand, Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Assam, Orissa, Rajasthan and Jammu & Kashmir. While these states have been classified as Low Performing States (LPS), the remaining states have been named as High performing States (HPS). Besides the maternal care, the scheme provides cash assistance to all eligible mothers for delivery care. ASHA, the Accredited Social Health Activist acts as an effective link between the Government and the poor pregnant women. Her role is to facilitate pregnant women to avail services of maternal care and arrange referral transport. In LPS (Low Performing States) States, all women including those from SC and ST families, delivering in Government health centres like Sub-centre, PHC/ CHC/ FRU/general wards of District and State Hospitals or accredited private institutions are eligible to receive the Annual Report 2010-11 324 cash assistance. In HPS (High Performing States) States, BPL pregnant women, aged 19 years and above and the SC and ST pregnant women are eligible to receive the cash assistance under the Yojana. The scale of Cash Assistance (in Rs.) for Institutional Delivery is as under:- * In HPS Tribal area (Notified by Ministry of Tribal Affairs), the ASHA package is Rs. 600 in Rural Area w.e.f. 15.6.2010. & in North East States the ASHA package is Rs. 600 in Rural Area w.e.f. September, 2006. The Limitations of Cash Assistance for Institutional Delivery are as under:- The scale of Cash Assistance (in Rs.) for Home Delivery is as under:- Category Rural Area Urban Area Mothers ASHA Mothers ASHA package package In LPS 1400 600 1000 200 In HPS 700 200* 600 200 State Category Eligibility LPS States In All births, delivered in a Health Centre Government or Accredited Private Health Institutions. HPS States In Up to 02 live births Category Rural Area Urban Area Mothers ASHA package Mothers ASHA package In LPS & HPS ** 500 Nil 500 Nil ** In LPS and HPS States, all BPL pregnant women, aged 19 years and above, delivery at home are entitled to cash assistance of Rs.500/-per delivery, up to two live births. ASHA package of Rs. 600/- available in LPS, NE States and in Tribal Districts of all States/UTs in the rural areas includes the following three components:- Cash assistance, over and above the mothers package, for referral transport to go to the nearest health centre for delivery. The state will determine the amount of assistance (should not be less than Rs.250/- per delivery) depending on the topography and the infrastructure available in their state. It would, however, be the duty of the ASHA and the ANM to organize or facilitate in organizing referral transport, in conjunction with Gram Pradhan, Gram Sabha etc. Cash incentive to ASHA should not be less than Rs.200/- per delivery in lieu of her work relating to facilitating institutional delivery. Generally, ASHA should get this money after her post-natal visit to the beneficiary and that the child has been immunized for BCG. Transactional cost (Balance out of Rs. 600/-) is to be paid to ASHA in lieu of her stay with the pregnant woman in the health centre for delivery to meet her cost of boarding and lodging etc. Therefore, this payment should be made at the hospital/ heath institution itself. The Yojana subsidizes the cost of Caesarean Section or for the management of obstetric complications, up to Rs. 1500/- per delivery to the Government Institutions, where Government specialists are not in position. LPS and HPS States, all such BPL pregnant women, aged 19 years and above, preferring to deliver at home is entitled to cash assistance of Rs.500/-per delivery, up to two live births The progress on implementation of JSY during the last five years is as reflected in the chart below:- JSY Physical and Financial progress in past 5 years Annual Report 2010-11 325 19.3 PRE CONCEPTION AND PRE- NATAL DIAGNOSTIC TECHNIQUES (PROHIBITION OF SEX SELECTION ACT, 1994) Adverse Child Sex-Ratio in India Sex ratio (number of females per thousand males) is one of the most important indicators used for study of population characteristics. The declining trend in sex ratio has been a matter of concern for all in the country. Sex ratio in India has declined over the century from 972 in 1901 to 927 in 1991. The sex ratio has since gone up to 933 in 2001. In contrast the child sex ratio for the age group of 0-6 years in 2001census was 927 girls per thousand boys as against 945 recorded in 1991 