Impact of Patient Welfare Society in Health Care syste

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How Patients welfare society helps to Primary Health centres


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Tamil Nadu

HealthCare System Pyramid:

HealthCare System Pyramid DPH&PM DMS DME Medical Colleges – 19 College Hospitals – 33 Taluks – 155 Non-Taluks – 80 HQ Hosps – 30 HSCs – 8706 CHC & PHCs – 1539 Primary Care, CHC, PHC & HSC Secondary Care Dist. HQ Hosp, Taluk & Non-Taluk Tertiary Care

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Hon’ble Minister for Health & Family Welfare Secretary to Government D M E D M S D P H & P M Health - Organisation Structure I S M TANSACS TNHSP TNMSC S H S Drug Control State Health transport Departments Projects

Organisation Structure District Health Administration:

Organisation Structure District Health Administration Director of Public Health Director of Medical and Rural Health Services Director of Medical Education Joint Director (Health Services) Dean Deputy Director (Health Services) Deputy Director (Medical) Deputy Director (TB) Deputy Director (Leprosy) Primary Health Centres Secondary level Hospitals RNTCP NLEP State District Medical Colleges

Health Services Field Level:

Health Services Field Level Disease Control Services National Programmes Epidemics Vector Borne Diseases Non Communicable Diseases New Diseases OP, IP, Outreach camps MCH Activities Family Welfare Vazhvoli Thittam Varumun Kappom Thittam Dr.Muthulakshi Reddy Maternity Benefit Scheme Lab Services Special Clinics RNTCP NLEP Blindness Control Programme and All other National Programmes

Major Legislations Enforced by the Directorate:

Major Legislations Enforced by the Directorate Tamil Nadu Public Health Act, 1939 Prevention of Food Adulteration Act, 1954 Birth & Death Act, 1969 and rules, 2000 PCPNDT Act, 1994 Tamilnadu Prohibition of Smoking and Spitting Act, 2002

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What do you mean by NRHM?

National Rural Health Mission:

National Rural Health Mission The National Rural Health Mission (NRHM) has been launched in 2005 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 seeks to provide universal access to equitable, affordable and quality health care which 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.


NRHM - AIM To undertake architectural correction of the health system To have a village health plan by a local team headed by the Health & Sanitation Committee of the Panchayat; To strengthening of the rural hospital – quality care to Indian Public Health Standards (IPHS); To integrate vertical Health & Family Welfare Programmes To give Importance to determinants of health like sanitation & hygiene, nutrition, and safe drinking water To decentralization of programmes for district management of health To improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare.

Core Strategies:

Core Strategies Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. Promote access to improved healthcare at household level through ASHA. Health Plan for each village through Village Health Committee of the Panchayat . Strengthening sub-centre through an untied fund to enable local planning and action MPHW. Strengthening existing PHCs and CHCs - provision of 30 bedded CHC per lakh pop for curative care Preparation and Implementation of inter- sectoral District Health Plan

Supplementary Strategies:

Supplementary Strategies Regulation of Private Sector including the informal rural practitioners Promotion of Public Private Partnerships for achieving public health goals Mainstreaming AYUSH – revitalizing local health traditions Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics Effective and viable risk pooling and social health insurance to provide health security to the poor

Facelift of PHC Omandur PHC, Villupuram Dist. :

Facelift of PHC Omandur PHC, Villupuram Dist. Before After

PHC Siruvanthadu:

PHC Siruvanthadu After Before

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Changes in Health System

Changes in health system :

Changes in health system Narrowing the manpower requirement Rationalisation of Medical Man Power Single MO institutions to have one more and UG PHC to have more skilled persons Contractual Members and Hired Anesthetist, Pediatrician and OG Specialist - Pre-placement Training to Medical Officers and SN working in special areas Enhancing service provisions especially MCH “Pick Me” – Tracking the mother and Child Facilitating RTI and Skill Training – SBA, IMNCI, AMTSL Skill Training – Anesthesia, SCAN,

Changes in Health System :

Changes in Health System 24 hrs Delivery Services in all Rural Institutions Special attention to remote, inaccessible area MMU and Incentives Work force incentives – Trophy and Certificates, Cash Awards, At any given point work force vacancy kept within tangible limits ISO Certification – Death Audit – maternal and infant deaths audited Birth Certificates issued in the Medical Institution Caesarian in PHC and with Block Storage Increased institutional Deliveries

