RTI / STI under NRHM (sub-district health facilities) STIs/RTIs ...

RTI / STI under NRHM(sub-district health facilities)STIs/RTIs present a huge burden of disease and these adversely affect thereproductive health of people. As per STI prevalence study (2003) over 6% ofadult population in the country suffers from STI/RTIs. These cause suffering forboth men and women but their consequences are far more widespread amongwomen than among men. These infections often go undiagnosed and untreated,and when left untreated, they lead to complications such as infertility, ectopicpregnancy and cervical cancer. Pelvic inflammatory diseases (PID) arising fromSTI/ RTIs poses a major public health problem and adversely affects thereproductive health of poor and untreated women. It also compromises withcontraceptive adhesion. In fact STI/ RTI rank second as the cause of healthy lifelost among women of reproductive age group, after maternal morbidity andmortality.For providing STI/ RTI services syndromic case management (SCM) isthe corner stone of STI/ RTI management, which is also approved by WHO.This approach classifies STI/ RTI into syndrome (easily identifiable group ofsymptoms and signs) and provides treatment for the most common organismscausing the syndrome. Implementation of standardized SCM simplifies training,supervision, reporting and drug management.The technical strategy reflected in the RCH programme (PIP) aim tocreate primary health care delivery system to improve the health of women andchildren’s Government of India guidelines for 24 hrs. RCH services by PHCs,list services of for prevention of STI/ RTI as a major package.

Implementation of STI/ RTI programmeNACO is implementing at district level and at sub-district level it isimplemented by NRHM by utilizing existing health care infrastructure. UnderNRHM, district RCH officer is responsible for implementation of programme inthe district.The programme is being implemented at all sub-district health facilitiesi.e. Sub-divisional Hospital, CHCs, PHCs, Block PHCs and Rural Hospital bysupplying colour coded STI/ RTI drug kits and test kits and fulfill minimumstandards of STI/ RTI service delivery.NRHM FacilitiesS.No. District Satellite SDH CHC PHC RH(PHC) TotalHospitals(PHC)1 Amritsar 5 2 4 31 2 392 Barnala 0 4 8 3 153 Bathinda 2 9 17 3 314 Faridkot 1 4 8 0 135 Fatehgarh1 4 13 1 19Sahib6 Ferozepur 3 8 31 3 457 Gurdaspur 2 15 38 2 578 Hoshiarpur 3 10 29 3 459 Jalandhar 2 10 26 3 4110 Kapurthala 2 4 10 3 1911 Ludhiana 4 9 28 5 4612 Mansa 1 4 12 2 1913 Moga 0 5 20 2 2714 Mohali 1 3 13 0 1715 Muktsar 2 5 14 3 2416 NawanShahar 1 3 15 2 2117 Patiala 3 11 29 0 4318 Ropar 1 2 12 2 1719 Sangrur 4 6 27 4 4120 Tarn Taran 1 9 20 2 325 36 129 396 45 611

Physical Achievement of NRHM:Out of a target of 174790 the achievement up to December 2011 was 58753(44.8%). The achievement was less due to non-reporting/ nil reporting by someof the facilities.StatePUNJAB TotalPHYSICAL TARGETS FOR STI/RTI (NACO, NRHM, PVT SECTOR) 2012-13Projected Adult STI/RTIPopulatio Populatio Episodesn 2011 n(50%) (6%)TotalAnnualSTI/RTItargets forgov. healthfacilities(35% ofAnnualestimatedSTI/RTIepisodes inthe State)NACOTargetforDesignated STI/RTIclinics (28% ofthe totalAnnualSTI/RTItargets forgov.healthfacilities )NRHMTargets52% ofthe totalAnnualSTI/RTItargets)PrivateSectorTargets19% of thetotalAnnualSTI/RTItargets)27175000 13587500 815250 285338 79895 148376 54214NRHM backwarddistricts in RTI/ NACP highNACP- Proposed New High prevalence DisrictsSTIprev. dist.Muktsar Ldh MogaNawanshahr Bhathinda PatialaFaridkotJalandharNRHM Trainings:RupnagarMohali (Sahibzada Ajit Singh Nagar)Nawanshahr(Shahid Bhagat Singh Nagar)Tarn TaranAmritsarFerozpurFaridkotGurudaspurHoshiarpurJalandharThe TOT for training of NRHM staff (MOs/ SNs/ LTs) has been done byPSACS and following staff were trained in 2011-12.Year Medical Officer Staff Nurse Para Medical Staff2011-12 upto January 289 479 635