Census. The encouraging trend in the sex ratio during 1991-2001 was marred by the decline of 18 points in the sex ratio of children aged 6 years or below. The Census 2001 figures further reveal that the child sex ratio is comparatively lower in the affluent regions, i.e., Punjab (798), Haryana (819), Chandigarh (845), Delhi (868), Gujarat (883), Himachal Pradesh (896) and Rajasthan (909). (These are the seven focus States/UTs for purposes of the PC&PNDT Act, 1994). Some of the reasons commonly put forward to explain the consistently low levels of sex ratio are son preference, neglect of the girl child resulting in higher mortality at younger age, female infanticide, female foeticide, higher maternal mortality and male bias in enumeration of population. Easy availability of the sex determination tests and abortion services may also be proving to be catalyst in the process, which may be further stimulated by pre- conception sex selection facilities. Sex determination techniques have been in use in India since 1975 primarily for the determination of genetic abnormalities. However, these techniques were widely misused to determine the sex of the foetus and subsequent abortions if the foetus was found to be female. In order to check female foeticide, the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was brought into operation from 1 st January, 1996. The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 has since been amended to make it more comprehensive. The amended Act and Rules came into force with effect from 14.2.2003 and the PNDT Act has been renamed as Pre- conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 to make it more comprehensive. The technique of pre-conception sex selection has been brought within the ambit of this Act so as to pre-empt the use of such technologies which significantly contribute to the declining sex ratio. Use of ultrasound machines has also been brought within the purview of this Act more explicitly so as to curb their misuse for detection and disclosure of sex of the foetus lest it should lead to female foeticide. The Central Supervisory Board (CSB) constituted under the Chairmanship of Minister of Health and Family Welfare has been further empowered for monitoring the implementation of the Act. State level Supervisory Boards on the line of the CSB constituted at the Centre have been introduced for monitoring and reviewing the implementation of the Act in States/UTs. The State/UT level Appropriate Authority has been made a multi member body for better implementation and monitoring of the Act in the States. More stringent punishments are prescribed under the Act so as to serve as a deterrent for minimizing violations of the Act. Appropriate Authorities are empowered with the powers of Civil Court for search, seizure and sealing the machines, equipments and records of the violators of law including sealing of premises and commissioning of witnesses. It has been made mandatory to maintain proper records in respect of the use of ultrasound machines and other equipments capable of detection of sex of foetus and also in respect of tests and procedures that may lead to pre- conception selection of sex. The sale of ultrasound machines has been regulated through laying down the condition of sale only to the bodies registered under the Act. Punishment under the Act Imprisonment up to 3 years and fine up to Rs. 10,000/-. For any subsequent offences, imprisonment up to 5 years and fine up to Rs. 50,000 / Rs.1,00,000. The name of the registered medical practitioner is reported by the Appropriate Authority to the State Medical Council concerned for taking necessary action including suspension of the registration if the charges are framed by the court and till the case is disposed off. Status and Report from States/UTs As per the reports received from the States and UTs, 39854 bodies using ultrasound, image scanners etc. have Annual Report 2010-11 326 been registered under the Act. 462 ultrasound machines have been sealed and seized for violation of the law. As on 30.06.2010, there were 706 ongoing cases in the Courts for various violations of the law. Though most of the cases (223) are for non-registration of the centre/clinic, 216 cases relate to non-maintenance of records, 155 cases relate to communication of sex of foetus, 36 cases relate to advertisement about pre-natal/conception diagnostic facilities and 76 cases relate to