Changes in Health System :

C hanges in Health System Drug use rationalize and Protocol – Standard Treatment Developed Support Services attended – Laundry, AN Diet and Inpatient Diet at PHC Telephones and cell phones provision Autoclave, use of Disposable Syringes EMRI – 108 ambulance service Video Conferencing – for review and monitoring PWS well utilised and extended to Tertiary care Institutions VHND –with established service package

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RCH - II GOAL Current status Target 2011-2012 Tamilnadu India MMR (per 100000 LB ) 111 85* 254 60 IMR 28 53 20 TFR 1.7 2.7 1.7 NRHM Goals * (HMIS 2007-08) Source : SRS

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Why you need the change?

The standards prescribed are for a PHC covering 20,000 to 30,000 populations with 6 beds.:

The standards prescribed are for a PHC covering 20,000 to 30,000 populations with 6 beds. All “Assured Services” as envisaged in the PHC should be available, which includes routine, preventive, promotive, curative and emergency care In addition to all the national health programmes. Appropriate guidelines for each National Programme for management of routine and emergency cases are being provided to the PHC. All the support services to fulfil the above objectives will be strengthened at the PHC level.

Minimum Requirements (Assured Services) at PHC for meeting the IPHS - 1:

Minimum Requirements (Assured Services) at PHC for meeting the IPHS - 1 Medical care: OPD services: 4 hours in the morning and 2 hours in the afternoon /evening. Minimum OPD attendance should be 40 patients per doctor per day. 24 hours emergency services: appropriate management of injuries and accident, First Aid, Stabilisation of the condition of the patient before referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions. There should be sufficient doctors to attend to 8-hourly shift duties to make 24-hour emergency services available. Referral services In-patient services (6 beds)

Minimum Requirements (Assured Services) at PHC for meeting the IPHS - 2:

Minimum Requirements (Assured Services) at PHC for meeting the IPHS - 2 MCH Care including Family Welfare a) Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12th week). Minimum 3 antenatal checkups and provision of complete package of services. Associated services like providing iron and folic acid tablets, injection Tetanus Toxoid etc Minimum laboratory investigations like haemoglobin, urine albumin, and sugar, RPR test for syphilis Nutrition and health counseling Identification of high-risk pregnancies/ appropriate management Chemoprophylaxis for Malaria in high malaria endemic areas Referral to First Referral Units (FRUs)/other hospitals of high risk pregnancy beyond the capability of Medical Officer, PHC to manage.

IPHS - 3:

Maternal Intra-natal care: (24-hour delivery services both normal and assisted) Promotion of institutional deliveries Conducting of normal deliveries Assisted vaginal deliveries -forceps / vacuum Manual removal of placenta Appropriate and prompt referral - specialist care. Management of Pregnancy Induced Hypertension Pre-referral management (Obstetric first-aid) Sufficient number of staff nurses to attend to 8-hourly shift duties and 24-hour delivery services Postnatal Care: A minimum of 2 home visits, within 48 hours of delivery, 2nd within 7 days Initiation of early breast-feeding within ½ hour Education on nutrition, hygiene, contraception, IPHS - 3

IPHS - 4:

Child Health Care New Born care: Facilities and care for neonatal resuscitation Management of neonatal hypothermia / jaundice Care of the child: Emergency care of sick children including Integrated Management of Neonatal and Childhood Illness (IMNCI) Care of routine childhood illness Essential Newborn Care Promotion of exclusive breast-feeding for 6 months. Full Immunization of all infants and children against vaccine preventable diseases Vitamin A prophylaxis to the children as per guidelines. Prevention and control of childhood diseases, infections, etc. Family Planning: Education, Motivation and counseling to adopt appropriate Family planning methods. Provision of contraceptives such as condoms, oral pills, emergency contraceptives, IUD insertions. Permanent methods like Tubal ligation and vasectomy / NSV. Follow up services to the eligible couples adopting permanent methods Counseling and appropriate referral for safe abortion services (MTP) for those in need. Counseling and appropriate referral for couples having infertility . IPHS - 4

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Process of Promoting AN Care & Institutional Deliveries

Significant Achievements in 2010-11:

Significant Achievements in 2010-11 Prenatal screening of early identification of foetal abnormalities 2 MO / UG PHC will be trained in Ultrasonogram to detect major foetal abnormalities through a online and hands on training by private organizations Periodic online audit of the suspected images for 1 yr.