List of Trained Staff in TOT 2011-12Name of theDistrictGMC, PatialaMKH, PatialaCH, SangrurCH, FatehgarhSahibCH, RoopnagarCH,NawanshaharCH, LudhianaCH, MohaliGGSMC,FaridkotCH, FaridkotCH, MogaCH, MuktsarCH, BathindaCH, BarnalaCH, FerozepurCH, MansaGMC, AmritsarCH, AmritsarName of Doctors with Phone NumbersDept. of Skin Dept. of Gynae Dept. of Pathology RCH OfficerDr. R.K. Bahl98784-19693Dr. Rama Garg94632-07688Dr. M.S. Dhaliwal Dr. Neena Gupta98140-8183098141-29357Dr. Shivali Aggarwal94643-59359Dr. Anju Singla Dr. Sumandeep94174-4915498761-78390Dr. Ritu Banga Dr. Bhupinder Kaur98728-9644894635-43726Dr. Manjeet Kaur Dr. Harpreet Kaur98148-0150394174-45398Dr. H.S. GillDr. Kulwinder Kaur98155-0407798152-46911Dr. GeetaDr. Anantjit Kaur94170-0608098150-66733Dr. Alka Mittal98551-00261Dr. IqbalDr. Tamana98145-3686398149-70505-- Dr. Parveen99883-83140Dr. Murari LalDr. Alka Goyal98143-5663398155-78218Dr. Jagroop Singh Dr. Neelu Koura98724-2695094172-78732Dr. Satish Kumar Dr. Kavita Gawri98142-1561480549-23004Dr. L.R. JainDr. Dheera Gupta98551-6443098550-57998Dr. Monica GuptaDr. Tapinderjot98149-31161Dr. Neerja Puri98146-16427Dr. Naresh Bansal94171-15210Dr. Ravi Saini94172-78811Dr. R.K. Gupta94170-1039494173-44644Dr. Jasbir SinghAulakh98723-78855Dr. Shweta98722-21312Dr. Ritu Mittal98728-14381Dr. Asha Kiran94176-82173Dr. Surinder98140-65527Dr. R.S. Butter95018-33665-- --Dr.Kajal Dhingra,93569-30460Dr. Inderjit Singla98882-69466Dr. Goldy Chhabra94634-48383Dr. Ravinder Pal Kaur,98146-85405Dr. Davinder Kataria96464-85400Dr. Bindu Nalwa98557-21034Dr. Madhurima Chawla98159-04424Dr. Kuldeep Singh98144-98680Dr. Nirwair Singh98140-38889Dr. Baljit Singh81464-62300--Dr. Sanjeev KumarHans, 99880-01056Dr. K.S. Sandha98765-02380Dr. S.P. Surila94171-77883Dr. Neeraj Jindal --94176-91818Dr. Ramesh Kumar Dr. Jagraj Singh98882-5005098143-22718Dr. Ritu JainDr. Anupam Bansal94640-9468298158-99963-- Dr. Sandeep Kumar98154-37032Dr. MrinaliniDr. Ashok Monga, MO98729-68884CHC Bhucho mandi,94634-64041Dr. Harjinder Kaur93572-52094Dr. Bhalinder Singh Gill88720-93355Dr Sushma Thakur, Dr. Reenu Singla99140-1268199142-60210-- Dr. Harbhajan Singh94174-37211--Dr. Arun Sharma98761-46538Dr. Satish Dugal