other violations of the Act/Rules. The concerned state governments are regularly requested to take effective measures for speedy disposal of the ongoing cases. Ministry of Health and Family Welfare has taken a number of steps for the implementation of the Act. The major steps taken are as follows: Meetings of the Central Supervisory Board (CSB) Meetings of the Central Supervisory Board (CSB) of PC & PNDT Act are being held regularly (every six months) under the Chairpersonship of Union Minister of Health and Family Welfare. So far, 16 meetings have been held. Sensitization through Members of Parliament Funds were released to the Governments of Chandigarh, Delhi, Gujarat, Haryana, Himachal Pradesh, Punjab and Rajasthan at the rate of Rs.5.00 lakh per Honble Member of Parliament (both Lok Sabha and Rajya Sabha) of these States/UTs, considered sensitive from the point of view of Child Sex Ratio, for undertaking awareness generation activities like organising exhibitions, seminars, workshops, trainings / orientations programmes for PRIs, public meetings, debates, essay competitions, nukkad nataks, stage shows etc. On 2.10.2007 on the occasion of the Birth Anniversary of the Father of the Nation, Mahatma Gandhi, a signature campaign was launched to generate awareness regarding the evils of female foeticide. H.E. the President of India appended her signature first on the scroll as the first citizen of the country. Rallies were also organised on 4.10.2007 in every district of the NCT of Delhi to generate awareness among the public. The National Level Meeting on Save the Girl Child held on 28.4.2008 at Vigyan Bhawan, New Delhi, was inaugurated by Dr. Manmohan Singh, Honble Prime Minister of India, in the presence of the Honble Union Minister of Health & F.W., Honble Union Minister of State (I/C) for Women & Child Development and Honble Minister of State for Health & F.W.. The large turn-out of Ministers, Members of Parliament and senior Health officers from the Central and State/UT Governments and representatives of various organisations active in the area of Child welfare at the day long fruitful deliberations of the National Meet lent the necessary impetus to the Save the Girl Child mission. All the State/UT Governments were requested to replicate such meeting in their respective States/UTs. The message of the above National Level Meet was disseminated through the accredited print and electronic media. Medical Audit It is proposed to conduct Medical Audit of the ultrasound clinics in the country in a phased manner to spread awareness of the Act and required procedural formalities so as to prevent violations of the Act. Scrutinizing Form F filled in respect of all pregnant women by the clinics will also help in detecting violations, if any. Changing Appropriate Authorities In place of Chief Medical Officer / District Health Officer, District Collectors / District Magistrates have been nominated as District Appropriate Authorities to strengthen the implementation of the Act at the ground level. States of Maharashtra, Tripura, Gujarat, and Chhattisgarh have informed that they have issued the necessary notification in this regard. Proposed Amendments to PC & PNDT Act. To make the implementation of the Act more effective and stringent, it is proposed to amend certain provisions of the Act, such as changing the Appropriate Authority at the State level from Director (H&FW) to Secretary (H&FW) to facilitate the reporting of District Appropriate Authority (DAA) to State Appropriate Authority (SAA), inclusion of an officer of or above the rank of Joint Director of H&FW in the SAA, and vesting the power of search and seize records to any Group B Gazetted Officer. Funding to the State through RCH - II Funds have been provided to all States/UTs, as requested by them, in their Programme Implementation Plan under RCH II for undertaking various activities for implementation of the Act at the State level. Inclusion of the issue under NRHM Sensitization on sex ratio issue has been made a part of curriculum for ANMs. For tracking delivery of a pregnant Annual Report 2010-11 327 woman, ASHAs are now provided a fixed remuneration at the village level (keeping a track of the ante-natal check-ups and accompanying the pregnant mother to an institution for delivery). Constitution of National Inspection and Monitoring Committee (NIMC) A National Inspection and Monitoring Committee (NIMC) has