Final pip 2008-09 - RRC-NE

corrective actions will be taken wherever needed. Reporting Formats aredeveloped for various activities which will be used for proper reporting andevaluating the performance. In NRHM/RCH Work Plan, different goals are setup for various activities specifying the time needed for achieving them. Thisalso will help in assessing the situation and back-log of activitiesFor ensuring service delivery from health facilities locally resident healthworkers are being appointed on contractual basis wherever needed. HumanResource Development is also taken up as a major activity for ensuringquality of service. Multi-skilling trainings are being taken up in the State fordifferent categories of Health Providers. The non-availability of Traininginstitutions is causing a major concern in carrying out the multi-skillingexercise. 34 AYUSH Doctors are in position in 14 CHCs and 20 PHCs. Thishas helped in providing the round the clock service in these institutions.1.2.5 Management structure1.2.5.1 At state levelSecretary Health & FamilyWelfareState Mission DirectorState ProgramManager (SPMU)Addl. Mission Director(I) / Dir. HealthAddl. Mission Director(II) / Dir. FWAddl. Dir. PlanningState DataManager (SPMU)State FinanceManager (SPMU)State AccountManager (SPMU)Addl. Dir. (HRD)Addl. Dir. (IDSP)State AYUSHOfficerState SchoolHealth OfficerAddl. Dir. (InfraStructure)Addl. Dir.(BCC/Gender)Addl. Dir. (FamilyPlanning)Addl. Dir.(Finance)Addl. Dir. (Proc. &Logistics)State NodalOfficer (M&E)State NationalProgram OfficersJoint Dir.(Maternal Health)Joint Dir. (ChildHealth)Manipur State Integrated NRHM PIP 2008-2009 6

3. Background and current statusKey RCH Indicators Past Trends Current status% of institutional deliveries• Overall• SC/ST% of deliveries by SBA• Overall• SC/STMaternal HealthChild Health% of 13-24 months of age fullyimmunized• Overall• SC/ST34.5 (NFHS-2)20.1 (NFHS-2)53.9 (NFHS-2)36.1 (NFHS-2)49.6 (NFHS-3)NA61.7 (NFHS-3)NA42.3 (NFHS-2)29.6 (NFHS-2)46.8 (NFHS-3)NA% of children with Diarrhoea treated 50.7 (NFHS-2) 36.8 (NFHS-3)with ORS% of children with pneumonia taken NA49.1 (NFHS-3)to health facilityFamily PlanningUnmet need for spacing methods• Overall13.6 (NFHS-2) 25.6 (DLHS-2)• SC/ST14.6 (NFHS-2)NAUnmet need for terminal methods 10 (NFHS-2) 15.3 (DLHS-2)Contraceptive prevalence rate 38.7 (NFHS-2) 48.7 (NFHS-3)Regarding Maternal Health the proportion of institutional delivery and delivery bySBA are 49.6% and 61.7% respectively.To improve institutional delivery the strategy of up-gradation of PHCs to 24/7 servicecentres along with SBA training and JSY scheme are adopted in the State.Out of 20 PHCs planned to be up-graded to 24/7 Service Centres, although civilworks are completed by 90%, only 15 PHCs have really started working as 24/7 Centres.The required number of additional GNMs has been filled up in these centres. One AYUSHDoctors are in placed in all these upgrading health facilities. To make 50% of the existingPHCs to make functional to 24x7, 18 more PHCs may be upgraded.To operationalize 24/7 PHCs and Subcentres, Skilled Birth Attendance (SBA) trainingis contemplated. State has started training of 36 ANMS for SBA in 2007-08, the training ofSBA for the remaining will continue in the coming year.Outsourcing referral vehicles for 14 CHCs and 20 PHCs to be upgraded to 24x7PHCs will continue for facilitation of early transportRegarding Child Health the current IMR is 13 per 1000 live births. The proportion ofexclusive breast-feeding for 4 months, fully immunized and anemic children are 61.7, 46.8and 52.8 respectively.IMNCI has not been implemented in all the districts. Trainings on IMNCI for the MOshave started in coordination with the Community Medicine Department of RIMS.Manipur State Integrated NRHM PIP 2008-2009 9

As drug-kits under RCH-II could not be procured in time, IFA, ORS and antibiotics forpneumonia could not be supplied to the districts.Regarding Family Planning the high unmet need according to NFHS-3 (5 forSpacing methods and 7.6 for Limiting methods) is mainly due to pressure groups opposingsterilization operations and lack of trained surgeons and lack of awareness for accessing theservices. The male Sterilization is 0.5% only and Female Sterilization is 8.1% (NFHS-3).Steps will be taken for increasing the limiting methods and spacing methods. Effort will bemade to meet the Unmet needs so as to achieve the target of population stabilization.Manipur State Integrated NRHM PIP 2008-2009 10

4. Situational analysis4.1 Public Health Facilities in the stateNumberHealth FacilityGovernmentTotalBuildingsRentedMedical College Hospital 1 1 0State Hospital 1 1 0District Hospital 7 7 0UFWC 2 2 0CHC 16 16 0PHC 72 70 2Subcentre 391 210 181Homeopathic Dispensary 6 6 0The State has started its construction of 100 Building less Sub- Centres in2007-08, out of which so far 40 could be completed. The remaining Sub-Centres areon the process of completion. More construction works of building-less Sub-Centresis proposed in 2008-09.4.2 Current status and target for Public health infrastructureNo.FacilityRequired(as per2001Census)SanctionedIn Position(as on31/12/07)Target in2008-09(Cumulative)1 Sub-centres 487 391 391 3911.1 Sub-centres functional 391 3912 Primary Health Centres 79 72 72 722.1 PHCs offering 24 hour services 15 203 Community HealthCentres21 16 16 163.1 CHCs functioning as FRUs 0 24 District Hospitals 9 7 7 74.1 DHs functioning as FRUs 1 7Currently up-gradation of Churachandpur and Bishnupur District Hospital isgoing on. Out of 7 DHs and 16 CHCs, only 1 DH is fully functioning as FRU. This isdue to the shortage of adequate manpower especially Gynecologists /anesthetists/pediatrician. Hiring of specialist from RIMS/Pvt. Hospital may be taken up by visitingthe DHs/ CHCs /PHCs once a week.Multi-skilling of MBBS Doctors in Life saving Anesthesia Skill and EmergencyObstetric Care training will be continue for the CHCs to be upgraded to FRUsAgain out of 20 PHCs planned to be up-graded to 24/7 Service Centres, allcivil works are completed by 90%, but the staff quarter are not adequate. All PHCsare filled up with GNMs.To operationalize 24/7 PHCs and Sub-Centres, Skilled Birth Attendance(SBA) training is contemplated. State has trained 36 ANMs for SBA in 2007-08,Manipur State Integrated NRHM PIP 2008-2009 11

another batch of 20 ANMs training on SBA is undergoing. More ANMs will be trainedin 2008-09.Outsourcing referral vehicles for 14 CHCs and 20 PHCs to be upgraded to24x7 PHCs will continue for facilitation of early transport.4.3 Private Health FacilitiesPrivate Services FacilitiesNumber and location.Multi-Specialty Nursing Homes 8 (1 Imphal east and 6 Imphal West and 1Senapati)Solo Qualified Practitioners19 (18 in valley districts; 01 in UkhrulDistrict))Practitioners from AYUSH 19 (13 Imphal east, 4 Imphal West, 2Ukhrul)Approved MTP centres in Private sector NilRMPs (Less than formal qualified practitioner) 2 (in Imphal West)Number of nursing homes with facilities for 8 (2 IW, 2IE, 1SNP. 2UKL.,1CCP)comprehensive emergency obstetric careAccredited centres for sterilization service NilAccredited centres for IUD services02 (CCP)05 Private Hospitals were accredited in 2007-08 for initiating Public PrivatePartnership (PPP) with these institutions. The districts have given the power toaccredit any hospitals/clinic so that the maternal and child care of the districts couldbe taken care of thus helping in achieving the NRHM goal.4.4 Human Resources in the stateStaff Sanctioned In-Position VacantChief Medical Officer 8 8 0State Health Program Officers 7 7 0District Health Program Officers 45 45 0Specialist Doctors 112 64 (1 Contravtual48AYUSH)Medical Officers 584 584 (73 Contractual0AYUSH, 48 MBBSDoctors)Lab technicians 110 110 (34 Contractual) 0X-ray technicians 26 26 (8 Contractual) 0Staff Nurse 238 218 (54 Contractual) 0LHV 72 72 0ANMs in Sub-centre 840 840 0Male MPWs 420 395 25Lack of 48 specialist doctors in the State resulting to non-availability of themin District Hospitals and CHCs has been filled up by recruiting MBBS Doctors. 01Gynaecologist has been trained in Surat for CEmOC. Training of MBBS Doctors inLife Saving Anesthesia Skill and Emergency Obstetric Care and also byconvergence with RIMS (rural posting of Senior Residents) and by Public PrivatePartnership in Districts having Private Clinics offering good quality care has started.As there is less number of facilities with FRUs status, CEmOC services can beprovided in only 01 District Hospital (DH Churachandpur).All the post for Additional ANMs and Staff Nurse are filled up.Manipur State Integrated NRHM PIP 2008-2009 12

Sl.No.Name ofdistrictNumber ofAWCsCDPOsandACDPOsSupervisors AWWs AWH7 Senapati 556 556 5 5 19 19 556 551 556 5518Churanchandpur537 537 6 6 5 5 537 537 537 5379 Tamenglong 298 298 4 4 10 10 298 298 286 286TOTAL 4501 4231 38 38 142 141 4501 4226 4501 4226ICDS is implemented in all the districts of the State. VHNDs are organized in theAWCs along with the ASHA, ANMs. The huge human resources available under thescheme are utilized in terms of giving awareness program to the community throughworkshop on immunization, institutional delivery, breast feeding and ante natal check up.4.9 Elected representatives to Panchayat institutions/ Village CouncilTotal Total ZP Total PanchayatSl. Name of theVillage Councilpanchayat Members PradhansNo. districtvillages Male Female Male Female Male Female1 Imphal East 56 1 - 39 17 NA NA2 Imphal West 44 1 - 29 15 NA NA3 Bishnupur 100 7 4 16 8 NA NA4 Thoubal 127 12 4 26 16 NA NA5 Ukhrul NA NA NA NA NA 239 06 Chandel NA NA NA NA NA 557 07 Senapati NA NA NA NA NA 512 08 Churanchandpur NA NA NA NA NA 607 09 Tamenglong NA NA NA NA NA 218 0TOTAL 327 21 8 130 46 2092 0PRI System is available only in the 04 Valley Districts. Yet the remaining 05 HillyDistricts have got similar administrative structure in the form of Village Councils. Both thePRIs and Village Councils may be tapped for NRHM implementation. Orientations of PRImembers/Village head man were conducted. Reorientation for initiating communitymonitoring may be taken up like performance based incentive to ANMs may be given basedon the attendance certificate provided by them. PRI will also help in proper monitoring on theobservation of VHNDs.4.10 NGOs & CBOsNames of MNGOs Key Activities Districts of operationsFamily Planning Association ofMCH Chandel, ChurachandpurIndia Manipur BranchLamding Cherapur UnaniAssociationMCH Thoubal , Imphal08 FNGOs under these two identified MNGOs are working in the above mentioned04 Districts for providing MCH activities. The process of identifying 03 more MNGOs @ 01MNGO per two Districts are finalized by the Regional Director (H&FW).4.11 District / sub-district variations:The services in the 05 hilly districts mainly inhabited by Tribal population need to begiven priority. Among them again Senapati District and Tamenglong District need to be giventop priority. Within the District again, Thanlon Block in Churachandpur District, KhengjoiBlock of Chandel District, Tamei Block in Tamenglong District and Mao-Maram Block inSenapati District needs to be given impetus. Taking into consideration, the poor performancethese districts, an award scheme is worked. The best performing district is awarded withManipur State Integrated NRHM PIP 2008-2009 15

certificate of honour and cash incentives. Performance is also discussed in the monthlyReview meeting chaired by the Chief Secretary, Govt. of Manipur. The possibility ofawarding best performing Blocks and individuals by the Districts is to be explored in 2008-09. Among the 04 valley districts special scheme for those inhabitants residing in LoktakLake of Manipur may give top priority in 2008-09 as the inhabitants having problem on toiletfacility and hygienic drinking water. Special scheme for this inhabitants are to be taken up in2008-09.4.12 Gender EquityThe Sex Ratio of the State is 978, but the under-6 sex ratio is declining (957)showing that selected abortion is taking place. Hence, PcPNDT Act needs to be enforcedmore strictly so that the figure does not go down.4.13 HMIS/ M&EA State HMIS Team is already identified with the State Data Manager as the NodalOfficer. Regular monthly meeting of the State and District Program management Unit is held.The meeting will be part of monitoring the report submitted by districts and analysis by givingproper feedback to the districts. Internet facility is so far available in the State Headquarters.Districts and Blocks will have it too as the required computer sets are available in the State,District and Block levels.4.14 Convergence/ coordinationSo far convergence/coordination with Department of Women and Child Development(WCD), Education, PRI and AYUSH has been established. Coordination with PHED andPWD needs to be strengthened. This component is taken care of during 2007-08 to 2009-10.4.15 Finance UtilizationUnder NRHM, in 2005-08 an amount of Rs. 61.59 crores was received, out of whichRs. 19.75 crores was utilized, giving a utilization rate of 32.06%.The poor utilization was mainly due to non-submission of UCs and SoEs fromDistricts and pending procurement of drug/medicine kits. With the establishment ofAccountant at each facility level, timely submission of SOEs will be taken care in the year tocome.In addition to the above allocation, the State allocated its share in the Health andFamily Welfare sector, which is as given below:2005-06 - Rs. 7986.82 lakhs (Plan-564.76; Non-plan- 6522.06)2006-07 - Rs. 9053.80 lakhs (Plan-3073.00; Non-plan-5980.58)2007-08 - Rs. 10455.71 lakhs (Plan-3700.00; Non-plan-6755.71)2008-09 - Rs. 12500 lakhsThe yearly increase in state budget outlay since 2005-06 is 27.75%, 15.49% and16% respectively.4.16 Institutional arrangements and organizational development: issues and gapsCurrently the implementation of NRHM Program in the State is supported jointly byDirectorate of Family Welfare Services and Health. Additional Director (Health) is the currentMission Director of NRHM. The Vertical Health programs are managed by another Director.Director (FW) is assisted by 02 Addl. Directors, 3 Joint Directors and 4 Deputy Directors.Manipur State Integrated NRHM PIP 2008-2009 16

Director (FW) is the State RCH Officer and so, activities under RCH are implementedthrough the existing infrastructure available in the State along with the SPMU and DPMUstaff. . The SPMU comprising of 1. State Program Manager 2. State Financial Consultant 3.State Data Manager and 4. State Accounts Manager is set up for providing efficientmanagement of RCH interventions during RCH Program. For effective programimplementation, State HRD Consultant and State BCC Consultant are appointed in contract.4.17 DP (donor assisted) programmes in the state:Under NLCPR assisted by DONER, there is a proposal for Construction of 05 new50-bedded District Hospitals at Ukhrul, Chandel, Senapati, Tamenglong Districts (all hillyDistricts) and at Jiribam Sub-Division of Imphal East District. In 2007-08, 02 DistrictHospitals not included in the above mentioned program for up - gradation to IPHS level havebeen started. There is also proposal for construction of Quarters in the hill districts with thefunding from SPA.Details is shown in table given belowSUPPORT GIVEN BY/TO THE STATE OTHER THAN PROVIDED FROM NRHMSl.No.NameA NLCPR1 Construction of 50 beddedDist. Hosp. Ukhrul2 Construction of 50 beddedDistrict HospitalTamenglong3 Construction of 50 beddedDistrict Hospital Chandel4 Construction of 50 beddedDistrict Hospital Senapati5 Construction of 50 beddedSub-District HospitalJiribam6 Equipment up-gradation ofDistrict Hospitals and5 CHCs7 Civil Works forUpgradation of JNH (DH-IE)8 Equipment Upgradation ofJNH9 Construction of 10 PHCsin the valley10 Construction of 10 BarrackType Quarters for the 10PHCs in Sl No.10ApprovedEstimatedCost(Rs. inLakhs)Year ofapprovalAmtsanctionedduring2007-08Cumulativeamountsanctionedtill(2007-08)1396.97 2006-07 440.04Amt likelyto besanctionedduring2008-09WorkAgencyDCEC-II1436.71 2006-07 452.57 DRDATML249.891315.77 2006-07 414.47 PDA1426.10 2006-07 449.22 MDS1564.26 2006-07 492.74 PDA826.70 2006-07 32.27 431.82 394.88 HealthDept.869.57 2006-07 273.90 273.90 273.90 TP Cell885.22 2006-07 278.85 278.85 278.85 HealthDept428.54874 2007-08 112.50 112.50 112.50492.21333 2007-08 129.50 129.50 129.50Manipur State Integrated NRHM PIP 2008-2009 17

Sl.No.NameApprovedEstimatedCost(Rs. inLakhs)Year ofapprovalAmtsanctionedduring2007-08Cumulativeamountsanctionedtill(2007-08)Amtlikely tobesanctioned during2008-09WorkAgency11 Construction of 32 PHSCs 743.5491 2007-08 165.00 165.00 165.00in the Hill Districts12 Construction of 18 PHCs 331.9648 2007-08 113.16 113.16 113.16in the valley DistrictsTOTAL A 11717.57591072.9 3753.77 1717.6871B NEC1 Support to J.N. Hospital,( Civil works forconstruction of OPD Blockand 100 bedded Ward)416.00 2004-05 40.29 415.29 1.71 TP Cell2 Support to DistrictHospital,Churachandpur3 Support to NursingSchool, Lamphelpat,Imphal Construction ofSchool and Hostel435.45 2004-05 100.00 250.00 185.45 TP Cell487.62 2004-05 105.00 350.00 137.62 TP CellTotal B 1339.07 1339.07 245.29 1015.29 324.78CDCPS(Urban DevMinistry)Construction of 100 2479.58 2004-05 1239.79 1239.79 NBCCbedded District Hospital atThoubalTotal C 2479.58 2004-05 1239.79 1239.79SPA1 Construction of StaffQuarters in the hilldistrcts(30 Barrack TypeQuarters,10 Type-IVquarters and 44 Type-IIIQuarters for PHC andCHCs )2 Construction of StaffQuarters in the HillDistricts(10 Barrack TypeQuarters,10 Type-IVquarters and 10 Type-IIIQuarters for PHC ,CHCsand DHQs )3 Equipment Upgradation ofJNHospital1800.72 2006-07 1800.72702.61 2007-08 702.61 702.61900.00 2007-08 900.00 900.00Manipur State Integrated NRHM PIP 2008-2009 18

Sl.No.NameApprovedEstimatedCost(Rs. inLakhs)Year ofapprovalAmtsanctionedduring2007-08Cumulativeamountsanctionedtill(2007-08)Amt likelyto besanctionedduring2008-09WorkAgency4 Construction of DH BPR 788.33 2008-09 200.005 Construction of TB and 350.00 2008-09 300.00Leprosy hospitalTotal D 4541.66 1602.61 3403.33 500.00Sub-Total (A+B+C+D) 20077.88592920.81 9412.18 3782.257E State Plan Outlay (Doesnot include matchingshare of the aboveSchemes)1 For infrastructureCHC,PHC and SubCentres.i) 2007-08 55.01ii) 2008-09 192.292 For District Hospitalsi) 2007-08 50.00ii) 2008-09 508.00Total E 105.01 700.29Grand Total3025.82 4482.54(A+B+C+D+E)Manipur State Integrated NRHM PIP 2008-2009 19

Successes:5. Progress and lessons learned: 2005-08NRHM was launched in NE States on 9 th Nov 2005. Actual implementation ofNRHM in the State could be undertaken only by 2006. As the Program was startedlate many activities could not be implemented as per the timeline given by the Govt.of India.NRHM implementation helped the State in decentralizing the programactivities. There is a close convergence with the PRI from the Sub-center levelinstitutions to the District-level institutions. This communization has helped in makingthe people work with the health providers. Rogi Kalyan Samitis (RKS) are functionalin all Health Institutions. Funds of RKS are utilized for development of the respectiveinstitutions and in managing crisis situation like shortage of medicine etc. There is anincrease in the number of institutional deliveries. This is due to the JSY Schemeunder NRHM. State could up-grade the infrastructure facilities of the HealthInstitutions in terms of building, manpower, consumables etc. The decentralization offinancial delegation has motivated people in the Districts.Constraints:Frequent turn-over of key persons during the last two years have sloweddown the progress of implementation of the whole NRHM including RCH-II Program.Health Ministers have been changed thrice, Health & FW Secretary twice and theState Mission Directors thrice during the Program period.Incomplete functional merger between the Health Department and FWDepartment also affected the program implementation resulting to duplicity in certainactivities. The inadequate convergence is evident in the District level also.Directors of Department of Health and Director of FW have been identified asAdditional Mission Directors, in the various Committees/ Sub-Groups for bettermanagement of NRHM activities. Even then the synergy will take place if both aremade to work under a single Director.The National Disease Control Programs and Integrated Disease SurveillanceProgram (IDSP) activities are not converged with NRHM resulting into poorperformance. The State Officials controlling the National Disease Control Programsand IDSP are directly submitting their requirements and activities to the concernedNational level offices.Inadequate infrastructure and non-availability of Specialist Doctors in theState of Manipur has been a major upset for the whole program. Even it is difficult toget Specialists from the Private Sector.There are certain villages which are frequented by militants resulting to poorcoverage of services. Some of the health institutions are occupied by the Militarypersons. The Health Providers are not in a position to perform their field activities insome of the border areas. Procurement process of commodities has become difficultdue to the reason that a share of the budget is to be given to the insurgents. Hence itis felt that for Manipur State drugs or other commodities should be supplied to theState in kind and not in cash. Civil works are also affected due the reason that themilitants are demanding for a share of fund sanctioned for the same.Manipur State Integrated NRHM PIP 2008-2009 20

The difficult geographical terrains, poor transport and communication facilities,scattered nature of inhabitations and Health Institutions have hindered the programbadly. Also frequent load-shedding of power, lack of safe drinking water has affectedthe program implementation.The key strategies which need to be addressed in the State are(i) Operationalizing Health Facilities by up-grading Infrastructure includingavailability of trained manpower(ii) Formulating a State Policy so that health care providers stay at theirrespective place of posting(iii) Capacity development• Multi-skilling training of MBBS Doctors (CEmOC, Life SavingAnesthesia, MVA, NSV, Tubectomy)• SBA Training of LHV, GNM, ANM• Other trainings (Capacity Development for Program Managers, IMNCI,ARSH, Blood Storage, BCC)• Hiring Consultants (BCC,M&E, HMIS, Trainings)(iv) Public Private Partnership in places where the Public Health Infrastructureis weak(v) Increasing awareness of the Health Facilities available to the people andmotivating them to utilize the service provisions through effective BCC.(vi) Strengthening Management Capacity by establishing ProgramManagement Unit at state, district and block level.(vii) Decentralized planning and implementation of activities through RogiKalyan Samitis and Village Health and Sanitation Committees and(vii) Intra/Intersectoral convergence with Health determinant DepartmentsManipur State Integrated NRHM PIP 2008-2009 21

Manipur State Integrated NRHM PIP 2008-2009 22

6. Current status and goals of RCH-II by 2010STATEINDIARCH IIGOAL Current statusTargetTargetCurrent status08-09 09-10 09-10MMR 374 (SRS 2001) 200

56712345Outcome IndicatorsCurrent Status% of children 6-35 months of age who are anemicTargets08 – 09 09–10Overall 52.8 (NFHS-3) 30 20SC/ST NA 35 25% of children under 5 years age who have received all nine doses of Vitamin AOverall NA 30 50SC/ST NA 20 40% of children under 3 years age with diarrhea in the last 2 weeks who receivedORSOverall 36.8 (NFHS-3) 65 80SC/ST NA 60 70% of children under 3 years age who are underweightOverall 23.8 (NFHS-3) 15 10SC/ST NA 20 15C. Family PlanningContraceptive prevalence rate (any modern method)Overall 48.7 (NFHS-3) 60 75SC/ST NA 55 58Contraceptive prevalence rate (limiting methods)Male Sterilization 0.5 (NFHS-3) 1.5 2.0Female Sterilization 8.1 15 17Contraceptive prevalence rate (spacing methods)Oral Pills 5.4 (NFHS-3) 20 22IUDs 5.3 (NFHS-3) 15 20Condoms 4.2 10 15Unmet need for spacing methods among eligible couplesOverall 25.6 (DLHS-2) 15

S/No678912341234CurrentIndicatorsStatusNo. of health facilities providing MTP services2008-09 20091q 2q 3q 4q -10a. DHs (Cumulative) 7 7 7 7 7 7b. SDHs (Cumulative) 0 0 1 1 1 1c. CHCs (Cumulative) 14 14 14 14 16 16d. PHCs (Cumulative) 35 35 35 35 40 70No. of districts whereReferral Transport servicesare functional (Cumulative)No. of planned RCHoutreach campsNo. of planned MonthlyVillage Health and NutritionDays heldB. Child HealthNo. of districts where IMNCIlogistics are suppliedregularly (Cumulative)No. of health facilities withat least one provider trainedin Facility Based NewbornCareProportion of outreachsession where AD syringeuse and safe disposal arefollowedNo. of districts and schoolswhere School HealthProgram is implementedC. Family PlanningNo. of health facilitiesprovidingFemaleSterilization services9 9 9 9 9 936 27 27 27 27 1082452 1000 1000 1500Manipur State Integrated NRHM PIP 2008-2009 25150045000 0 4 4 6 90 02 (9)7 DH,14CHC100%7 DH,14CHC7DH,14CHC, 10PHC7DH,14CHC,36PHCTo be expanded to other districtsafter appraisala. DHs (Cumulative) 4 4 7 7 7 7b. CHCs (Cumulative) 0 0 10 14 14 14No. of health facilities providing Male Sterilization servicesa. DHs (Cumulative) 7 7 7 7 7 7b. CHCs (Cumulative) 6 6 6 8 10 14c. PHCs (Cumulative) 25 25 25 30 40 50No. of health facilities providing IUD insertion servicesa. CHCs (Cumulative) 16 16 16 16 16 16b. PHCs (Cumulative) 72 72 72 72 72 72c. Sub Centres (Cumulative) 106 106 150 175 200 390No. of accredited private institutions providing:a. Female sterilizationservices (Cumulative)b. Male sterilization services(Cumulative)c. IUD insertion services(Cumulative)5 No. of districts with QualityAssurance Committees5 Subject to availability of interestedPrivate Partners5 Subject to availability of interestedPrivate Partners5 Subject to availability of interestedPrivate Partners4 0 9 9 9 9

(QACs) (Cumulative)S/NoIndicators6 No. of district QACs havingquarterly meetings(Cumulative)7 No. of planned Male &Female Sterilization campsD. Adolescent & Reproductive Sexual Health1 % of ANC registrations infirst trimester of pregnancyfor women < 19 years ofageCurrent2008-09 2009Status 1q 2q 3q 4q -104 4 9 9 9 90 0 2 2 2 12NA (Preg

S/NoIndicatorsH. Human resources1 % of Sub-Centres havingAddl. ANMs (Cumulative)2 No. of specialist positionsfilled at CHCs (againstrequired) (Cumulative)3 State Consultants (HMIS, M& E, Training/HRD, BCC(Cumulative)I. Monitoring & evaluation1 No. of districts reporting onthe new MIES format ontimeJ. Logistics1 No. of districts havingadequate stock ofa. Measles vaccineb. OCPc. EC Pillsd. Surgical GlovesK. Program Management1 % of state and districtshaving full time Programmanagers for RCH withfinancial & administrativepowers delegated2 % of sampled state anddistrict program managerswhose performance wasreviewed during the past 6months3 No. of district action plansready4 No. of sampled districts thatare implementing M&Etriangulation involvingcommunityCurrentStatus2008-09 20091q 2q 3q 4q -10100 100 100 100 100 1000 According to availability orPPP/hiring from RIMS )3 3 3 3 3 39 (9) 9 9 9 9 99 (9)9 (9)0 (9)6 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)9 (9)100 100 100 100 100 100100 - - - 100 1000 - - - 9 9Nil - - 2 4 75 SPMU staff 4 (100%) 4 4 4 4 46 No. of DPMU staff in place 27 (100%) 27 27 27 27 27L. Finance Management1 % of districts reportingquarterlyfinancialperformance in timeM. Trainings1 No. of Medical Officers trained (Cumulative)100 100 100 100 100 100a. Blood storage 0 0 8 8 16 32b. MVA 0 0 20 20 40 80Manipur State Integrated NRHM PIP 2008-2009 27

Current2008-09 2009S/No IndicatorsStatus 1q 2q 3q 4q -101 c. EmOC 0 0 2 2 4 10d. RTI/STI 24 24 49 49 74 98e. IMEP 0 0 25 25 50 98f. Minilap 25 35 455575 98g. IMNCI 0 20 40 60 100 100h. NSV 25 29 33 37 41 98i. Anesthesia 2 0 4 6 6 122 No. of Staff trained in SBAa. ANM 36 126 216 306 396 8003 No. of ASHAs trained inHome Based NewbornCare4 No. Of Lab Tech trainedon Blood storage(Cumulative)9 No. of health personnelwho have undergoneContraceptive Update/ISDTraining10 School Health for SchoolTeachers0 0 250 250 500 10000 0 8 16 16 2430 30 30 40 100 2000 30 60 90 120 5006.2 Technical Activities6.2.1 Maternal HealthObjective: To improve Maternal Health by increasing Safe Delivery to 80% byend of 2010.STRATEGY 16.2.1.1 Operationalising health facilities6.2.1.1.1 Operationalising District Hospitals and Community HealthCentres as First Referral Units (FRUs)Activity (i)Activity (ii)Up-gradation of basic infrastructure in 14 identified CHC and all 07 DistrictHospitals by 2010 in phases. By end of 2008-09 at least 4 CHCs (Wangoi,Sagolmang, Kakching & Moirang) and all existing 07 District Hospitals (DH isalready functioning as FRU) are to be made functional as FRUs.Fund for civil work up-gradation for the 02 DHs and the CHCs are alreadyavailable under Part “B” of NRHM and work is in progress. Hence, noadditional fund is needed for 2008-09.Filling up gaps in manpower: Manpower gaps for the 14 identified CHCs arealready filled up by hiring contractual staffs except for Specialist Doctors. Tosolve the problem of unavailability of Specialist Doctors, two interventions aretaken up. One is training of MBBS Doctors on “Life Saving Anesthesia Skills”and “Comprehensive Emergency Obstetric Care” is contemplated. This isdiscussed under the heading of “Training. The other is “Public PrivatePartnership” under which Specialists from Private Hospitals/ Clinics and RIMSare to be paid honorarium for attending the FRUs on fixed days. This isdiscussed under Part “B” of NRHM.Manipur State Integrated NRHM PIP 2008-2009 28