CH, GurdaspurCH, HoshiarpurCH, KapurthalaCH, JalandharCH, Tarn TaranDr. Rana Verma94170-32688Dr. Sham Sunder94171-24488Dr. Princejit Singh98762-95191Dr. Anoop Kumar98144-30158Dr. Brenna98154-21898Dr. Ravinder Kaur98155-54427Dr. Tejinder KaurTung, Batala98143-34330Dr. Bhupinder JeetKaur81461-1556Dr. Rajinder Raj95018-35572Dr. Ritu Narad81460-43400Dr. Simmi Dhawan98159-86369Dr. Varinder98725-12260Dr. Balwinder Kaur98727-43370Dr. Jaspreet Singh,95010-20750Dr. Seema Garg98155-51674Dr. Prem Kumar98151-85898Dr. Davinder Virdi98154-21898Dr. Damini95010-44661Dr. Jagjiwan Lal98140-37798Dr. Chuni Lal98720-44737Dr. Chaman Lal Sharma98143-19206Dr. S.S. Cheema98728-61472Dr. Tarsem94632-84321Dr. Maninder Minhar96460-65158Dr. Surjit Singh Chhina88720-94726STI/ RTI Drugs: These were received in all the districts except for Barnala,Bathinda & Moga and were distributed to the sub-district level health facilities.District Ropar has received it in 2009 but not in 2010-11. Till now the drug kitswere being supplied directly by NACO but in this FY 2012-13 NRHM willprocure and supply the drugs & kits and the budget has been proposed in thePIP as per guidelines of NACO.Coordination Meeting with PSACS:During 2011-12 convergence meeting were held with focal persons STI PSACSevery month regarding reporting, training and colour coded kits supply etc.Budget in PIP:Allocation of fund for STI/RTI services in the PIP 2011-12:ActivitiesFund allocated in thePIP (in Lacs)Expenditure tilldate (in Lacs)Training of Doctors, Nurse and Laboratory Technician(Training cost, printing of module, stationary, venueetc)4747200 1622391

Fund Proposed for the STI/RTI services in 2012-13.Activities Fund proposed in the PIP (in Lacs) for 2012-13Training of Doctors, Nurse and LaboratoryTechnician (Training cost, printing of module,stationary, venue etc)Monitoring and supervision of the facilitiesUpgrading of infrastructure of the facilities (audiovisualprivacy, examination facilities, speculum,gloves etc)RPR test KitsColour coded STI/RTI drug kitsIEC/BCC44.5712.83 L130.15 L5:4 L22.85 L7.41 LTotal Budget in PIP 218.04Detailed break up of fund proposed in 2012-13Schedulesof Approximate Price (Per No. requiredcostprocurement (Kit No.) Kit) (Rs.)I (Kit-1) 22 18162 399564II (Kit-2) 848074 384592III (Kit-4) 36 2137 76932IV (Kit-5) 26 5342 138892V (Kit-6) 42 21367 897414VI (Kit-7) 42 1069 44898VII (Kit-3)-Inj. Benz16Penicillin10684 170944VIII (Kit-3) – Tab Azithro 1210684 128208IX(Kit-3)-Dispo Syringe4& Needle10684 42736TOTAL COST 2284180RPR TESTING KIT REQUIREMENT FOR NRHM 2012-13State NameNRHMSTItargetCoverage50%AnnualEstimated noofpregnanciesCoverage50%Totalcoverageof RPRtestingRPR TestKits (50Test perKit with10%wastage)TotalRPR KitsRequired(with20%buffer)PUNJAB 148376 74188 527000 263500 337688 7504 9005Approx cost/kit in Rs. Total cost in Rs.No of RPR kits9005 60 540300

Subject: STI/RTI Service Delivery.S.NOActivity Details of Activities Remarks Comments Funds tobebudgetedin PIP2012-13(Rs. Inlakh)1 Training Detailed activities to be put44.572 InfrastructureStrengtheningup by training wingEach of the Health Facilitiesto have audiovisualprivacy(partition), facilityforexamination(ExaminationTable, flexi lamp etc),instruments(speculum, proctoscope) andinfection mechanism.Infrastructuremoney shouldbe beedbased. EachHealthFacility to beassessed forinfrastructureandaccordinglyexisting gapmay be filledthrough PIP.Audio- Video privacy: aseparateenclosure/cabin/Partitionwith wash Basin, cabin fanetc. to be provided in theSTI/RTI clinic room forexamination andadvice/councelling etc. atan average estimated costof Rs. 12000/- per facilityfor total 611 facilities:SDHs: 36CHCs:129PHCs:446 Examination table& flexi lamp:Estimated cost Rs.6000per facility. Instruments: (ataverage estimatedcost of Rs. 2000per facility) ProctoscopeRs.1000 per piece Cuscus VaginalSpeculum@Rs. 250 perpiece8 per SDH for 36SDHs6 per CHC for 129CHCs3Per PHC for 446PHCs Infection Controlmechanism:Hypochloritesolution 5litre jar@Rs. 200 per jar5 jar/SDH/Year3 jar/CHC/Year2 Jar/PHC/YearMedical Waste DisposalBins@ Rs. 200 per BinFour differently colouredbins per PHC for 446PHCs.73.3236.6612.224.383.57