been constituted at the Centre to take stock of the ground realities through field visits to the problem states. During 2006-09, the Committee visited the States of Delhi, Haryana, Maharashtra, UP, Rajasthan, Orissa, Karnataka, Kerala, H.P. and Punjab. It is proposed to strengthen the National Support and Monitoring Cell with induction of appropriate consultants to oversee the implementation of the Act. Annual Report on implementation of the PNDT Act Implementation of the PNDT Act is being published in Annual Report since 2005 which gives complete information on the implementation of PC & PNDT Act. Frequently Asked Questions (FAQs) booklet The Ministry of Health and Family Welfare, in collaboration with the United Nations Population Fund (UNFPA), have developed a Frequently Asked Questions booklet about the PNDT Act which has proved to be quite useful to the lay persons, medical community and to the Appropriate Authorities in understanding the provisions of the Act for better implementation. Website on PNDT In addition to the Union Health & F.W. Ministrys Website, (www.mohfw.nic.in), an independent website, pndt.gov.in for PNDT Division was launched by the Honble Union Minister of Health & F.W. on 28.4.2008. This website, in addition to containing all the relevant information relating to PNDT Act, Rules, Regulations and activities, enables online filing of data right from Clinics (including submission of From-F online by the Clinics) in the field to the District and State level and their retrieval at the District, State and National levels. An exercise is on to impart training to the user groups on the use of the website in a phased manner beginning with the focused states of Punjab, Haryana, Rajasthan, Gujarat, Himachal Pradesh, Maharashtra and Delhi. This training programme will be conducted by the experts from National Informatics Centre. Toll Free Telephone: Similarly, the Honble Union Minister of Health & F.W. launched a Toll Free Telephone (1800 110 500) on the same day under the PNDT Division of the Ministry to facilitate the public to lodge complaints anonymously against any violation of the provisions of the Act by any authority or individual and to seek PNDT related general information. (The service is presently suspended, pending resolution of certain operational issues; mainly unauthorized advertising by the outsourced service provider). Awareness Generation The problem has its roots in social behaviour and prejudices and along with the legislation various activities have been undertaken to create awareness against the practice of pre-natal determination of sex and female foeticide through Radio, Television, and Print Media. Workshops and seminars are also organized through voluntary organizations at state/regional/district/block levels to create awareness against this social evil. Cooperation has also been sought from religious / spiritual leaders, as well as medical fraternity to curb this practice. The Government of India has launched Save the Girl Child Campaign with a view to lessen son preference by highlighting achievements of young girls. Shri Kapil Dev, former Captain of the Indian national Cricket Team, has been nominated as the Brand Ambassador for the campaign. Advt. over the Internet regarding Gender Testing Kits: A new factor which is threatening to adversely impact the PNDT efforts of the Government, i.e. the advertisements placed on the websites regarding the Gender Testing Kits. The Honble High Court of Punjab and Haryana Suo Motu took congnisance of the above report and issued notices to the State Governments of Haryana and Punjab and also to the Central Government. Affidavit on behalf of UOI has been filed. On 29.11.2007, the Customs Department was requested by this Ministry to examine the possibility of intercepting such Gender Determination Kits when imported into the country under the Customs Act. They were also requested to furnish details of such importers to facilitate the Ministry to take appropriate action against them under the PC & PNDT Act. Annual Report 2010-11 328 In response to the above request of this Ministry, the Customs Department informed that it has suitably alerted its field formations to seize the Gender Testing Kits imported from abroad. Subsequently, the Central Board of Excise & Customs on 1.4.2008 made certain suggestions for consideration of this Ministry for interception of the Gender Testing Kits