Greetings From Chhattisgarh

1
Greetings From Chhattisgarh
2
A new state Chhattisgarh is born on 1st November
2000 with 16 districts
3
GENERAL INFORAMTION

• Area 146361 Sq. Km. (6 times of Kerala
  State)
• Population 20795956(Census 2001)
  Rural-80 , Urban-20
• SC- 12, ST-33
• Sex ratio 990 female per 1000 male
• No. of districts 16 Blocks-146(Tribal 85)
• IMR 79 per 1000 live births

4
Sex Ratio 990/1000
5
Decadal Growth Rate 18.06
6
Literacy Persons 65.18 Male 77.86 Female 52.4
7
SRS 2001(Released by RGI in October 2002)
8
Some Important Indicators of NFHS-2Fertility
Indicators
9
Some Important Indicators of NFHS-2Maternal
Health Indicators
10
Some Important Indicators of NFHS-2Child Health
Indicators
11
Infrastructure
12
Some Important Gaps
Infrastructure Gaps
Manpower Gaps
Other Gaps

• Deficiency of over 500 doctors in Public Sector
• Major deficiency of paramedics
• Very few doctors, and paramedics in Private
  Sector in rural areas

• Poor Monitoring
• Poor Managerial and other related skills
• Difficult Geographical area, and poor
  communication

• Only 2 Medical Colleges
• No District Hospital in 10 out of 16 Districts
  (Sanctioned in all)
• No CHC in 54 out of 146 Blocks

13
The new Strategy

• Health Systems Improvement
• Improve Routine Programme Monitoring
• Capacity Building at all levels - Improve
  Training Infrastructure and Manpower
• Community Health Volunteers ("Mitanins') - New
  Scheme of Community Participation
• Improve Infrastructure
• Better MIS based on IT
• Involve PRIs and ULBs
• Mobile Hospitals

14
Important Areas of Reforms

• Strengthening health intelligence, surveillance,
  epidemiology and planning
• Rational Drug Use Policy
• Uniform Treatment Clinical Protocols
• Improving internal systems of the Department of
  Public Health
• Workforce management and transfer policy
• Management Information System
• Mainstreaming of Indian Systems of Medicine esp.
  tribal medicines into the state health system

15
The Real CNAA
Item Estimated in CNAA Last Years Performance Surveyed
Target Couples 36,55,371 34,54,248
Protected 21,29,336 17,47,376
CPR 58.25 50.58
Need Assesment Need Assesment Need Assesment Need Assesment
CVT 4,849 2,629 5,852
NSVT 4,015 795 4,381
CTT 28,711 33,449 38,759
LTT 62,589 50,215 79,215
IUD 1,05,247 86,852 1,05,280
CC 3,64,107 3,50,104 2,78,646
OP 4,52,644 4,16,219 1,80,736
16
The New Plan of Action- Contraception

• Uneven distribution of LTT surgeon (reallocation
  needed)
• 63 trained but only 23 working
• No LTT surgeon in 2 districts
• 18 NSVT trained surgeons but only 5 are working -
  Need to train in large number
• Skill training in IUD needed for ANMs
• Training of ANMs needed in counselling skills
• Days of week fixed in each hospital for
  Contraceptive Services

17
Requirement of Equipment for Family Planning

• Laproscopes - 20 are irrepairable
• IUD Insertion instrument kit - 3841 (3818 rural,
  41 urban)
• NSVT instruments kit (146-18128)
• Contraceptives
• 23,49,568 OP Cycles
• 2,11,77,096 CC pieces

18
The New Plan of Action- Mother and Child Health

• Microplanning of immunization and ANC sessions
• Plan to improve outreach
• Intersectoral coordination
• Better Logistics including cold chain
• Out of 146 blocks 66 do not have a vehicle
• Community Midwifery
• Improvement in FRUs

19
Requirement of Cold Chain Equipment

• Walk in Freezer - 1
• Walk in Cooler in Bilaspur and Raipur need
  Replacement
• Cold Chain Equipment beyond repair
• ILR, Deep Freezer 140 L - 78
• ILR, Deep Freezer 300 L -88
• Vaccine Vans - 6
• Refrigerated Vaccine Van - 1
• Vaccine Carriers -1000

20
The " Indira Swasthya Mitanin" Scheme

• This is an innovative scheme in which the village
  people will select a Community Health Volunteer
  called "Mitanin" to help them in developing a
  "Village Health Plan" and for "Community Action
  in Health"
• "Mitanin" in Chhattisgarhi means a Female Friend