Training 82% of the Health Personnel in the State have undergone AMTSL Training (Active Management of Third Stage Labour ). 25 districts have completed training in F-IMNCI. In the remaining 5 districts the training will be completed in mid March 2011. All the PHC Staff have been orientated on IMEP guidelines of GoI all the district health personnel have under gone similar training by TNHSP of GoI . NRHM Training for AYUSH doctors - 751 doctors (98.9%) have been trained up to Dec 2010. Significant Achievements in 2010-11


Training All the Village Health and Water Sanitation committee members along with 10-12 active members in the community from each Village panchayat have been trained. Integrated refresher training for Village Health Nurse for improved antenatal and post natal care - 5644 female health functionaries have been trained up to Dec 2010 Significant Achievements in 2010-11

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t Food for AN Mothers

Steps to Improve Deliveries in the PHCs :

Steps to Improve Deliveries in the PHCs

Maternity Picnics in the PHCs :

Maternity Picnics in the PHCs

Clean Ward at Banavaram Upgraded PHC:

Clean Ward at Banavaram Upgraded PHC

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Janani Suraksha Yojana:

Janani Suraksha Yojana Institutional deliveries occurring in the rural area -Rs.700/ Mother Institutional deliveries occurring in the urban area -Rs.600/ Mother Home deliveries -Rs.500/ Mother. 2007-08 2008-09 2009-10-Dec JSY beneficiaries 2,29,609 3,86,688 2,41,410 Amount Disbursed Rs. 21.41 Cr Rs. 35.38 Cr Rs.28 Cr

Manpower for Maternal health:

Manpower for Maternal health All PHCs provide 24x7 services with 3 Staff Nurses All 385 blocks are provided with Mobile medical units. Anaesthetists and Obstetricians are hired for providing emergency obstetric care services including caesarian section.

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1971 1981 1991 1996 20.3 18.0 61.7 31.0 18.1 50.9 56.8 24.4 18.8 64.7 20.9 14.4 INSTITUTIONAL DELIVERIES DELIVERIES CONDUCTED BY TRAINED PERSONNEL DELIVERIES CONDUCTED BY UNTRAINED PERSONNEL 2008 98.3 0.8 0.9 Growth of Safe Deliveries (%)

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Process of Reducing Infant Deaths


CHILD HEALTH All the PHCs provided with New Born Corner – Radiant warmer, other necessary equipment and trained staff .

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Warmer; Weighing Scale;

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Fetal Doppler;

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Birth Certificate – in polythene cover- at the place of delivery in rual area

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* Source : SRS 2009 National Target < 30 by 2012 1991 2001 2009 Reduction in Infant Mortality

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Rural Urban TAMILNADU - INFANT MORTALITY RATE Source: SRS CSSM, 1992 RCH, 1997 NRHM, 2005 UIP, 1985 Combined 30 26 28

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* Source : SRS 2008 Before NRHM Since 1971, the Infant Mortality Rate (IMR) reduced from 113 (1971) to 41 (2004) i.e 64% reduction in 33 years. The average reduction in IMR was 2.1 points per annum. After NRHM The IMR reduced from 41 (2004) to 31 (2008) I.e 32% reduction in 4 years The average reduction in IMR was 2.5 points per annum. Since 1971, -Reduction rate of IMR In Rural – 2.5 points / year -Reduction rate of IMR In Urban – 1.3 points/ year This difference is due to the high inputs in rural areas Reduction in Infant Mortality


Districts are selected based on IMR status for intensified activities for reduction of IMR with the following components. District Level Establishment of Neonatal Intensive Care Unit in phases Two CmONC hospitals / districts 9 staff nurses and 3 medical officers trained in neonatology for 3 months. Equipments worth for Rs.25 Lakhs per centre. CHILD HEALTH

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50 Neonatal Intensive Care Unit – Models


All new born corners in the PHC of NICU districts are strengthened with new born warmth kit (1 lakh per PHC). Home based new born warmth kit with booklet are provided to delivered mother in the PHC. Introduction of Home based new born care at the field for building linkage with community for post natal care. CHILD HEALTH B. PHC and Community Level

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Process of Reducing Maternal Deaths

Significant Achievements in 2010-11:

Anaesthetists and Obstetricians are hired for providing emergency obstetric care services including caesarian section. No. of Caesarean Conducted in PHCs for 2010-11 (upto Jan 2011) – 4080 No. of PHCs conducting Caesarean deliveries 79 (in 24 HUDs) Significant Achievements in 2010-11

Significant Achievements in 2010-11:

Blood Storage Centres 74 centres obtained license from drug controller and functional. Establishment of 181 Blood Storage Centres are under progress Significant Achievements in 2010-11 Note :This initiative will reduce the Maternal death due to PPH

Maternal Death Audit :

Maternal Death Audit Maternal Death audit is conducted by District Collectors Clinical Audit Video Conference conducted for Obstetrician and Anesthetists

Further Actions: MATERNAL HEALTH:

Further Actions: MATERNAL HEALTH Focused anaemia control management including deworming at the second trimester, improved packaging of IFA tablets, adding vitamin B12 complex ,Vitamin-C and using injectible iron for severe anaemia. Active Management of third stage labour training to all Heath functionaries to combat Post Partum Heamorrhage (PPH). Introduction of Non- Pnuematic Anti Shock Garment (NASG) for the management of PPH.

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t Bangle ceremony for the pregnant women ‘Gap’ reduced between PHCs and Community

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Source : State HMIS National Target < 1 by 2012 2004-05 2009-10 Maternal Mortality Rate (per 1000 live births) 2001-02

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Maternal Death Cause Analysis 2008-09 60% of Maternal Deaths are Preventable

Significant Achievements in 2010-11:

Significant Achievements in 2010-11 Maternal Anaemia control programme Interventions Anaemia management protocol for normal, moderate and severe anaemia cases including mandatory deworming in view of the high worm load Ensuring proper measurement of hemoglobin levels Use of Iron sucrose for severe anaemia - documentation to be done on improvement in anaemia levels Supplementation with Vit C and B-12 in ISO PHCs to test whether absorption improves. Statewide Adolescent Anaemia Control programme – joint programme with NGO in 5 blocks.


EMRI Emergency Referral Services (Toll free no 108) introduced in all the districts. 385 Ambulances on road. AN mothers transported (upto Dec. 2010) – 100499 Cases of inter facility transfer (upto Dec. 2010) - 32747 Significant Achievements in 2010-11 Note- This initiative will enable the needy patients to avail the treatment within the golden hour

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Maternal Death - Gravida wise Analysis 2009-10

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Maternal Death – Place of Death Analysis 2009-10

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Process of Improving Adolescent Health and Others Living in difficult area


ADOLESCENT HEALTH Implemented through 14 Medical colleges by establishing Teen Clinics Third year MBBS students and Nursing students are trained in Adolescent health. Linkage with the improved School Health Programme Biannual deworming and weekly supplementation of Iron tablets on every Thursday to school and non school going girls.

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About Anemia – Information Board at PHC Kosavapatty

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Adolescent girls – attained menarche responding eagerly

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Urban Health Care delivery through adoption of health posts by 14 medical colleges. Strengthening of Urban Health Posts by providing infrastructure and Man Power in 71 Municipalities with less than 1 lakh population. URBAN HEALTH

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12 Tribal Mobile Medical Units to reach the remote and inaccessible districts. 2650 Village Health Volunteers (ASHA) appointed in 12 Districts. Birth waiting room in 15 PHCs in the foothills of tribal villages Feeding and Dietary charges for 7 Days for AN Mothers and one attender. TRIBAL HEALTH

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Our weapon - PWS, Untied Funds, AMG & Approval Through PIP – Infrastructure & manpower eveopment

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PATIENT WELFARE SOCIETIES (PWS) Govt. HQ Hospital fund per hospital 29 500000 Taluk / Non Taluk Hospital( sub District / Area hospitals fund per hospital 235 100000 Primary Health Centre (existing -1421 + New -117) fund per PHC 1538 100000 Medical Colleges (existing -15 + New -3) fund per college 17 1000000 Other Institutes under DME control fund per institute 12 500000 Other Hospitals under DME control fund per hospital 5 100000 Urban Health Centres fund per UHC 60 100000

PWS – Salient Feature :