effectively. In the light of CBECs letter dated 1.4.2008 cited above, two rounds of Inter-Ministerial Meetings were held on 7.5.2008 and 16.5.2008 under the Chairmanship of Joint Secretary (PK), where the representatives of the Customs Department, DGFT, DGHS and DCG (I) were invited to find a solution to the problem posed by the import of Gender Testing/Sex-Determination Kits. It was, inter alia, decided to amend the PC & PNDT Act, 1994 and the Rules/Regulations framed thereunder suitably to provide for establishment of a registration mechanism in the matter of import of Gender Testing Kits and other similar medical kits. On the request of the Customs authorities, DCG (I) and DDG (M) have been requested to frame the required parameters for identification of the Gender Testing Kits from among the similar kits imported into the Country. Sting operation carried out of BBC in Delhi and NOIDA: The sting operation conducted recently by BBC at NOIDA and New Delhi revealed that illegal sex determination tests were carried out at Dr. Mangala Telang clinics on an NRI couple from the U.K. This was reported in the website of BBC News.The Appropriate Authorities of Uttar Pradesh and NCT of Delhi were requested to inquire into the matter and furnish their respective reports thereon. In their respective reports, the State Governments indicated that inspection of the facilities of Dr. Mangala Telang at NOIDA and Delhi were carried out, the Premises and sealed and her registration suspended. In addition to the above, the Government of U.P. has filed a court case against Dr. Mangala Telang at NOIDA. 19.4 FAMILY PLANNING Background: Nationwide, the small family norm is widely accepted (the wanted fertility rate for India as a whole is 1.9: NFHS-3) and the general awareness of contraception is almost universal (98% among women and 98.6% among men: NFHS-3). Both NFHS and DLHS surveys showed that contraceptive use is generally rising (see adjoining figure). Contraceptive use among married women (aged 15-49 years) was 56.3% in NFHS-3 (an increase of 8.1 percentage points from NFHS-2) while corresponding increase between DLHS-2 & 3 is relatively lesser (from 52.5% to 54.0%). The proximate determinants of fertility like age at first marriage and age at first childbirth (which are societal preferences) are also showing good improvements at the national level and adjoining figure indicates the current position of social determinants of fertility in the country. Current family planning efforts: The Family Planning (FP) Division is involved in the development, implementation and monitoring of strategic interventions for fulfilling the twin objectives of population stabilization and promoting reproductive health within the wider context of sustainable development. Annual Report 2010-11 329 The salient features of the family planning services are as follows: Counselling, access to and provision of good quality services and follow-up care. Fixed Day Static Services (FDS) approach in sterilization services to increase access. Continuation of sterilization camps in the states with high fertility till the time FDS is implemented effectively. Revised compensation scheme for sterilization acceptors. National Family Planning Insurance Scheme (NFPIS) to cover service providers in both public and accredited private facilities, where the clients are insured in the eventualities of deaths, complications and failures in sterilization and the providers/ accredited institutions are indemnified against litigations in those eventualities. Quality Assurance Committees (QACs) have been constituted at state and district levels. The Division has repositioned IUD as short and long term spacing method. Guidelines have been developed and disseminated regarding use of Emergency Contraception Pills (ECPs). Increasing male participation in Planned Parenthood, including No Scalpel Vasectomy (NSV): Increasing male participation in Planned Parenthood is one of the major strategic themes of NPP-2000. Promotion of NSV acceptance is one of the most important & visible component of increasing male participation in RCH towards addressing the gender equity issues. The No Scalpel Vasectomy (NSV), a modified male sterilization technique, was introduced in 1997. Camp approach for male sterilization was adopted initially to re-popularize male sterilization method. Based on the experiential lessons from male sterilization camps in certain