Total FundsPRPOSED3 Mentoring andsupportiveSupervisionEach of the Health CareFacility in the district to bementored by the STI mentorsonce in every six month.RCH Officer from the districtand RCH officer from state tomonitor at least 25% ofHealth Facilities every sixmonth.TA, DA forthe STImentors,district &state RCH/MH Officerto be put inPIP.For Mentoring:Four district level STI/RTItrainers will function asDistrict Mentors. 2 Institution to becovered per visit Average 30 visitsper yearTA/DA for Mentors: HonorariumRs, 500 pervisit +POLaverage Rs.500 per visit(Govt.Vehicle@ Rs.Per 6 km) TA/DA forSupportiveSupervision District level: ByDistrict NodalOfficer STI/RTI130.156.003.00 2 Institution to becovered per visit Average 15 visitper year Per Visit:Honorarium Rs.500+ POL Rs. 500(average)3.83State Level: ByState NodelOfficer STI/RTI +Any other officernominated2 Institution to becovered per visit153 Visits peryearPer Visit:HonorariumRs. 500 + POLRs. 2000(Average)Total FundsPRPOSED12.83

S.NOActivity Details of Activities Remarks Comments Funds tobebudgetedin PIP2011-12(per inlakh)4 IEC and jobAIDSLeaflets, posters and othereducation material to bebudgeted for the patients. JobAIDS like syndromic wallposters, anaphylaxis chart,STI counseling flip book,infection control chart etc.Funds forprinting ofIEC materialand job aidsto be put inPIP.Leaflets for Patients: 2.50lakh leaflets @Rs. 0.60paisa eachPosters for public (2types):(15000posters)Size 18”*24” @ Rs. 5.00each 50 posters per DHfor 21 DHs 30 posters perSDH for 36 SDHs 30 posters perCHC for 129CHCs 20 posters perPHC for 446PHCsSyndromic Wall Posters:(1200 posters)Size 18”*24” @ Rs.5.00Each)3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446 PHCsInfection Control Chart:(1200 posters)Size 18”*24” @ Rs. 5.00each3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446 PHCsMedical Waste DisposalChart:(1200 posters)Size 18”*24” @ Rs. 5.00each3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446 PHCs1.300.750.060.060.06

Anaphylaxis Chart:(1200 posters)Size 18”*24” @ Rs. 5.00each3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446 PHCsOath of ConfidentialityChart:(1200 Chart)Size 18”*24” @ Rs. 5.00each3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446Counceling Checklistchart:(1200 Chart)Size 18”*24” @ Rs. 5.00each3 posters perDH/SDH/CHCfor total 186institutions1 poster per PHCfor 446Condom DemonstrationChart:(4000 charts)Size 18”*24” @Rs.5.00each3 charts perDH/SDH/CHCfor total 186institutions1 chart per PHCfor 446 PHCs1 chart per SC for2950 SCs0.060.060.060.20Penis Model for condomDemonstration:4000 models @ Rs. 30.00each.3 models perDH/SDH/CHCfor total 186institutions1 model perPHCfor 446 PHCs1 model per SCfor 2950 SCs1.20Counseling Flip Books. 1.80

TotalFundsPRPOSED(1200 Flip Book)Size 12”*8”@ Rs.150each 3 flip books perDH/SDH/CHCfor total 186institutions. 1 flip Book perPHC for 446PHCs.Sign Board:(1200 Sign Boards)Size 18”*24” @ Rs. 150each3 Sign Board perDH/SDH/CHCfor total 186institutions1 Sign Board perPHC for 446PHCs.1.807.41