Specialist Doctors: As specialist Doctors were not available the vacantposts of 48 Specialist Doctors were filled by hiring MBBS Doctors oncontractual basis in last year by giving an honorarium of Rs. 15,000/- permonth. The budget requirement for 2008-09 for supporting these Doctors willbe Rs. 86.40 Lakhs.The District-wise allocation of this budget (Rs. in lakhs) will be:IE IW TBL BPR UKL TML CDL SPT CCP TotalNo. ofdoctors8 6 8 5 4 4 0 8 5 48Budget 14.40 10.80 14.40 9.00 7.20 7.20 0 14.40 9.00 86.40This year re-advertisement for specialist doctors will be made again offeringan honorarium of Rs. 25,000/- per month. The same monthly honorarium maybe made applicable to Senior Residents (PG Holders) of RIMS if they arewilling to be posted in the CHCs. Also an effort will be made with PrivateClinics/ Hospitals having specialist Doctors so that they may be madeavailable in the CHCs. If available, they will be paid an honorarium for thedays they are present at the CHCs (having vacant posts of specialist) which isbased on the monthly honorarium of Rs. 25,000/-14 Public Health Nurses were engaged on contractual basis in the 14 CHCsby giving an honorarium of Rs. 7000/- per month. Their services will becontinued in 2008-09 by giving the same honorarium. The budget needed forsupporting these 14 PHNs will be Rs. 11.76 Lakhs. The District-wiseallocation is as shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofPHNs2 2 3 2 1 1 2 0 1 14Budget 1.68 1.68 2.52 1.68 0.84 0.84 1.68 0 0.84 11.7654 Staff Nurses were already recruited on contractual basis to meet the normof 7-9 Staff Nurses in 2006-07 in CHCs. Their services will be continued inthis year, The total budgetary support needed to meet the honorarium ofthese 46 Staff Nurses @ Rs. 6000/- per month will be Rs. 38.88 lakhs. TheDistrict-wise allocation is as shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofGNMs7 10 11 8 4 5 4 0 5 14Budget 5.04 7.20 7.92 5.76 2.88 3.60 2.88 0 3.60 38.8814 ANMs were placed in the 14 CHCs so that they can monitor and supervisethe ASHAs working in their jurisdiction. As this has not yielded the desiredresults, this scheme will be terminated from this year. The services of theseANMs will be utilized in establishing 02 Maternal Waiting Centres which isdiscussed under “Innovations” under Part “A”09 Contractual Pharmacists were placed in CHCs in 200-07 by giving anhonorarium of Rs. 6000/- per month. Their services will be needed in 2008-09, also. The budgetary support needed will be Rs. 6.48 Lakhs. If theMinistry of Health & Family Welfare, Govt. of India is not going to supportManipur State Integrated NRHM PIP 2008-2009 29

them, they will be supported from the State’s share of NRHM budget. TheDistrict-wise allocation is as shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofPharm0 2 3 2 0 1 1 0 0 9Budget 0 1.44 2.16 1.44 0 0.72 0.72 0 0 6.4804 Contractual Radiographers were placed in CHCs in 200-07 by giving anhonorarium of Rs. 5000/- per month. Their services will be needed in 2007-08. The budgetary support needed will be Rs. 2.40 Lakhs. If the Ministry ofHealth & Family Welfare, Govt. of India is not going to support them, they willbe supported from the State’s share of NRHM budget. The District-wiseallocation is as shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofX-Ray 0 2 1 1 0 0 0 0 0 4TechBudget 0 1.20 0.60 0.60 0 0 0 0 0 2.40In addition to the above staffs the CHCs were given the provision of hiringsupport staffs e.g. sweeper, dresser, Ayah, Chowkidar, Dhobi etc. if needed.Their honorarium are to be supported from the RKS fund available with theCHCsActivity (iii)Activity (iv)Filling gaps in equipment: Facility Survey of all existing DHs and CHcs arecompleted. Based on it, the gaps are identified and procurement is going on.Hence no further fund except for procurement of Blood Storage Cabinets forDistrict Hospitals may be needed in 2008-09.Budget is discussed in Part ‘B’Filling gaps in drugs: No drugs except for AYUSH drugs worth Rs. 6.83 lakhswere procured out of the sanctioned amount of Rs. 160.00 lakhs under Part“B” of NRHM in 2006-07. MoU for procuring the essential drugs from TNMSChas been signed. The consignment is expected to reach State by May 2008.Hence, no further fund will be needed for 2008-09.6.2.1.1.2 For making PHCs 24/7 Service Delivery CentresActivity (i) 38 PHCs (at least 50% of existing PHCs) are targeted to be up-graded to 24/7Service Centres by end of 2010. By 2007-08 20 PHCs were up-gardaed to24/7 Service Delivery Centres. Extra doctor in the form of AYUSH Doctors,two additional GNM were posted in these identified PHCs.In 2008-09 another 18 more PHCs @ 2 PHCs per District will be up-graded to24/7 Service Delivery Centres.Budget for supporting the honorarium of existing 40 Addl. GNMs for existing20 Centres and new 36 GNMs for new 18 Centres is shown below.District IE IW TBL BPR UKL CCP SPT TML CDL TotalExisting24/7 2 2 3 2 2 2 2 2 3 20CentresProposednew 24/7 2 2 2 2 2 2 2 2 2 18CentresTotalGNMs8 8 10 8 8 8 8 8 10 76Manipur State Integrated NRHM PIP 2008-2009 30

Budget 5.76 5.76 7.20 5.76 5.76 5.76 5.76 5.76 7.20 54.726.2.1.1.3 Operationalise MTP services at health facilitiesActivity (i)Activity (ii)Activity (iii)Activity (iv)Training of MBBS Doctors in MVA. Details discussed under the heading of“Trainings”.Encouraging confidential counseling and spreading awareness of the facilitiesavailable in health facilities through BCC activities involving ASHAs/ AWWsAccrediting more private clinics (in addition to existing 5 Private Clinics) forMTP services in areas where public health facilities can not properly give theservices.State and District Quality Assurance to monitor the services6.2.1.1.4 Operationalise RTI/STI services at health facilitiesActivity (i)Activity (ii)Activity (iii)Activity (iv)Activity (v)Training of MOs CHC/PHC on management of RTI/STI. This is discussedunder “Training”Provision of RTI/STI investigation and treatment facility in DH, CHC and PHCTraining of ASHAs to encourage referral services to health facilitiesDistrict Mobile Medical Units to have provision of RTI/STI management facilityConvergence with Manipur AIDS Control Society (MACS): MACS to provideRTI/STI management facility at District level. RTI/ STI drugs and laboratorysupport at Sub-District level health facilities (SDH, CHC, PHC) @ Rs. 0.45per unit to be borne by RCH.The District-wise allocation (Rs. in lakhs) will be as given below.IE IW TBL BPR UKL CDL CCP SPT TML TotalNo. of 13 10 17 7 7 4 10 14 7 89Sub-DistrictHealthfacilitiesBudget 5.85 4.5 7.65 3.15 3.15 1.8 4.5 6.3 3.15 40.05Activity (vi)Monitoring through monthly HMIS and supervision.6.2.1.1.5 Operationalise Sub-centresActivity (i)Activity (ii)Activity (iii)Construction of building for building-less Sub-Centres: Under Part “B”construction of 100 buildings out of the 221 building-less Sub-Centres wasstarted in 2007-08. 38 are completed as on date. The remaining is expectedto be completed by last quarter of 2007-08. 65 more buildings are proposedto be constructed in this year. The proposal is included under Part “B”.Repair/renovation of Sub-Centres: 45 identified Sub-Centre buildings needmajor repair which cannot be afforded through the maintenance Grant givento them under Part “B”. The budget required for this is reflected under Civilworks for infrastructure in later parts.121 Sub-Centres will continue to work in rented buildings in 2008-09. The rent@ Rs. 250/- per month for these 121 Sub-Centres for the whole year will beRs. 3.63 lakhs.The District-wise allocation (Rs. in lakhs) will be as given below.IE IW TBL BPR UKL CDL CCP SPT TML TotalNo. of 12 12 11 11 18 5 19 24 9 121Manipur State Integrated NRHM PIP 2008-2009 31

unitsBudget 0.36 0.36 0.33 0.33 0.54 0.15 0.57 0.72 0.27 3.63Activity (iv)Activity (v)SBA Training of ANMs. Discussed under “Trainings”Additional ANMs in all existing 391 Sub-Centres. The posting of regularANMs in all the existing Sub-Centres is rationalized so that each has got oneregular ANM. Additional ANMs are recruited in all the existing Sub-Centres.They will be paid a minimum basic honorarium of Rs. 2000/- per month (forANMs posted in plain Districts except Jiribam Sub-Division of Imphal EastDistrict) and Rs. 3000/- per month (for ANMs posted in hilly Districts andJiribam Sub-Division of Imphal East District. As an innovative approach ontrail basis, they will be paid a performance-based additional honorarium, thedetails of which are explained below.Sl.No.The basis of paying the performance-based incentives will be:1. A fixed basic honorarium of Rs. 2000/- per month for Additional ANMsposted in valley districts except Jiribam Block of Imphal East District and afixed honorarium of Rs. 3000/- per month for Additional ANMs posted inhilly districts including Jiribam Block of Imphal East District forsustainability.2. Another fixed basic additional honorarium of Rs.500/- per month forAdditional ANMs from valley districts posted in Sub-Centres not having inbuiltquarter facility in hilly districts due to non-availability of qualified localcandidate.3. Additional performance-based incentive for all Additional ANMs details ofwhich are given in Annexure4. Monthly Performance Report duly signed by PRI representative(Pradhan/Member of the Sub-Centre Village in Districts having PRIsystem) and Village Chairman/ Headman in Districts not having PRIsystem are to be submitted to the MO in-charge of PHCs latest by 20 th ofevery month. These reports are to be countersigned by concerned MOsin-charge of PHCs and submitted to District Mission Director on or before25th of each month. District Mission Director to submit summary report toSMD on monthly basis.5. Payment of honorarium to be made at the Block level having BPMU bylast working day of every month.6. Advance honorarium to be made available to the Block level CHC/PHChaving BPMU on quarterly basis from the District levelThe total budgetary requirement for 2008-09 will be:DetailsNo. ofSub-CentresTotalbudget inlakhsTo be borneby GoITo beborne byState(1) (2) (3) (4) (5) (6)Fixed basic honorarium ofRs. 2000/- per month for1ANMs in valley areasexcluding Jiribam Block168 40.3223Fixed basic honorarium ofRs. 3000/- per month forANMs working in hillyareas including JiribamBlockAdditional honorarium ofRs. 500/- per month forANMs posted in Sub-223 80.28182 10.92Calculated@ Rs.5000/- permonth perhead for 391Addl. ANMsposted inSub-CentresAdditionalbudgetrequirementin additionto Col. (5)Manipur State Integrated NRHM PIP 2008-2009 32

4Centres not having in-builtresidential quarter facilityAdditional Performancebasedincentives(maximum of Rs. 6325/-296.77per month) for 391 Addl.ANMsTotal 428.29 234.60 193.69The District-wise distribution of budget needed (Rs. in lakhs) is shown below.IE IW TBL BPR CCP SPT UKL CDL TML Total52.58 48.18 51.48 35.05 70.10 66.80 42.74 28.50 32.86 428.29Manipur State Integrated NRHM PIP 2008-2009 33

Sl.No.ANMs ActivityUnitRate of performancebasedincentive (inRs.)Target per Sub-Centre permonthANNEXURE-IMaximum Performance basedincentive per month perAdditional ANM (in Rs.)1 2 3 4 5 61 Early registration of PW registered in 1 st trimester 5 7 (500035Pregnant Womenpopulation X 14.7CBR + 10%)2 Ante-natal care PW given at least one ANC 40 7 280PW given 2 nd ANC visit 50 7 350PW given 3 rd or more ANC visit 75 7 525PW given TT 1 5 7 35PW given TT 2/B 10 7 70PW tested Hb% 10 21 210PW tested USA 10 21 210HRP detected & referred toPHC/CHC25 2 503 Intra-natal care Home deliveries attended 50 0-1 50Institutional delivery at Sub-Center200 0-1 200Complicated deliveries referredto PHC/CHC/DH50 0-1 504 Post-natal care 1 st home visit within 48 hours ofdelivery100 0-1 1002 nd home visit within 10 days ofdelivery100 0-1 100Mothers initiated B/F within halfan hour of delivery50 0-1 50Manipur State Integrated NRHM PIP 2008-2009 32

Sl.No.ANMs ActivityUnitRate of performancebasedincentive (inRs.)Target perSub-Centreper monthMaximum Performance basedincentive per month perAdditional ANM (in Rs.)1 2 3 4 5 65 Child Health BCG 10 6 60DPT (1) 5 6 30DPT (2) 10 6 60DPT (3) 20 6 120DPT (B) 20 6 120OPV (0/1/2/3/B) 5 30 150Measles 10 6 60Vit A (1/2/3/4/5/6/7/8/9) 5 30 150Under 5 Children treated with5 18 90ORS for diarrhoeaUnder 5 children with ARImanaged5 18 906 Family Planning IUD inserted 20 5 100CC beneficiaries 20 5 100ECP user 20 2 40Follow-up visit to EC adoptingpermanent methods20 5 100Referral for MTP toPHC/CHC/DH20 5 1007 Adolescent Health care Counseling of adolescence 10 5 50Attendance on School HealthServices50 2 100Febrile cases from which P.S.for MP taken and presumptivetherapy given20 40 800Manipur State Integrated NRHM PIP 2008-2009 33

Sl.No.ANMs ActivityUnitRate of performancebasedincentive (inRs.)Target perSub-Centreper monthMaximum Performance basedincentive per month perAdditional ANM (in Rs.)1 2 3 4 5 68 Disease surveillance Water sources disinfected 25 2 50Testing of water quality usingH2S stripHouseholds motivated toconstruct sanitary toilets9 Curative services Cases treated for other minordiseases except diarrhea &ARI20 2 4050 2 1005 20 100Organizing monthly VH & NDat AWCs100 5 50010 Training, Monitoring & On-site trg./ supervision Of20 (5 ASHA25SupervisionASHAsweekly)500Sub-Centre reports submittedin time50 1 5011 Recording Vital events Births 20 7 140Deaths 20 4 80Marriage 20 4 80Proper record maintenance 50 1 50Total per month per head 6325Manipur State Integrated NRHM PIP 2008-2009 34

STRATEGY 26.2.1.2 Referral transportActivity (i) Out-sourcing Referral transport for 34 Centres (14 CHCs and twentyPHCs up-graded as 24/7 Service Delivery Centres is already initiated in2007-08. The budgetary support needed is discussed under Part “B”.STRATEGY 36.2.1.3 Integrated outreach RCH servicesActivity (i)Outreach RCH camps will be organized in under-served/un-served areaswhich will be based on the concerned PHCs whereas support formanpower has to be taken from District Hospitals. Two types of suchcamps are planned, General Camps and Specialty Camps. Monitoring ofthese activities will be conducted on a regular basis. 108 camps (monthlyin each District) will be held @ Rs. 20,000/- per camp in 2007-08.The District-wise allocation (Rs. in lakhs) will be as given below.IE IW TBL BPR UKL CDL CCP SPT TML TotalNo. of 12 12 12 12 12 12 12 12 12 108campsBudget 2.40 2.40 2.40 2.40 2.40 2.40 2.40 2.40 2.40 21.60Activity (ii)It is proposed to organize Village Health & Nutrition Days at AnganwadiCentres on Wednesdays involving Village Health & Sanitation Committeemembers, TBA, ASHA, AWW. All the activities as per the guideline ofVillage Health & Nutrition Days shall be implemented. Regular monitoringand reporting will be ensured. The budgetary support needed for thisactivity is reflected under Part “B”.STRATEGY 46.2.1.4. Janani Suraksha Yojana (JSY)For 2008-09, the objective will be to increase the proportion of institutionaldelivery from current 49% (NFHS-3) to 60% and to increase the proportionto >80% by end of Mission period.The financial assistance given to the mothers as well as the ASHAs toencourage institutional delivery will be as given below:1. Mother’s package(i) For institutional delivery - Rs. 700/- per casein rural areas(ii) For institutional delivery - Rs. 600/- per casein urban areasManipur State Integrated NRHM PIP 2008-2009 35

(iii) For home delivery both - Rs. 500/- per casein rural & urban areas2. ASHA’s accompaniment package - Rs. 200/- per case3. For Caesarian section - Rs. 1500/- per casein Govt. Health facilities4. Referral package - Maximum of Rs. 200/- percaseThe National Maternity Benefit Scheme (NMBS) will be continued in theState in the form of the cash assistance given for home deliveries.In the 04 plain districts where PRI System exist only women having up-to2 live births and belonging to poor families as certified by the PRIrepresentatives will be eligible for getting the financial assistance underJSY. In the 5 hilly districts inhabited by the SCs/STs population womenhaving 2 live-births will get the financial assistance irrespective of theirBPL status. But for home deliveries in these areas the Village Chairmanhas to certify that the women belong to poor family.A. Estimated number of deliveries in 2007-08 (based on mid-yearpopulation of 26,18,307 and CBR of 14.7 per 1000 mid-year population of14.7) = 38,490B. Estimated deliveriesB.1 In Rural areas (76.2%) = 29330B.2 In Urban areas (23.8%) = 9160B.3 In General population (57%) = 21940B.4 In SC/ST population (43%) = 16550C. Targeted number of institutional deliveries (60%) = 23094D. Expected home deliveries = 15396E. Estimated deliveries needing C/S (2%) = 770JSY budget needed (in Lakhs)In GeneralPopulationIn SC/STPopulationMother’s packageUrba Rural Urban RuralnEstimated total No. of deliveries 5222 16718 1450 15100Estimated No. of deliveries in 1570 6690 NA NABPL/poor General families(assuming 30% in urban areas and40% in rural areas in Generalpopulation) (except for SC/ST)Estimated No. of deliveries up-to the 785 3345 725 7550order of 2 in BPL Population (50%)(BPL status not binding for SC/ST)Targeted No. of institutionaldeliveries (60% out of above)471 2007 435 4530Total(Rs. Inlakhs)Manipur State Integrated NRHM PIP 2008-2009 36

Mother’s packagePackage for institutional delivery(@ Rs. 700/- in rural areas and Rs.600/- for urban areasEstimated No. of Home deliveries inBPL/ poor families up-to Birth orderof 2 (BPL status applicable to allpopulation)Package for Home delivery (@ Rs.500/- per case)ASHA’s package foraccompanying institutionaldelivery (@ Rs. 200/- per case)Assistance for C/S @ Rs. 1500/-(Assuming 2% of all institutionaldeliveries)Referral transport (Maximum ofRs. 200/- per case)In GeneralPopulationIn SC/STPopulationTotal(Rs. Inlakhs)Urba Rural Urban Ruraln2.83 14.05 3.05 31.71 51.64314 1338 362 18882.36 10.04 2.18 22.65 37.230.95 4.02 0.44 9.06 14.47Net total 112.34Program Management Cost2.25including printing of JSY Card,MCH Card and Registers4.504.50Grand total 114.79The district-wise allocation (Rs. In lakhs) for JSY for 2008-09 is shown below:IE IW TBL BPR SPT TML UKL CDL CCP Total20.19 21.21 17.38 10.73 15.32 5.35 6.72 6.98 10.91 114.79STRATEGY 56.2.1.5 Other strategies6.2.1.5.1 Ensuring early registration and ANC (at least 3) for allpregnant womenActivity (i)Activity (ii)Activity (iii)Ensuring that ANMs stay at their place of posting by promoting theenvironment of the Sub-centres through provision of untied funds. Thebudgetary support needed is reflected under Part “B”.Including 3 ANCs as one of the criteria for claiming financial assistanceunder JSY.District Mobile Medical Units to hold ANC sessions in difficult to beaccessed areas.Manipur State Integrated NRHM PIP 2008-2009 37

6.2.1.5.2 Maternal Death Auditing:Activity (i)Formation of a State level Committee under the Chairmanship of PrincipalSecretary (HFW) is to be completed in 1 st quarter of 2008-09 and anyreported maternal deaths will be audited by using a verbal autopsy proforma (Enclosed as ANNEXURE 4) which is already formed so that thereason of maternal death and measures to prevent further deaths can befound out. A sum of Rs. 2.00 lakhs may be sanctioned for this.6.2.1.5.3 Strengthening PNCActivity (i) Promoting at least 03 PNC (1st day, 1 st week, 6 th week) viits throughASHAs, AWWs, ANMs.Activity (ii) Making at least one PNC visit a pre-requisite for JSY.Activity (iii) PNC through home visits by ANM before holding Monthly Village HealthDaysActivity (iv) District Mobile Medical Units for hard to reach areas.6.2.1.5.4 Strengthening PPPActivity (i)Accreditation of at least 02 Pvt. Clinics/ Hospitals per District for servicecoverage in under-served areas was tried in 2007-08. So far 05 Pvt.Clinics/ Hospitals have been accredited for providing Maternal HealthServices. The remaining will be targeted in current year.6.2.1.5.5. ASHA Scheme: This is discussed under “Part B” .Manipur State Integrated NRHM PIP 2008-2009 38

6.2.2 Child HealthObjectives: To improve health status of newborns and childrenSTRATEGY 16.2.2.1 Implementation of IMNCI03 Districts viz., Churachandpur, Imphal West and Thoubal were selected forimplementation of IMNCI in 2007-08 as a trial project. But due to certain technicaldifficulties the same could not materialize. Nevertheless, the followingachievements have been made.• Appointment of a State and District IMNCI/ Child Health Nodal Officers• Establishment of State and District IMNCI Coordination Committees• Training of 05 State IMNCI Trainers• Training of 35 District level Program Managers on operationalization of IMNCI• Dissemination of IMNCI Operational Guideline to DistrictsActivity (i)Training of 100 Doctors on IMNCI at State level by using the 13 Modulesprepared by MoHFW, GoI. RIMS has been identified as the Training NodalAgency.No.alreadytrainedNo. tobetrainedNo. ofbatches0 100 5 (inbatchesof 20)Place oftrainingBudget per batchParticulars Amount(Rs. inlakhs)RIMS Honorarium for 5trainers @ Rs.400/- per head perday X 10 daysHonorarium for 20trainees @ Rs. 200per head per day X10 daysTraining materialfor 20 trainees @Rs. 500 per head(Printing of 13modules, A-V aidsetc.)Overheadexpenditure,refreshment & othercontingenciesTotalbudgetfor allbatches(Rs. inlakhs)0.20 1.000.40 2.000.10 0.500.30 1.501.00 5.00Manipur State Integrated NRHM PIP 2008-2009 39

Activity (ii)District-level training of 150 FHS/GNM/ANM of Districts where IMNCI is toimplementedNo.alreadytrainedNo. tobetrainedNo. ofbatches0 150 15 (inbatchesof 10)Place oftrainingDistrictHospitals ofBishnupur,Imphal West &ChurachandpurBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 5trainers @ Rs.400/- per headper day X 10daysHonorarium for15 trainees @Rs. 200 per headper day X 10daysTraining materialfor 15 trainees @Rs. 500 per head(Printing of 13modules, A-Vaids etc.)Overheadexpenditure,refreshment &othercontingenciesTotalbudgetfor allbatches(Rs. inlakhs)0.20 3.000.30 4.500.075 1.1250.30 4.500.875 13.125The total District-wise budgetary support needed for trainings (Rs. in lakhs) is shownbelow.ForStateleveltrgForDistrictleveltrgState IE IW TBL CCP BPR UKL SPT CDL TML Total5.00 0 0 0 0 0 0 0 0 0 5.000 0 4.375 0 4.375 4.375 0 0 0 0 13.125Total 5.00 0 4.375 0 4.375 4.375 0 0 0 0 18.125Manipur State Integrated NRHM PIP 2008-2009 40

Activity (iii)Activity (iv)Activity (v)Activity (vi)Pre-service & In-service training on IMNCI: IMNCI Chapters to be includedin pre-service training curriculum of ANMs and in the promotional trainingcourse for FHS.Provision of Essential Drugs: MoU for procuring RCH drugs has beensigned with TNMSC from the available fund with State. Hence noadditional fund will be needed for 2008-09.BCC activities on health seeking behavior and awareness of the facilitiesavailable in health Centres: To be implemented in an integrated mannerwith other RCH activities.Monitoring and supervision which will be done in integrated manner alongwith other activities under RCH.STRATEGY 26.2.2.2 Essential New-born care based on Management of Diarrhoea, ARI,Malnutrition, Vit. A deficiency, Zinc supplementation etc.Activity (i) In-service re-orientation training of ANM in Facility-based and Home-Based Newborn care (FB & HBNC): To be taken as a component ofmonthly PHC level meetingActivity (ii) Periodic training of ASHAs to include Home-based Newborn Care (HBNC)Activity (iii) Medicines/ Drugs for Health facilities and ASHAs. Discussed under “ASHAinitiative”Activity (iv) BCC activities. Discussed under “BCC”STRATEGY 36.2.2.3 School Health ProgramLast year School Health Program was implemented in 2 Districts(Imphal East and Ukhrul) as a trial project in collaboration withDepartment of Education. The following actions were taken up:• Formation of a State School Health Committee under thechairmanship of Secretary (HFW)• Identification of State Nodal Officer (School Health)• Preparation of dissemination of Operational Guideline for SchoolHealth• Preparation and Printing of monthly Reporting Formats• Preparation and printing of School Health CardsThe project failed because of lack of logistic support in terms ofweighing machine, anthrometer by Dept. of Education and lack oflogistic support from State Dept. of Health & Family Welfare.Activity (i)Training of 120 School Teachers of Imphal East and Ukhrul District. Thebudget needed is discussed under “Training”Manipur State Integrated NRHM PIP 2008-2009 41

Activity (ii)Activity (iii)Activity (iv)Activity (v)Quarterly visit and health check-up by PHC MO to schools along withconcerned ANM of Sub-Centre and referral of cases. Schools having Girlstudentsto be given priority during implementation. Action Plan to beprepared by MO i/c PHC concerned. TA/DA to be supported throughUntied Fund of PHC wherever admissible.Equipments and medicine to be supported by PHC concernedMonthly reporting by concerned MO to District and henceforth to State.Printing of 2.00 Lakh School Health Cards @ Rs. 1.50/- per Card giving atotal amount of Rs. 2.50 lakhs.Activity (vi) Monitoring by Joint Team of Education and HFW.STRATEGY 46.2.2.5 Infant and Young Child Feeding / IYCFActivity (i)Activity (ii)Activity (iii)Activity (iv)BCC activities through Mass Media and IPC through ASHAsPeriodic training of ASHAs to include chapter on IYCFRe-orientation training of Health Workers at PHC level monthly meetingsCoordination with Breast-Feeding Promotion Network of India (BPNI).Manipur ChapterSTRATEGY 56.2.2.6 Care of sick children and severe malnutrition at FRUsActivity (i)Activity (ii)Operationalization of Newborn Care Corners and Nutritional RehabilitationCentre in FRUs and 24/7 PHCs. Budget needed for establishing NBCC isalready discussed. For NRCs, supplementary feeds will be made availableon exchange basis.Community mobilization through ASHA for timely referral of sick childrenManipur State Integrated NRHM PIP 2008-2009 42

6.2.3 Family PlanningOBJECTIVE: To reduce the unment needs (Terminal- from 5 to < 1;spacing- from 7.6 to < 2) by end of 2008-09STRATEGY 16.2.3.1 Terminal/limiting methodsActivity (i)Activity (ii)Activity (iii)Activity (iv)Activity (v)Activity (vi)Observation of Sterilization Days (Wednesday for Tubectomy andSaturday for Vasectomy)a. Weekly at State Hospital and District Hospitalsb. Fortnightly at CHCs wherever trained manpower are availablec. Monthly at identified PHCs where trained manpower for No ScalpelVasecomy (NSV) are availableTraining of MBBS Doctors in NSVs and Minilap.Provision of compensation money for clients, motivation fee for ASHA andfree provision of drugs & dressing materialsExpanding the panel of eligible surgeons and health institutions (bothpublic and private) district-wise for holding sterilization operationsQuarterly NSV mega-camps at the 05 hilly districts by using the trainedmanpower available at PPPC, Imphal,/State Hospital/ District HospitalsProvision for sterilization operation in quarterly out-reach RCH camps inall Districts at PHCs which are under-utilizedActivity (vii) Provision of sterilization services in District Mobile Medical UnitsActivity (viii) BCC activities to make people aware of the sterilization services availablein the health facilities and also to encourage male participation. BCC to bedone in an integrated manner for all RCH activities and discussed under“BCC”.Activity (ix)Activity (x)STRATEGY 2Community mobilization through ASHAsQuality assurance and monitoring through State and District QualityAssurance Committees. 10% of all sterilizations to be cross-checked bythe District Quality Assurance Committees.6.2.3.2 Spacing methodsActivity (i) BCC activities to make people aware of the spacing methods available inthe health facilitiesActivity (ii) Provision of IUD services at all health facilitiesActivity (iii) Making available ECP, Cu-T 380 in addition to OCP and Condom in allHealth Institutions up-to the level of Sub-centres.Activity (iv) Motivation fee for ASHAs for Cu-TActivity (v) Performance-based honorarium for Addl. ANMs for spacing servicesActivity (vi) Social marketing of Condoms in collaboration with Manipur AIDS ControlSociety (MACS)Activity (vii) Training of newly recruited Additional ANMs on Cu-T insertionActivity (viii) Quarterly Contraceptive up-date seminars for MOsActivity (ix) Quality Assurance and monitoringManipur State Integrated NRHM PIP 2008-2009 43

Budget (in lakhs):Sl.No.Particulars/Activity Unit rate Units Total1 Quarterly NSV Megacamps in 5 hilly districts 0.50 20 10.002Monthly integrated out-reach RCH camps in all Reflected under “Maternal9 districtsHealth”Compensation & motivation fee3.1 For Tubectomy (Acceptor-600, Motivator-150, Drugs & dressings-100, Surgeon’scharge-75, Anesthetist’s charge-25, StaffNurse-15, OT Tech-15, Refreshment-10, Camp0.01 inPublicfacilities;0.015 in 2000 20.00Mngt-10 in Public facilities; Facility-1350, Accredited3Motivator-150 in Accredited Private facilities) privatefacilities3.2 For Vasectomy (Acceptor-1100, Motivator-200, Drugs & dressings-100, Staff Nurse-15,OT Tech-15, Refreshment-10, Camp Mngt-10 0.015 1000 10.00in Public facilities; Facility-1300, Motivator-200in Accredited Private facilities)3.2 Motivators’ fee for Cu-T 0.0002 9000 1.804Procurement of spare parts /repair of2.005678equipments laparoscopes (to be done by State)Printing of Eligible Couple Register and FamilyPlanning registers (to be done at State level)Monitoring & supervision(both by District andBlock)Procurement of IUD sets (to be done at Statelevel)Seminars on Contraceptive up-date, Trg. ofMBBS Doctors on NSV & minilap and Trg. ofnewly recruited Addl. ANMs on Cu-T insertion0.002600each2.404.000.01 400 4.00Reflected under “Training”0 BCC activities Reflected under “BCC”Total 50.20The District-wise distribution (Rs. In lakhs) will be as given below.IE IW TBL BPR CCP SPT CDL UKL TML State TotalHdqs.6.50 6.50 3.50 3.50 8.50 4.00 4.00 4.00 4.00 9.70 54.20Manipur State Integrated NRHM PIP 2008-2009 44

6.2.4 Adolescent Reproductive and Sexual Health (ARSH)Objectives: To improve the health status of adolescentsSTRATEGY 16.2.4.1 Provision of Adolescent Friendly Services (ARSH) in Health facilitiesActivity (i)Holding of ARSH clinics in State Hospital, District Hospitals, SDH/CHCsand PHCs once in every week. Each unit will be supported with a budgetof Rs. 10,000/- per annum for equipment and drug/medicine support. TheDistrict-wise budget (Rs. in lakhs) needed will be as shown below.IE IW TBL BPR UKL CDL SPT CCP TML TotalNo. of 13 10 18 8 8 6 15 11 8 97unitsBudget 1.30 1.0 1.80 0.80 0.08 0.60 1.50 1.10 0.80 9.70Activity (ii)Activity (iii)Activity (iv)Coordination with MACS for ARSH Counseling in DHs and CHCs.Counselor under MACS to be posted in DHs and CHCs. Re-orientationtraining of ANMs in monthly PHC level meetingsCommunity mobilization through ASHAsSchool-based Question Boxes to set up in the schools where doubts canbe written and posted in these boxes anonymously. Every month on afixed day the doubts will be cleared in the School Assembly by MO PHCconcerned. 1000 such boxes will be installed at Schools @ Rs. 500/- permonth giving a total of Rs. 5.00 lakhs in schools. The District-wise budget(Rs. in lakhs) needed will be as shown below.IE IW TBL BPR UKL CDL SPT CCP TML Total0.75 0.75 0.50 0.50 0.50 0.50 0.50 0.50 0.50 5.00Activity (v)Screening for visual impairment in convergence with NBCP.Manipur State Integrated NRHM PIP 2008-2009 45

6.2.5 Urban RCHThe State of Manipur does not have any identified slum areas. Yet to provideequitable health services to the floating migrant population and shanty villages lying inand around the cities and towns 08 Sub-Centres situated at sub-urban areas have beenup-graded to the level of Urban Health Centres in terms of infrastructure, manpower (1LMO, 1 PHN, 4 ANMs, 1 LT, 2 Peon cum Chowkidar and 1 Office Asst. per UHC),equipments and drugs. Also a Technical Support Unit is established in the State MissionSecretariat. The list of the 08 Centres are:1. UHC Kshetigao in Imphal East District2. UHC Ningom Thongjao in Imphal East District and3. UHC Mantripukhri in Imphal East District4. UHC Keirak in Thoubal District5. UHC Thoubal Haokha in Thoubal District6. UHC Thingkhanphai in Churachandpur District7. UHC Karong in Chandel District8. UHC Mongsangei in Imphal West DistrictThe process of civil work up-gradation for the later 04 UHCs are continuing andare expected to be completed by the last quarter of 2007-08.Objectives: To provide quality RCH services in the urban areas of the State focusingon the Urban slums, and also cover the poor floating populations living in the urbanareas.STRATEGY 16.2.5.1. Strengthening the existing 04 urban health centres alreadyestablished in the State and to provide 04 more UHCs in sub-urbanareasThe activities and the budget (Rs. in lakhs) to be needed during 2008-09 is asshown below.Sl.No.Activity StateDistrictsTotalHdq IE IW TBL BPR UKL CDL CCP SPT TMLNo. of UHCs 3 1 2 0 0 1 1 0 0 81.20 1.80 0.60 1.20 0 0 0.60 0.60 0 0 6.001 Honorariumof Office Asst.@ Rs. 5000/-p.m.2 Honorariumof LMO @Rs. 15,000/-p.m.3 Honorariumof PHN @ rs.7,000/- p.m.4 Honorariumof LT @ Rs,5000/- p.m.0 5.40 1.80 3.60 0 0 1.80 1.80 0 0 14.400 2.52 0.84 1.68 0 0 0.84 0.84 0 0 6.720 1.80 0.60 1.20 0 0 0.60 0.60 0 0 4.80Manipur State Integrated NRHM PIP 2008-2009 46