states a strategy on advocacy and community mobilization for increasing NSV acceptance through camps was introduced in 2005. Human resource development with a three pronged strategy for training surgical faculty from Medical colleges, district NSV trainers and service providers is in place. Achievements in 2010-11: The camp approach was continued in most states across India (http://mohfw.nic.in/NRHM/FP/ Revised_Budget_Guidelines_CSS.pdf) Training in NSV, was continued on a priority basis. As on September 2010: o As per the latest report (HMIS) there are 9239 facilities in the country with trained NSV providers. o Most districts in the country have district NSV trainer/s. o Surgical faculty training is being continued in 2010-11 across five regional training centres and funds for the same are being disbursed. The annual National NSV Review Workshop was held in September 2009 to review states performance in NSV, and top three performing states for the year 2008-09 (West Bengal, Punjab & Maharashtra) were felicitated. NSV performance has continued its positive trend and has shown an increase in 2009-10: April March* 2009-10 Annual April-September^ Contraception Period 2008-09 (lakhs) Change 2010-11 (lakhs) (%) (lakhs) Male Sterilizations 2.52 2.74 8.7 0.77 Male Sterilization as % of Total Sterilization 5.2 5.5 4.7 Achievements in Male Sterilization, Nationwide Source: * MIS for NRHM as on November 2010 ^ HMIS RCH Reports accessed on 25 th November 2010 Annual Report 2010-11 330 19.5. REVISED NATIONAL TB CONTROL PROGRAMME (RNTCP) For creating mass awareness, facts related to Tuberculosis and Dos and Donts have been developed and are available on the programme website (www.tbcindia.org). For IEC activities at States and District level, funds are released to them from the centre. The states are advised to publish information material on tuberculosis in their local languages for distribution to the masses particularly the weaker segment of the society. TB affects all irrespective of age and sex. Under the Revised National TB Control Programme, facilities are provided free of cost to the TB patients. Thus the benefits of the Programme are uniformly available for all including women and girls. For providing DOTS to the TB patients, women self-help groups are encouraged to work as DOT providers. ASHAs, Anganwadi workers, Mahila Mandals etc are particularly involved for this purpose. Under the Revised National TB Control Programme, gender based data in respect of TB cases detected and put on treatment and their outcome is monitored. Information on male to female ratio in different types of cases and treatment outcome is given below: Patients registered 1q 2010 M:F Ratio 2q 2010 M:F Ratio 3q 2010 M:F Ratio M F M F M F NSP 106313 47569 2.2 : 1 120990 52780 2.3 : 1 109463 47897 2.3 : 1 Relapse 19705 6935 2.8 : 1 22470 7523 3.0 : 1 21526 7107 3.0 : 1 NSN 57338 34133 1.7 : 1 62101 37592 1.7 : 1 57336 35246 1.6 : 1 NEP 29407 27981 1.1 : 1 33670 31568 1.1 : 1 30023 28103 1.1 : 1 Total 212763 116618 1.8 : 1 239231 129463 1.8 : 1 218348 118353 1.8 : 1 NSP New Sputum Positive NSN New Sputum Negative NEP New Extra Pulmonary Total cases (NSP, NSN, NEP & Relapse) put on treatment in the year 2010 (Jan Sept) Male Female M:F Ratio 670342 364434 1.8 Male % Female % Total % Cured 92664 83.8% 41633 87.1% 134297 84.8% Treat. Compl. 2968 2.7% 1229 2.6% 4197 2.6% Died 4941 4.5% 1631 3.4% 6572 4.1% Failure 2237 2.0% 763 1.6% 3000 1.9% Defaulted 6909 6.2% 2221 4.6% 9130 5.8% Transferred 920 0.8% 341 0.7% 1261 0.8% Total 110639 47818 158457 Male to female ratio of different types of cases Treatment Outcome (NSP cases) in Males and Females, 3rd Quarter, 2009 Annual Report 2010-11 331 19.6. DEVELOPMENT OF NURSING SERVICES Nursing Personnel are the largest workforces in a Hospital. They play an important role in the health care delivery system. 