PWS – Salient Feature Governing Body Once in every quarter – Compliance of IPHS, OP, IP, Service deliveries including report of monitoring committee and Public Grievance Annual Report of GB to be prepared Notification not less than 21 days clear days before meeting Urgent meeting – 10 clear days Business resolution must be approved by 1/3 members and must be circulated Executive Body Once a month with notification with 7 clear days Review – OP, IP, Service Delivery, SOP, Out Reach, Utilization of Funds, Monitoring Committee Report and remedial actions Monitoring Committee Visit ward and collect patients feed back Monthly report to district collector

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ANNUAL MAINTENANCE GRANTS FOR PHCS/CHCS(AMG-PHC) PHCs with own Building fund per PHC 1390 50000 PHCs declared as BEmONC centers/upgraded PHCs (equivalent to CHCs)(in addition to the Rs.50000/- grant provided above) fund per PHC 449 50000 ANNUAL MAINTENANCE GRANTS TO HSCS (AMG - HSC) HSCs fund per HSC 6510 10000

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UNTIED FUNDS TO PHCS/CHCS/DISTRICT AND SUB DISTRICT HOSPITALS Primary Health Centre fund per PHC 25000 PHCs declared as BEmONC centers/upgraded PHCs (equivalent to CHCs) fund per PHC 449 50000 Urban Health Centers fund per UHC 60 25000 Taluk / Non Taluk Hospitals fund per hospital 235 50000 District Head Quarters Hospitals fund per hospital 29 100000 UNTIED FUNDS TO HSCS Untied Funds to HSCs fund per HSC 8706 10000

Untied Funds and AMG - Salient Feature :

Untied Funds and AMG - Salient Feature Permitted Minor Modification – Privacy, Repair, Elec bulbs replacement, repairs and instruments like tray, weighing scale, Hb Meter, scissors, plasters bucket, stools, Macintoshosh sheet etc Provision of Running water & electricity Cleaning ad hoc payment – material and wage Consumables and for epidemic control activities Transport payment – patients and for specimen Not Permitted Stationeries, Training Related Equipment and for vehicle Full time staff, Furniture and major equipment Ad in papers Incentives and No duplication

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VILLAGE HEALTH AND SANITATION COMMITTEES Village Health and Sanitation in Village Panchayats fund per VHWSC 12618 10000 Village Health and Sanitation in Town Panchayats fund per VHWSC 2540 10000 HEALTH MELA Health Mela fund per mela 39 800000

Pattern of utilization of funds under NRHM :

Pattern of utilization of funds under NRHM


INFRASTRUCTURE UPGRADATION 148 First Referral Units and CEmONC centers provided with essential equipments for maternal and child care including central oxygen supply . 513 PHCs taken up for Infrastructure upgradation, extensions, renovations and repair works in 2009-10 to cope up with additional service demands.

NRHM Additionalities:

NRHM Additionalities Patient welfare societies established in 1421 PHCs,29 district hospitals,235 taluk and nontaluk hospitals and15 Medical colleges. 60 Urban Health Centres are being established with patient welfare societies. Untied funds are being provided to 1421 PHCs, 8706 HSCs, 235 Taluk and Non taluk Hospitals, 29 District Hospitals and 60 Urban Health Centres Annual Maintenance Grant provided to 8706 HSCs and 1390 PHCs. Village Health Sanitation Committees established in 12618 Village Panchayats and 2540 Town Panchayats.

NRHM Additionalities:

NRHM Additionalities 42 PHCs are in the process of getting ISO certification for providing quality services in coordination with NHSRC. Model School Health Programme to be introduced in 6 districts to supplement the existing State government “ Vazhvoli thittam ” Kannoli Kaappom Thittam - correction of refractive errors in middle school children was performed. 117443 spectacles were issued so far. Mechanized laundry services in all the HUDs proposed (washing machines with driers).

Public Private Partnership:

Public Private Partnership Active management of Third stage of labour – to prevent Post partum hemorrhage-Introduction of Non pneumatic Anti Shock Garment(NASG)- in collaboration with UNICEF and Pathfinders International . Pre-service training of Medical students in Integrated management of New born and Child hood illness in collaboration with WHO Anaemia Control through Behavior Change Communication by DHAN foundation . 12 Mobile Medical Unit in Tribal area in collaboration with Tamil Nadu Health system project.