Sl.No.Activity StateDistrictsTotalHdq IE IW TBL BPR UKL CDL CCP SPT TMLNo. of UHCs 3 1 2 0 0 1 1 0 0 80 1.44 0.48 0.96 0 0 0.48 0.48 0 0 3.845 Honorariumof Peon @Rs. 2000/-p.m.6 Honorariumof ANMs @Rs. 5000/-p.m.0 7.20 2.40 4.80 0 0 2.40 2.40 0 0 19.207 Medicines/ 0 3.00 1.00 2.00 0 0 1.00 1.00 0 0 8.00drugs8 Administrative 5.00 0 0 0 0 0 0 0 0 0 5.00SupportTotal 6.20 26.16 8.72 17.44 0 0 8.72 8.72 0 0 75.966.2.6 Tribal healthSTRATEGYObjective: Provide adequate an equitable RCH services to the tribalpopulation living in villages/ hamlets in the valley districts of the State.6.2.6.1. To make RCH services available and accessible in thehamlets/villages of tribal minority areas in the valley areas of Imphal,Thoubal and Bishnupur districts.Activity (i)Activity (ii)Activity (iii)A mobile dispensary van fully equipped with medical facilities, andmanned by a doctor, an ANM and an assistant to cover the 100 odd tribalhamlets/villages identified in the valley area. It may cover 3-4 villages perday on fixed place, fixed day and fixed time basis.Monitoring through the State Technical Support Unit established under6.2.5.Convergence with Tribal Development Department.The budget requirement (rs. in lakhs) will be:Sl.No. Particulars Total (Rs. in lakhs)1 Outsourcing dispensary van @ Rs. 15,000/- 1.80p.m.2 Honorarium of MO @ Rs. 15,000/- p.m. 1.803 Honorarium of ANM @ Rs. 5,000/- p.m. 0.604 Drugs/ medicines 5.005 Monitoring 1.00Total 10.20Manipur State Integrated NRHM PIP 2008-2009 47

6.2.7 Vulnerable groupsObjective:To provide equitable RCH services to vulnerable and other marginalizedcommunitySTRATEGY 16.2.7.1. Preventive and promotive health services to marginalizedcommunity living in floating huts of Loktak Lake (largest fresh-waterlake in India)Loktak Lake Community (Bishnupur District) is living confined to Floating Huts inthe lake as they depend on fishing for their livelihood. (No. of houses-738, Population-2048)From case studies done at Loktak Lake, it was found out that the whole communitydefaecate in the lake and also consume untreated water from the lake thereby makingprone to water-borne outbreaks. As these population are floating in nature as well asthey can be approached through boats only they are also under-served by theconcerned PHCs and Sub-Centres.Interventions for Floating community in Loktak Lake: Provision of Service-TypeLatrine for each household. The excreta are to be collected by local volunteers usingboats on weekly basis and disposed at prepared places in dry-land.Activity (i)Activity (ii)Activity (iii)Activity (iv)Provision of filters and disinfectantsSpecial weekly health check-up by staffs of PHC ThangaHealth awareness programs with community participation including localASHAs.Convergence with PHEDThe budgetary support (Rs. in lakhs) needed for this scheme in BishnupurDistrict will be:Sl.Particulars Unit rate Units TotalNo.1 Cost of Service-Type Latrine 0.0205 738 15.132 Preparation of disposal area 0.12 4 0.483 Engaging local boats 0.12 14 1.684 Engaging volunteers for collection & 0.36 14 5.04disposal of excreta5 Mobility support (hiring boats) for Health 0.005 52 0.26Staff on weekly basis6 Procuring Plastic water filters 0.003 738 2.217 Purchasing alum and Chlorine tab/powder - - 0.508 Organizing monthly health awareness 0.05 12 0.60programs9 Training of women on practice of 0.08 10 0.80chlorination in 10 batches ( each batchhaving 25 participants)Total 26.70Manipur State Integrated NRHM PIP 2008-2009 48

6.2.8. InnovationsActivity (i)Activity (ii)Activity (iii)Activity (iv)Performance-based incentives for Additional ANMs posted at Sub-Centres. The budget is already reflected under (Maternal Health)Performance-based incentive for MBBS Doctors trained in CEmOC andLife-Saving Anesthesia skills. They will be paid an honorarium of Rs.1000/- per case. An amount of Rs. 2.00 lakh may be needed for 2008-09.Risk pooling: As the current BPL list is not yet available, this scheme willbe tried as and when reliable BPL list is availableMaternity Waiting-Centres near RIMS and JN Hospital:As Regional Institute of Medical Sciences, Lamphelpat and JN Hospital,Porompat are the two important multi-specialty public hospitals in theState, poor people of the State who cannot afford to attend the costlyprivate institutions prefer these two institutions for delivery purpose. Dueto the limited number of maternity beds in these two institutions, all theneeds of the poor people cannot be met by these two institutions andwomen are compelled to attend to the costly private institutions.To solve this problem, maternity waiting centres are proposed to be madeavailable as pilot project near these two institutions having a capacity of20 beds each. Reputed NGOs having adequate manpower will beentrusted for running this project in coordination with RIMS and JNHospital on Public Private Partnership. The 14 ANMs whose serviceswere previously utilized the CHCs will be employed so that at least 02ANMs is on duty round the clock in each of the Centres to look after theneeds of the women. There should be adequate support for communitykitchen/ canteen, toilets and washing purposes. Only women belonging topoor families certified by PRI members/pradhan/ Village Chairman/ VillageHeadman may be admitted in these institutions by giving nominaladmittance fee and daily fee which will be deposited in the State HealthMission Society, Manipur. Pregnant women will be shifted to the referralCentres for delivery and in case of emergency.This activity will be closely monitored by the State Nodal Officer (MH)along with Technical Support Unit established in the State Hdqs. andevaluated annually.The budgetary support (Rs. in lakhs) needed will be:Sl.No.DetailsBudget (Rs. inlakhs)1 Building rent @ Rs. 10,000/- per month X 2 Centres 2.402 Honorarium of 14 ANMs @ Rs. 5000/- p.m. 8.403 Procuring 40 cots & mattresses @ Rs. 10000/- 4.004 Office set-up for 02 Centres 4.00Total 18.80Manipur State Integrated NRHM PIP 2008-2009 49

Activity (v)Educational Radio Program for ASHAs: It is proposed that all the ASHAsare provided with branded radio transmitters and a weekly radio programon prime time when the ASHAs will be free at home on fixed day and fixedtime is broadcasted. The time period will be for a period of 20 minutes (10minutes for health talk by a member of the State Training Team for ASHAScheme and another 10 minute for answering questions sent by ASHAs inthe week). This will help in re-orienting ASHAs as well as motivate them.The budget needed (Rs. in lakhs) will be:State IE IW TBL CCP BPR UKL SPT CDL TML TotalRadio set @ 0 4.31 3.29 3.65 6.27 2.35 3.02 7.87 5.50 2.52 38.78Rs. 1000/-AIR2.60 0 0 0 0 0 0 0 0 0 2.60productioncharge for 52episodes @Rs. 5000/-Resource 0.52 0 0 0 0 0 0 0 0 0 0.52persons fee@ Rs. 1000/-Total 3.12 4.31 3.29 3.65 6.27 2.35 3.02 7.87 5.50 2.52 41.90STRATEGY 36.2.8.3 NGO ProgramActivity (i)Activity (ii)Activity (iii)Activity (iv)Activity (v)MNGO Scheme: 02 MNGOs viz., (i) Family Planning Association of India(FPAI), Manipur Branch and (ii) Lamding Cherapur Unani Association(LACHUA) are working for under-served areas in 04 Districts. As theyhave been provided an amount of Rs. 30.00 each in 2006-07 forimplementation of RCH activities for a period of 03 years, no further fundwill be required for the current year.Identification of 03 additional MNGOs so that one MNGO covers only twodistrictsField supervision by State and District Program ManagersRoutine monitoring of physical and financial achievement through monthlyState level NRHM review meeting.Coordinating with Medicins Sans Frontiere for providing RCH services ininterior parts of Churachandpur DistrictManipur State Integrated NRHM PIP 2008-2009 50

6.2.9. Infrastructure strengtheningObjective:Provision of adequate infrastructure and Human resources foreffective implementation of RCH activities in the State.STRATEGY 16.2.9.1 Major Civil WorksActivity (i)Construction of MCH Hospital in Imphal West District”PHC Kakwa in Imphal West District was nominally up-graded from Sub-Centre Kakwa without any up-gradation in infrastructure five years ago.Hence, the present PHC functions are running on a Sub-Centreinfrastructure. This is causing many difficulties in the smooth running ofthe PHC. So as to reduce the MMR in the State, and to improve thematernal health, MCH Hospital at Thongju may be constructed.It may be noted that under Sector Investment Plan under EuropeanCommission (SIP-EC), there was a plan for construction of an MCHHospital at Thongju which is quite adjacent to PHC Kakwa. Necessaryland development and fencing of the area were completed. Later on theplan was abandoned as EC refused to continue funding. This land areaoffers an opportunity for construction of a well infrastructured MCHHospital. Estimates for constructing building and 4 staff quarters (one forMO and 3 for GNMs) are being worked out by the Engineering Cell of theState Mission.An amount of Rs. 180.13 Lakhs (Rs. 72.13 lakhs for the building and Rs.108.00 Lakhs for the staff quarters) will be needed.Manipur State Integrated NRHM PIP 2008-2009 51

STRATEGY 26.2.9.3 Minor Civil WorksActivity (i)In addition to the existing 20 PHCs up-graded to 24/7 Service Centres: Itis proposed to up-grade another 18 more PHCs @ 2 PHCs per Districtup-graded to 24/7 Service Delivery Centres. Based on the Facility SurveyUp-gradation work for up-grading 18 PHCs to 24/7 Service DeliveryCentresReport necessary interventions will be taken up viz.• Extension for Labor Room @ Rs. 2.10 lakhs in plain Districtsand Rs. 2.30 in hilly Districts)• Extension for Toilets @ Rs. 2.00 Lakhs in plain districts and Rs.2.20 in hilly Districts• Provision of Bio-Medical Waste Management System @ Rs.1.50 lakhs• Extension for Newborn Care Corner @ Rs. 0.30 lakhs• Construction of Generator Installation shed @ Rs. 0.60 lakhs inplain Districts and 0.70 in hilly Districts• Renovation/ repair Staff Quarters• Extension of ward and• Repairing works of existing structures.The District-wise allocation (Rs. in lakhs) will be as given below.IE IW TBL BPR UKL CDL CCP SPT TML Total20.00 20.00 20.00 21.00 23.00 23.00 23.80 23.80 23.80 198.40Activity (ii)Repair/renovation of Subcentres: 45 identified Sub-Centre buildings needmajor repair which cannot be afforded through the maintenance Grantgiven to them under Part “B”. An average of Rs. 0.50 Lakhs per unit willbe needed giving a total of Rs. 22.50 lakhs.The District-wise allocation (Rs. in lakhs) will be as given below.IE IW TBL BPR UKL CDL CCP SPT TML TotalNo. of 2 2 3 4 6 5 8 8 7 45unitsBudget 1.00 1.00 1.50 2.00 3.00 2.50 4.00 4.00 3.50 22.50Manipur State Integrated NRHM PIP 2008-2009 52

STRATEGY 36.2.9.5 Other add-on facilities at DHs, CHCs and 24/7 PHCsSl.No.ActivityNo. ofunitsUnit rate(in lakhs)Total(in lakh)1 Double Telephone line for FRUs 11 0.06 0.66targeted2 Single Telephone line for 20 0.03 0.60operational 24/7 PHCs3 TV, DVD player for new FRUs 7 0.10 0.70targeted4 Computer sets for new FRUs 7 0.50 3.50targeted5 Blood Semi Auto-analyzer for new 7 3.00 21.00FRUs targeted6 10 KVa Gen-set for new FRUs 7 2.20 15.40targeted8 Installation shed for above 7 1.00 7.009 Blood Storage Cabinet 6 2.00 12.00Total 60.86The District-wise allocation (Rs. in lakhs) will be as given below.No. of IE IW TBL BPR UKL CDL CCP SPT TML TotaltargetedunitsDH 0 0 1 1 1 1 1 1 1 11CHC 1 1 1 1 0 0 0 0 0 4PHC 2 2 3 2 2 3 2 2 2 20Budget (Rs. in lakhs)2-Tel line 0.06 0.06 0.12 0.12 0.06 0.06 0.06 0.06 0.06 0.661-Tel line 0.06 0.06 0.09 0.06 0.06 0.09 0.06 0.06 0.06 0.60TV, DVD 0 0 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.70Comp set 0 0 0.50 0.50 0.50 0.50 0.50 0.50 0.50 3.50Bl Analys 0 0 3.00 3.00 3.00 3.00 3.00 3.00 3.00 21.00Gen-set 0 0 2.20 2.20 2.20 2.20 2.20 2.20 2.20 15.40Shed 0 0 1.00 1.00 1.00 1.00 1.00 1.00 1.00 7.00Bl Cabinet 0 0 2.00 2.00 2.00 2.00 0 2.00 2.00 12.00Total 0.12 0.12 9.01 8.98 8.92 8.95 6.92 8.92 8.92 60.86Manipur State Integrated NRHM PIP 2008-2009 53

6.2.10. Institutional StrengtheningObjective:To develop proper institutional structure for RCH service deliverySTRATEGY 16.2.10.1 Human Resource DevelopmentActivity (i)Continuation of services of State HRD Consultant, State EngineerConsultant, State BCC Consultant. To enhance planning, monitoring andprogram implementation in the state, 01 MCS officer and 01 Junior MCSofficer may be engage on deputation basis. The budget needed as shownbelow.Sl.No.Particular Unit Budget(Rs. in lakhs)Honorarium of St. Eng. Consultant @ Rs. 1 2.7623,000/- p.m.46 Honorarium of State HRD cum Trg. 1 2.16Consultant @ Rs. 18,000/- p.m.7 Honorarium of State BCC Consultant @ Rs. 1 2.1618,000/- p.m.8 Honorarium of Stenographer @ Rs. 6,000/- 1 0.72p.m.9 Honorarium of Data Entry cum Analysists 2 1.68@ Rs. 7,000/- p.m.10 Honorarium of MCS Officer on deputation 1 2.75with pension contribution11 Honorarium of Junior MCS Officer on 1 2.25deputation with pension contributionTotal 14.48Activity (ii)Activity (iii)Activity (iii)Activity (iv)Activity (v)Key persons in RCH not to be transferred before 3 years of serviceRationalization of posting place regular Health & FW staffs along withformation of transparent Transfer & Posting PolicyPerformance appraisal and reward system among districts and staffsDeveloping a Transfer & Posting policy for contractual staffsTrainings both inside and outside StateSTRATEGY 26.2.10.2 Logistics ManagementActivity (i)Activity (ii)Activity (iii)Activity (iv)Drugs and medicines to be procured from TNMSC by MoHFW, GoI andsupply in kind to the StateQuarterly supply to Districts from State levelSpecial indent in times of necessityLocal purchase during calamitiesManipur State Integrated NRHM PIP 2008-2009 54

STRATEGY 36.2.10.3 Monitoring and Evaluation / HMISActivity(i) Formation of State level Monitoring Sub-Committees to visit and stay forone weekly monthly facilitating RCH implementation at District and Sub-District levels. The budget requirement for this will be met from ProgramManagement CostActivity (ii) Monthly and quarterly reporting of Monitoring ReportsActivity (iii) Weekly supportive supervision of ASHAs by ANMActivity (iv) Weekly field visits by FHSActivity (v) Forthrightly field supervision by MO PHCs.Activity (vi) Monthly field visits by District level OfficersActivity (vi) Holding of monthly PHC level and District level review meetingActivity (vii) Monthly Physical and Financial Review Meeting at State level: Reorientationtrainings of HMIS formats for new recruitsActivity (viii) Printing of Health & FW Registers at State level: 11 types ofRegisters viz. (i) ANC Register (ii) JSY Register (iii) PNC Register (iv)Birth Register (v) Birth Register (vi) Death Register (vii) Delivery Register(viii) Village Health Register and (ix) Stock Indent Register may be printedat State level and Distributed to all Health facilities and ASHAs. A sum ofRs. 18.00 lakhs will be needed for this.6.2.11 Strengthening Training InfrastructureEstablishment of 03 GNM Training Centres is reflected in Part “B”6.2.12 BCC/IEC1. Manpower available:A. Technical specificState level:State BCC Consultant (Contractual)State Audio-Visual OfficerDistrict level: District Mass Media OfficersBlock level: Block Extension EducatorsB. GeneralASHAs in all villages/ hamlets, AWWS and other health fieldworkersManipur State Integrated NRHM PIP 2008-2009 55

2. Existing systems through which BCC messages are being disseminated tocommunity:• Observation of Village Health & Nutrition Days• District Health Melas• Home visits and community mobilization by ASHAs and ANMs• Mothers’ meetings organized by Mobile Team under Tribal Health andANMs of Sub-Centres• Block level awareness programs on major public health issues• School Health Services for Adolescent Counseling• Publication of annual State Health Society Calendar• Exhibition of Gate/ Tableaux during National Day Celebrations• Broad-cast in TV (local/ DDK)/ Radio• Newspapers• Publication of newsletters• Hoardings, posters, leaflets• Wall paintings• Hoardings3. Other systems which can be effective for BCC• Church services in the 05 hilly Christian Districts (CCP, UKL, SPT, CDL,TML)• Womens’ Self-help groups/organizations including Meira-paibis (Womens’Torch bearers working against social injustice)• BCC Resource Collection Centres from where people can borrow or takeaway freely IEC materials• Folk artistso Valley area: Shumang lila (Jatrawali), Eishei lila (Songjatrawali), Ipom (Joke episodes) , Khongjom Purv(folk-song), Musical nites and other culturalcelebrations• Hill area: Folk-Dance Troupes4. Departments/ sectors which can be coordinated• Song & Drama Division, Govt. of Manipur• Education• Department of Nutrition, GoI, Manipur, Chingamathak• WCD• Field publicity• Any reputed advertising firmsEquipments available:Digital camera, PA System, LCD, ComputersObjective: To apprise the health behavior of the people and to improve the healthbehavior so that the health seeking behavior for Maternity, Child Health and FamilyPlanning can be improved.Manipur State Integrated NRHM PIP 2008-2009 56

Strategy 16.2.12.1 Capacity development of BCC staff on up-to dated BCC activitiesJob-specification: State HRD Consultant will be responsible for this.Activity (i) Training of State BCC Consultant and State level BCC staff outside State(subject to provision of such capacity development program from MoHFW,GoIActivity (ii) State level quarterly work-shops on up-gradation of skills of District MediaOfficers at State level by the State BCC Consultant and State level officersActivity (iii) District-level quarterly work-shops on up-gradation of skills of BlockExtension Educator by the District Media OfficersActivity (iv) PHC level skill up-gradation of ANMs in monthly PHC level meetings byBlock Extension EducatorActivity (v) Weekly on-site skill up-gradation of ASHAs and AWWs by ANMsStrategy 26.2.12.2 To implement local specific BCC activities (Responsibility: District andBlock Mass Media officers)Activity (i) Needs assessment for identification of block-specific health problems,positive and negative factors influencing health behavior, enabling factors,target group, BCC message and channel of communication – to becompleted by 1 st quarter by BEEs in consulation with State BCCConsultant. Block level IPC and mass media activities to be startedsimultaneously based on behaviour change needed as per DLHS-2findingso Breast feeding, ante-natal care, institutional delivery, immunization andHIV/AIDS in all 05 hilly districts (Target groups- Pregnant women andother women of reproductive age group, opinion leaders)Activity (ii) Other District and Sub-District level BCC activities as per NeedsassessmentStrategy 36.2.12.3 Reinforcement from State level to local specific BCC activities(Responsibility: State BCC Consultant)Activity (i) Printing of leaflets in local dialects based on top-three health behaviourswhich need to be improved (as per needs assessment report) – 1000leaflets per Block (in 2 nd quarter)Activity (ii) Preparation and Erection of 45 bill-boards/hoardings which are localspecific @ 5 per District (in 2 nd quarter)Activity (iii) Publication of attractive Annual Calendar showing season specific healthmessages (in 4 th quarter)Activity (iv) Participation in State level events e.g. display of gate & tableaux duringRepublic Day and Independence Day celebrationManipur State Integrated NRHM PIP 2008-2009 57

Activity (v) Publication of newsletters (quarterly)Activity (vi) Broadcasts/telecasts in DDK, Local TV Channel (ISTV) and AIRo Monthly group discussionso Weekly health talks on prime timeo Tele-film based on Gender equity in ISTVo Spots in ISTVo Radio jinglesActivity (vii) Publications and press releases in local newspapers and other leadingmagazinesActivity (viii) Opening of a BCC Resource Centre at State Mission Headquarters atwhich BCC materials can be made accessible by the District and Sub-District staffs.Budget required:Sl.Activity No. of units Unit rate Total in ResponsibilityNo.lakhs1 Capacity building of State1.00 StateBCC staffs outside State2 Capacity Building of 4 50,000 2.00 StateDistrict BCC staffs atState level3 Capacity Building of Sub- 36 10,000 3.60 DistrictDistrict BCC staffs atDistrict level4 Block level Needs 36 5,000 1.80 DistrictAssessment Survey onBCC5 Block-specific BCC 36 50,000 18.00 Districtactivities6 Printing of leaflets 36,000 2 0.72 State7 Erection of hoardings 45 10,000 4.50 State8 Publication of annual 1000 25 0.25 StateCalendar9 Participation in National/ 2 1,50,000 3.00 StateState events10 Publication of newsletter 4 1,00,000 4.00 State(1000 in numbers)11 Group discussions in 12 20,000 2.40 Statelocal TV channel12 Health talks in AIR 52 2,000 1.04 State13 Tele-film in local ISTV 1 1,00,000 1.00 Statechannel14 ISTV spots 12 7000 0.84 State15 Radio jingles 52 2000 1.04 State16 Radio drama 1 15,000 1.50 State17 DDK spots 10 10,000 1.00 State18 Publication/ press 50 5,000 2.50 Statereleases in newspapers19 Establishment of BCC 1 50,000 0.50 StateResource CentresTotal 50.69Manipur State Integrated NRHM PIP 2008-2009 58

Sl.ActivityNo.1 Capacity building of State BCC staffsoutside State2 Capacity Building of District BCC staffsat State level3 Capacity Building of Sub-District BCCstaffs at District level4 Block level Needs Assessment SurveyTable showing distribution of fund for BCC across districts (Rs. in lakhs)StateDistrictsTotalHdqs. IE IW TBL BPR CDL CCPUKL SPT TML1.00 0 0 0 0 0 0 0 0 0 1.002.00 0 0 0 0 0 0 0 0 0 2.000 0.30 0.30 0.30 0.30 0.40 0.50 0.50 0.60 0.40 3.600 0.15 0.15 0.15 0.15 0.20 0.25 0.25 0.30 0.20 1.80on BCC5 Block-specific BCC activities 0 1.50 1.50 1.50 1.50 2.00 2.50 2.50 3.00 2.00 18.006 Printing of leaflets 0.72 0 0 0 0 0 0 0 0 0 0.727 Erection of hoardings 4.50 0 0 0 0 0 0 0 0 0 4.508 Publication of annual Calendar 0.25 0 0 0 0 0 0 0 0 0 0.259 Participation in National/ State events 3.00 0 0 0 0 0 0 0 0 0 3.0010 Publication of newsletter (1000 in 4.00 0 0 0 0 0 0 0 0 0 4.00numbers)11 Group discussions in local TV channel 2.40 0 0 0 0 0 0 0 0 0 2.4012 Health talks in AIR 1.04 0 0 0 0 0 0 0 0 0 1.0413 Tele-film in local ISTV channel 1.00 0 0 0 0 0 0 0 0 0 1.0014 ISTV spots 0.84 0 0 0 0 0 0 0 0 0 0.8415 Radio jingles 1.04 0 0 0 0 0 0 0 0 0 1.0416 Radio drama 1.50 0 0 0 0 0 0 0 0 0 1.5017 DDK spots 1.00 0 0 0 0 0 0 0 0 0 1.0018 Publication/ press releases innewspapers19 Establishment of BCC ResourceCentres2.50 0 0 0 0 0 0 0 0 0 2.500.50 0 0 0 0 0 0 0 0 0 0.50Total 27.29 1.95 1.95 1.95 1.95 2.60 3.25 3.25 3.90 2.60 50.69Manipur State Integrated NRHM PIP 2008-2009 59

6.2.13 ProcurementObjective:To develop a transparent Procurement policy in the state for RCHimplementationSTRATEGY 16.2.13.1 Procurement of equipmentActivity (i)Activity (ii)Activity (iii)Operationalization of State Procurement Committee which is alreadyformedWorld Bank and MoHFW, GoI guidelines to be followed for anyprocurement process except at times of emergencies, epidemics andother calamitiesDH, CHC, PHC and Sub-Centre equipments: Discussed under relevantHeadingsSTRATEGY 26.2.13.2 Procurement of Drugs and SuppliesIt is proposed that MoHFW, GoI supplies drugs/ medicines and othersupplies in kind. Recently MoU was signed between TNMSC, RRC-NEand State to procure drug/medicine kits from TNMSC. Theconsignment is expected to reach State by April-May 2008. Hence nofurther fund is needed for 2008-09 for procuring of RCH drugs.6.3 Program ManagementObjective:To strengthen the program management at State and district levelsSTRATEGY 16.2.14.1 State Program Management UnitActivity (i)Continuation of the existing contractual services of State ProgramManager, State Finance Manager, State Data Manager, State AccountOfficer and other support staffs viz., State Engineer Consultant, StateHRD cum Training Consultant, State BCC Consultant, StatisticalAssistant, Stenographer, 2 Data entry Cum Analysts are also hired oncontractual basis.Manipur State Integrated NRHM PIP 2008-2009 60

The budgetary support needed (Rs. in lakhs) will be as given below.Sl.No.Particular Unit Budget(Rs. in lakhs)1 Honorarium of SPM @ Rs. 25,000/- p.m. 1 3.002 Honorarium of SFM @ Rs. 23,000/- p.m. 1 2.763 Honorarium of SDM @ Rs. 15,000/- p.m 1 1.805 Honorarium of State Accounts Officer @ Rs. 15,000/- 1 1.80p.m.Total 9.36STRATEGY 26.2.14.2 District Program Management UnitsActivity (i)Activity (ii)Continuation of the contractual services of 09 DPMs, DFM and DDMs.Office rent @ Rs. 3000/- per month per District for Districts not havingoffice buildings of their own viz. UKL, SPT and TMLThe budget requirement is as shown below.Sl.No.Particular Unit Budget(Rs. in lakhs)1 Honorarium of DPM @ Rs. 18,000/- p.m. 9 19.442 Honorarium of DFM @ Rs. 15,000/- p.m. 9 16.203 Honorarium of DDM @ Rs. 12,000/- p.m 9 12.964 Room rent @ Rs. 3000/- per month 3 10.80Total 59.40The District-wise budgetary support needed (Rs. in lakhs) will be as givenbelow.IE IW TBL BPR UKL CDL CCP SPT TML TotalHonorarium 5.40 5.40 5.40 5.40 5.40 5.40 5.40 5.40 5.40 48.60of staffsRoom rent 0 0 0 0 0.36 0 0 0.36 0.36 10.80Total 5.40 5.40 5.40 5.40 5.76 5.40 5.40 5.76 5.76 59.40STRATEGY 36.2.14.3 Other Program Management CostThis will be for Rs. 10.00 lakhs at the State level and Rs. 4.00 lakhseach for the districts.6.2.14.4 Strengthening of Finance Management System ActivitiesActivity (i)State Finance Committee headed by SFM (SPMU) to be formed byconverging with Account staffs of vertical health programs except thoseof MACS and State Cancer Society.Manipur State Integrated NRHM PIP 2008-2009 61

Activity (ii) Adoption of Financial delegation power at State and District level asper MoHFW, GoI guidelinesActivity (iii) Release of fund to Districts within 02 weeks of receiving fund fromMoHFW, GoI and on quarterly basis as Flexi-fund which will be basedon utilization status in DistrictsActivity (iv) FMR from Districts to be submitted to State on quarterly basisActivity (v) Review of Physical and Financial Achievement at State level onmonthly basisActivity (vi) Annual auditing by independent agenciesActivity (vii) Internal and concurrent auditing at District and Sub-District level byState Finance Consultant and State Accounts Officer on quarterly basis6.4 Quality assuranceA State Quality Assurance Committee (SQAC) is already formed following theGoI guidelines. Similarly, Districts under the chairmanship of the District DeputyCommissioner, districts are in the process of forming District Quality AssuranceCommittees (DQAC). It is expected to be completed by end of March 2008. TheseTeams will to look after the quality of care provided for all the services providedunder RCH-II.The claiming of insurance money under Special Contingency Plan for anydeath or complication following Sterilization operations will be the sole responsibilityof the DQACs.6.5 TrainingsVarious trainings of health providers including those of private/ NGO healthproviders are to be taken up in 2008-09. Some training were already initiatedin 2007-08 as per approved State PIP. They are:(i) Skilled Birth Attendance (SBA) training of 36 ANMs as first batch(ii) 2 nd Round Periodic training of 3000 ASHAs covering Module 2,3 4 and5(iii) Re-orientation training of 3000 PRI/ Village Council representatives(iv) IMNCI training for 05 State Trainers(v) Induction training of all newly recruited Block Program ManagementUnit (BPMU) staffs(vi) Capacity Development Training of State Planning Team at RRC,Guwahati(vii) Capacity Building of all District Planning TeamsManipur State Integrated NRHM PIP 2008-2009 62

(viii)(ix)(x)(xi)(xii)(xiii)Capacity Building of all Block Planning TeamsCapacity Development Training of SPMU staffs and State ProgramOfficers at NIHFW, Munirka, New DelhiTraining of Principal, RH & FWTC, Porompat on A-V aids at NIHFW,Munirka, New DelhiTraining of 02 MBBS Doctors on Life-Saving Anesthesia skillsTraining of State Trainer for MBBS Doctors’ training on EmergencyObstetric Care (EmOC)Training of District Teams on operational aspects of IntegratedManagement of Newborn and Childhood Illnesses (IMNCI)The following trainings are to be started in March 2008.(i) 2 nd batch training of ANMs on SBA(ii) IMNCI training of 20 Medical Officers(iii) MBBS Doctors’ training on NSV and Minilap(iv) Training on Blood Storage for MBBS Doctors and LaboratoryOther types of training which are very important and contemplated to be takenup in 2007-08 could not be taken up in time. Hence in the current year thefollowing trainings are to be taken up/ continued.The Comprehensive Training Plan for these various trainings to be taken up in2008-09 is as given below:A. SBA training of ANMs for 28 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches36 360 30 (10batches of12 ANMsper eachof the 03trainingcentre)Place oftrainingRIMS, StateHospital &DH CCPBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 5trainers @ Rs. 400/-per head per day X 28daysHonorarium for 12trainees @ Rs. 200per head per day X 28daysTraining material for12 trainees @ Rs.200per headOverhead expenditure& other contingencies0.56 16.8Totalbudgetfor allbatches(Rs. inlakhs)0.672 20.160.024 0.720.08 2.40Total 1.336 40.08Manipur State Integrated NRHM PIP 2008-2009 63

B. MBBS Doctors’ training on NSV for 5 daysAs cases of NSV are not routinely available in the health facilities, this will betaken up along with holding of NSV Mega-Camps.No.alreadytrainedNo. tobetrainedNo. ofbatches0 28 7 (inbatches of4)Place oftrainingRIMS, JNH,PPP(IMP),DH CCP,DH (TBL),DH (UKL)DH (TML)Budget per batchParticulars Amount(Rs. inlakhs)Honorarium for 1trainer @ Rs. 2000/-per day X 5 daysHonorarium for 4trainees @ Rs. 400per head per day X 5days0.10 0.700.08 0.56Totalbudgetfor allbatches(Rs. inlakhs)Training material 0.12 0.84Overheadexpenditure,refreshment & othercontingencies0.20 1.400.50 3.50C. Training of MBBS Doctors on Minilap for 12 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches25 50 10 (inbatches of5)Place oftrainingRIMS, JNH,DH CCP,DH UKL &DH TMLBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 1trainer @ Rs. 2000/-per day X 12 daysHonorarium for 5trainees @ Rs. 400per head per day X12 daysTraining material(Printing of module,NSV Kits, Gloves,Threads Band-aidetc.)Overheadexpenditure,refreshment & othercontingencies0.12 1.200.24 2.400.10 1.000.20 2.00Totalbudgetfor allbatches(Rs. inlakhs)0.66 6.60Manipur State Integrated NRHM PIP 2008-2009 64