21
Basics of the Mitanin Scheme

• Empowerment
• Participation
• Sharing
• Caring
• Gender Equity
• Self Sufficiency

22
Selection

• Selection by the Community
• Help by trained Facilitators
• Approval by Gram Sabha
• Training by Government

23
Who Can be a Mitanin

• A woman from the same habitation
• Preferably a married woman
• Acceptable to the Community
• Not necessarily educated

24
Role of Mitanin

• Health Education
• Leadership in Community Action for Health
• First Aid OTC Drugs
• Treatment of Minor Ailments
• Timely referral

25
Chief Minister on the "Mitanin" Scheme
26
Relationship with ANM

• Role of ANM
• Support to Mitanin
• Give refresher training every fortnight
• Visit the Mitanin often
• Give the Mitanin Legitimacy and Confidence
• Help her in referral

• Role of Mitanin
• Be a link between ANM and community
• Help in National Programmes
• Provide basic information

27
Relationship with PRIs

• Role of PRIs
• Facilitate approval of Selection by Gram Sabha
• Provide all inputs' support incl. irrigation of
  Mitanin Land
• Monitor activities of Mitanin
• Send Mitanin for training
• Ensure supplies of essential medicines
• Seek help from Mitanin for other social sector
  programmes

• Role of Mitanin
• PRIs may seek information about health status of
  people
• Help PRIs in developing a Health Plan
• Bridge between Gram Panchayat and the community
• Help PRIs in other Social Sector Programmes

28
Training Method

• Participative, Gradual, Repetitive, Fun filled,
  Practical with field experience, at the pace of
  learning of Mitanins
• Initiation training Mainly on attitudes,
  behavior, communication, working in groups,
  community participation, concepts in Public
  Health
• Refresher training mainly for knowledge and
  skills of diagnosis and treatment of common
  ailments
• Responsibilities will be increased gradually with
  On the Job Training

29
Achievement so far

• A group of NGOs and GOs Constituted as a State
  Advisory Committee
• Work already started in 16 blocks
• More than 2000 Mitanins already selected
• Facilitators manual and the first two Mitanin
  Training manuals ready
• Training of Mitanins to begin soon

30
Requirements under Existing RCH Programme

• Training of at least 20 more surgeons in NSVT
• Training of ANMs in counselling skills, and IUD
  insertion
• Large Scale TBA training
• IUD insertion kits for ANMs
• Equipping of FRUs with blood storage and
  emergency obstetric surgery facilities

31
The proposal for EAG funds

• Improvement of Training Infrastructure
• Mobile Hospitals - to improve Outreach
• Telemedicine - at Pendra
• Community Midwifery Course
• Training of Doctors in Anesthesia and money for
  their insurance coverage

32
Gaps in Training Infrastructure

• Only 5 out of 16 Districts have DTCs
• No SIHFW
• RHFWTC Bilaspur not well equipped
• 5 AMNTCs, 3 MPW(M)TCs, 4 GNTCs - all buildings
  need repairs
• All Centers need Training equipment
• Capacity building of training faculty needed

33
Requirement of funds for Training Infrastructure
34
Mobile Hospitals

• Initially 3 mobile hospitals proposed
• Each mobile hospital will be fully equipped and
  cost approximately 30 lakh
• Public - Pvt -NGO partnership
• Provided by Govt., managed by Pvt/NGO
• Pvt/NGO to provide for recurring expen.
• Govt. to give Medicines under National
  Programmes, and for BPL
• Run on Predefined routes in Hat-Bazars

35
Telemedicine

• To begin with Link Medical College Raipur with
  Pendra
• Video-conferencing link through VSAT
• Total Cost 40 lakh
• Provide good secondary level care at remote
  locations

36
Community Midwifery Course

• The "Paramedical Council Act" already passed
• Affiliation and examination by Chhattisgarh
  Paramedical Council
• Course design workshop - cost Rs 1 lakh
• Equipping all ANMTCs - Rs 30 lakh
• Stipend to 50 reserved category students - Rs
  5.40 lakh

37
Aneshthesia Training of Doctors

• Course design workshop - Rs 1 lakh
• Equipping Medical College Raipur for Training -
  Rs 15 lakh
• Cost of training of 40 doctors for 3 months -
  6.20 lakh
• Cost of Insurance of Anesthesia trained MBBS
  doctors - Rs 10 lakh

38
The Proposal for EAG funds
S.No. Scheme Cost
1 Improvement in Training Infrastructure 59900000
2 Mobile Hospitals 9000000
3 Telemedicine 4000000
4 Community Midwifery 3640000
5 Anesthesia Training 3220000
Total 79760000