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Health Mela No of Health Mela conducted till now – 115

Valaikappu Ceremony conducted at PHCs:

Valaikappu Ceremony conducted at PHCs This programme reduces the GAP between the PHC and the public

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Sub-Societies and other National Programmes


Component NRHM Flexi pool RCH II includes FW Immunisation VBDC IDSP RNTCP NLEP NBCP IDD AIDS NPPCD NCD NTCP NMHP Elderly Oral Health Policy on Clinical Establishment

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National Target < 2.1 by 2012 1997 2004 2007 TOTAL FERTILITY RATE

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National Target < 2.1 by 2012 1997 2004 2009 Total Fertility Rate * Source : SRS

Sterilisation at PHCs:

Sterilisation at PHCs


FAMILY WELFARE-2009-2010 Methods Annual ELD Prop. ELD Achievement % Sterilization 4,00,000 3,00,000 2,66,445 88.8 IUCD 4,50,000 3,37,500 2,42,242 71.8 OP users 1,75,000 1,75,000 99,521 56.9 CC Users 3,75,000 3,75,000 1,57,692 42.1 MTP 1,50,000 1,12,500 40,435 35.9

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DFW +9205 -1944 +2030 +695 -4604 STERILIZATION PERFORMANCE 2008-09 & 2009-10 (UPTO Dec.09) -2507 +2610


IMMUNIZATION No Polio case for the past 4 years. Neonatal Tetanus eliminated. The Incidence of Diptheria, Pertussis, Childhood TB are almost Nil. Measles cases are reported less than 1500 cases per annum as compared to 15000 cases reported every year during 80s.

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TAMILNADU – Situation of Vector Borne Diseases

VBD - Control Activities:

VBD - Control Activities

Significant Achievements in 2010-11:

Establishment of Dental Clinics at FRU/PHC Recruitment of Dentist and Dental Assistant completed in 75 centers. Equipment supply (Dental Chair and accessories) completed in 65 centers Significant Achievements in 2010-11

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96 Anganwadi Worker “Campaign” once a year – Age 0-5 yrs MPHW/ VHN VHNDay – Once a month- age 0-5 yrs School Health Visit by ANM / LHV – age 6-15 yrs Health Melas one per parliamentarian Constituency in the district per year- All age group VKT Camps – one per HSC (5000)- Once per project period (2-2.5 yrs) All age group PHC Clinic – daily & Special Clinic once a month by Hired ENT Surgeon & Planning of Camps with follow up District ENT Units Medical College ENT Units D I S T R I C T PHC V I LLAGE Cases Identified – Hard of hearing and require more specialized care Immunisation Card School Health Card Specialist Flow Case Flow Tamil Nadu – NPPCD Program Plan – 2009-10 Referral Slip

Significant Achievements in 2010-11:

8169683 Houses Surveyed 13016507 Persons (>30 years) Screened 1314269 People with "ENN SCORE" <30 identified and treated Significant Achievements in 2010-11 Comprehensive Community Strategy to screen the entire rural population of Tamil Nadu above 30 years Government Of Tamil Nadu Diabetes And Hypertension Prevention Initiative


e- goverence & e-Health in DPH COMPUTERIZATION OF DATA THROUGH ONLINE TRANSMISSION Data being received and reviewed through online for the following schemes Dr.Muthulakshmi Reddy Maternity Benefit scheme Varumun Kappom Thittam PHC Delivery and other Performance PHC Morbidity monitoring Mobile Outreach Services Camps Blood donation camps BEmONC services of PHCs IDSP surveillance Health Condition Reports Rural Civil Registration Systems (Births and Deaths Reports)

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Resulting improvement Quantitative !!! Qualitative ?

Improved Utilization Of PHCs:

Improved Utilization Of PHCs Average OP per Day Average IP per Month Average Deliveries per Month

% of PHCs with more than 10 Deliveries:

% of PHCs with more than 10 Deliveries

Caesarean section conducted at PHC (Comparative) Upto January:

Caesarean section conducted at PHC (Comparative) Upto January

Significant Achievements in 2010-11:

Main streaming of AYUSH – PHCs with ISM clinics 300 Clinics established in the PHC addition to 479 Clinics. Government Orders obtained for another 175 Clinics in PHC. Significant Achievements in 2010-11

Significant Achievements in 2010-11:

114 PHCs upgraded with 30 beds. 102 New PHCs constructed. 403 PHCs taken up for minor civil work and renovation Significant Achievements in 2010-11

ISO Certification:

ISO Certification Significant Achievements in 2010-11 48 PHCs are in the final stages of getting ISO certification for providing quality services in coordination with NHSRC Another 30 PHCs proposed for 2011-12 Note- This initiative will ensure the quality care to the community

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New Initiatives


NEW INITIATIVES -2011-12 Postnatal Services- Infection Control Objective is to reduce the sepsis during the postpartum period Promotion of post partum hygiene by using sanitary napkins during the post natal period. The programme will be implemented by SHGs through the Corporation for Development of Women and the required packs will be distributed to the concerned PHCs through the District Health Society. Budget proposed –Rs 394.03 lakhs


NEW INITIATIVES 2011-12 MCH Centres Operationalisation 31 Health Sub Centres are identified which are remote and do not have access to the PHCs to function as Level 1 care centres. The centers will be provided with 2 more VHNs and equipments . 42 facilities identified at the rate of 1 per Health Unit District to function as Level II MCH Centres. 2 additional doctors (preferably specialists), 3 more Staff nurses, and supporting staff. Will provide Emergency Obstetric Care and full package of services. Budget proposed for staff and equioments: Rs 366.66 Lakhs


Karungalakudi Thumbaipatti Kanjarampettai Ayyankottai Katchakatti Chellampatti Vikramanagalam M.Subbalapuram Koodakoil T.Pudupatti Santhankudi Melakkal Kallendri Kottampatti T.Vadipatti Madurai East Alanganallur Melur Madurai West Tiruparankundram Thirumangalam Usilampatti Chellampatty Kallikudi T.Kallupatti Sedapatti T.Ramanathapuram Therkutheru Rajakoor Othakadai Koilpappakudi Kulamangalam Thummagundu Thuvariman Valayankulam T.Vadipatti Alanganallur Melur Tiruparankundram Sedapatty Madurai West Chellampatty Usilampatti Kallikudi T.Kallupatti Kottampatti Thirumangalam Madurai East Service Reach 15 Km Diameter Madurai Medical College Hospital Dist. Head Qts. Taluk Hospitals. Non Taluk Hos. UG PHC PHC CEmONC Hospital (2) Madurai Medical College Hospital Usilampatti HQ Hospital Madurai Proposed MCH centre Alanganallur


NEW INITIATIVES Sl. No Description Rs. in Lakhs 1 Strengthening of EMRI Vehicle with Neonatal support system 96 (under NRHM – EMRI Scheme) 2 Essential New Born Care Services at CHCs – NBSUs 72.27 ( under the operationalisation of 42 MCH Centres )


NEW INITIATIVES In 2010-11 , ‘’NALAMAANA THAMILAGAM’’ phase – I was successfully launched under NRHM. Goal of the ‘’PENGAL NALAMUDAN’’ Spread awareness regarding risk for breast and cervical cancer. Detect and treat early asymptomatic and undiagnosed cases especially those at high risk. PENGAL NALAMUDAN’’(WELL WOMAN) ‘’NALAMAANA THAMILAGAM’’(HEALTHY TAMIL NADU) PHASE – II


NEW INITIATIVES Establishing Elderly Clinic with Physiotherapy in UG PHC (CHC) A Pilot project in coordination with PPP in 15 Upgraded PHCs (CHCs) with 3 centres each in the 5 districts. These clinics will be functioning with the support of manpower available in the existing physiotherapy colleges. This pilot project will also use facilities in AYUSH as an integral part of services in the PHC. A total budget of Rs.30 lakhs has been proposed for for the e stablishing Elderly Clinic with Physiotherapy in UG PHC (CHC) .


ISSUES An amount of Rs 879.45 lakhs( 75%) towards the establishment of 399 ICTC at the PHCs have been requested by the Project Director from NRHM for the year 2010-11 for which the orders are awaited from GOI. Rs.1394 Lakhs (100% recurring cost for 399 ICTCs in the PHCs) has been proposed by the Project Director TANSACS. Approval of incentives for staff working in PHCs located difficult and remote area ICTCs IN PHCs Difficult area PHCs


CONCERNS Shortfall in the availability of specialists, doctors and staff in certain designated CHCs No second ANM / MPW in the sub centres. Drop in full immunisation of Children Prevalence of anaemia in children Decline in the outreach activities of Sub-centre Male participation in FP needs to be improved. Regular drug supply to the sub-centers Biomedical Waste Management: improvement at all levels. Accounts maintenance at the facility level to be improved

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