D. MBBS Doctors’ training on Life-Saving Anesthesia Skills for 18 weeksNo.alreadytrainedNo. tobetrainedNo. ofbatches02 04 02 (inbatches of2Place oftrainingBudget per batchParticulars Amount(Rs. inlakhs)RIMS Honorarium for 2trainer @ Rs. 500/-per day X 126 daysHonorarium for 2trainees @ Rs. 200per head per day X126 days1.26 2.52Totalbudgetfor allbatches(Rs. inlakhs)0.504 1.008Training material 0.10 1.00Overheadexpenditure,refreshment & othercontingencies0.20 0.502.064 5.028E. Training of MBBS doctors on Caesarian section for 4 monthsNo.alreadytrainedNo. tobetrainedNo. ofbatches00 04 02 (inbatches of2Place oftrainingRIMS andDH CCPBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 2trainer @ Rs. 500/-per day X 120 daysHonorarium for 2trainees @ Rs. 200per head per day X120 days1.20 2.400.48 0.96Totalbudgetfor allbatches(Rs. inlakhs)Training material 0.10 1.00Overheadexpenditure,refreshment & othercontingencies0.20 0.50One-time fund forinfrastructure upgradationof Rs. 4.00each to 2 trainingcentres8.00 8.009.98 12.86Manipur State Integrated NRHM PIP 2008-2009 65

F. MBBS Doctors’ training on Blood Storage for 5 daysNo.alreadytrainedNo. tobetrained00 16(SMOof allCHCs)No. ofbatches08 (inbatches of2Place oftrainingJNH & DHCCPBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 2trainer @ Rs. 500/-per day X 5 daysHonorarium for 2trainees @ Rs. 200per head per day X 5days0.05 0.400.02 0.16Totalbudgetfor allbatches(Rs. inlakhs)Training material 0.04 0.32Overheadexpenditure,refreshment & othercontingencies0.05 0.400.16 1.28G. Blood Storage training of Lab. Technicians for 5 daysNo.alreadytrainedNo. tobetrained00 16(SMOof allCHCs)No. ofbatches08 (inbatches of2Place oftrainingJNH & DHCCPBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 2trainer @ Rs. 500/-per day X 5 daysHonorarium for 2trainees @ Rs. 200per head per day X 5days0.05 0.400.02 0.16Totalbudgetfor allbatches(Rs. inlakhs)Training material 0.04 0.32Overheadexpenditure,refreshment & othercontingencies0.05 0.400.16 1.28Manipur State Integrated NRHM PIP 2008-2009 66

H. MBBS Doctors training on Manual Vacuum Aspiration (MVA) for 5 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches00 40 20 (inbatches of2)Place oftrainingRIMS, JNH,DH CCP,DH TBL &DH BPR (2batches pertrainingcentre)Budget per batchParticulars Amount(Rs. inlakhs)Honorarium for 2trainers @ Rs. 1000/-per day X 5 daysHonorarium for 2trainees @ Rs. 200per head per day X 5days0.10 2.000.02 0.40Totalbudgetfor allbatches(Rs. inlakhs)Training material 0.05 1.00Overheadexpenditure,refreshment & othercontingencies0.10 2.000.27 5.40I. MBBS Doctors’ training on ARSH for 3 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches24 50 02 (inbatches of25Place oftrainingRH &FWTCBudget per batchParticulars Amount(Rs. inlakhs)Honorarium for 5trainers @ Rs. 500/-per day X 3 daysHonorarium for 25trainees @ Rs. 200per head per day X 3daysTraining material @Rs. 100/- per traineeOverheadexpenditure,refreshment & othercontingencies0.075 0.150.15 0.300.025 0.050.50 1.00Totalbudgetfor allbatches(Rs. inlakhs)0.75 1.50Manipur State Integrated NRHM PIP 2008-2009 67

J. Training of MOs on RTI/STI including HIV/AIDS for 3 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches24 50 02 (inbatches of25Place oftrainingRH &FWTCBudget per batchParticularsHonorarium for 5 trainers@ Rs. 500/- per day X 3daysHonorarium for 25 trainees@ Rs. 200 per head perday X 3 daysTraining material @ Rs.100/- per traineeOverhead expenditure,refreshment & othercontingenciesAmount(Rs. inlakhs)0.075 0.150.15 0.300.025 0.050.50 1.00Totalbudgetfor allbatches(Rs. inlakhs)0.75 1.50K. Training of MOs on IMEP for 2 daysNo.alreadytrainedNo. to betrainedNo. ofbatches00 25 01 (MOs ofDHs andCHCs)Place oftrainingRH &FWTCBudget per batchParticularsHonorarium for 5 trainers @ Rs.500/- per day X2 daysHonorarium for 25 trainees @Rs. 200 per head per day X 2daysTraining material @ Rs. 100/-per trainee for 25 traineesOverhead expenditure,refreshment & othercontingenciesAmount(Rs. inlakhs)0.050.100.0250.100.275L. Teachers on School Health for 02 daysNo.alreadytrainedNo. tobetrainedNo. ofbatches00 120 04 (inbatches of30)Place oftrainingConferenceHall of StateMissionSecretariatBudget per batchParticularsHonorarium for 5 trainers@ Rs. 500/- per day X2daysHonorarium for 30trainees @ Rs. 200 perhead per day X 2 daysTraining material @ Rs.200/- per trainee for 30traineesOverhead expenditure,refreshment & othercontingenciesAmount(Rs. inlakhs)0.05 0.200.12 0.480.06 0.240.10 0.40Totalbudget(Rs. inlakhs)0.33 1.32The State HRD cum Training Consultant will take responsibility for holding allaforementioned trainings on time.Manipur State Integrated NRHM PIP 2008-2009 68

6.6 Gender EquityThe sex ratio in the state is 978, which is much better than the National figure.But the U-6 Sex Ratio is 957 which threaten the figure. To improve the figure, thePre-conception and Pre-natal Diagnostic Techniques Prevention Act, 1991 need tobe strictly enforced in the state.Activity (i)Activity (ii)Activity (iii)Activity (iv)Operationalize PcPNDT Cell:• State Supervisory Board chaired by Minister (Health & FW):Already formed• State Advisory Board chaired by a Sr. Paediatrician: Alreadyformed• State level Appropriate Authority chaired by an Addl. Director:Already formed• Registration of Private Clinics having USG facility: All 21 Clinicsregistered.Orientation of service providers and Program Managers on PcPNDT isto be taken up.Surprise spot-checks to Clinics having USG including use of decoycustomer for sex determinationMonitoring of the activities will be taken up.An annual budgetary support of Rs. 3.00 lakhs will be needed for thiscomponent.6.7 Financial management:Fund from Centre to the State is to be through e-banking system. Suchsystem is yet to develop in the districts as there in no e-banking facility in them. Themoney within 15 days of receipt by the State is to be released to the Districts forprogram implementation. The Districts further will release the money to Sub-districtlevel wherever needed for program implementation within 02 weeks. All the financialencashment at State to Village Health Committees are to be done through jointsignatories.6.8. Convergence/CoordinationSo far convergence/coordination with WCD, Education, PRI, MACS andAYUSH has been established. Coordination with PHED and PWD needs to bestrengthened. Activities needing intervention from the Health determinantDepartments may be highlighted to the concerned Department in the SocietyMeetings at State and District Levels.Manipur State Integrated NRHM PIP 2008-2009 69

6.9 District, block and Village Health plansAll the existing 36 blocks and 09 Districts have submitted their Block andDistrict specific Integrated Health Plans which included RCH-II. From 2009-10onwards it is targeted to start the planning process from village level. A sum of Rs.90.00 lakhs @ Rs. 10.00 lakhs per District will be needed.6.10 Role of State, District and BlockDetails reflected in Work-Plan.6.11 Synergy with NRHM Additional ties:Construction for buildings building-less Sub-centres, PHCs, Up-gradation ofDistrict Hospitals and Community Health Centres to IPHS level, Decentralization ofpower to DHs/CHCs/PHCs by forming Rogi Kalyan Samitis will have synergisticeffect with RCH-II.6.12 Work-plan (Enclosed as ANNEXURE 3d))Manipur State Integrated NRHM PIP 2008-2009 70

7. PROGRAMME MANAGEMENT ARRANGEMENTS7.1. Management Structure at state levelThe management structure at State level is as given below. Various Sub-Committees led by Additional/ Joint Directors are identified, some Sub-Committeesfunctioning directly under State Mission Director and some under the two identifiedAdditional Mission Directors. The same management structure will be continued in2008-09.Principal Secretary (HFW)State Mission DirectorState ProgramManager (SPMU)Addl. Mission Director(I) / Dir. HealthAddl. Mission Director(II) / Dir. FWAddl. Dir. PlanningState DataManager (SPMU)State FinanceManager (SPMU)Addl. Dir. (HRD)Addl. Dir. (IDSP)State AYUSHOfficerAddl. Dir. (InfraStructure)Addl. Dir.(BCC/Gender)Addl. Dir.(Finance)Addl. Dir. (Proc. &Logistics)State AccountManager (SPMU)State SchoolHealth OfficerAddl. Dir. (FamilyPlanning)State NodalOfficer (M&E)State NationalProgram OfficersJoint Dir.(Maternal Health)Joint Dir. (ChildHealth)The SPMU would perform the following roles.A. Planning & Monitoring• Preparation of Planning & Monitoring manual for NRHM/RCH-II which isup-dated on yearly basis.• Disseminate the manual to Districts and Sub-District level• Provide assistance to Districts and Blocks for preparation of Annual HealthAction Plans• Prepare SPIP and obtain approval of MoHFW, Govt. of India• Ensure timely submission of completed and reliable reports from Districts,analyse, compile and submit consolidated Report to MoHFW, Govt. ofIndia• Maintain a up-dated data base• Carry out independent assessment/studiesManipur State Integrated NRHM PIP 2008-2009 71

B. Management of fund• Ensure that funds are released to Districts on time• Ensure that UCs are collected from Districts on time• Submit consolidated Report promptly to MoHFW, Govt. of IndiaC. Financial accounting• Develop accounting manual and train concerned District staffs• Maintain books of accounts• Identify suitable auditing firms and carry out auditsD, Health Sector Reforms• Prepare proposals for new initiatives• Provide assistance in taking forward the new reforms• Facilitate implementationE. Administrative• Secretariat support to State Health Mission and Society• Oversee functional and HR related aspects of DPMU staff and provideassistance.7.2. Management structure at District levelDeputy CommissionerChief Medical OfficerDistrict MissionDirectorDistrict ProgramManagerDFWO / DIODistrict HealthOfficersDistrict DataManager (DPMU)District FinanceManager (DPMU)The key roles of DPMU will be as given below.A. Planning & Monitoring• Review Planning & Monitoring Manual provided by SPMU,discuss and agree with SPMU for any changes, if required• Ensuring preparation of Annual Health Action Plans based onBlock Health Action Plans and obtain approval of District HealthSociety/Mission• Closely monitor progress of implementation in District and Sub-District level• Maintain up-dated District data-baseManipur State Integrated NRHM PIP 2008-2009 72

B. Fund management• Ensure timely release of fund for implementation• Ensure timely submission of UCs from implementing agencies• Monitor release of JSY fundC. Financial Accounting• Maintain books of accounts• Facilitate auditD. Continuous process improvement• Identify priority areas for process improvement & facilitateimplementationE. Administrative• Secretariat function to District Health Mission/ Society7.3. Job descriptions of PMU staffs7.3.1 SPM• Planning & Monitoring• Continuous process improvement• Secretariat support to State Health Mission/Society• Basis for performance appraisalo Up-dated Planning & Monitoring manual in placeo Annual SPIP and DHAPs prepared in timeo Monthly & quarterly Monitoring Reports prepared and analysed before10 th of each montho Number of process improvement proposals prepared & implementedo Number of meetings with DPMU staffo Arrangement of meetings of State Health Mission/ Society madeincluding preparation of agenda notes, recording of minutes.7.3.2 SFM Develop operational manual for management of funds at State, District andfacility level Manage Society funds for implementation including• Overseeing fund disbursement• Ensuring accounting manuals are followed• Preparation of SoE and collecting UCs• Ensuring management audits• Basis for performance-appraisalo Timely disbursement of fumds to Districts, collection of SoEs & FMRand prepare consolidated State FMR Reporto Budget analysis of State, Districts and health facilitieso Timely conduct of auditso Number of suggestions for improved utilization of fundo Quantum of financial utilization7.3.3 State Accounts Manager Maintenance of books of accounts Disbursement of fund to implementing agencies All bank-related activitiesManipur State Integrated NRHM PIP 2008-2009 73

Basis of performance-appraisalo Maintenance of books of accountso Monthly/annual closing of accounts in timeo No outstanding UC from Districtso Number of complaints from implementing agencies without allocatedfundo Number of audit objections7.3.4 SDM Work closely with team entrusted with preparation of Planning & MonitoringManual Up-date data base continuously Compile monthly Physical & Financial Reports and analyze Implement systems for efficient functioning of SMD’s office Basis for performance-appraisal Maintenance of data-base Physical 7 Financial reports compiled in time7.3.5 DPM Planning & Monitoring Financial management/ Accounting District data-base maintenance Continuous process improvement Administrative functions Basis for performance-appraisalo Annual DHAP prepared on timeo Monthly & quarterly Monitoring Reports prepared and analysed before10 th of each montho Number of process improvement proposals prepared & implementedo Arrangement of meetings of State Health Mission/ Society madeincluding preparation of agenda notes, recording of minutes7.3.6 DFM Ensuring timely release of funds to implementing agencies Ensuring submission of UC/ SoE from implementing agencies Maintain books of accounts Facilitate audit Basis for performance-appraisalo Maintenance of books of accountso Monthly/ Yearly closing of accounts in timeo No outstanding UC with the Districto Number of audit objections7.3.7 DDM Maintenance of up-dated district data-base Assist DPM in preparation of monthly progress reports, development ofDHAP, routine monitoring Basis for performance-appraisal• Data-base maintenance• Physical & Financial reports compiledManipur State Integrated NRHM PIP 2008-2009 74

8. BUDGET (Enclosed as AMMEXURES 3c, 3e and 3f)9. MONITORING AND EVALUATIONThe key indicators for monitoring physical progress are already given in 3b.The financial indicators used by the GoI for monitoring Financial Progress of Stateswill be adopted by the State.The New MIES format prepared by GoI is already implemented in the State.Necessary modification in registration is done and printing of formats at variouslevels of reporting is done through the District Societies10. SUSTAINABILITYUser charges are to be maintained at the health facilities wherever RogiKalyan Samitis are formed under NRHM. Also, the state budget allocation is beingincreased from Rs. 9053.58 lakhs (2006-07), Rs. 10455.71 lakhs (2007-08) and Rs.12500.00 lakhs (2008-09) giving a percentage increase of 27.75%, 15.49 % and16.35% respectively in the last 03 years.Manipur State Integrated NRHM PIP 2008-2009 75

Annexure 3aFORMAT FOR SELF-APPRAISAL OF STATE PIP AGAINST APPRAISALCRITERIASl.CriteriaNo.A. Overall1 Has SPIP been reviewed in detail by a singleperson to ensure internal consistency? If yes, bywhom?2 Has a chartered accountant reviewed budget indetail?Remarks (yes/ No)Yes. State Prog. ManagerNo. But reviewed byFinancial Consultant(SPMSU) who is an MBA(Finance)B. Has SPIP spelt out the Prog. Management arrangements already in placeand addl. Steps to be taken (These include)?1 Firming up background & tenure (at least 3years) of key RCH persons at State & Districtlevels including delegation of powers/ NodalOfficers2 Steps to ensure that RCH II is high priority forDistrict Collector/ Deputy Commissioner3 Extent to which SPMSU structure at State,District & Block levels is consistent withexpertise required; job descriptions includingpersonal specifications, delegation of powersand basis of assessment of performance;strategy and time-bound plan for sourcing ofvacancies, if any4 Steps to establish financial management systemincluding fund flow mechanism to districts;accounting manuals, training, auditYes. Key-persons not tobe changed before 3years. Delegation ofpowers doneYes. DC made Chairmanof District Health societiesYes. SPMSU staffssourced as per requiredqualifications. Jobdescriptions given.Delegation of power done.Annual appraisal systemof staffs established. Nomore vacancyYes. FM systemestablished and staffstrained. Auditing systemidentifiedYes. Annual appraisalsystem establishedYes.5 Steps to ensure performance review of DistrictProgram Managers6 Capacity building of Program Management staffat State & District levels7 Steps to ensure/establish quality assurance YesCommittees in Districts8 Step to ensure systems for holistic monitoring Yesagainst SPIP including variance analysisC. Institutional strategies: Has SPIP spelt out steps undertaken for the following1 Have DHAPs been prepared for all Districts? YesHas the approach to incorporating DHAps inSPIP been spelt out?2 Review of HRD practices in order to motivatestaff & increased effectivenessYes. Performance-basedincentive for ANMs,Transfer & Posting Policyfor staffs, Recruitment oflocal-based staffs etc.Manipur State Integrated NRHM PIP 2008-2009 76

Sl.CriteriaNo.3 Strengthening of HMIS with emphasis onimproved decision-making/ initiation of correctiveaction based on timely availability of reliable &relevant information at appropriate levels4 Improved logistics/ management of drugs &supplies to ensure continuous availability ofessential supplies at health facilities5 Development of revised criteria (eg. Travel time,cost, potential patient load, referral arrangementetc.) for location of facilitiesRemarks (yes/ No)Yes. New Revised formatalready in use.Partially. State wantsdrugs supplied in kindfrom Ministry. To bedistributed to healthfacilities according to localneed.Partially. Referralarrangements for CHCs &24/7 PHCs on outsourcingbasis6 Provision of MoU with Districts No. Not required7 Strategy of piloting PPP and social franchising &subsequent scale up8 Functional review of State HFW Dept includingrespective roles of State, District, Block &Community level institutional structures;delegation of powers; organizational emphasisto key functions9 Optimising the utilization of existing healthfacilities/ scope of re-location based on load/utilization, distance/ travel time and costespecially for the poor/ women and taking intoaccount availability of pvt/ NGO run facilities,Attempted for PPP withRIMS & Pvt. Hospitals forprovision of specialistDoctors at FRUsreferral transport arrangement10 Training strategy Yes11 BCC Strategy Yes12 Convergence/ coordination arrangement Yes13 Pro poor strategy Yes. Data segregation,policy for staffs to stay atremote areas included14 IMEP Plan Partially. Only capacitybuilding of State ProgramOfficers15 Sustainability Yes. Retention of userfeesat facility level &increased State HFWbudgetD. Technical strategies1 Separate goals & strategies for IMR, MMR, TFR& ARSH based on evidence and in consonancewith the results of situational analysis2 Steps to ensure availability of anaesthetists &Gynaecologists at FRUsYesYesYesYes.Manipur State Integrated NRHM PIP 2008-2009 77

Sl.CriteriaNo.3 Steps to ensure acceleration of immunizationactivities, ENBC, promotion of breast-feeding,micronutrient supplementation collaborating withICDS4 Steps to increase availability of qualitysterilization services by training more providersor increasing range of sterilization methods5 ARSH plan for provision of ARSH Services andlinkage with SACS6 Strategy and activities for assuring quality ofservice delivery at health facilitiesE. Work plan1 Consistency of work-plan with statedcomponents/ objectives, strategies & activitiesF. Costs/ budgetYesYesYesRemarks (yes/ No)Yes. SQAC, DQACfomation Accreditationsystem (GoI) followed1 Does budget follow prescribed formats? Yes2 Are districts allocated a certain amount/ % of Yestotal allocation as untied?3 Steps to increase absorptive capacity Yes. Quarterly release ofFund to Districts & Sub-Districts; PMU staffs tofacilitate health facilities bygiving supportive fieldsupervisionYesManipur State Integrated NRHM PIP 2008-2009 78

Budget head 07-08(Actualexpenditure)07-08(Actual/estimatedexpenditure)2008-09RCH-II1Q 2Q 3Q 4Q TotalRs. in lakhs %1. Maternal Health(a) JSY 30.04 60 28.69 28.69 28.69 28.72 114.79 5.4 114.79 0 114.79(b) Others 0.87 40 16.82 16.82 16.82 16.82 67.28 3.2 67.28 0 67.28Sub-total 30.91 100 45.51 45.51 45.51 45.54 182.07 8.6 182.07 0 182.072. Child Health 2.15 15 3.625 6.125 3.625 7.25 20.625 0.9 20.625 0 20.6253. Family Planning 0 20 19.85 11.45 11.45 11.45 54.2 2.6 54.2 0 54.24. ARSH 0 15 4.2425 2.7425 2.7425 0.2425 14.7 0.7 14.7 0 14.75. Urban Health 7.95 20 18.99 18.99 18.99 18.99 75.96 3.6 75.96 0 75.966. Tribal Health 3.24 5 2.55 2.55 2.55 2.55 10.2 0.5 10.2 0 10.27. Vulnerable0 0 20.22 2.22 2.22 2.22 26.7 1.3 26.7 0 26.7groups8. Innovations 0 0 52.26 3.48 3.48 3.48 62.7 3 62.7 0 62.79. Infrastructure & 173.31 50 192.76 483.59 272.53 162.34 1111.22 57.6 917.53 193.69 1111.22Human resources10. Institutional0 20 21.62 3.62 3.62 3.62 32.48 1.7 32.48 0 32.48strengthening11. Training 4.76 50 28.401 16.132 19.842 15.348 80.623 3.8 80.623 0 80.62312. BCC 6.97 20 21.745 4.5 19.945 4.5 50.69 2.4 50.69 0 50.6913.PcPNDT 0 3 0.75 0.75 0.75 0.75 3 0.1 3 0 314. DHAP 54 36 90 0 0 0 90 4.3 90 0 9015. Procurement 90 10 0 0 0 0 0 0 0 0 016. Prog.78.94 50 28.69 28.69 28.69 28.69 114.76 5.4 114.76 0 114.76ManagementTotal 452.23 414 551.214 630.35 435.945 306.971 1929.93 100 1736.24 193.69 1929.93NRHMStateshareTotalSummary BudgetANNEXURE 3cManipur State Integrated NRHM PIP 2008-2009 79

ANNUAL WORK PLAN 2008-09ANNEXURE 3dStrategy/ Activity Timeline Responsibility(State/ Dist)Source offund1. Maternal Health 1Q 2Q 3Q 4Q1.1. Operationalize facilities1.1.1. Operationalize DHs/ CHCs as FRUs1.1.1.1. Organize dissemination workshops for FRUDistRCH-IIguidelines1.1.1.2. Prepare plan for operationalization State/ Dist RCH-II/ NRHM1.1.1.3. Monitor progress against plan State/ Dist RCH-II1.1.1.4 Monitor quality of service delivery & utilization State/ Dist RCH-II1.1.2. Operationalize 24/7 PHCs1.1.2.1 Prepare plan for operationalization of 24/7 PHCs Dist RCH-II/ NRHM1.1.2.2. Monitor progress against plan State/ Dist RCH-II1.1.2.3. Monitor quality of service delivery & utilization State/ Dist RCH-II1.1.3. Operationalize safe Abortion Services1.1.3.1. Prepare plan for operationalization RCH-II1.1.3.2. Monitor progress against plan State/ Dist RCH-II1.1.3.3. Monitor quality of service delivery & utilization State/ Dist RCH-II1.1.4. Operationalize RTI/STI Services1.1.4.1. Prepare plan for operationalization RCH-II1.1.4.2. Monitor progress against plan State/ Dist RCH-II1.1.4.3. Monitor quality of service delivery & utilization State/ Dist RCH-II1.1.5. Operationalize Sub-Centres1.1.5.1 Prepare plan for operationalization RCH-II1.1.5.2 Monitor quality of service delivery & utilization State/ Dist RCH-II1.2. Referral transport1.2.1. Prepare & disseminate guidelines for referral transportRCH-IIfor PW & sick children1.2.2. Implementation by Districts Dist NRHMManipur State Integrated NRHM PIP 2008-2009 80

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund1.3. Integrated outreach RCH camps1.3.1. RCH Outreach camps in under-served areas1.3.1.1. Implementation by Districts Dist RCH-II1.3.1.2. Monitor quality of service delivery & utilization State/Dist RCH-II1.3.2. Monthly VH & NDs at AWCs1.3.2.1. Implementation by Districts Dist NRHM1.3.2.1. Monitor quality of service delivery & utilization State/Dist RCH-II1.4. JSY1.4.1. Dissemination of guidelines to Sub-district level RCH-II1.4.2. Implementation by Districts Dist RCH-II1.4.3. Monitor quality & utilization State/ Dist RCH-II1.5. Other strategies/ innovations1.4.2. Performance-based incentive of Addl. ANM at SCs State/ Dist RCH-II1.4.3. Performance-based incentive for trained MBBS Drs. State/ Dist NRHM1.4.4. Establishment of Maternity Waiting Centres State NRHM2. Child Health2.1. IMNCI2.1.1. Prepare operational plan State/ Dist RCH-II2.1.2. Implementation in Districts Dist RCH-II2.1.3. Monitor progress against plan State/ Dist RCH-II2.1.4. Pre-service IMNCI activities in Trg. College/ Schools State2.2. FBNC2.2.1. Prepare & disseminate guidelines State RCH-II2.2.2. Prepare operational plan across districts Dist RCH-II2.2.3. Implementation in districts Dist RCH-II2.2.4. Monitor progress against plan State/Dist RCH-II2.3. HBNC2.3.1. Prepare & disseminate guidelines State RCH-II2.3.2. Prepare operational plan across districts Dist RCH-IIManipur State Integrated NRHM PIP 2008-2009 81

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund2.3.3. Implementation in districts Dist RCH-II2.3.4. Monitor progress against plan State/Dist RCH-II2.4. School Health Program2.4.1. Prepare & disseminate guidelines State RCH-II2.4.2. Prepare operational plan across districts Dist RCH-II2.4.3. Implementation in two identified districts Dist RCH-II2.4.4 Monitor progress & quality of services State/Dist RCH-II2.5. IYCF2.5.1. Prepare & disseminate guidelines State RCH-II2.5.2. Prepare operational plan across districts Dist RCH-II2.5.3. Implementation in districts Dist RCH-II2.5.4. Monitor progress against plan State/Dist RCH-II2.6. Care of sick children & severe malnutrition2.6.1. Prepare & disseminate guidelines State RCH-II2.6.2. Prepare operational plan across districts Dist RCH-II2.6.3 Implementation in districts Dist RCH-II2.6.4 Monitor progress against plan State/Dist RCH-II2.7. Management of Diarrhoea, ARI & Micronutrient Def. State/Dist RCH-II3. Family Planning3.1. Limiting methods3.1.1. Dissemination of manuals on sterilization standards &quality assurance3.1.2. Prepare operational plan for provision of sterilizationManipur State Integrated NRHM PIP 2008-2009 82StateDistRCH-IIRCH-IIservices across districts3.1.3. Implementation of sterilization services by districts Dist RCH-II3.1.3.1. Provide female Sterilization on fixed days at healthfacilities3.1.3.2. Provide NSV services on fixed days at healthfacilitiesDistRCH-II3.1.3.3. Organize Sterilization camps in districts State/Dist RCH-II

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund3.1.4. Accreditation of private providers Dist RCH-II3.1.5. Monitor progress, quality & audit of services throughState/Dist RCH-IIQACs3.2. Spacing methods3.2.1. Prepare operational plan across districts Dist RCH-II3.2.2. Implementation of IUD Services by districts Dist RCH-II3.2.2.1. Provide IUD services at all health facilities Dist RCH-II3.2.2.2. Organize IUD Camps at Districts Dist RCH-II3.2.3. Accreditation of private providers for IUD service Dist RCH-II3.2.4. Social marketing of contraceptives State/Dist RCH-II3.2.4.1. Set up CBD outlets Dist RCH-II3.2.5. Organize Contraceptive Update seminars for healthState RCH-IIproviders3.2.6. Monitor progress, quality and utilization of services State/Dist RCH-II4. ARSH4.1. Adolescent-friendly services4.1.1. Disseminate ARSH guidelines State4.1.2. Prepare operational plan across districts State/Dist4.1.3. Implement ARSH services in districts Dist RCH-II4.1.3.1. Setting up Adol. Clinics at health facilities Dist RCH-II4.1.4. Monitor progress, quality and utilization of services State/Dist RCH-II4.2. Anonymous Question boxes in schools Dist RCH-II5. Urban Health5.1. Urban RCH services5.1.1. Identification of urban areas/ slums5.1.2. Prepare operational plan5.1.3. Implementation of RCH activities Dist RCH-II5.1.3.1. Strengthening of UHCs State/ Dist RCH-II5.1.3.2. Provide RCH Services Dist RCH-IIManipur State Integrated NRHM PIP 2008-2009 83

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund5.1.3.3. Monitor progress, quality and utilization of services State/Dist RCH-II6. Tribal Health6.1. Tribal RCH services6.1.1. Mapping of tribal areas in valley districts6.1.2. Prepare operational plan6.1.3. Implementation of Tribal RCH activities State RCH-II6.1.3.1. Provide RCH services State RCH-II6.1.4. Monitor progress, quality & utilization of services State RCH-II7. Vulnerable Groups7.1. Services for vulnerable groups7.1.1. Mapping of vulnerable groups Dist RCH-II7.1.2. Prepare operational plan Dist RCH-II7.1.3. Implementation of activities Dist RCH-II7.1.3.1. Provide RCH services Dist RCH-II8. Innovations8.1. PNDT and Sex ratio8.1.1. Operationalize PNDT Cell State RCH-II8.1.2. Orientation of Prog. Managers & service providers State RCH-II8.1.3. Monitoring of sex ratio at birth State/Dist RCH-II8.2. PPP8.3. NGO Program State/Dist RCH-II8.3. Weekly Radio Education Prog. For ASHAs State/Dist RCH-II9. Infrastructure & human resources9.1. Contractual staff & services9.1.1. ANMs recruited & in position State/Dist RCH-II9.1.2. LT recruited & in position State/Dist RCH-II9.1.3. GNMs recuited & in position State/Dist RCH-IIManipur State Integrated NRHM PIP 2008-2009 84

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund9.1.4. Specialist Dostors recruited & in position State/Dist RCH-II9.1.5. PHNs recruited & in position State/Dist RCH-II9.1.6. AYUSH Doctors recruited & in position State/Dist RCH-II9.2. Major Civil Works9.2.1. Major Civil Works for FRUs Dist RCH-II/NRHM9.2.2. Major Civil Works for 24/7 PHCs Dist RCH-II9.3. Minor Civil Works9.3.1. Minor Civil Works for FRUs Dist RCH-II9.3.2. Minor Civil Works for 24/7 PHCs Dist RCH-II9.3.3. Minor Civil works for SCs Dist RCH-II9.4. Operationalize IMEP9.4.1. Organize IMEP workshops State RCH-II9.4.2. Prepare operational plan across districts Dist RCH-II9.4.3. Monitor progress against plan State/Dist RCH-II10. Institutional strengthening10.1. Human Resource Development10.1.1. HR Consultant recruited & in position State RCH-II10.1.2. Mapping of human resources State10.1.3. Transfer & cadre structuring policy developed State10.1.4. Performance appraisal & reward system developed State/Dist RCH-II10.1.5. Incentive policy for posting in under-served areas State/Dist RCH-II10.2. Logistic management10.2.1. Identification Nodal Officer Logistic State RCH-II10.2.2. Development of logistic plan & dissemination State RCH-II10.3. Monitoring & Evaluation / HMIS10.3.1. Strengthening of M & E Cell10.3.1.1. M & E Consultant recruited & in position State RCH-II10.3.1.2. Procurement of Computers/ Inter-net connectivity Dist RCH-II10.3.2. Operationalizing new HMIS format10.3.2.1. Review of existing registers State RCH-II10.3.2.2. Printing of new forms, registers State RCH-IIManipur State Integrated NRHM PIP 2008-2009 85

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund10.3.2.3. Trg. of staffs Dist RCH-II11. Training11.1. Strengthening Trg. centres11.1.1. Establishment of GNM Trg schools Dist RCH-II11.2. Development of training packages11.2.1. Translation /Development of training materials State/Dist RCH-II11.2.2. Specialised trg equipment provide State/Dist RCH-II11.3. Maternal Health trg11.3.1. SBA11.3.1.3. Training of ANMs on SBA State/Dist RCH-II11.3.2. EmOC Training11.3.2.1. Setting up of EmOC trg centre11.3.2.2. Trg of MBBS Doctors on EmOC State/Dist RCH-II11.3.3. Life saving Anaesthesia skills trg11.3.3.1. Trg. Of MBBS Doctors State/Dist RCH-II11.3.4. Trg on safe abortion services11.3.4.1. TOT on safe abortion services State/Dist RCH-II11.3.4.2. Trg. Of MBBS Doctors on MVA State/Dist RCH-II11.3.5. RTI/STI Training11.3.5.1. Trg. Of doctors on RTI/STI State RCH-II11.3.5.2. Trg of LTs on RTI/STI State RCH-II11.4. IMEP training11.4.1. IMEP trg for state & district program managers State RCH-II11.5. Child Health Training11.5.1. IMNCI trg (pre & in-service) State RCH-II11.5.1.1. IMNCI trg. For paramedics Dist RCH-II11.5.2 FBNC11.5.3.1. Trg. Of Doctors on FBNC State RCH-II11.5.3.2. Trg. Of paramedics on FBNC Dist RCH-II11.5.3. HBNCManipur State Integrated NRHM PIP 2008-2009 86

Strategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund11.5.4.1. Trg of ASHAs on FBNC Dist RCH-II11.6. Family Planning Training11.6.1. Minilap training11.6.1.1. MOs trg on minilap State RCH-II11.6.2. NSV training State RCH-II11.6.2.1. NSV trg for MOs11.6.3. Contraceptive update training State RCH-II11.7. ARSH11.7.1 ARSH trg for MOs State RCH-II11.7.2 ARSH trg for paramedics Dist RCH-II12. BCC12.1. Strengthening of BCC Cell at State & District12.1.1. BCC Consultant recruited & in place State RCH-II12.2. development of State BCC strategy State/Dist RCH-II12.3. Implementation of BCC strategy12.3.1. BCC activities based on DLHS-2 finding State/ Dist RCH-II12.3.2. BCC activities based on CAN finding State/ Dist RCH-II13. Procurement13.1. Procurement of equipment13.1.1. Procurement of RCH equipments13.1.1.1. For PHCs State RCH-II/NRHM13.1.1.2. For Sub-entres State RCH-II13.1.1.3 For CHCs State NRHM13.1.1.4. For District Hospitals State RCH-II13.2. Procurement of drugs13.2.1. Procurement from TNMSC RRC-NE RCH-II/NRHM14. Program managementManipur State Integrated NRHM PIP 2008-2009 87

14.1. Strengthening of SPMSUStrategy/ Activity Timeline Responsibility Source of1Q 2Q 3Q 4Q (State/ Dist) fund14.1.1. SPMSU staff recruited & in position State RCH-II14.1.2. Office maintenance & mobility support State RCH-II14.2. Strengthening of DPMSU14.2.1. DPMSU staff recruited & in position Dist RCH-II14.2.2. Office maintenance & mobility support Dist RCH-II14.3. Strengthening of Financial Management Systems14.3.1. Formation of State Finance management group State RCH-II/NRHM14.3.2. Audits14.3.2.1. Annual audit State RCH-II14.3.2.2. Concurrent audit State RCH-IIManipur State Integrated NRHM PIP 2008-2009 88

Detailed Budget 2008-09ANNEXURE 3eBudget head1. Maternal health1.1. Operationalisefacilities healthfacilities1.1.1. OperationalizeDHs/CHCs1.1.2. Operationalize24/7 PHCs1.1.3. Operationalizesafe AbortionServices1.1.4. OperationalizeRTI/STI Services1.1.5. OperationalizeSub-Centres1.2. Referraltransport1.3. Integratedoutreach RCHcamps1.3.1. RCH Outreachcamps in underservedareas1.3.1.1.Implementation &monitoring byDistricts1.3.2. Monthly VH &NDs at AWCs1.3.2.1.Implementation byDistricts of monthlyBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual1 DH DH/CHC 0 0 6DH4CHC10 Fund already available20 Functional 0 9 9 0 18 Fund reflected in relevant sections24/7 PHC25 DH/CHC/PHC 0 0 0 20 40 Fund reflected in relevant sections7 DH DH/CHC/PHC391 SCs having 2ANMs34 CHCs/24X7PHCQlyContinuingOutreachRCH camps0 40 40 9 89 0.45 0 18.00 18.00 4.05 40.05391 391 391 391 391 Reflected under Contract staff34 34 34 34 1.80 Reflected under Part B27 27 27 27 108 0.20 5.40 5.40 5.40 5.40 21.60Reflected under Part BRemarksManipur State Integrated NRHM PIP 2008-2009 89

VH & NDsBudget head1.3.2.1. Monitorquality of servicedelivery & utilization1.4. JSY1.4.1. Disseminationof guidelines to Subdistrictlevel1.4.2. Implementationby Districts1.4.2.1. Homedeliveries1.4.2.2. Institutionaldeliveries1.5. Otherstrategies/innovations1.4.2. Performancebasedincentive ofAddl. ANM at SCs1.4.3. Performancebasedincentive fortrained MBBS Drs.1.4.4. MaternityWaiting CentresBaseline/CurrentstatusContinuingDoneUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q TotalannualHome del 974 974 974 976 3898 0.005 Budget reflected separately0 EmOC caseshandled inFRUsInstl. Del 1860 1860 1860 1863 7443 0.007(R);0.006 (U)10 40 50 100 200 0.01 0.10 0.40 0.50 1.00 2.00RemarksReflectedunder PartBBudgetreflectedunderInnovations1.4.5. ASHA scheme BudgetedunderInnovations1.4.6. Maternal DeathAuditingSub-total MaternalHealth excludingJSY0 Maternaldeathsaudited10 40 50 100 200 0.01 0.10 0.40 0.50 1.00 2.00Manipur State Integrated NRHM PIP 2008-2009 90

Sub-total JSY 28.69 28.69 28.69 28.72 114.79Budget head Baseline/ Unit ofPhysical targetRate Financial allocation (Rs. in lakhs)Currentstatusmeasure 1Q 2Q 3Q 4Q Totalannual(Rs./Unit) 1Q 2Q 3Q 4Q Totalannual2. Child Health2.1. IMNCI2.1.1. Implementationin Districts0 No. ofDistricts2.1.2. Monitorprogress against plan2.1.3. Pre-service/inserviceIMNCIactivities in Trg.College/ Schools2.1.3.1. MOs 0 Batches of 20MOs2.1.3.2. Paramedics 0 Batches of 10Paramedics2.2. FBNC2.2.1. Prepare &disseminateguidelines2.2.2. Prepareoperational planacross districts2.2.3. Implementationin districts2.2.4. Monitorprogress against plan2.3. HBNC2.3.1. Prepare &disseminateguidelines2.3.2. Prepareoperational planacross districts2.3.3. Implementationin districts2.3.4. Monitorprogress against plan0 2 0 0 2 Budget reflected in relevant sections1 1 1 2 4 1.00 1.00 1.00 1.00 2.00 5.003 3 3 6 15 0.875 2.625 2.625 2.625 5.25 13.125Done Budget reflected in relevant sectionsDoneOn-goingOn-goingDone Budget reflected in relevant sectionsDoneOn-goingOn-goingRemarksManipur State Integrated NRHM PIP 2008-2009 91

Budget head2.4. School HealthProgram2.4.1. Prepare &disseminateguidelines2.4.2. Prepareoperational planacross districts2.4.3. Implementationin two identifieddistricts2.4.4 Monitorprogress & quality ofservices2.5. IYCF2.5.1. Prepare &disseminateguidelines2.5.2. Prepareoperational planacross districts2.5.3. Implementationin districts2.5.4. Monitorprogress against plan2.6. Care of sickchildren & severemalnutrition2.6.1. Prepare &disseminateguidelines2.6.2. Prepareoperational planacross districts2.6.3 Implementationin districtsBaseline/CurrentstatusDoneUnit ofmeasure2 partially No. ofoperationalDistrictsDoneDoneOn-goingPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual0 2 0 0 2 1.25 0 2.50 0 0 2.50RemarksManipur State Integrated NRHM PIP 2008-2009 92

Budget head2.6.4 Monitorprogress against plan2.7. Management ofDiarrhoea, ARI &Micronutrient Def.Sub-total ChildHealthBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q TotalannualRemarks3. Family Planning3.1. Limitingmethods3.1.1. Disseminationof manuals onsterilization standards& quality assurance3.1.2. Prepareoperational plan forprovision ofsterilization servicesacross districts3.1.3. Implementationof sterilizationservices by districts3.1.3.1. Providefemale Sterilizationon fixed days athealth facilities3.1.3.2. Provide NSVservices on fixeddays at healthfacilities3.1.3.3. OrganizeSterilization camps indistrictsM-6,F-477Procurementof lap partprinting,Supervision,No. ofbeneficiaryM-250;F-500M-250;F-500M-250;F-500M-250;F-5003.1.4. Accreditation of 5 Accr. Pvt. Subject to availabilityM-1000;F-20005.40 1.00 1.00 1.00 8.40BudgetreflectedseparatelyReflectedseparatelyManipur State Integrated NRHM PIP 2008-2009 93

private providersBudget head3.1.5. Monitorprogress, quality &audit of servicesthrough QACs3.2. Spacingmethods3.2.1. Prepareoperational planacross districts3.2.2. Implementationof IUD Services bydistricts3.2.2.1. Provide IUDservices at all healthfacilities3.2.2.2. Organize IUDCamps at Districts3.2.3. Accreditation ofprivate providers forIUD service3.2.4. Socialmarketing ofcontraceptives3.2.4.1. Set up CBDoutlets3.2.5. OrganizeContraceptive Updateseminars for healthproviders3.2.6. Monitorprogress, quality andutilization of servicesBaseline/CurrentstatusprovidersUnit ofmeasure3926 No. ofbeneficiaries7 Accr. Pvt.providresPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)2250 2250 2250 2250 9000 Motivfee-0.0002;Proc IUDset- 0.01Subject to availabilityFinancial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual4.45 0.45 0.45 0.45 5.801 Seminars 0 1 0 1 2 Budget reflected under TrainingRemarksManipur State Integrated NRHM PIP 2008-2009 94

Budget headSub-total FamilyPlanning excludingSterilizationCompensation &NSV CampsBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q TotalannualRemarks4. ARSH4.1. Adolescentfriendlyservices4.1.1. DisseminateARSH guidelines4.1.2. Prepareoperational planacross districts4.1.3. ImplementARSH services indistricts4.1.3.1. Setting upAdol. Clinics at healthfacilities4.1.4. Monitorprogress, quality andutilization of services4.2. AnonymousQuestion boxes inschoolsSub-total ARSH5. Urban Health5.1. Urban RCHservices5.1.1. Identification ofurban areas/ slums7 DH No. of healthfacilitieshavingweekly ARSHClinics0 SchoolshavingoperationalQ. boxesDoneIUD kits 400 0 0 0 400 0.01 4.00 0 0 0 097 97 97 97 97 Drugs @0.100.2425 0.2425 0.2425 0.2425 9.700 500 500 0 1000 0.005 0 2.50 2.50 0 5.00Manipur State Integrated NRHM PIP 2008-2009 95

Budget head5.1.2. Prepareoperational plan5.1.3. Implementationof RCH activities5.1.3.1. Selection &training of urban LWs5.1.3.2.Strengthening ofUHCs5.1.3.3. Provide RCHServices5.1.3.4. Monitorprogress, quality andutilization of servicesBaseline/CurrentstatusDoneUnit ofmeasure8 FunctionalUHCsPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual8 8 8 8 8 2.37 18.99 18.99 18.99 18.99 75.96Remarks6. Tribal Health6.1. Tribal RCHservices6.1.1. Mapping oftribal areas in valleydistricts6.1.2. Prepareoperational plan6.1.3. Implementationof Tribal RCHactivities6.1.3.1. Provide RCHservices6.1.4. Monitorprogress, quality &utilization of servicesSub-total TribalHealth25 Tribal pocketsin valleyareas gettingmonthlyMobileService75 75 75 75 75 2.55 2.55 2.55 2.55 10.20Manipur State Integrated NRHM PIP 2008-2009 96

Budget head Baseline/Currentstatus7. VulnerableGroups7.1. Services forvulnerable groups7.1.1. Mapping of Donevulnerable groups7.1.2. Prepareoperational plan7.1.3. Implementationof activities 07.1.3.1. Provide RCHservicesSub-totalVulnerable GroupsUnit ofmeasureHouseholdsgiven RCHservicesPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual738 738 738 738 738 20.22 2.22 2.22 2.22 26.70Remarks8. Innovations8.1. PNDT and Sexratio8.1.1. Operationalize 1 0.75 0.75 0.75 0.75 3.00PNDT Cell8.1.2. Orientation ofProg. Managers &service providers8.1.3. Monitoring ofsex ratio at birth8.2. PPP8.3. NGO Program 2 MNGOs 0 0 5 0 5 Fund for 3 yrsalreadyreleased toMNGOs8.4. Maternity0 Number of 2 2 2 2 2 5.40 10.70 2.70 2.70 2.70 18.80Waiting Centres8.5. Weekly RadioEducation Prog. ForASHAsSub-totalCentres0 ASHAsavailingRadio Prog3878 3878 3878 3878 3878 39.56 0.78 0.78 0.78 41.90Manipur State Integrated NRHM PIP 2008-2009 97

InnovationsBudget headBaseline/CurrentstatusUnit ofmeasure9. Infrastructure &human resources9.1. Contractualstaff & services9.1.1. ANMs recruited& in position391 Addl. ANMsat SCs9.1.2. GNMs40 Addl. GNMsrecruited & in positionat 24/7 PHCs9.1.3.GNMs at CHCs 54 GNMs atCHCs9.1.4. Doctorsrecruited & in position9.1.5. PHNs recruited& in position9.1.6. Pharma 9 Phrama atCHCs9.1.7. X-Ray Tech 4 X-Ray Techat CHC9.1.8 Lab tech 34 LT at CHC,9.2. Major CivilWorks9.2.1. Major CivilWorks for FRUs9.2.2. Major CivilWorks for 24/7 PHCs9.3. Minor CivilWorks9.3.1. Minor CivilWorks for FRUs9.3.2. Minor CivilWorks for 24/7 PHCsPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual391 391 391 391 391 107.7 107.7 107.7 107.8 428.2936 0 0 0 76 0.72 13.68 13.68 13.68 13.68 54.720 0 0 0 54 0.72 9.72 9.72 9.72 9.72 38.8848 MOs 0 0 0 0 48 1.80 21.60 21.60 21.60 21.60 86.4014 PHN at CHC 0 0 0 0 14 0.84 2.94 2.94 2.94 2.94 11.7624/7 PHCBuildingconstructionof buildinglessMCHHospital0 0 0 0 9 0.72 1.62 1.62 1.62 1.62 6.480 0 0 0 4 0.60 0.60 0.60 0.60 0.60 2.400 0 0 0 34 0.60 5.10 5.10 5.10 5.10 20.400 1 0 0 1 0 180.13 0 0 180.1320 24/7 PHCs 0 9 9 0 18 0 99.20 99.20 0 198.409.3.3. Minor Civil Sub-Centres 0 23 22 0 45 0.50 0 11.50 11.00 0 22.50RemarksManipur State Integrated NRHM PIP 2008-2009 98

works for SCsrepaired9.3.4. Other facilities 30.43 30.43 0 0 60.86Budget head Baseline/ Unit ofPhysical targetRate Financial allocation (Rs. in lakhs) RemarksCurrentstatusmeasure 1Q 2Q 3Q 4Q Totalannual(Rs./Unit) 1Q 2Q 3Q 4Q Totalannual9.4. OperationalizeIMEP9.4.1. Organize IMEPBudget reflected under relevant headingsworkshops9.4.2. Prepareoperational planacross districts9.4.3. Monitorprogress against planSub-totalInfrastructure &Human resources10. Institutionalstrengthening10.1. HumanResourceDevelopment10.1.1. HRConsultant, Eng.Conslt, BCC Conslt,Steno, 2 DECArecruited & inposition, 01 MCS &01 Junior MCS10.1.2. Mapping ofhuman resources10.1.3. Transfer &cadre structuringpolicy developed10.1.4. Performanceappraisal & rewardsystem developed10.1.5. Incentivepolicy for posting inDone 3.62 3.62 3.62 3.62 14.48DoneDoneDevelopedBudgetedunderManipur State Integrated NRHM PIP 2008-2009 99

under-served areas10.2. LogisticmanagementBudget head10.2.1. IdentificationNodal Officer Logistic10.2.2. Developmentof logistic plan &dissemination10.3. Monitoring &Evaluation / HMIS10.3.1. Strengtheningof M & E Cell10.3.1.1. M & EConsultant recruited& in position10.3.1.2.Procurement ofComputers/ Inter-netconnectivity10.3.2.Operationalizing newHMIS format10.3.2.1. Review ofexisting registers10.3.2.2. Printing ofnew forms, registersSub-totalInstitutionalstrengtheningmaternalHealthBaseline/ Unit ofPhysical targetRate Financial allocation (Rs. in lakhs) RemarksCurrentstatusmeasure 1Q 2Q 3Q 4Q Totalannual(Rs./Unit) 1Q 2Q 3Q 4Q TotalannualDone To besupplied inkind by GoIDoneCopies of 8types ofregister600 0 0 0 600 0.03 fora set of 8registers18.00 0 0 0 18.0011. Training11.1. StrengtheningTrg. centresManipur State Integrated NRHM PIP 2008-2009 100

11.1.1. Establishmentof GNM Trg schoolsBudgetedunder PartBBudget head11.2. Developmentof trainingpackages11.2.1. Translation/Development oftraining materials11.2.2. Specialisedtrg equipment provide11.3. MaternalHealth trg11.3.1. SBA11.3.1.3. Training ofANMs on SBA11.3.2. EmOCTraining11.3.2.1. Setting upof EmOC trg centre11.3.2.2. Trg ofMBBS Doctors onEmOC11.3.3. Life savingAnaesthesia skills trg11.3.3.1. Trg. OfMBBS Doctors11.3.4. Trg on safeabortion services11.3.4.1. TOT onsafe abortionservices11.3.4.2. Trg. OfMBBS Doctors onMVABaseline/CurrentstatusUnit ofmeasure36 Batches of 12ANMsPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual7 7 7 8 30 1.336 9.352 9.352 10.688 10.688 40.08Trgcentresset up2 0 0 0 2 4.00 8.00 0 0 02 Batches of 2 1 0 1 0 2 2.43 0 2.43 0 4.862 Batches of 2 1 0 1 0 2 2.064 2.064 0 2.064 0 5.028Done25 Batches of 2 5 5 5 5 20 0.27 1.35 1.35 1.35 1.35 5.40RemarksManipur State Integrated NRHM PIP 2008-2009 101

11.3.5. RTI/STITraining11.3.5.1. Trg. Ofdoctors on RTI/STIBudget head11.3.5.2. Trg of LTson RTI/STI11.3.5.3. Trg of MOson Bl. Storage11.3.5.4. Trg of LTson Bl. Storage11.4. IMEP training11.4.1. IMEP trg forstate & districtprogram managers11.5. Child HealthTraining11.5.1. IMNCI trg (pre& in-service)11.5.1.2. IMNCI trg.For paramedics11.5.2 FBNC11.5.3.1. Trg. OfDoctors on FBNC11.5.3.2. Trg. Ofparamedics on FBNC11.5.3. HBNC11.5.4.1. Trg ofASHAs on FBNC11.6. FamilyPlanning Training11.6.1. Minilaptraining11.6.1.1. MOs trg onminilap11.6.2. NSV training11.6.2.1. NSV trg forMOs24 Batches of 25 1 1 0 0 2 0.75 0.75 0.75 0 0 1.50Baseline/CurrentstatusUnit ofmeasure0 Batches of 8MOs0 Batches of 8MOsPhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual4 4 0 0 8 0.16 0.64 0.64 0 0 1.284 4 0 0 8 0.16 0.64 0.64 0 0 1.280 Batch of 25 1 0 0 0 1 0.275 0.275 0 0 0 0.275Reflected under Child HealthReflected under Child HealthReflected under Child HealthReflected under Child HealthIncluded under ASHA0 Batches of 5 2 2 3 3 10 0.66 1.32 1.32 1.98 1.98 6.6025 Batches of 4 1 2 2 2 7 0.50 0.50 1.00 1.00 1.00 3.50RemarksManipur State Integrated NRHM PIP 2008-2009 102

11.6.3. Contraceptiveupdate trainingBudget head11.7. ARSH11.7.1 ARSH trg forMOs11.7.2 ARSH trg forparamedics11.8 Teachers’ trgon schools HealthSub-total Training12. BCC12.1. Strengtheningof BCC Cell at State& District12.1.1. BCCConsultant recruited& in place12.1.2. Capacitybuilding12.2. developmentof State BCCstrategy throughCNA Survey12.3.Implementation ofBCC strategy12.3.1. BCC activitiesbased on DLHS-2finding & CNA12.3.3. StateactivitiesSub-total BCCBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q Totalannual24 Batches of 25 1 1 0 0 2 0.75 0.75 0.75 0 0 1.500 Batches of 30 1 1 1 1 4 0.33 0.33 0.33 0.33 0.33 1.32DoneBlockssurveyed3.30 0 3.30 0 6.6036 0 0 0 36 0.05 1.80 0 0 0 1.80Blocks 36 36 36 36 36 0.50 4.50 4.50 4.50 4.50 4.50 18.0012.145 0 12.145 0 24.29Remarks13. ProcurementManipur State Integrated NRHM PIP 2008-2009 103

13.1. Procurementof equipment13.1.1. Procurementof RCH equipmentsBudget head13.1.1.1. For PHCs13.1.1.2. For Subentres13.1.1.3 For FRUs13.2. Procurementof drugs13.2.1. Procurementfrom TNMSC byMoHFW, GoISub-totalProcurementBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs)1Q 2Q 3Q 4Q TotalannualAlreadyreflectedRemarksTo besupplied inkind by GoI14. Programmanagement14.1. Strengtheningof SPMSU14.1.1. SPMSU staffrecruited & in position14.1.2. Officemaintenance &mobility support14.2. Strengtheningof DPMSU14.2.1. DPMSU staffrecruited & in position14.2.2. Officemaintenance &1 FunctionalSPMU1 FunctionalSPMU9 FunctionalDPMUs9 FunctionalDPMUsmobility support14.3. Strengtheningof FinancialManagementSystems14.3.1. Formation of 0 FM Group 14 4 4 4 4 2.34 2.34 2.34 2.34 9.361 1 1 1 1 2.50 2.50 2.50 2.50 10.009 9 9 9 9 14.85 14.85 14.85 14.85 59.409 9 9 9 9 9.00 9.00 9.00 9.00 36.00Manipur State Integrated NRHM PIP 2008-2009 104

State Financemanagement group14.3.2. AuditsBudget headBaseline/CurrentstatusUnit ofmeasurePhysical target1Q 2Q 3Q 4Q TotalannualRate(Rs./Unit)Financial allocation (Rs. in lakhs) Remarks1Q 2Q 3Q 4Q TotalannualTo be borne from Program Management Head14.3.2.1. Annualaudit14.3.2.2. ConcurrentauditSub-total Prog.Management15. DHAP 9 10.00 90.00 0 0 0 0 90.00Total RCH-IIflexipoolTotal JSY 28.69 28.69 28.72 114.79SterilizationCompensationM-6,F-477No. ofbeneficiaryM-250;F-500M-250;F-500M-250;F-500M-250;F-500M-1000;F-2000M-0.015;F-0.017.50 7.50 7.50 7.50 30.00Total NSV Camp 0 NSV Camp 5 5 5 5 20 0.50 2.50 2.50 2.50 2.50 10.00GRAND TOTALManipur State Integrated NRHM PIP 2008-2009 105

The District-wise allocation of budgets (Rs. in lakhs) is shown below.Annexure 3fSl.No.ParticularStateHdqDistrictsIE IW TBL BPR UKL CDL CCP SPT TML1 Maternal Healthexcluding JSYRTI/STI 0 5.85 4.5 7.65 3.15 3.15 1.8 4.5 6.3 3.15 40.05 0 40.05Rent for SCs 0 0.36 0.36 0.33 0.33 0.54 0.15 0.57 0.72 0.27 3.63 0 3.63RCH Out-reach 0 2.40 2.40 2.40 2.40 2.40 2.40 2.40 2.40 2.40 21.60 0 21.60campsMaternal Death 2.00 0 0 0 0 0 0 0 0 0 2.00 0 2.00Audit2 JSY 0 20.19 21.21 17.38 10.73 6.72 6.98 10.91 15.32 5.35 114.79 0 114.794 Child Health 0 0 0 0 0 0 0 0 0 0 0 0 0IMNCI 5.00 0 4.375 0 4.375 0 0 4.375 0 0 18.125 0 18.125School Health 2.50 0 0 0 0 0 0 0 0 0 2.50 0 2.505 Family Planning 9.70 6.50 6.50 3.50 3.50 4.00 4.00 8.50 4.00 4.00 54.20 0 54.206 Adolescence 0 0 0 0 0 0 0 0 0 0 0 0 0HealthARSH Clinics 0 1.30 1.0 1.80 0.80 0.08 0.60 1.50 1.10 0.80 9.70 0 9.70School-basedAnonymous Q.boxes0 0.75 0.75 0.50 0.50 0.50 0.50 0.50 0.50 0.50 5.00 0 5.007 Urban Health 6.20 26.16 8.72 17.44 0 0 8.72 8.72 0 0 75.96 0 75.968 Tribal Health 10.20 0 0 0 0 0 0 0 0 0 10.20 0 10.209 Vulnerable0 0 0 0 26.70 0 0 0 0 0 26.70 0 26.70Groups10 Innovations 0 0 0 0 0 0 0 0 0 0 0 0 0Maternity Waiting 18.80 0 0 0 0 0 0 0 0 0 18.80 0 18.80CentresRadio Program 3.12 4.31 3.29 3.65 2.35 3.02 5.50 6.27 7.87 2.52 41.90 0 41.90for ASHAsPerformancebasedincentiveof MOs trained inCEMOC/ Anes2.00 0 0 0 0 0 0 0 0 0 2.00 0 2.00Manipur State Integrated NRHM PIP 2008-2009 106GoIshareStateshareTotal

Sl.No.ParticularStateHdqDistrictsIE IW TBL BPR UKL CDL CCP SPT TML11 Infrastructure & 0 0 0 0 0 0 0 0 0 0 0 0 0contractual staffMajor Civil works 0 0 180.13 0 0 0 0 0 0 0 180.13 0 180.13Up-gradation for 0 20.00 20.00 20.00 21.00 23.00 23.00 23.80 23.80 23.80 198.40 0 198.4024/7 PHCsRepair of Sub- 0 1.00 1.00 1.50 2.00 3.00 2.50 4.00 4.00 3.50 22.50 0 22.50CentresAdd-on facilities 0 0.12 0.12 9.01 8.98 8.92 8.95 6.92 8.92 8.92 60.86 0 60.86Addl. GNMs in 0 5.76 5.76 7.20 5.76 5.76 7.20 5.76 5.76 5.76 54.72 0 54.7224/7 PHCsAddl. ANMs at 0 52.58 48.18 51.48 35.05 70.10 66.80 42.74 28.50 32.86 234.60 193.69 428.29SCsDoctors at CHCs 0 14.40 10.80 14.40 9.00 7.20 0 9.00 14.40 7.20 86.40 0 86.40PHN at CHCs 0 1.68 1.68 2.52 1.68 0.84 0 0.84 1.68 0.84 11.76 0 11.76GNMs at CHCs 0 5.04 7.20 7.92 5.76 3.60 0 2.88 2.88 3.60 38.88 0 38.88Pharma at CHCs 0 0 1.44 2.16 1.44 0.72 0 0 0.72 0 6.48 0 6.48X-Ray Tech 0 0 1.20 0.60 0.60 0 0 0 0 0 2.40 0 2.40Lab Techs 0 2.40 2.40 3.60 2.40 1.80 1.80 1.80 2.40 1.80 20.40 0 20.4012 Institutional0 0 0 0 0 0 0 0 0 0 0 0 0strengtheningHRD 14.48 0 0 0 0 0 0 0 0 0 14.48 0 14.48Printing of HFW 18.00 0 0 0 0 0 0 0 0 0 18.00 0 18.00Registers13 BCC 27.29 1.95 1.95 1.95 1.95 3.25 2.60 3.25 3.90 2.60 50.69 0 50.6915 Trainings 0 0 0 0 0 0 0 0 0 0 0 0 0SBA training for 26.72 0 0 0 0 0 0 13.36 0 0 40.08 0 40.08ANMMOs trg on NSV 3.50 0 0 0 0 0 0 0 0 0 3.50 0 3.50MOs trg on6.60 0 0 0 0 0 0 0 0 0 6.60 0 6.60MinilapMOs trg on 5.028 0 0 0 0 0 0 0 0 0 5.028 0 5.028AnesthesiaMOs trg on 12.86 0 0 0 0 0 0 0 0 0 12.86 0 12.86CEmocMOs trg on Bl.Storage1.28 0 0 0 0 0 0 0 0 0 1.28 0 1.28Manipur State Integrated NRHM PIP 2008-2009 107GoIshareStateshareTotal

Sl.No.ParticularStateHdqDistrictsIE IW TBL BPR UKL CDL CCP SPT TMLLT trg on Bl. 1.28 0 0 0 0 0 0 0 0 0 1.28 0 1.28StorageMOs trg on MVA 5.40 0 0 0 0 0 0 0 0 0 5.40 0 5.40MOs trg on ARSH 1.50 0 0 0 0 0 0 0 0 0 1.50 0 1.50MOs trg on1.50 0 0 0 0 0 0 0 0 0 1.50 0 1.50RTI/STIMOs trg on IMEP 0.275 0 0 0 0 0 0 0 0 0 0.275 0 0.275Trg of Schoolteachers1.32 0 0 0 0 0 0 0 0 0 1.32 0 1.3216 PcPNDT 3.00 0 0 0 0 0 0 0 0 0 3.00 0 3.0017 District, Block &Village HealthPlan Preparation0 10.00 10.00 10.00 10.00 10.00 10.00 10.00 10.00 10.00 90.00 0 90.0014 ProgramManagementHonorarium ofSPMU staffsHonorarium ofDPMU staffs &office rentOther ProgramManagementCostGoIshareStateshare0 0 0 0 0 0 0 0 0 0 0 0 09.36 0 0 0 0 0 0 0 0 0 9.36 0 9.360 5.40 5.40 5.40 5.40 5.76 5.40 5.40 5.76 5.76 59.40 0 59.4010.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 46.00 0 46.00Total 208.913 192.15 354.365 196.39 169.855 168.36 162.9 181.995 154.93 129.63 1736.238 193.69 1929.928TotalManipur State Integrated NRHM PIP 2008-2009 108

ANNEXURE- 4VERBAL AUTOPSY PRO FORMA FOR MATERNAL DEATHSName of Data collector with designation:Date of data collectionInformant’s name with relation to deceased:……………………………..…………………………….……………………………..1. General description1.1 Name of deceased: …………………………………………..1.2 Name of husband : …………………………………………..1.3 Household No.: …………………………………………..1.4 Village : …………… 1.5 Block: ……………. 1.6 District: ………….1.7 Date of death: ……………………….1.8 Age (in completed years) at death: ……………………..1.9 If already delivered, date of delivery: ……………………..1.10 If not delivered, week of gestation when death took place: ………… week2. Obstetric history2.1 Parity: …………………2.2 Gravidae: …………………2.3 LMP: …………………2.4 EDD: …………………2.5 Details of past deliveriesOrder ofbirth12345678Gestationalage inweeksMode ofdelivery (NVD/Assisted/ CS)PlaceofdeliveryDate &time ofdeliveryDetails of complications(if any)3. Ante-natal care3.1 Received AN care? Yes/ No/ Not knownIf yes,3.1.1 From whom? MO/ANM/FHS/Dai/ Others3.1.2 Where? …………………………….3.1.3 How many times? …………………………….3.1.4 Were IFA tablets taken? Yes/ No/ Not knownIf yes,3.1.4.1 For how many months? ……………………3.1.5 Were TT given? Yes/ No/ Not knownIf yes,3.1.5.1 How many doses? ……………………3.1.6 Any investigations done? Yes/ No/ not knownIf yes,3.1.6.1 Details (if ANC card is available, details to berecorded from it) …………………….Manipur State Integrated NRHM PIP 2008-2009 109