95% of the beneficiaries of this program are women only. Nursing Personnel are better equipped through this program to provide quality patient care in the Hospitals and other settings also. Activities undertaken under the Program for Women The activities under the programme of Development of Nursing Services are: 1. Training of Nurses under in-services training scheme to update the knowledge and skills of Nursing Personnel, 2. Strengthening of Schools and Colleges of Nursing to improve the quality of Nursing education and basic Training Program. About 95 % of the candidates opting for Nursing Courses are females only. (1) Training of Nurses. In order to update the knowledge and skills of the nursing personnel, Continuing Nursing Education Programme was started in the area of Nursing Specialty for the Staff Nurses, Education Technology for the faculty of the Schools and Colleges of Nursing, Management Techniques for the Nursing Administrators. It is conducted for 7 days. The venue will be in the selected College of Nursing in the state. The pattern of assistance for conducting Continuing Nursing Education Programme has been revised from Rs. 75,000 /- to 1,65300/- to train 30 Nurses. (2) Strengthening / Upgradation of Schools/ Colleges of Nursing. In order to improve the quality of training imparted at the existing Schools and Colleges of Nursing grant is released towards procurement of A.V Aids, furniture, improvement of library, additions/alterations of building and transport. A grant of Rs. 10.00 lakhs is provided per institution during the Xth Plan period. 3. Upgradation of Schools of Nursing attached to Medical Colleges into Colleges of Nursing. 20 institutions in the states of Rajasthan (5), Jharkhand (3) Gujarat (2). Tamil Nadu (2), West Bengal (2) Himachal Pradesh (1), Manipur (1) , Mizoram (1),& Uttar Pradesh (3) have been released grant-in aid during the year 2010-11. The admission capacity has been kept as minimum 60 per institution. Allocation of Budget A sum of Rs.21.00 crores have been allocated in the Budget under the Development of Nursing Services during the year 2010-11 . Up Gradation/Strengthening of Nursing Services under Human Resources Nursing Personnel are the largest workforces in a Hospital. They play an important role in the health care delivery system. 95% of the beneficiaries of this program are women only. Nursing Personnel are better equipped through this program to provide quality patient care in the Hospitals and other settings also. Activities undertaken under the Program for Women The activities under the programme of up gradation/ strengthening of Nursing Services under Human Resources include; Opening of ANM / GNM Schools Faculty Development programme. Allocation of Budget A sum of Rs.250.00 crores have been allocated in the Budget under the Upgradation/ Strengthening of Nursing Services during the year 2010-11 CCEA has approved this Ministrys proposal for opening of 132 ANM Schools and 137 GNM Schools in those districts of the states where there are no such schools. 154 districts in 23 High Focus States have been identified having no ANM and GNM schools. A Sum of Rs. 123.00 crore has been approved so far for release under the new scheme of Opening of ANM /GNM Schools to ten (10) states. In order to meet the shortage of qualified Post Graduate teachers in nursing to improve the quality of nursing education in the high focused States a faculty Development programme has been approved and 22 nominations have been received from 7 States for under going training in M.Sc (Nursing) at the identified Institutions wiz. SNDT College of Nursing, Mumbai, PGIMER, Chandigarh and Govt. College of Nursing, SSKM Hospital, Kolkata. ORGANISATION CHART OF DEPARTMENT OF HEALTH & FAMILY WELFARE Annual Report 2010-11 335 ANNEXURE D y . D i r e c t o r G e n e r a l ( S t a t s ) S h r i P r a v i n S r i v a s t a v a Annual Report 2010-11 336 S h . N . K . S e n g u p t a D r . G . P . K u m a r , A d d l . S h . G . P . K o r i A s s t t . D i r . A d d l . S h .
N . K .
G u p t a S h . V . P . S i n g h J . D . ( O L ) S h . R . K . B a h t i , A . D . ( O L . I I ) Annual Report 2010-11 337 S h . R . P . N a r a n g S h . D e b a s h i s h R o y ( S O , E . I . ) Annual Report 2010-11 338 S h . K . K .
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( P M S S Y ) Annual Report 2010-11 339 Annual Report 2010-11 340 B a n g a l u r u Annual Report 2010-11 341 P a r m a r , K h e t r a p a l S h .
G . R . Annual Report 2010-11 342 Annual Report 2010-11 343 M s . Annual Report 2010-11 344 T e t e , S m t . J a g j i t K a u r , S O ( R C H - P ) Annual Report 2010-11 345 Annual Report 2010-11 346 Annual Report 2010-11 347 O r g a n i s a t i o n
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2 0 1 1 ) Annual Report 2010-11 348 Annual Report 2010-11 349 No. of Paras/ PA/Reports on which ATNs have been submitted to PAC after vetting by Audit
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