3.2 Any high-risk factor detected during ANC? Yes/ No/ Not knownIf yes,3.2.1 By whom? MO/ANM/FHS/Dai/ Others3.2.2 At what week of gestation? ………………………3.2.3 What was the risk factor? ………………………3.3 Was there any referral? Yes/ No/ Not knownIf yes,3.3.1 By whom?3.3.2 Where to?3.3.3 Was the woman taken to the referral centre? Yes/ No/ Not knownIf yes,3.3.3.1 What was the mode of journey? ……………3.3.3.2 Time taken to reach the referral centre ……………3.3.3.3 Time taken between arrival and start of treatment ………If not taken for referral,3.3.3.4 Why not? ……………………………………………4. For deaths associated with abortion/MTP4.1 Week of gestation of abortion/ MTP ………………………..4.2 Type of abortion Induced/ SpontaneousIf induced,4.2.1 By whom? ………………………..4.2.2 Where performed? ………………………..4.2.3 Date of abortion/ MTP ………………………..4.2.4 Process of abortion, If known ……………………………4.2.5 Was there any complications? Yes/ No/ Not knownIf yes,4.2.5.1 Details of complications ………………………..4.2.6 Any referral made? Yes/ No/ Not knownIf yes,4.2.6.1 By whom?4.2.6.2 Where to?4.2.6.3 Was the woman taken to the referral centre? Yes/No/Not knownIf yes,4.2.6.3.1 What was the mode of journey? ……….…4.2.6.3.2 Time taken to reach the referral centre ..…4.2.6.3.3 Time taken between arrival and start oftreatment ………If not taken for referral,4.2.6.3.4 Why not? ………………………………5. For ante-partum deaths5.1 Was the woman visibly pale? Yes/ No/ Not known5.2 Did she complain of breathing difficulty? Yes/ No/ Not known5.3 Was the legs swollen? Yes/ No/ Not known5.4 Was her BP high or reported to be high? Yes/ No/ Not known5.5 Was there any convulsion? Yes/ No/ Not known5.6 Was there any bleeding PV? Yes/ No/ Not knownIf yes,5.6.1 At what week of gestation? ……………………..5.6.2 How many hours before delivery? ……………….Manipur State Integrated NRHM PIP 2008-2009 110

5.6.3 For how many days? ……………….5.6.4 What was the amount? Scanty/ medium/ excessive/ Not known5.6.5 Any preceding abdominal trauma? Yes/ No/ Not known5.6.6 Any associated pain abdomen? Yes/ No/ Not known5.6.7 Any associated fever? Yes/ No/ Not known5.6.8 Any associated cold sweating? Yes/ No/ Not known5.7 Was there any induction of labour? Yes/ No/ Not knownIf yes,5.7.1 By whom? ………………..5.7.2 Where? ………………..5.7.3 How? ………………..5.7.4 What was the outcome? Baby delivered normally/ motherhad sudden abdominal painfollowed by shock/ CS/Others (specify)5.8 Was there any referral ? Yes/ No/ Not knownIf yes,5.8.1 By whom?5.8.2 Where to?5.8.3 Was the woman taken to the referral centre? Yes/No/Not knownIf yes,5.8.3.1 What was the mode of journey? ……….…5.8.3.2 Time taken to reach the referral centre ..…5.8.3.3 Time taken between arrival and start oftreatment ………If not taken for referral,5.8.3.4 Why not? ………………………………6. For post-partum deaths6.1 What was the duration of labour? ………………………6.2 Presentation of baby? ………………………6.3 Type of delivery? NVD/ Assisted/ Em CS/ Elective CS6.4 Who attended the delivery? ………………………6.5 Place of delivery? ………………………6.6 Was clean gloves used? Yes/ No/ Not known6.7 Was there massive PV bleeding? Yes/ No/ Not known6.8 Was there cold sweating? Yes/ No/ Not known6.9 Was there retention of placenta? Yes/ No/ Not known6.10 Was there injury/ tear in perineal area? Yes/ No/ Not known6.11 Any s/s of septicaemia e.g. shock with bounding pulse?Yes/ No/ Not known6.12 Any s/s of peritonitis e.g., generalised pain abdomen with fever?Yes/ No/ Not known6.13 Details of any other complications, If any ………………………..Yes/ No/ Not known6.14 Was there any referral?If yes,6.14.1 By whom?6.14.2 Where to?6.14.3 Was the woman taken to the referral centre? Yes/No/Not knownManipur State Integrated NRHM PIP 2008-2009 111

If yes,6.14.3.1 What was the mode of journey? ……….…6.14.3.2 Time taken to reach the referral centre ..…6.14.3.3 Time taken between arrival and start oftreatment ………If not taken for referral,6.14.3.4 Why not? ………………………………7. Probable cause of death ………………………………………………………8. Corrective Measures that could have saved the woman’s life8.1 At family level ………………………………………………………………….8.2 At community level ……………………………………………………………8.3 At health facility level …………………………………………………………Signature of data collectorOfficial seal………….Manipur State Integrated NRHM PIP 2008-2009 112

Manipur State Integrated NRHM PIP 2008-2009 113

1. Village Health & Sanitation Committees:During 2007-08, 2004 Village Health & Sanitation Committees were formed out oftargeted 2391 Committees based on Census village. This year so as to provide equitablefacilities to the hamlets which are marginalized communities VHSCs will be formed at thelevel of all villages and hamlets. The proposed number VHSCs to be formed and fundneeded as untied fund (@ Rs. 10,000/- per VHSC) in the current year as given below.Sl. No.DistrictNumber of VHSCs Untied Fund neededproposed(Rs. in lakhs)1 Imphal West 249 24.902 Senapati 615 61.503 Ukhrul 339 33.904 Chandel 350 35.005 Bishnupur 155 15.506 Imphal East 204 20.407 Tamenglong 208 20.808 Churachandpur 558 55.809 Thoubal 525 52.503203 320.30The District-wise and VHSC-wise fund will be released to the Districts and VHSCsbased on the utilization status in last year so that the fund released to the VHSCs willbecome Rs. 10,000/- taking into account of the balance Untied Fund.2. Observation of Village Health & Nutrition DaysIt is targeted to observe Monthly Health & Nutrition Days on fixed day, fixed place basisat all the villages and hamlets which will be based on the 4501 existing Anganadi Centreswhere the ANM of the Sub-Centre along with the local ASHA, AWW and other members ofthe Village Health & Sanitation Committee has to provide integrated health care services.For site arrangement as well as for arranging refreshments a sum of Rs. 100/- per VHNDmay be sanctioned. An amount of Rs. 54.012 lakhs will be needed for this, the District-wiseallocation (Rs. in lakhs being as shown below.District IE IW TBL BPR UKL CCP SPT TML CDL TotalExistingAWC680 537 637 384 339 537 556 298 533 4501Budget 8.16 6.444 7.644 4.608 4.068 6.444 6.672 3.576 6.396 54.0123. Subcentres strengthened to IPHS by provision of additionalANMs:Regular ANMs are placed in all the existing 391 Sub-Centres by rationalization ofposting. In addition Additional contractual ANMs are placed, one in each of the Sub-Centres.An initiative of paying honorarium based on performance to Additional contractualANMs posted in the Sub-Centres will be started in 2008-09 as trial phase. If successful thesame mechanism will be replicated to the other contractual staffs from 2009-10 onwards.The budget requirement is reflected under Part “A”.Manipur State Integrated NRHM PIP 2008-2009 114

4. PHCs strengthened with 3 GNMs per PHC for running on 24/7basis:20 PHCs have already been up-graded to function as 24/7 Services Centre. And 02Additional Staff Nurses are already recruited on contractual basis. In 2008-09 another 18PHCs @ 2 PHCs per District will be up-graded to 24/7 Servoce Centres. These Centres willbe identified according to case load, accessibility and infrastructure availability. Districts inthe hilly districts where the health service care is poorer will be given priority duringidentification of the 24/7 Service Centres.36 more Additional GNMs in addition to the existing 40 GNMs will be recruited in thecurrent year.The budget requirement for paying the honorarium of these 76 GNMs is reflectedunder Part “A”.5. Manpower strengthening of CHCs to IPHS level:This is discussed under Part A6. Strengthening of District HospitalsAn amount of Rs. 200.00 lakhs was sanctioned last year for up-grading 02 DistrictHospitals to IPHS level @ Rs. 100.00 Lakh per District Hospital. Estimates based on FacilitySurvey Report are worked out for up-grading (i) DH Bishnupur and (ii) DH Churanchandpur.The up-grading process has started under the guidance of the Rogi Kalyan Samiticoncerned. Up-gradation of other District Hospitals will be taken up only when these worksare completing. The total budget needed for up-grading infrastructure of these two DistrictHospitals to IPHS level is as shown below.Sl.No.Works/ActivityQty.1. DH BishnupurUnit Ratein Rs.Amountin Rs.1Extension of 20 bedded Wardwith separate Gents’ and Ladies’ 1 4474836.00 4474836.00Toilet2 Construction of a 6 Seater Toilet 2 409412.00 818824.003 Construction of septic Tank 2 100000.00 200000.00Construction of Water Supply4System1 600000.00 600000.005 Construction of T- IV Quarters 5 1013377.00 5066885.006 Construction of T- III Quarters 5 759689.00 3798445.007 Construction of T- II Quarters 4 558236.00 2232944.008 Compound fencing 1744800.00Sub-Total A 18936734.00Manipur State Integrated NRHM PIP 2008-2009 115

Sl.No.Works/ActivityQty.2. DH ChrachandpurUnit Ratein Rs.Amountin Rs.Construction of Hospital Waste1management Pit1 250000.00 250000.002 Construction of a 6 Seater Toilet 2 443529.52 887059.043 Construction of septic Tank 2 100000.00 200000.00Construction of Water Supply4System1 600000.00 600000.005 Construction of T- IV Quarters 5 1097825.00 5489125.006 Construction of T- III Quarters 5 822997.00 4114985.007 Construction of T- II Quarters 5 604754.00 3023770.00Sub-Total B 14564939.04Grand Total (A + B) 33501673.047. Rogi Kalyan Samitis at District Hospitals/CHCs/PHCs:All the existing State Hospital, 07 DHs, 01 Sub-District Hospital (Moreh), 16 CHCsand 72 PHCs have registered RKS formed with their own bank accounts opened. TheCorpus Fund/ Seed Money (Rs. in lakhs) needed for these various RKS for 2008-09 is asshown below. The Corpus Fund will be released to the various health facilities taking intoaccount of the amount utilized in last year.Health Facility Unit Corpus No. of units Total RemarksfundamountState Hospital 5.00 1 5.00 State is givinganother Rs.50.00 lakhs asCorpus FundDistrict Hospitals 5.00 7 35.00Sub-District Hospital 1.00 1 1.00CHCs 1.00 16 16.00PHCs 1.00 72 72.00Total 129.00The District-wise fund allocation (Rs. in lakhs) will be as given below.No. ofStateHospNo. ofDHNo. ofSDHNo. ofCHCsNo. ofPHCsNRHMshareStateshareIE IW TBL BPR CCP UKL CDL SPT TML Total1 0 0 0 0 0 0 0 0 10 0 1 1 1 1 1 1 1 70 0 0 0 0 0 1 0 0 12 2 5 2 1 1 0 2 1 1611 8 12 5 9 6 3 12 6 7218.00 10.00 22.00 12.00 15.00 12.00 9.00 19.00 12.00 129.0050.00 0 0 0 0 0 0 0 0 50.0068.00 10.00 22.00 12.00 15.00 12.00 9.00 19.00 12.00 179.00Manipur State Integrated NRHM PIP 2008-2009 116

8. Maintenance Grant for CHCs, PHCs and Sub-CentresThe budget requirement for 2008-09 will be:Sl. No.Type of Health Untied Fund perTotalUnitsFacilityUnit (in lakhs)(in lakhs)1 Urban Hosp. Moreh 1.00 1 1.002 CHCs 1.00 16 16.003 PHCs 0.50 72 36.004 Subcentres 0.10 391 39.10Total 92.10The District-wise allocation will be as given below:9. Annual Untied Fund for CHCs, PHCs and Subcentres:The budget requirement (Rs. in lakhs) in 2008-09 will beSl. No.Type of Health Untied Fund perTotalUnitsFacilityUnit (in lakhs)(in lakhs)1 Urban Hosp. Moreh 0.50 1 0.502 CHCs 0.50 16 8.003 PHCs 0.25 72 18.004 Subcentres 0.10 391 39.10Total 65.60The District-wise allocation will be as given below:IE IW TBL BPR CCP UKL CDL SPT TML TotalNo. ofSDH0 0 0 0 0 0 1 0 0 1No. ofCHCs2 2 5 2 1 1 0 2 1 16No. ofPHCs11 8 12 5 9 6 3 12 6 72No. ofSub- 44 48 47 32 64 39 26 61 30 391CentresTotal 11.90 10.80 15.70 7.70 11.90 7.90 5.10 14.10 7.00 92.10IE IW TBL BPR CCP UKL CDL SPT TML TotalNo. ofSDH0 0 0 0 0 0 1 0 0 1No. ofCHCs2 2 5 2 1 1 0 2 1 16No. ofPHCs11 8 12 5 9 6 3 12 6 72No. ofSub- 44 48 47 32 64 39 26 61 30 391CentresTotal 9.15 7.80 9.20 5.45 9.15 5.90 3.85 10.10 5.00 65.60Manipur State Integrated NRHM PIP 2008-2009 117

10. Community monitoring:Re-orientation programs on NRHM were held in last year for representatives of PRIand Village Councils so that the communities are aware of their roles and responsibilities inNRHM.Community monitoring will be started in the current year which will be based onaffirming the performance of the Additional ANMs posted in the Sub-Centres for calculatingthe performance-based incentive to be given to them. Also the Village level HealthCommittees will maintain register for observation of monthly Village Health & Nutrition Days.11. Procurement and logistics:Rs. 160.00 Lakhs was received by the State for procurement of Drug/Medicine Kitsfor the various health institutions in 2006-07. For the last two years no drugs/ medicine couldbe procured due to lateral pressures except for AYUSH Drugs worth Rs. 6.83 Lakh. Hence,intervention from the Ministry of Health & Family Welfare, Govt. of India was sought. ByFebruary of 2008 an MoU was signed between TNMSC, RRC (NE) and the State forprocuring the drugs/medicines from TNMSC. The drugs/ medicines are expected to come tothe State by May/ June 2008. Hence, no extra fund will be needed for 2008-09.12. Equipping of CHCs, PHCs and Sub-Centres:All CHCs identified for up-gradation to IPHS level have been equipped with basicequipments in last year.The PHCs still lack in basic equipments. Based on the Facility Survey Reports of thePHCs the following equipments need to be procured.All existing Sub-Centres have been provided with Bag & Mask and Mucus Extractors.As per Facility Survey Report of the Sub-Centres it was found that the Normal Delivery Kitsin all the Sub-Centres are either not existent or are not in working order. Hence NormalDelivery Kits need to be procured and supplied to the Sub-Centres.The budgetary support (Rs. in lakhs) needed for equipping the PHCs and Sub-Centres @ Rs. 2.00 Lakhs per PHC and Rs. 0.03 per Sub-Centre will beIE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofPHCs11 8 12 5 9 6 3 12 6 72No. ofSub- 44 48 47 32 64 39 26 61 30 391CentresBudget 23.32 17.44 25.41 10.96 19.92 13.17 6.78 25.83 12.90 155.73Manipur State Integrated NRHM PIP 2008-2009 118

13. District Mobile Medical Units (DMMU):Mobile Medical Units each unit comprising of 02 vehicles equipped with diagnosticand therapeutic accessories are in operation in all the existing 09 Districts of the State. Theyare attached to the respective District Hospitals. For smooth functioning of these vehicles inthe districts additional manpower in terms of Lab technician, x ray technician and drivers willbe hired in contract.It is proposed that the honorarium of lab -Tech and X – Ray Technician each of the09 districts @Rs.5000/- per month and for each of vehicles, 18 drivers @ Rs. 4,000/- beprovided.Also an annual maintenance fund including POL may be sanctioned @ Rs.1.00 Lakhfor plain districts and Rs. 1.50 Lakhs for hill districts.The Budget requirement (Rs. in lakhs) for supporting the salary component of theseLab tech, X Ray Tech. and drivers is shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalSalary forLT, XT & 5.04 5.04 5.04 5.04 5.04 5.04 5.04 5.04 5.04 45.36DriversPOL &maintenance1.00 1.00 1.00 1.00 1.50 1.50 1.50 1.50 1.50 11.50Total 6.04 6.04 6.04 6.04 6.54 6.54 6.54 6.54 6.54 56.8614. BLOCK MOBILE MEDICAL UNITS (MMUs)As the DMMUs are functioning by attaching to the respective District Hospitals,in2008-09, it is proposed to establish similar units in (i) Khengjoy Block of Chandel District (ii)Thanlon Sub-Division of Churachandpur District (iii) Laii Sub-Division of Senapati District (iv)Kasom Khullen Sub-Division of Ukhrul District (v) Tousem Sub-Division of TamenglongDistrict and (vi) Jiribam Sub-Division of Imphal East District which are very much isolatedfrom the District Headquarters and as such are very difficult to be covered by the DistrictMobile Medical Units. These units will be attached to the CHC/ Block PHC available there.As District Mobile Medical Units supplied by Speck Systems Ltd., New Delhi warefound to be satisfactory similar units will be procured from the same agency. The amountrequired for procuring these Block Mobile Medical Units @ Rs. 43.00 Lakh per unit will beRs. 258.00 Lakhs.The District-wise budget allocation (Rs. in lakhs) is as shown below.IE IW TBL BPR UKL CDL CCP SPT TML Total43.00 0 0 0 43.00 43.00 43.00 43.00 43.00 258.0015. Mainstreaming AYUSH:34 AYUSH Doctors including Specialist AYUSH Doctors and 34 AYUSH Pharmacistsare recruited on contractual basis in 2006-07 and posted in 14 functioning CHCs and 20PHCs to be up-graded as 24/7 centres. Again in 2008-09 another 40 more AYUSH Doctorswere placed in another 40 strategic PHCs. The services of these 74 AYUSH Doctors will becontinued in 2008-09, also.The services of 34 AYUSH Pharmacists were also utilized in these health facilities.As the State is not in a position to appoint them on regular basis it is proposed thatMoHFW, GoI support the salary component of these contractual AYUSH staffs @ Rs.Manipur State Integrated NRHM PIP 2008-2009 119

18,000/- per month for AYUSH Specialist, Rs. 15,000/- per month for AYUSH non-specialistDoctors and Rs. 7,000/- per month for AYUSH Pharmacists.The Infrastructure up-gradation and drugs needed for all the AYUSH Centres will besupported under AYUSH CSS.The Budget requirement (Rs. in lakhs) for supporting the salary component of theseAYUSH staffs is shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofAYUSH 0 0 0 1 0 0 0 0 0 1SpecialistNo. ofAYUSH 12 7 15 6 8 7 8 3 7 73DoctorsNo. ofAYUSH 4 4 6 4 3 3 4 3 3 34PharmaBudget 24.96 15.96 28.68 16.32 16.92 15.12 17.76 7.92 15.12 158.7616. Construction of building for building-less Subcentres:Rs. 600.00 lakhs was sanctioned in 2006-07 for construction of 100 buildings @ Rs.6.00 lakhs out of the identified 221 building-less Subcentres in the State. The construction of38 Sub-Centres are completed and are operational. The construction works of the remaining62 are expected to be completed by the last quarter of 2007-08.Hence, it is proposed that in 2008-09 the construction of 65 Sub-Centres out of theremaining 121 building-less Sub-Centres be started. Priority will be given to the hilly districtsfor this construction. The unit rate of Rs. 6.00 lakhs was found to be too meager and thecompleted output lacked in certain components e.g. the water harvesting & reservoir part aswell as in the drainage system. Hence, the unit rate for the construction may be increased toRs. 8.00 Lakhs and Rs.9.00 Lakhs in valley area and hill area respectively. The District-wisebudget (Rs. in lakhs) needed is as shown below;IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofproposed 6 6 5 5 10 10 10 5 9 65constructionUnit rate 8.00 8.00 8.00 8.00 9.00 9.00 9.00 9.00 9.00Budgetneeded48.00 48.00 40.00 40.00 90.00 90.00 90.00 45.00 81.00 572.0017. Referral transport in CHCs and 24/7 PHCs:The process of out-sourcing Referral transport for 34 Centres (14 CHCs and twentyidentified PHCs up-graded as 24/7 Service Delivery Centres is in progress. The process willbe completed by the last quarter of 2007-08. For this activity Rs. 61.20 lakhs will be needed@ Rs. 15,000/- per month per vehicle.The District-wise distribution of this fund (Rs. in lakhs) is as shown below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. ofCHCs2 2 3 2 1 1 2 0 1 14No. of24/7 PHCs2 2 3 2 2 2 2 3 2 20Total units 4 4 6 4 3 3 4 3 3 34Budgetneeded7.20 7.20 10.80 7.20 5.40 5.40 7.20 5.40 5.40 61.20Manipur State Integrated NRHM PIP 2008-2009 120

18. District Health Melas:It is proposed to observe District Health Melas in each of the 09 existing Districts @Rs. 5.00 Lakh per mela. The total budget requirement is Rs. 45.00 Lakhs, the district-wiseallocation being as given below.IE IW TBL BPR CCP UKL SPT CDL TML Total5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 45.0019. Further Research/study:The following study is proposed to be taken up in 2008-09(i)Multi-stage Sampled Survey for estimation of deliveries attended by SkilledBirth Attendance which will be used as a proxy indicator for estimating MMR.It may be noted that the existing State MMR status is based on SRS 2001which is quite back-dated. Also a part of the process evaluation of SafeDelivery and Essential Newborn Care (Qualitative Study) will be included sothat the main reasons of maternal and infant deaths can be found out andalso the bottle-necks from the Public Health Service Delivery System and thecommunity may be highlighted.The Study will be taken taken up in collaboration with Centre for CommunityMedicine, RIMS.All Districts will be covered in the Study and the findings are to be analysedboth for the whole State as well as District-wise.A budget of Rs. 15.00 lakhs will be needed.20. Opening a separate State NRHM web-siteThe currently available State Health web-site is focused only on details of Directorateof Health Services, Manipur. An effort was started in 2007-08 for establishing a separateState NRHM web-site. System studies are completed. A budgetary support of Rs. 5.00Lakhs (Rs. 3.00 lakhs for H/W and Rs. 2.00 lakhs for S/W) will be needed.21. Establishment of GNM Training SchoolsThe State has got adequate number of unemployed ANMs at present to cover theState demand under NFRHM. However, there is need for establishing GNM TrainingSchools in districts where there is no public or private GNM Training School. In the firstphase the GNM Schools may be established in 03 remote districts namely,1. Ukhrul District2. Tamenglong District and3. Chandel DistrictThese 03 GNM Schools may be established in rented buildings and may have (i) J.N.Hospital, Porompat or (ii) RIMS, Lamphelpat or (iii) the concerned District Hospitals as theirparent institutions where the GNM trainees may undergo clinical course. Due to the longdistance between the districts and the RIMS/ JN Hospital, it is proposed that the DistrictManipur State Integrated NRHM PIP 2008-2009 121

Hospitals concerned are identified as the parent institutions in the respective districts. Theonly hitch is that the case load in the District Hospitals may not fulfill the criteria as given bythe Indian Nursing Council (INC). The Ministry of Health and Family Welfare, Govt. of Indiamay intimate the INC to relax the criteria of case load for North- Eastern States where thecase loads in the District Hospitals are low. Each of the Training Schools will have a capacityof 60 students (an annual intake of 20) and will be accountable to the District Health MissionSociety concerned.1. Manpower:The State will give an effort as far as possible to identify suitable regular staffs whowill act as the faculty staffs of these three Training Centres. Also the support staffs will beidentified from existing regular staffs wherever possible. The maximum budgetary supportneeded for hiring contractual staffs per Training Centre will be:Sl.No.Manpower Qualification Consolidatedpay per annumin lakhsA. Faculty1 Principal MSc Nursing with 6 yrs ofteaching experience or BScNursing (Basic)/Post basicwith 8 yrs experience2 Vice Principal MSc Nursing with 4 yrs ofteaching experience or BScNursing (Basic)/Post basicwith 6 yrs experience3 Senior Tutor MSc Nursing with 2 yrs ofteaching experience or BScNursing with 4 yrs experience4. Tutors MSc Nursing or BSc Nursing(Basic)/Post basic or Diplomain Nursing Edn and Adm or itsequivalent with 2 yrsexperience after graduation5 Additional Tutorfor InternsMSc Nursing or BSc Nursing(Basic)/Post basic or Diplomain Nursing Edn and Adm or itsequivalent with 2 yrsexperience after graduationNo.personnelofTotallakhs1.80 1 1.801.68 1 1.681.44 1 1.681.20 5 6.001.20 1 1.20Subtotal 12.36B. Support staffs6 Stenographer Graduate with Computer 0.96 1 0.96Knowledge7 Senior Clerk Graduate with Computer 0.96 1 0.96cum Accountant Knowledge8 Junior Clerk Graduate with Computer 0.84 1 0.84cum Typist Knowledge9 Librarian 0.84 1 0.8410 Laboratory Asst MLTC 0.72 1 0.7211 Chowkidar Matriculate 0.48 1 0.4812 Driver Matriculate 0.60 1 0.6013 Cleaner Matriculate 0.48 1 0.4814 Peon Matriculate 0.48 1 0.4815 Sweeper Matriculate 0.48 1 0.4816 MachineoperatorMatriculate 0.48 1 0.48Subtotal 7.32Grand total 19.68In addition to the above mentioned Faculty members, Guest Lectures may beneeded on relevant topics by experts. These experts may be given honorarium as per StateGovt. norms.inManipur State Integrated NRHM PIP 2008-2009 122

The schools should have their own Management Committee, the composition ofwhich is as given below.1. Principal - Chairperson2. Vice Principal - Member3. Senior Tutor - Member4. Nursing Supdt/Chief Nursing Officer - Member5. Representative of Med. Supdt, DH - Member2. Infrastructure:Each of the training Schools will be established in rented buildings having aconstructed area of 4000 square feet. The building should at least have the followingfacilities.1. 04 numbers of classrooms2. 04 numbers of Laboratories viz. Nursing Practice, CommunityPractice, Nutrition and Computer laboratories3. Auditorium4. Multi-purpose Hall5. Library with furniture6. Office rooms for Principal, Vice Principal and Common FacultyRoom7. Record Room8. Store Room9. Room for Audio-visual aids10. Safe drinking water supply and 03 sanitary toilets11. Garage12. PlaygroundThe budgetary support needed on infrastructure per Training Centre may be asshown below.Sl. No. Particulars Unit rate in lakhs Quantity Total in lakhs1 Building Rent for 1 year 1.80 1 1.802 Overhead water storage 2.00 1 2.00tank3 Furniture for Class 0.50 4 2.00Rooms4 Furniture for offices 0.50 3 1.505 Furniture for Library 1.00 1 1.006 IEI 2.00 2.007 Computer with 0.60 1 0.60peripherals8 LCD 2.00 1 2.009 Xerox Machine 1.00 1 1.0010. Other teaching aids 4.00 4.0011 10 KVa Gen set 2.00 1 2.0012 Outsourced bus (big) 1.80 1 1.8013 Outsourced minibus 1.80 1 1.8014 Laboratory equipments & 3.00 1 3.00reagents15 Library books, journals 3.00 1 3.00etc16 Telephone Lines 0.03 2 0.06Total 29.56Manipur State Integrated NRHM PIP 2008-2009 123

3. Maintenance charges, contingency, honorarium to guest lecturers, stipend totrainees etc. (Recurring) per Training Centre: Rs. 5.00 lakhs annuallyThe total budget needed for establishing the new 03 schools will be:Sl. Particulars Unit rate Units Total in lakhsNo.1 Manpower 19.68 3 59.042 Infrastructure 29.56 3 88.683 Contingency, honorarium 5.00 3 15.00to guest lecturers, stipendto trainees etcGrand total 162.72The District-wise budget allocation for 2008-09 (Rs. in lakhs) is as shown below.UKL TML CDL Total54.24 54.24 54.24 164.7222. Strengthening Program Management:This will be limited to 6% of the total budgetary support available under Part “B” ofNRHM and will be inclusive of the following activities22.1 Honorarium of BPMU staffs36 Block Program Management Units comprising of 1 Block Program Manager, 1Block Data Manager and 1 Block Finance Manager are established in all existing blocks byhiring contractual staffs. The staffs are re-oriented both at State level and District level. Theirservices will be continued in 2008-09.The Monthly Honorarium of these staffs recruited on contract basis will be same aslast year i.e., Rs. 10,000/- for BPM and Rs. 7,500/- for each of the BDM and BFM.below:The total budgetary support needed for supporting the BPMUs will be as givenSl. Particulars Units Unit Rate in Total in LakhsNo.Lakhs1 Honorarium of BPM 36 1.20 43.202 Honorarium of BDM 36 0.90 32.403 Honorarium of BFM 36 0.90 32.40Total 108.00The District-wise allocation for this fund will be as given below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. 3 3 3 3 5 5 6 4 4 34BPMUsUnit Rate 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00per annumBudget 9.00 9.00 9.00 9.00 15.00 15.00 18.00 12.00 12.00 108.00Manipur State Integrated NRHM PIP 2008-2009 124

22.2 Provision of Finance/ Account Managers in PHCsIn 2008-09 in addition to the aforementioned 36 BFMs, 36 contractual Finance/Account Managers were placed in PHCs so that all the 72 PHCs have Finance/AccountManagers. Their services will be continued in this year. The budgetary support needed forpaying honorarium to these 36 Finance/ Account Managers @ Rs. 7500/- per month perhead will be Rs. 32.40 lakhs.The District-wise allocation for this fund will be as given below.IE IW TBL BPR CCP UKL SPT CDL TML TotalNo. Fin/ 8 7 6 2 4 1 6 0 2AccManagersUnit rate 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90perannumBudget 7.20 6.30 5.40 1.80 3.60 0.90 5.40 0 1.80 32.4022.3 Other Program Management Costs:State IE IW TBL BPR CCP UKL SPT CDL TML TotalHdq10.00 2.46 10.04 4.64 12.34 12.87 5.60 3.99 5.33 5.75 73.5223. E-Health:There is an on-going Program on Tele-medicine under NEC under which all the DistrictHospitals are to be connected with the State Hospital as well as with the Regional TeachingMedical College. The program is in mid-way and is expected to take the whole year forcompletion in all the Districts. Until this project is operational further projects may not betaken up.24. ASHA initiative:3000 ASHAs were selected and given re-orientation training on Modules1, 2, 3 and4. The distribution of these ASHAs among the districts is as given below.Sl. No DISTRICT Total no. ofASHA1 Imphal East 3812 Imphal West 2493 Thoubal 2764 Churachandpur 5395 Bishnupur 1556 Senapati 6157 Ukhrul 2528 Chandel 3259 Tamenglong 208Total 3000Manipur State Integrated NRHM PIP 2008-2009 125

The above mentioned number of ASHA was based on 2001 census. Because ofincrease in population as well as establishment of new villages and hamlets in the last 7years the following additional numbers of ASHA are needed to be in place.Sl. NoDISTRICTExistingnumber ofASHAsAdditionalnumber ofASHAs neededTotal to be inplace1 Imphal East 381 50 4312 Imphal West 249 80 3293 Thoubal 276 89 3654 Churachandpur 539 88 6275 Bishnupur 155 80 2356 Senapati 615 172 7877 Ukhrul 252 50 3028 Chandel 325 225 5509 Tamenglong 208 44 252Total 3000 878 3878During 2008-09 the existing 3000 ASHAs will be given (i) Periodic training for 2 daysfor every alternate month (total 12 days) at Block level and (ii) On-the-job training. For theperiodic training the Block Training Team will be the trainers. During this training, interactivesessions will be held to help refresh and up-grade their knowledge and skills, troubleshootproblems they are facing, monitor their work and also for keeping up motivation and interest.For the on-the-job training ANMs and Block Facilitators will be responsible. ANMs hileconducting outreach sessions in the villages will contact the ASHA sans use the opportunityfor continuing education.For the new ASHAs to be selected, induction training for 23 days spread over aperiod of 12 months (7 days initially and 4 days on every quarter) will be taken up at Blocklevel in batches of 25-30 ASHAs per batch.The budget requirement (Rs. in lakhs) for 2008-09 will be as given below.ParticularsSl.DetailsTotalNo.For periodic training (2 days on 1 TA @ Rs. 100/- per head 6 times for 3000 ASHAs 18.00every alternate month) of 3000 2 DA @ Rs. 100/- per head for 12 days for 3000 36.00existing ASHAsASHAs3 Honorarium to trainers @ Rs. 100/- per head per 7.20day X 12 days X 5 trainers X 120 batches (of 25ASHAs each)4 Training material @ Rs. 100/- per head for 3000 3.00ASHAs5 Contingencies @ Rs. 1000 per batch for 120 7.20batches per session X 6 sessionsFor induction training of new 6 TA @ Rs. 100/- per head 5 times for 878 ASHAs 4.39878 ASHAs for 23 days (7 days 7 DA @ Rs. 100/- per head for 23 days for 878 20.194initial training followed by 4 daystraining on every quarter) 8ASHAsTraining materials @ Rs. 300/- per head for 878 2.634ASHAs9 Honorarium to trainers @ Rs. 100/- per trainer per 4.025day X 35 batches X 5 trainers per batch X 23days10 Contingencies @ Rs. 1000/- per batch for 35 1.75batches per session X 5 sessionsDrug Kits for 3878 ASHAs 11 @ Rs. 600/- per head 23.268Total 127.661Manipur State Integrated NRHM PIP 2008-2009 126

The District wise budget allocation (Rs. in lakhs) will be as given below:ForperiodictrainingForinductionIE IW TBL CCP BPR UKL SPT CDL TML Total8.925 5.95 6.545 13.09 3.57 5.95 14.875 7.735 4.76 71.401.89 2.83 3.77 2.83 2.83 1.89 6.59 8.473 1.89 32.993trainingDrug Kit 2.586 1.974 2.19 3.762 1.41 1.812 4.722 3.30 1.512 23.268Total 13.401 10.754 12.505 19.682 7.81 9.652 26.187 19.508 8.162 127.66125. Mentoring Group for ASHA:A State Mentoring Group for ASHA will be formed under the Chairmanship of theState Nodal Offiicer (Maternal Health). Also District level Mentoring Groups will be formed. Areputed NGO e.g. Voluntary Health Association of India, Manipur Chapter will be taken intopartnership for mentoring the ASHAs.26. Construction of PHC Moreh buildingThe office building and staff quarters of PHC Moreh in Chandel District is in adilapidated state and is beyond repair. The Staffs are currently functioning from theSub-District Hospital Moreh. Hence people from the rural areas of Moreh aresuffering.It is proposed that a building along with staff quarters be built for Moreh PHC. Anestimated amount of Rs. 182.00 Lakhs will be needed for this purpose.The District budget allocation for 2008-09 (Rs. in lakhs) is as shown below.CDLTotal182.00 182.00Manipur State Integrated NRHM PIP 2008-2009 127

The District-wise budget (Rs. In lakhs) required in 2008-09 under Part “B” of NRHM will be:Sl. ActivityStateDistrictsTotalNo.Hdq IE IW TBL BPR UKL CDL CCP SPT TML GoI State TotalShare Share1 U/F for VHSCs 0 20.40 24.90 52.50 15.50 33.90 35.00 55.80 61.50 20.80 320.30 0 320.302 Holding of VHNDs 0 8.16 6.444 7.644 4.608 4.068 6.396 6.444 6.672 3.576 54.012 0 54.0123 Strengthening DHs 0 0 0 0 189.37 0 0 145.65 0 0 335.02 0 335.02to IPHS4 Corpus Fund for 0 18.00 10.00 22.00 12.00 12.00 9.00 15.00 19.00 12.00 129.00 0 129.00RKS5 Maintenance Grant 0 11.90 10.80 15.70 7.70 7.90 5.10 11.90 14.10 7.00 92.10 0 92.10for CHC, PHC &SCs6 U/F for CHC, PHC & 0 9.15 7.80 9.20 5.45 5.90 3.85 9.15 10.10 5.00 65.60 0 65.60SCs7 Procurement of 153.17 0 0 0 0 0 0 0 0 0 153.17 0 153.17logistics8 Equipments for PHC 0 23.32 17.44 25.41 10.96 13.17 25.83 19.92 6.78 12.90 155.73 0 155.73& SC9 DMMUs 0 6.04 6.04 6.04 6.04 6.54 6.54 6.54 6.54 6.54 56.86 0 56.8610 Block MMU for hard 0 43.00 0 0 0 43.00 43.00 43.00 43.00 43.00 258.00 0 258.00to reach areas11 Honorarium of 0 24.96 15.96 28.68 16.32 15.12 7.92 16.92 17.76 15.12 158.76 0 158.76AYUSH staffs12 Building0 48.00 48.00 40.00 40.00 90.00 45.00 90.00 90.00 81.00 572.00 0 572.00construction ofBuilding-less SCs13 Referral transport 0 7.20 7.20 10.80 7.20 5.40 5.40 5.40 7.20 5.40 61.20 0 61.20for CHCs & 24/7PHCs14 District Health Melas 0 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 45.00 0 45.0015 Further research 15.00 0 0 0 0 0 0 0 0 0 15.00 0 15.0016 Opening NRHM 5.00 0 0 0 0 0 0 0 0 0 5.00 0 5.00web-site17 Establishment of 0 0 0 0 0 54.24 54.24 0 0 54.24 162.72 0 162.72GNM TrainingSchools18 Program 10.00 18.66 25.34 19.04 23.14 21.70 17.63 31.47 27.39 19.55 213.92 0 213.92Manipur State Integrated NRHM PIP 2008-2009 128

Management Cost19 ASHA initiative 0 13.401 10.754 12.505 7.81 9.652 19.508 19.682 26.187 8.162 127.661 0 127.66120 Construction of 0 0 0 0 0 0 182.00 0 0 0 182.00 0 182.00buildingless PHCsTotal 183.17 257.191195.678 254.519 351.098 327.59 471.414 481.876 341.229 299.288 3163.053 0 3163.053N.B.This budget has taken into account the un-utilized fund already available with the State.Manipur State Integrated NRHM PIP 2008-2009 129

Manipur State Integrated NRHM PIP 2008-2009 130

1. Background1.1. State profileSl.DataManipurNo.1 Districts* 09 (4 in plain & 5 in hilly areas)02 sub districts in the hill areas2 Blocks* 363 Villages* 23914 Towns/Urban areas* 335 Total estimated mid-year population 26.18 (ST-38%, SC-5%, OBC-4.5%)6 Rural population (%)* 767 Urban population (%)* 248 Infant Mortality Rate † 139 Maternal Mortality Ratio ♀ 37410 Below Poverty Line/Low Standards of 31Living Index (5) †11 Crude Birth Rate † 14.712 Estimated No. of Pregnant Woman 5028113 Estimated No. of (based on estimatedmid-year population, CBR and IMR)• Infants• 1-2 yrs children• 5 yrs children• 10 yrs children• 16 yrs children4571045253449794344941451(*Census 2001, † NFHS-3, ♀SRS)1.2. Recent performance1.2.1. Reported and evaluated coverageAntigenReportedCoverage2004-05Reportedcoverage2005-06Reportedcoverage2006-07Reportedcoverage2007-08(up-toDecember2007)NFHS-32005-06Fully vaccinated 46.80%BCG 86% 87% 120.51% 82% 80%DPT-3 74% 76% 104.88% 69% 61.20%OPV-3 75% 76% 104.88% 68% 77.50%Measles 22.1% 69% 103.34% 63% 52.80%BCG-Measles Drop 64.1 18 17.17 20 28.00outTT (2/B) 57% 58% 74.03% 47.5% 70.1Manipur State Integrated NRHM PIP 2008-2009 131

1.2.2 District-wise evaluated coverage in % (DLHS-3)Antigen Districts StateIE IW TBL BPR UKL CDL CCP SPT TMLDPT (3) 65.3 70.8 25.8 64.4 26.2 19.4 51.9 17.2 34.9 48.8Msls 66.9 76.3 46.3 71.9 39.5 21.1 62.1 16.1 38.3 55.6FullImm.55.9 57.8 15.3 55.2 19.7 3.6 28.8 6.2 29.3 371.2.3 Reported Vaccine preventable diseasesVPD 2004-05 2005-06 2006-07 2007-08Measles 230 194 278 270Diphtheria 0 0 0 0Pertussis 346 105 0 0Neonatal tetanus 3 1 0 0Poliomyelitis 0 0 0 01.2.4. Infrastructure and staffing patterna. General staffPosition Sanctioned In position Proposed Trained in last yearadditionRegular FHWs at420 420 0 100SubcentresContractual Addl. FHWs atSub-Centres420 420 0 0b. Dedicated Immunization staffsPosition Sanctioned In position ProposedadditionTrained in last 3yearsState Immunization Officer 1 1 0 1Deputy Director (Imm.) 1 1 0 1State Cold Chain Officer 1 1 0 1DIO 11 11 0 11Computer Assistant 10 10 0 0Cold Chain Mechanic 8 4 5 0c. Public Health InfrastructureHealthInstitutionsSanctioned NumberfunctioningWith functional coldchain equipmentsProposedexpansionSubcentres 391 391 391 0PHCs 72 72 70 2CHCs 16 16 16 0d. Cold chain Storage PointsCold Storage Points Total numbers Proposed expansionState Store 1 Extension of a work-shop roomDistrict Stores 9 0ILR Storage Points 76 12Manipur State Integrated NRHM PIP 2008-2009 132

2. Goals• To achieve universal immunization by 2010• To reduce BCG – Measles dropout to < 5 % by 2010• To sustain the zero polio case with adequate AFP surveillance3. Assessment of critical bottle necks for full coverage3.1. Availability:• Irregular or no electrification in certain PHCs thereby making vaccine storageimpossible• Difficult geographical terrains and poor transport mechanism making most ofthe hilly villages inaccessible, mainly during rainy season• Bad law and order situation making movements risky and difficult3.2. Accessibility: Same as the later two mentioned above3.3. Utilization/adequate coverage:• Directorates of Health and Family Welfare not co-coordinating properlycausing difficulty in active participation of Health staffs in MCH activities• Lack of residential quarters for FHWs and MOs resulting to staffs not stayingat their places of posting• Insufficient private sector/community involvement• Overburdening the work-load of FHWs• Poor HMIS. Incomplete, irregular and inaccurate reporting from District andSub-District level. No analysis done at local level4. Objectives and targetsSpecific objectives and targets pertaining to the State of Manipur are made as givenbelow as the road to universal immunization by 2010. Also, efforts will be given so that theBCG → Measles drop-out rate is reduced to 90>85>90>85100>95100>954.1. Improve vaccine/ supply logistics4.1.1 Key performance indicatorsIndicator Current 2006-0708-09 09-10Districts with any antigen stock-out more than1 month in the last 12 months 0 0 0Districts with AD syringe stock-out more than 1month in the last 12 months00 0Manipur State Integrated NRHM PIP 2008-2009 133

4.2. Expand Cold Chain Reach and Improve Performance4.2.1 Key performance IndicatorsIndicatorPlanned08-09 09-10Cold Chain assessment done and planned yes YesProportion of ILR registered (not condemned) non-functional 1,000 pop) covered 1 or more times amonth> 80 >90 100% Villages( 80 >90 100% of high-risk areas covered monthly > 80 >95 100% Urban areas covered monthly > 90 100 100% Sessions planned Vs sessions held >90 100 1004.4. Improve injection safety by introducing AD syringesIndicator4.4.1. Key performance indicatorsCurrent07-08Planned08-09PHCs using ADS for all immunizations (%) 100 100PHCs with appropriate waste disposal in place (%) 80 1004.5. Ensure accurate record-keeping/monitoring with improved supervision4.5.1. Key performance indicatorsGap between reported and evaluated full immunizationcoverage (%)Current Planned07-08 08-09 09-10

5. Action plan5.1. Alternative vaccine delivery: For out-reach Immunization Sessions in areas wherethe accessibility for collection of vaccines from the concerned PHC/CHC/DistrictHdqs is difficult “Porters” who have to collect vaccines from Storage Points may beprovided by giving a porter fee of Rs. 50/- per collection. AccreditedNGOs/community organizations/ ASHAs will also be involved in vaccine delivery.Also, based on the work-plan prepared by the various Sub-Centres, vaccines will bedropped by any vehicle available with the District Hdqs./ CHCs/ PHCs whereverpossible.For 900 identified villages in the hilly districts and 100 identified villages in the plaindistricts will be given the provision of using porters will be given. The annual budgetrequirement as Porters’ fee for holding monthly sessions at these 1000 villages @ Rs50/- per session will be Rs. 6.00 Lakhs.5.2. Mobilization of children by ASHAASHAs (3000 in nos.) developed under NRHM are to be involved for this purpose. Acompensation package of Rs. 150 per month will be given to them, on the same dayof the Immunization Session, by the FHW from the Untied Fund available with theVillage Health & Sanitation Committee. Wherever ASHAs are not availableAWWs/other Village-level Link workers will be utilized for the same purpose.The budget needed for this for the 3000 ASHAs/ Other mobilizers for holdingImmunization sessions in all villages @ Rs.150/- per session will be as shown below.No. of ASHAs No. Sessionsper village peryearMobilization fee persession3000 3 150 13.50Total (Rs. inlakhs)5.3. Under-served areas: The services of Retired /Unemployed ANMs/GNMs/Vaccinators will be used for vaccinating in areas which are relatively underservedareas by giving an honorarium of Rs. 350/- per session.The total budget needed for this will be as given below.Districts No. of underserved No. of Unit rate (in Total (Rs. invillagesimmunization Rs.)lakhs)sessions in ayearSPT 200 3 350 2.10CDL 50 3 350 0.525UKL 50 3 350 0.525TML 100 3 350 1.05CCP 200 3 350 2.10Total 600 3 50 6.30Manipur State Integrated NRHM PIP 2008-2009 135

5.4. Strengthening monitoring & supervision and surveillance:5.4.1. Strengthening monitoring & supervisionAt the State level District-wise Monitoring Sub-Committees under NRHM are to beformed. These Committees will go the Districts every month and stay there for aweek for monitoring all NRHM activities including immunization in the District andSub-District levels.Further supervisory visits by the District and Sub-District staffs will be madecompulsory: Field visits are to made weekly by FHS, fortnightly by MOs of PHCs,monthly by SMOs of CHCs and quarterly by DFWOs/DIOs by using supervisorycheck-lists. The supervisory visits are to be facilitative in nature.Again Physical and Financial review meetings on immunization will be done incombination with monthly NRHM reviews monthly at State level, District level andFacility level.For mobility support of the State level officers 02 vehicles may be out-sourced bygiving a monthly fee of Rs. 20,000/- per month. The budget for this will be Rs. 4.80Lakhs.5.5. Computer assistant at districts and at State levelThe services of the 12 Computer Assistants (10 at District level and 1 at State level)which was recruited on contractual basis last year will be continued in this year. TheComputer Asst. at the State Hdqs. May be given a monthly honorarium of Rs. 8,000/-per month whereas the Computer Assts. at District levels may be paid a monthlyhonorarium of Rs. 7000/-. The budget needed for this activity will be as given below.Computer Asst. inState Hdqs.Computer Asst. inDistrictsTotal1 No. Monthly honorarium ofRs. 8,000/- p.m.11 Nos Monthly honorarium ofRs. 7,000/- p.m.Annual budget= Rs. 0.96 LakhsAnnual budget= Rs. 9.24 LakhsRs. 10.20 lakhs5.6. Review meetings:Half-yearly review meetings will be held at the State level to review the performanceand bottle-necks in which all the DFWO/DIO, CMOs, NPSP Consultant and all Statelevel Program Officers have to attend. The budgetary support needed will be Rs.0.70 Lakhs @ Rs. 0.35 per Review meeting.5.7. Strengthening of Manpower for Cold Chain System.a. Refrigerator Mechanic:Sl. No. Name of District Existing Requirement1. State Head Quarter 1 02. Bishnupur 1 03. Chandel 0 14. Churachandpur 0 15. Imphal East 0 16. Imphal West 1 07. Senapati 1 08. Tamenglong 0 19. Thoubal 1 010 Ukhrul 0 1Total 5 5Manipur State Integrated NRHM PIP 2008-2009 136

The 5 additional Refrigerator Mechanics will be recruited on contractual basis bygiving a monthly honorarium of Rs. 6,000/- per month. The annual budgetrequirement for this activity will be Rs. 3.60 Lakhs. In coming year effort will be madeto appoint them on regular basis.5.8. Training for Vaccine Handlers:100 persons from the District and Sub-District level who are dealing with handling ofvaccines will be given re-orientation training course at the State level for 02 days inthe first quarter of 2008-09 in 4 batches comprising 25 trainees per batch.The budgetary support needed for this activity will be as shown below.Sl.No.Particular Details Amount for 1batch(Rs. in lakhs)1 TA for 25 participants @ Rs. 250/- per head 0.0625 0.252 DA for 25 participants @ Rs 300/- per head for 2 0.15 0.60days3 Honorarium to 4 @ Rs. 500/- per head per 0.04 0.16trainersday for 2 days4 Teaching materials @ Rs. 200/- per head for 0.05 0.2025 trainees5 Overhead expenditure 0.05 0.206 Other contingencies 0.05 0.20Total 0.4025 1.61Amount for 4batches(Rs. in lakhs)5.9. Cold-Chain Strengthening, Vaccine supplies, AD Syringes and tally sheetsThe status of cold-chain equipments in the State are as shown below. In remoteareas ILRs and Deep Freezers are not installed as there is no regular electricity supplyor no electrification at all. Hence solar refrigerators / freezers may be supplied for suchinstitutions. The current numbers of Cold-Chain Equipments which are currentlyfunctioning in the State are given below.Sl. No. Equipment Number functioning AdditionalRequirement1 Walk-in cooler 1 02 Walk-in-freezer 0 13 Deep Freezers (large) 15 104 Deep Freezers (small) 64 405 ILR (large) 14 106 ILR (small) 71 307 Solar Refrigerator/Freezer 0 208 Voltage Stabilizer 120 309 Stabilizer (low voltage) 0 10010 Cold boxes (large) Adequate 011 Cold boxes (small) Adequate 012 Vaccine Carriers Adequate 013. Ice-packs Adequate 014 0.1 ml AD syringes 2.35 lakhs15 0.5 ml ADsyringes 20.15 lakhs16 5 ml Syringe 0.19 LakhsManipur State Integrated NRHM PIP 2008-2009 137

In addition, the following activities will be needed at the State Cold Chain Office andDistrict Hdqs..Sl.No.ParticularsAmount(Rs. in lakhs)1 Provision of 10 KVa Generator at State Hdq. 2.002 Purchase of spare parts for Cold-Chain at State Hdq. 0.203 Extension of Cold-Chain Room at State Hdq. for storing Cold 1.00Chain equipments4 Repair of Vaccine Store Room at State Hdq. 0.205 Repair of Vaccine Store Room at Dist. Hdq. @ Rs. 0.20 per 1.80DistrictTotal 5.205.10.Cold chain maintenanceThe activities and budget needed will be as given below.Sl.No.ParticularsAmount(Rs. in lakhs)1 Cold Chain Maintenance Fund for 98 Health Facilites @ Rs. 500 per 0.49year2 Cold Chain Maintenance Fund for 11 District Cold Chain Room @ 1.10Rs. 10,000/- per year3 Cold Chain Maintenance Fund at State Hdq. 1.00Total 2.595.11 Re-orientation of paramedics:All the ANMs (both regular and additional) are to be given re-orientation training onRoutine Immunization including use of AD Syringes and safe disposal of usedsyringes in phases. The trainings will be done at District level for duration of 02 days.400 ANMs (50% of ANMs posted in Sub-Centres) will be trained in 2008-09 in 20batches (each batch having 20-25 ANMs). The remaining will be covered in nextyear.The budget support (Rs. in lakhs) needed will be as given below.Sl.No.Activity Details Amountper batchAmount for 20batches1 Honorarium of ANMs @ Rs. 200/- per head X 20 0.08 1.60trainees X 2 days2 Honorarium to 4 @ Rs. 500/- per head X 2 days 0.04 0.80trainers3 Training materials @ Rs. 100/- per head X 20 0.02 0.40trainees4 Overhead expenditure 0.05 1.005 Contingencies 0.05 1.00Total 0.24 4.805.12 Printing of Immunization Cards and other LogisticsImmunization Cards will be printed at the State level and distributed to the Districts.1,00,000 Immunization Cards will be printed @ Rs. 3.50 per Card. The total budgetrequirement will be Rs. 3.50 Lakhs.Manipur State Integrated NRHM PIP 2008-2009 138

5.13 Monitoring Tools for improving Immunization Coverage:The following activities were attempted to be taken up in 2007-08. But it could not befulfilled. Hence these will be taken up in the current year.Sl. No. Particulars Amount(Rs. in lakhs)1 Tickler Box for all 508 Health Centres2.54@ Rs. 500 x 5082 Achievement display boards (4’ x 6’) for PHCs1.32and CHCs @ Rs. 1500 x 883 Prestrograph for Districts and State HQ1.20@ Rs. 10000 x 12Total 5.065.14 Coverage Evaluation Survey:An Immunization Coverage Survey by using EPI 30 Cluster Sample Survey will betaken up by the second quarter of 2008-09. Reputed Independent agencies e.g VolunatryHealth Association of India, Manipur Chapter or Centre for Community Medicine, RIMS willbe entrusted for this job.An amount of Rs. 5.00 lakhs may be sanctioned for this.6. Annual budgetSl. No. Particulars Amount(Rs in Lakhs)1 Alternate Vaccine Delivery 6.002 Mobilization by ASHA for immunization sessions 13.5033 Under-served areas 6.304 Monitoring & Supervision 4.805 Honorarium for Computer Assistants at State & District levels 10.206 State level Review Meetings 0.707 Honorarium of Addl. Refrigerator Mechanics 3.608 Training of vaccine handlers 1.619 Strengthening Cold Chain 5.2010 Cold Chain Maintenance 2.5911 Re-orientation of Paramedics 4.8012 Printing of Immunization Cards 3.5013 Development of monitoring tools 5.0614 Immunization Coverage Survey 5.0015 Program Management Cost 4.00Total 76.863Manipur State Integrated NRHM PIP 2008-2009 139

Manipur State Integrated NRHM PIP 2008-2009 140

Revised National Tuberculosis Control ProgramObjectives:(i)(ii)To achieve & maintain 85% Cure Rate of TB cases among newlydetected infections (new sputum smear positive) cases andTo achieve & maintain at least 70% detection in the populationSection AA.1 General Information of Manipur StateSl.ParticularsNo.1 Projected State Population in 2008-09 26.20 lakhs2 Number of Districts 093 Urban Population 9.50 lakhs4 Tribal Population 9.30 lakhs5 Hilly Population 7.40 lakhs6 No. of Districts without DTC Nil7 No. of Districts that submitted annual action plans 09A.2 Organization of services in the StateSl. Name of the Projected Number o f TUs No. of DMCsNo District populationin lakhsGovt. NGO PublicsectorNGO Privatesector1 Imphal West 5.02 2 0 8 0 02 Imphal east 4.23 2 0 8 0 03 Thoubal 4.00 2 0 6 0 04 Bishnupur 2.03 1 0 3 0 05 Tamenglong 1.30 1 0 5 0 06 Ukhrul 2.00 1 0 4 0 07 Churachandpur 2.30 1 0 4 1 08 Chandel 1.30 1 0 4 0 09 Senapati 4.00 2 0 5 0 0Total 26.18 13 0 7 1 0Manipur State Integrated NRHM PIP 2008-2009 141

A.3 RNTCP performance indicators in last quarterDistrict(DTCS)No. ofpts. ontreatmentAnnualizedcasedetectionrate per 01lakh popl.No. of newsmear +vecases ontreatmentAnnualize dnew smear+ve caseson treatmentCure rate forcasesdetected inlast 04correspondingQtrs.Plan for next yearAnnualized CureNSP case ratedetection (%)rate (%)IE 836 190 228 55 83 57 86IW 912 182 199 40 84 55 85BPR 313 151 93 43 88 53 88TBL 649 162 126 32 91 53 90CCP 1077 458 136 65 85 65 85SPT 449 112 114 30 85 53 85TML 89 64 35 28 79 53 85CDL 245 203 63 52 81 55 85UKL 214 138 71 47 64 54 85Total 4784 1660 1065 392 740 498Section BB. 1 Priority areasSl. No. Priority area Activities planned1 Defaulter patients 1. a) To intensify defaulters retrieval action1. b) Distribution of leaflet in local dialect1. c) Motivate DOTS provider to ensure timely sputum checkupand defaulter retrieval2 NGOs 2.a) Quarterly meetings in DTCs2.b) Training/retraining of MPWs & NGOs2.c) More participation of NGOs / Clubs/ Women Societies3 Laboratory measures 3.a) Cross checking of pos slide inter district wise3.b) Strengthening of laboratory manpower & reporting system4 TB/HIV coordination 4.a) Organization of frequent CME of TB&HIV among Healthworkers4.b) To increase coordination with DTCs, DMCs (RIMS) &VCTC5 TB case detection 5.a) To do mike publicity, awareness of DOTS, wall painting,etc.5.b) Motivation of Lab. techs.B.2 Priority Districts for supervision & monitoring by StateSl. No. District Reason1 TML Low Case detection and low treatment outcome2 SPT Low Case detection and low treatment outcome3 UKL Low Case detection and low treatment outcome4 CDL Low Case detection and low treatment outcomeManipur State Integrated NRHM PIP 2008-2009 142

Section C – Consolidated plan for Performance & ExpenditureC.1 Civil WorksActivityNo. reqd.as pernormNo.alreadypresentNo.planned tobe upgradedduring 08-09Justificationfor increaseEstimatedexpenditure(in Rs.)Quarter inwhichplannedactivity isto becompletedSTDC/ IRL 1 1 0 NA 10000State TB 1 1 0 NA 10000SDS 1 1 0 NA 10000DTCs 9 9 0 NA 40500TUs 13 13 0 NA 11700DMCs 47 47 3 NA 180000 *Total 262200* Thoubal District: 2new DMCs (District hospital and Sugnu)Senapati:Motbung DMCTamenglong: Renovation of Tamei PHCImphal West: Renovation of DTC LaboratoryImphal East: Renovation of DTC LaboratoryC.2 Laboratory materialActivityPurchase oflab materialsby districtsLab material byEQA activity atSTDCAmountpermissible asper normAmount spentin last 04 QtrsProcurementplanned duringcurrent year (inlakhs)578160 564826 300000 63900050000Estimatedexpenditure in08-09 (in lakhs)Justification/ remarksC.3 HonorariumActivity Amount Amount Expenditure Estimated Justification /permissible spent in last planned for expenditure remarksas per norm 04 Qtr current year for 08-09(in Rs.)Honorarium 90000 435700 275000 1566000 Including patienthonorarium andsputum collectorManipur State Integrated NRHM PIP 2008-2009 143

C.4 IEC / PublicityPermissible budget as per norm - Rs. 9, 05,450Permissible IEC budget for districts - Rs. 4, 50,000Permissible IEC budget for state - Rs. 7, 32,000TargetgroupPts &gen.publicforawarenessgeneration &socialmobilizationOpinionleaders/ NGOsforadvocacyHealthcareproviders (pub.& pvt.)AnyotherActivitiesActivities planned at State levelActivity No. ofactivitiesheld in last04 Qtrs.Outdoors:- hoardings- tin platesOutreach:- pt. provider 80meetings- community 60meetings- other theatre/Natak in 09districts & stateSchool activities in09 districts & statePrinting- poster2000- pamphlets 20000- Advertisement in 11News paper/JounalMedia activities- Local/Cable TV- radio (7language)Production cost in -- radio- cableSensitizationmeetingsInformationBoklets/BrochuresWorld TB DayactivitiesAdvertisement inMusical Nite- CMEs- interactions meetg- one to oneinteractionmeetings- InformationBooklets- Any Other50315No. of activities proposed in 08 - 091Q 2Q 3Q 4Q202003030301103030101103030101103030Totalactivitiesproposed2020012012010Estimated cost6,00010020020005000Total cost( in Rs.)12000020000240002400005000010 10 5000 50000200050000255011020005000025100440150.502000300450300002500050000300001980007 3000 210003 300090001 1 1 1 1 4 15000 6000031 1000 20 2000010 10 15000 1500006 6 6 6 18 1500 270001 1 111142000020002000080001 1 10000 10000- Digital Camera 1 20000 20000Total budget 1182000Manipur State Integrated NRHM PIP 2008-2009 144

C. 5 Equipment maintenanceItemNo.present inStateAmountspent inlast 04qtrsAmountproposedduring currentyearEstimatedexpenditurefor 08 – 09(in Rs.)Justification/ remarksComputer (maintenance 11 309446 429000includes AMC, Softwareand Hardware upgrades,Printer Cartridges andInternet expenses)Photo copier11 0(includes AMC, toner, etc)Fax 1 25000 No functionOHP 10 0Binocular Microscopes 53 79500 79500SRDC/IRL Equipment 0Any other (pl.specify) 0Total 533500C. 6 TrainingsActivityNo.in theStateNo.alreadytrainedNo. planned in 2008-091Q 2Q 3Q 4QExpenditureplanned forcurrent yearEstimatedexpenditurefor 08-09 (inRs.)Trg. of DTOs at 17 17 0National levelTrg. of MO-TCs 9 18000Trg. Of MOs 410 297 0 20 20 20 30000 120000(Govt.+ Non Govt.)Trg of LTs of 150 89 17 45000DMCsTrg. of MPWs 550 425 0 25 25 25 6500 11250Trg. Of MPHS, 1200 70 15 15 15 15 4500 9000Pharmacists,nursing staff, BEOetc.Trg. of Comm.Volunteers/ASHAs450 400 50 50 50 15000 50000Justification/ remarksTrg of Pvt. 40 10 10 10 30000PractitionersRetrg. of MOs 410 276 20 20 20 20 85000Retrg of LTs of 76 28 8 8 8 32280DMCsRetrg of CVs/ 450 200 50 50 50 40000 1dayASHAsTB/HIV trg of STS 13 13 12000 Refreshertraining forSTS &STLSRev. meeting/ 4 4 1 1 1 1 20000other trgsTotal 472530Manipur State Integrated NRHM PIP 2008-2009 145

C. 7 Vehicle maintenanceType ofvehicleFour -wheelersTwo -wheelersNumberpermissibleas pernormNumberactuallypresentAmountspent onPOL &Maintenancein last 04Qtrs.Expenditureplanned forcurrentyearEstimatedexpenditurefor 08-09(in Rs.)Justification/remarks14 14 2130146 1000000 2275000 Based onnew norm8 8 200000 260000Total 2535000C. 8 Vehicle hiring (where RBTCP vehicles have not been provided)Numberpermissibleas pernormNumberactuallyhiredAmountspent inlast 04Qtrs.Expenditureplanned forcurrentyearEstimatedexpenditurefor 08-09(in Rs.)Hiring offourwheelersFor STC/3 271950 300000 550000 NoteSTDCFor DTO 1 (Imphal 1 90000 270000East)For MO- 10 10 0 0 609000TCTotal 1429000Justification/remarksC. 9 NGO/PPP SupportActivityNGOinvolvementin Scheme1NGOinvolvementin Scheme2NGOinvolvementin Scheme4No.currentlyinvolvedin RNTCPAddl.Enrollmentplanned in08-09Amt.spent inlast 04Qtrs.Expenditureplanned forcurrentyearEstimatedexpenditurefor 08-09(in Rs.)72 325000 200000 440000522 2 50000 100000Total 540000Justification/ remarksManipur State Integrated NRHM PIP 2008-2009 146

C. 10 Misc.ActivityOfficecontingency &travelexpensesAmt.permissibleas per normAmt. spentin previous4 Qtrs.Expenditureplanned incurrent yearEstimatedexpenditurefor 08-091176396 1535067 600000 1500000Total 1500000Justification/remarksC. 11 Contractual servicesCategory of staffNo.permissible aspernormNo.actuallypresentAddl.Planned in08-09Amt. spentin last 4Qtrs.(in Rs.)Expenditure plannedin currentyear(in Rs.)Estimatedexpenditure for 08-09(in Rs.)MO-STCS 1 1 0 226800 118800 253800State Acct 1 1 0 189000 99000 207000State IEC Officer 1 1 0 189000 99000 207000Pharmacist 1 1 0 107100 56100 117300Secretarial Asst 1 1 0 88200 46200 96600MO-DTC 2 2 0204000 432000345600STS 13 9 0 1014800 670500 1417500STLS 17 17 0 1416800 927750 1855500TBHV 5 5 1 338400 243000 486000DEO 11 11 0 856800 503700 1007400Accountant (parttime)9 9 0 226800 124200 248400LT 25 25 9 1418400 1109400 2305200Driver 14 14 0 793800 434700 869400Microbiologist 1 1 0 366000 189000 378000Communicationfacilitator2 2 0 180000 90000 180000Total 10061100C. 12 PrintingActivityAmt.permissibleas per normAmt. spentin last 4Qtrs.Expenditureplanned forcurrent yearEstimatedexpenditurefor 08-09(in Rs.)State level 200000 163894 80000 250000 NoteDist. Level 390000 325182 160000 400000Total 650000Justification/remarksC. 13 Research & studies• No Operational Research planned - NilManipur State Integrated NRHM PIP 2008-2009 147

C. 14 Medical CollegesActivityContractual Staff:• MO-Medical College• STLS in Medicalcolleges• LT for Medical colleges• TBHV for MedicalcollegesAmountpermissible asper norm192000900007800072000EstimatedExpenditure for thenext financial year(Rs.)Justification/Remarks(a) (b) ©2208001035008970082800Research and Studies: Rs. 20,000 Rs. 20,000Travel Expenses for attending50000STF/ZTF/NTF meetingsIEC: Meetings and GME planned 5000Salary areincluded incontractualheadC.15 Procurement of vehiclesVehiclesNo. actuallypresentNo. planned forprocurement inthis yearEstimatedexpenditure for08-09(in Rs.)Justification/remarksFour-wheelers 14 2 1240000 Jeep & MiniBusfor STDCTwo-wheelers 8 0Total 1240000C. 15 Procurement of equipmentEquipmentNo.actuallypresentAddl. No.plannedfor thisyearEstimatedexpenditurefor 08-09(in Rs.)Justification/remarksComputer 11 1 400000 One for the State Drug Store andreplacement in all the DTCS andState TB cell which waspurchase in 1999 and 2001 needto be replaced.Photocopier 11 4 440000 New 4 photocopier replacementfor the Imphal west,Churachandpur, Thoubal andState because it was notrepairable and more than 6 yearsand condemned.OHP 10 0LCD 1 0TotalManipur State Integrated NRHM PIP 2008-2009 148

Section D:Summary of proposed budgetSl. No. Category of expenditure Budget estimate for 08-09 (in Rs.)1 Civil Works 2622002 Laboratory materials 6390003 Honoraria 15660004 IEC/ Publicity 11820005 Equipment maintenance 5335006 Trainings 4725307 Vehicle maintenance 25350008 Vehicle hiring 14290009 NGO/ PPP support 54000010 Misc. 150000011 Contractual services 1006110012 Printing 65000013 Research and Studies 2000014 Medical Colleges 5500015 Vehicle procurement 124000016 Equipment procurement 40000Total 227,25,330Manipur State Integrated NRHM PIP 2008-2009 149

National Leprosy Elimination ProgramObjective: To sustain the Leprosy prevalence rate of < 1/10,000 (Eliminationlevel)STRATEGY(i) Decentralization and Institutional Development(ii) Strengthening and integration of services(iii) Disability care and prevention(iv) IEC(v) TrainingServices will be continued to be provided at Hospitals, CHCs and PHCs withsupport from the district nucleus. The Subcentres will be involved in delivery ofsecond and subsequent doses of MDT. NGOs will continue to be involved inreconstructive surgery, disability care and prevention and IEC. Village and DistrictHealth Plans will include identification which will ensure referral of cases requiringdisability treatment to the appropriate facility.Activities and Budget requirement for 2008-09 (Rs. in lakhs)Sl.ActivitiesProposedRemarksNo.amount1 Honorarium of contract staffs and audit fee01 BFO @ Rs. 14,300/- p.m. 1.7201 Epidemiologist @ Rs. 22,000/- p.m. 2.6401 DEO @ Rs. 7,150/- p.m. 0.8609 Drivers @ Rs. 3,850/- per head p.m. 4.1608 Acc. Staff at DLS @ 400/- p.m. 0.39TA/DA of Drivers & Epidemiologist 1.80Audit fee 0.502 Office expenditureSLS 0.30DLS @ Rs. 15,000/- per District 1.353 ConsumablesSLS 0.30DLS @ Rs. 10,000/- per District 0.904 Vehicle operation 002 vehicles at SLS @ Rs. 50,000/- per unit 1.0001 vehicle at SSAU @ rs. 8,000/- p.m. 0.9602 vehicles per District @ Rs. 4,000/- 6.40Outsourcing 01 vehicle for DLO (IE) @ Rs. 0.968,000/- p.m.5 Supportive Medicine9 DLS @ Rs. 15,000/- per unit 1.356 Material suppliesPatients’ welfare @ Rs. 6,000/- per District 0.54Printing cost @ Rs. 8,000/- per District 0.727 Quarterly State Review Meeting @ Rs. 25,000/- 1.008 Capacity Building/ Training 9.00 Details in Annexure i9 ULC Program 2.28 Details in Annexure II10 IEC 15.97 Details in Annexure III11 Monitoring & Evaluation 5.00Total 60.10Manipur State Integrated NRHM PIP 2008-2009 150

DETAILS OF TRAININGANNEXURE IThe expenditure for capacity building may be supported by ILEP/TLM.a. District Nucleus Team @ Rs.20,000/- 1.80Training for 09 D.N. Teamb. One day orientation training for 100 Nos. of 2.40MLFHW, Pharmacist in 30 batchesRs. 8,000/- per batchc. Half day orientation training for 3000 Nos. 4.00of ASHA in 100 batches @ Rs.4,000/- perbatchd. One day orientation training for 300 MOs in 0.80PHC/CHC @ Rs.8,000/- per batch; 10batchesTotal 9.00URBAN LEPROSY CONTROL PROGRAM (ULCP)ANNEXURE II04(four) townships viz., Imphal,Thoubal, Churachandpur and Ukhrul havebeen identified for the program and activity-wise budget is as followsSl.No Item Category of urban Activities (Rs. In thousand)area(1) (2) (3)A. Unit cost per year Township 9 23 25 57B. Total cost per year Township 4 36 92 100 228i.e Rs. 2.28 lacs1. Supportive Medicine includes Prednisolone, Dressing Material and Medicines2. MDT delivery services and follow up of under-treatment patient.3. Monitoring, Supervision and coordination which includes periodic meeting andmobility.Manipur State Integrated NRHM PIP 2008-2009 151

IEC DetailsANNEXURE IIIDetails of IEC Cost Unit Number Total CostHoarding Rs.10,000/- For 72PHC/CHC Rs.72,000/-Posters Rs.8/- 10,000 Rs.80,000/-Wall Painting Rs.200/- 300; 09 district Rs.5,40,000/-Rally Rs.5000/- 09 district Rs.45,000/-Spots in radio, local channel, DDK- - Rs.4,50,000/-,etc02 Workshop(HW&MO) Rs.6000/- 09 District Rs.54,000/-Meeting with Zilla Parishad Rs.2500/- 09 District Rs.22,500/-Orientation camp for NGOs/mahilla Rs.2000/- 09 District; 02 Rs.36,000/-mandol, etc.each districtHealth mela Rs.3000/- 09 District Rs.27,000/-IEC meeting for influencer/opinionof public leader 60 no. of eachdistrictRs.500/-per meeting09 District Rs.2,70,000/-Total Rs.15,96,500Manipur State Integrated NRHM PIP 2008-2009 152

National Program on Control of BlindnessGoal: To reduce the Prevalence of Blindness to less than 3 per 1000 population byend of 2012Sophisticated instruments received so far from Government of IndiaInstitutionMicroscope A-Scan Keratometer Yag- Laserfor operation BiometryJN Hospital 1 1 1 1RIMS, Lamphelpat 1 1 1 1DH Thoubal 1 1 1 -DH Bishnupur 1 1 1 -DH Churachandpur 1 1 1 -Central Mobile1 1 1 -Ophthalmic UnitTotal 7 7 7 2STRATEGY 1Improving Eye Screening (to achieve Eye screening of 1,00,000 children

STRATEGY 2Strengthening provision of Catops (to achieve 1,200 Catops)Activity(i)Equipping District OTsSr.No.123DistrictsCatops(RIMS &JNH)Schools EyeScreeningTrainingcamps forTeachers –3 at eachdist.Budget requirement for 2008-09 (Rs. in lakhs)Other StateIMP TBL BPR CCPTotalDistricts HdqPhy Fin Phy Fin Phy Fin Phy Fin Phy Fin Phy Fin Phy Fin6.00 4.50 100 0.75 100 0.75 100 0.75 100 0.75 - - 1000 7.5015,0000.60 10,000 0.40 10,000 0.7010,00070 0.16 60 0.15 60 0.15 60 0.15 - -0.40 5,000 0.20 - - 50,000 2.00Eyecamp1.70 250 2.314 Contingency 0.60 0.60 0.60 0.60 0.70 2.00 5.105Travelexpenditureincludingoutsourcing01 vehicleat Statelevel0.10 0.10 0.10 0.10 - 2.80 3.20678VisionCentre3 0.75 1 0.25 1 0.25 1 0.25 4 1.00Eyecamp1.00 10 3.50OTequipments2.04 1.50 1.50 1.50 - 1.65 8.19Sub-Total 8.75 3.75 3.75 3.75 2.65 9.15 31.80Xeroxmachine- - - - - - - - - - 1 1.00 - 1.00Grand-Total 32.80Manipur State Integrated NRHM PIP 2008-2009 154

Background:NATIONAL IODINE DEFICIENCY DISORDERSCONTROL PROGRAM (NIDDCP)State IDD Cell: Established in 1987 as NGCP (National Goiter ControlProgram) Cell, Medical Directorate, along with the creation of identified posts andsubsequent appointment and posting of staff. The staff available are:Sl.DesignationNo.1 Program Officer (IDD)2 Statistical Assistant3 LDC/Typist4 Lab. Tech (Contract basis)5 Lab. Asst. (Contract Basis)IDD Monitoring Laboratory: Established in IDD Cell, Medical Directorate. TheStaff currently available are 01 Laboratory Technician and 01 Laboratory Assistant.The iodized salt sample submitted by the district functionaries are analyzed in theMonitoring Laboratory to find out the actual iodine content by titration method.Ban Notification: The State Government had issued three Ban Notifications onEntry, Sale, Storage, Transportation and Distribution of Salt other than iodised saltthroughout the state in the year 1996, 1975 and 1988.Distribution System in the State: There is no manufacturer of common salt inthe State. Iodised salt is procured by the State Government and distributed to thepublic by food and civil supply (FCS) Department though PDS (Public DistributionSystem).Surveys: NIDDCP, Manipur had conducted four IDD surveys. The first surveywas done in 1970 with the Government of India Team, throughout the State, thesecond in 1986, the third in 1992 and the fourth in 1996. The Prevalence Rates ofIodine Deficiency Disorders detected were 32.0%, 25.60%, 21.1% and 13.0%respectively.Monitoring of Iodization of salt (Quality control): Quality control is done with thechecking of iodine content of iodised salt. This is done at the IDD Laboratory byIodometric titration and in other places done by spot testing kits. Analysis ofiodised salt sample by using spot testing kits is done by members of HealthDepartment, Education Department, Social Welfare Department, NGOs, local bodiesand by the shopkeepers.Manipur State Integrated NRHM PIP 2008-2009 155

1. OBJECTIVE OF NIDDCP, MANIPUR -To reduce the prevalence of iodine deficiency disorders to

4.3. Sensitization training of wholesalers & retailers on IDD at DistrictLevel (one per District) @ Rs. 25,000/- per District giving a total of Rs.2.25 lakhs..4.6 Information, Education and Communication: A sum of Rs.4.00 lakhs may be sanctioned for the following activities.1. Production of Booklets on iodine2. Exhibition of IDD3. Production of booklets for school children etc.5. Production of films, radio spots, TV spots / JingleFurther, a sum of Rs. 20.00 lakhs may be sanctioned for other HealthEducation activities and publicity.4.7 Surveys/ Re-surveySurvey on Prevalence of iodine deficiency disorders in 02 plain and 02hilly districts @ Rs. 50,000/- per District giving a total of Rs. 2.00 lakh.The total budgetary support needed for 2007-08 is as given below:Sl.No.ActivityTotal inlakhs1 Strengthening of State IDD Cell 3.602 Strengthening IDD Monitoring LabHonorarium for Lab Techs 2.40Capacity Development Training 3.00Procurement of Glass ware & reagents 3.003 Sensitization trainings 2.254 IEC 24.006 Surveys 2.00Total 36.65Manipur State Integrated NRHM PIP 2008-2009 157

NATIONAL VECTOR BORNE DISEASECONTROL PROGRAMME5 YEARS STATE MALARIA EPIDEMIOLOGICAL DATA OF MANIPURYear BSC/E Positives Pf SPR Pf% ABER API Death2003 149316 2589 1168 1.7 45.1 5.8 1.0 172004 154202 2736 771 1.7 28.0 5.7 1.0 82005 141378 2071 769 1.5 37.1 5.6 0.8 32006 94608 2709 1301 2.86 48.0 3.6 1.0 82007 120895 1194 400 1.0 33.5 4.4 0.4 4Graph showing Malaria prevalence and surveillance parameter for the last 5 years7ABERSfRSPR65.8 5.7 5.654.4ABER %433.62.86SPR/SfR2101.7 1.70.701.50.4 0.52003 2004 2005 2006 20071.3710.31COMPARATIVE SPR 2005, 2006 & 20076543210Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecSPR 2005 0.7 0.5 0.5 0.7 1.9 2.2 2.5 2.3 1.5 1.3 1.1 0.8SPR 2006 1 1.6 1.5 2.3 3.2 2.7 3.4 3.1 3.9 3.5 5.1 2.3SPR 2007 0.9 0.6 0.6 1.1 1.3 1.1 1.1 1.2 0.8 0.8 0.6 0.52Manipur State Integrated NRHM PIP 2008-2009 158

Observation: The State has been having a poor surveillance system shown by theepidemiological data of the last 5 years which ranges from 4 to 6%. The poorsurveillance system has been mainly due to unequal distribution of surveillanceworkers (MPWs). Most of the MPWs were posted in the 4(four) valley districts wherethe disease endemicity is very low. Lack of MPWs in the high endemic hill districtscoupling with inaccessibility and less commitment to the surveillance activity hasresulted to the non achievement of 10% ABER. SPR is declined by 50% during thetransmission period in the year 2007 as compared with the preceding years. SPRtrend ranging from 0.5 to 1.3 in the year 2007 shows that disease burden in the stateis kept under a desirable level. There is also a little improvement (22%) in diseasesurveillance activity.F. Outbreaks :Year No. ofoutbreak2004 12005 22006 1Period of outbreakJuly-Aug. TMLLenglong TameiJune-JulyKPI-Saikul, Yangoi,TML Khunphung ,Tamei PHCJunePHC Saikul andSanakeithel, UKLDistrict2007 1 October – NovemberMoreh, ChandelDistrictNo. of deathduringoutbreak7 Clin.suspectedReasonsoutbreakInadequatesurveillancebecause ofinaccessibilityfor5 Clin.suspected -do - -do-Nil -do- -do-NADengue FeverOutbreak (275sample collected51+ve at Moreh)ContainmentmeasuresSpray Focal DDTmass Radicaltreatment. IECetc.-FoggingOperation(Malathion)- IEC Campaign-LarvicidaltreatmentManipur State Integrated NRHM PIP 2008-2009 159

G. Prioritization of the areas including the criteria of prioritizationG (a). Specific activities RD Kits : Rapid Diagnostic Kit for detection of Pf caseswill be used extensively in inaccessible areas of high endemic districts wherefacilities for Malaria Microscopy are very far and road connectivity are not existent.RD kits will be used at the sub-centre level by the MPWs, FHWs ASHAs and FTDholders. The following table shows selected Pf endemic districts for used of RD Kitsin 2008-09.Planning for use of Rapid Diagnostic KitsSl. No. Details Sub-centre(no)1. No. of subcentres/villageswith high Pf %2. No. of these situated ininaccessible areas(microscopy results notavailable within 24-48 hrs)3. Of the above no. prioritizedto be equipped with RDKits4. Pf cases expected to bediagnosed by RDTs (no)Village (no)TotalPopulationTribalPopulation187 2244 9,22,002 8,84,709176 2072 8,33,571 7,96,278-do- -do- -do- -do-2,000approx.G (b). Introduction of ACTArtesunate Combination Therapy (ACT) will be introduced in all the Districts of theState.Planning for distribution of ACT in districts :Sl.No.1.2.Planning for distribution of ACT:District PHCsDetails(no.) (no.)CHCs/PHCs planned to beequipped with ACTExpected no of Pf casesto be treatedwith ACT in aboveTotalPopulationTribalPopulation9 88 23,66,678 10,35,7352000 2000Manipur State Integrated NRHM PIP 2008-2009 160

G (c) Bed-netsThe State is planning to distribute the central supply of bed-nets to all BPLfamilies, 80,000 tribal households and 51,898 pregnant women giving priority inareas where IRS operation is infeasible because of inaccessibility, bamboo walledhouses and other local conditions.2(two) bed-nets will be provided to every household of 6 (six) villages inTamei Sub-division, Tamenglong, 4(four) villages in Saikot, Churachandpur and 4(four) villages in T.Waichong, Kangpokpi Sub-division for impact study of ITBN.Sl.No. Districts Population BPL Family(no.)Pregnant Women(no.)1. Tamenglong 1,11,499 70,521 3,3602. Churachandpur 2,67,586 30,000 2,7413. Chandel 1,62,031 24,603 4,0454. Ukhrul 1,76,968 21,577 5,2855. Kangpokpi SD 1,90,386 7,005 5,7106. Senapati 2,04,351 72,883 2,0867. Imphal West 2,76,539 1,11,998 4,9778. Imphal East 3,11,131 21,779 8,3339. Thoubal 4,31,709 24,003 8,32710. Bishnupur 2,34,479 7,870 7,034TOTAL 23,66,678 3,92,239 51,898PLANNING FOR DISTRIBUTION OF BEDNETSCriteria followed for distribution of ITNs (priority groups like BPL, pregnantwomen, children under 5, tribal ):Sl. No. Details No.1. No. of sub-Centres/villages to be covered with ITNs 420 / 30562. No. of targeted beneficiaries for distribution of ITNs in the above 15,00,000sub-Centres/villages3. No. of above planned to be covered with ITNs in the current year 5,00,0004. No. of Tribal population planned to be covered with ITNs in the 4,00,000current year5. No. of Households to be covered in the current year 1,00,0006. No. of Tribal households to be covered in the current year80,0007. No. of pregnant women to be covered in the current year (only for 22,141high risk areas)Community owned bed-nets1. Total community owned bed-nets in the high risk areas 1,94,5172. Total community owned bed-nets in the planned to be treated in 2,00,517the current year3. Total community owned bed nets in tribal population in high risk 1,90,517areas4. Total community owned bed nets in tribal population planned to betreated in the current year90,000@ 2 nets per household of 5 members.Manipur State Integrated NRHM PIP 2008-2009 161

G (d) Planning for IRS :IRS operation for the state has been planned on the basis of having API of 2 andabove. The operation will be carried out only in accessible areas and the areaswhere accessibility is poor because of difficult terrain system are excluded in theplanning.Unit of planning – Sub-CentreCut off API - API 2 & aboveHigh risk - As per MAP criteriaSl.NoDistrict/ PHCSelected forIRS1 UKL6 PHC/CHC2. CCP9 PHC/CHC3. KGP SD 4PHC/CHC4. CDL4 PHC/CHC5. TMN7 PHC/CHC6. Jiribam SD2 PHC/CHCTot 6 Districtsal 32 PHC/CHCSub-Centreselected(no)Villageselected(no)TribalPopl.Spraysquadsrequired(no)Trainings basesof spraysquads(no)Equipmentrequired(no)6 56 46132 46132 3 1 6 HCP30 265 63179 63179 4 1 8 HCP18 219 79575 79575 5 1 10 HCP9 81 46899 46899 3 1 6 HCP22 147 53991 53991 4 1 8 HCP6 94 52823 6645 3 1 6 HCP91 862 342599 296421 22 6 44 HCPSl.NoDistrict/ PHCSelected forIRS1 Ukhrul6 PHC/CHC2. Churachandpur9 PHC/CHC3. KangpokpiSD 4PHC/CHC4. Chandel4 PHC/CHC5. Tamenglong7 PHC/CHC6. Jiribam SD2 PHC/CHCTot 6 Districtsal 32 PHC/CHCPopl.SelectionSub-Centreselected(no)Villageselected(no)Date ofSpraySupervisionSupervisorat PHC6 56 15-3-08 MHW MHS DMOof S/C of PHC PHC30 265 -do- -do- -do- -do-18 219 -do- -do- -do- -do-9 81 -do- -do- -do- -do-22 147 -do- -do- -do- -do-Supervisorat District6 94 -do- -do- -do- DMO(IE)MO CHC91 862 15-3-08 MHW MHS DMO MOof S/C of PHC PHCMOThe selection of sites for dumping insecticides is done. Safe-guard for storageand handing of insecticides is ensured. Certification on functional status ofequipment by DMOs is done. 100 Nos. of Stirrup pumps will be needed. Repair ofexisting pumps will not be required. The certification process for coverage of IRS byPRI/ Village Council will be done.Manipur State Integrated NRHM PIP 2008-2009 162

ACTION PLAN FOR IRS 2008Tentative Date of spray 15 - 3 - 2008.SPRAY PLANNING FOR TWO ROUNDBUDGET ESTIMATE FOR IRS FOR TWO ROUND IN RUPEESSl.No.1.Name of District(Qualified for IRS)IMPHAL EASTJIRIBAM S/BNo.ofCHC/PHCNo. ofPHSCNo. ofVillageNo. ofPopulationNo. ofH.D.No. ofPumpNo.ofSprayManNo. ofSquadDDTReqd.InM.T.StatusofIRSSprayManWagesTrainingofSpraySquadTransportationDumpingchargesAdvancenotificationothercontingencySupervisionmonitoring2 6 94 52,823 9,783 6 12 3 6 API 1,04,256 15,000 25,000 12,000 20,000 1,76,256GrandTotal2. UKHRUL 6 6 56 46,132 8,117 6 12 3 5.5 API 1,04,256 20,000 30,000 12,000 20,000 1,86,2563.CHURACHANDPUR9 30 265 63,179 10,538 8 16 4 74. CHANDEL 4 9 81 46,899 7,744 6 12 3 55.SENAPATIKANGPOKPI S/DAPIHRAPIHR1,39,008 25,000 40,000 60,000 20,000 2,84,0081,04,256 20,000 30,000 18,000 20,000 1,92,2564 18 219 79,575 12,312 10 20 5 8 API 1,73,760 25,000 35,000 36,000 20,000 2,89,7606. TAMENGLONG 8 22 147 53,991 10,515 8 16 4 7 API 1,39,008 20,000 40,000 44,000 20,000 2,63,0087.STATENVBDCP H.Q.- - - - - - - - - - - - - 80,000 80,000 1,60,000GRAND TOTAL 33 91 862 3,42,599 59,009 44 88 22 38.5APIHR7,64,544 1,25,000 2,00,000 2,62,000 2,00,000 15,51,544Note : Hd = Human Dwelling structure.Spray-men wages @ Rs. 72.40 p.d.No. of days in one round = 60 days.Spray squad composition HCP = FW – 3 + SFW = 1 = 4 persons. No. of pump per squad = 2 pumpsManipur State Integrated NRHM PIP 2008-2009 163

STATE LEVEL MONITORING AND SUPERVISION OF IRSI. COMPOSITION OF TEAMTEAM –A : 1) State Program Officer2) Entomologist3) Biologist4) Health Supervisor5) Health Worker6) Field WorkerTEAM-B : 1) Regional Director2) Chief Medical Officer3) Sr.Lab.Technician-24) Insect Collector-2II.Member of PRI and Village Health Authority (Hills) will supervise IRSoperation at their respective areas.III. AREAS OF IRS :1) Imphal East : Jiribam Areas2) Ukhrul : 6 (Six) PHSC3) Churachandpu r: 30 (Thirty) PHSC4) Chandel : 9 (Nine) PHSC5) Kangpokpi SD : 18 (Eighteen) PHSC6) Tamenglong : 22 (Twenty two) PHSCIV. PROGRAMME OF IRS SUPERVISION W.E.F. 15-03-2008Imphal East Ukhrul Churachandpur Chandel Kangpokpi SD TamenglongI II I II I II I II I II I IIA A B B A A B A B A BNote – I fortnight,II fortnight.V. PERIOD OF IRS: (I Round) From 15-03-2008 to 13-5-2008(II Round) From 14-07-2008 to 11-9-2008Manipur State Integrated NRHM PIP 2008-2009 164

C2. High Risk Areas stratified on the criteria of MAP 1995 and APISl.NoName ofDistrictHigh riskPHCsSubcentreVillageAnnexure-Popl.TribalPopulation(no)1. Imphal East 2 6 94 52,823 6,257& Jiribam SD2. Ukhrul 7 39 234 1,73,305 1,73,3053. Churachandpur 10 64 624 2,67,585 2,67,5854. Chandel 5 26 621 1,62,031 1,62,0315. Kangpokpi SD 7 30 511 1,90,386 1,62,386(SenapatiDistrict)6. Tamenglong 7 30 218 1,32,483 1,32,483Total 38 PHCs 195 2302 9,78,613 9,04,047Specific constraints for implementation of the program1. Surveillance activity – There is irrational distribution of MPWs/SW all over thestate. No. of MPWs posted in the high endemic hill districts are less ascompared to the no. posted at the low endemic valley districts. In addition,lack of motivation for implementation of program by the Medical and Paramedical personnel because of other priority programs has affected thesurveillance activity.Solutionsa) DMO shall organized monthly meeting of MO PHCs at District levelexclusively on Vector Borne Disease Control Program for inclusion in otherpriority programs.b) MO PHCs shall organized monthly meeting of paramedical personnelexclusively on Vector Borne Disease control program for monitoring ofsurveillance activity.c) The plan for placement of 14 MTS (Malaria Technical Supervisor), 12 labTechnicians and 19 MPWs sanctioned by the Govt. of India under IMCP(GFATM) and DBS are followed in the state. Plan for placement of abovecategories of contractual staff has been worked out in consideration of thenon posting and frequent transfer of staff in high endemic areas.Manipur State Integrated NRHM PIP 2008-2009 165

VIDE LETTER NO.16-2/2007-NVBDCP (GFATM=11) PHASE-II (MTS)PLAN FOR PLACEMENT IN THE STATESl.No. Name of District Name of PHC No. of Post1. Ukhrul PHC Kasom Khullen 12. Thoubal PHC Kakching KhunouPHC Sugnu113. Imphal East PHC Borobekra 14. Chandel Chandel District Hospital 15. Tamenglong PHC TameiPHC OinamlongPHC TousemPHC Waichong11116. Kangpokpi SDSaikul 1(Senapati District)7. Imphal West PHC KakwaPHC Sekmaijin11Total 12Vide letter No.16-2/2007-NVBDCP(GFATM-II) Phase-II(MTS),Director, NVBDCP, Government of IndiaPLAN FOR PLACEMENT IN THE STATE:Sl.No.Name of District No. of Block Designated MUCentre1. Tamenglong 4 nos.Tamenglong-1Tamei, Tousem Nungba-1TamenglongNungba2. Churachandpur 6 nos.Thanlon-1Parbunmg, Thanlon Churachandpur-1Henglep, CCpur Singhat-ISamulamlan andSinghat3. Imphal East 4 nos. Jiribam,Sawombung andKeiraomakting4. Bishnupur 2 nos.Moirang,Bishnupur5. Senapati 3 nos.Tadubi, PurulPaomata6. Chandel 5 nos.Chandel, MachiMoreh, Khingjoy andChakpikarong7. Ukhrul 3 nos. KamjongChingoi, Ukhrul8. Thoubal 2 nos.Kakching, ThoubalJiribam – 1Sawombung-1Keiraomakting-1Bishnupur-1Tadubi-1Chandel-1Moreh - 1Ukhrul-1Thoubal-1TotalNo. ofPosts2 nos.3 nos.3 nos.1 no.1 no.2 nos.1 no.1 no.14 nos.Manipur State Integrated NRHM PIP 2008-2009 166

Plan for placement of 19 (Nineteen) Male MPWs to be appointed on Contractualbasis under XI Plan with the Financial Assistance of the Government of IndiaSl.No.Name ofDistrict(HR)Name of PHC/CHC Name of Sub-Centre No. ofplacement1. Imphal East, 1) CHC Jiribam Chandranathpur 1Jiribam SD 2) PHC Borobekra Durgapur 12. Ukhrul 1) CHC Kamjong ChammuChahong112) PHC Phungyar T.HundungSingkap113) PHC Somdal TuinemTolloi114) PHC Chingai Chingjaroi 13. Churachandpur 1) PHC Senvon Leisen 12) PHC Patpuimun NampabungPhailenthangChingmun1114. Senapati,Kangpokpi SD1) PHC T.Waichong Manidara 12) PHC Maphou Salam Patong 13) PHC Saikul Gangpikon 15. Tamenglong 1) PHC Haochong NurathelNaga ChingThingra111Total 192. IRS -a) In view of the law and order situation prevailing in the state thetransportation of DDT from the State HQ to the District HQ especiallyChandel, Tamenglong districts and Jiribam Sub division has been arecurring problems. The underground elements are demanding vehicletax of the highway during transportation.b) Operation of IRS is not feasible in many villages of high risk areasbecause of the inaccessibility, difficulty in dumping of DDT at thetargeted villages and engagement of porter incurs huge expenditure.Solution:a) Help of the paramilitary forces is absolutely necessary for escorting inthe transportation of the DDT in the above areas which also requirescommitment of the State Government.b) Large scale provision of ITBN for covering all households of the IRSleft out areas to be done. FTDs of the areas are to be activated anddue recognition of their services in the form of incentives to be given.Manipur State Integrated NRHM PIP 2008-2009 167

3. RD Kits:a) Logistic supply of RD Kits is irregular and maintenance of temperatureduring storage is a difficulty.4. ITBN:a) Non maintenance of quality of Central supply bed-nets.b) Insufficient receipt of quantity of bed-nets as per State ActionPlan.c) Insufficient and irregular supply of Deltamethrine 2.5% (SPflow).5. Fund: Untimely release and late receipt of fund from the CentralGovernment.6. Administration: Frequent change of Program Officers both at theState and District level. 5(five DMOs were transferred out in December 2007for which there was a setback in the implementation of the program.G (e) InnovationsSl.No. InnovationsDetails1. Patient referral Eg. use ofNRHM/RKS flexi funds forTransport of severe cases2. Transportation of slidesEg. Use of Public transportsystemImplementation of free Ambulance service for critically illpatients under NRHM/RKS is under process.Involvement of public transport system for transportation ofslides is not at all feasible in the State.(A) Incentive for transportation of slides on foot by peripheralHealth Workers/Community Volunteers etc. from inaccessibleareas to PHC for malaria microscopy and treatment of positivecases @ Rs.50 per visit. Activity to be monitored by MO, PHC &DMO.(B) Involvement of Paramilitary Forces in remote inaccessibleareas in EDPT, ITBN, BCC with support from State HQ.(C) Incentive to ASHA @ Rs.55/- per complete treatment of acase (RDK test + Blood slide collection + submission to PHC +treatment of positive case). To be monitored by MO, PHC &DMO.(D) Linking up Peripheral private labs to PHCs with incentive @Rs.5/positive slide. Support based on cross-checking of slidesby MO, PHC. Separate code for such slide while sending forcross checking at State HQ.(E) Submission of weekly epidemiological information from PHCto DMO through Mobile Telephone connectivity with support@ Rs. 1000/ month for DMO and Rs.500/per month MO i/cPHC.(F) Monthly meeting of MO PHCs with DMO, CMO exclusivelyfor NVBDCP.(G) Monthly meeting of MO PHCs with MPWs/FHWs/AWWs/ASHAs on VBD.(H) Collection of report from Pvt. Diagnostic Centers & Pvt.Hospitals with Incentive @ Rs.500/month.(I) Impact study of ITBN at selected Villages of Tamenglong,Churachandpur and Kangpokpi.3. NGO/CBO involvement Scheme wise implementation absolutely necessary4. Community mobilization eg. Community mobilization through women Self-help groups andMobilizing using street FBOsplays, puppet plays, selfhelp groupsManipur State Integrated NRHM PIP 2008-2009 168

H. (a) Commodity Requirement :ItemPreviousyear’sutilization(no)Requirementfor currentyear (no)BalanceAvailable(no)Netrequirementwith bufferstock1 2 3 4Insecticide for IRS(Kg) 45,000 38,000 12,000 30,000Insecticide for ITMN(Lts) 402 lit. 5,000 lit 3453 lit 5,000ITNs 2,15,000 6,00,000 1,15,000 4,85,000Chloroquine (No) 18,16,000 Adequate 65,45,000 NilPrimaquine 2.5 (No.) 1,52,750 -do- 1,52,250 NilPrimaquine 7.5 (No.) 3,00,000 -do- 6,89,900 NilACT (Artesunate+SP) 2,800 2000 200 2,000Blister (No.)Blister pkt. Blister pktArtesunate tabs (No.) 63,000 Adequate 30,000 30,000S+P Combination (No.) 95,180 Adequate 1,48,219 1,48,219Quinine Injection (No.) 4825 Adequate 8,175 8,175Quinine Sulphate (No.) 6,580 6,000 3,420 NilArteether Inj. (No.) 402 1,000 636 364RDK (No) 64,750 Test 2,80,000 Test 2,64,500TestPumps (No.) a) HCP 23 100 Nil 100 nos.Fenthion 40 200 lit Nil 400 lit.Temephos Nil 200 lit Nil 200 lit.Malathion Technical Nil 0.5 MT Nil 0.5 MT1,85,000 testFogging machine (Vehicle Nil 2 Nil 2 no.mounted)Fogging machine (Portable) 25 2 23 nos.Binocular microscope 30 nos. Nil 30 nos.Micro slides 50x5000 pkts 3,00,000 Nil 3,00,000Blood lancet 1,00,000 3,00,000 Nil 3,00,000JSB stain-I (50 ml) 2000 bottles 12,000 Nil 12,000bottlesJSB stain-II (50 ml) 2000 bottles 12,000 Nil 12,000bottlesStaining jar 400 nos. Nil 400 nosSpirit, 500 ml (Rough) 200 nos. Nil 200 nosParaffin Liquid 148 Bottles NilEye piece (Microscope) 15 50 35 15Vehiclea) Supervisory (Gypsy/ Jeep) Nil 11 nos. Nil 11 nos.b) Pick up. Nil 10 nos. Nil 10 nos.Manipur State Integrated NRHM PIP 2008-2009 169

H. (b)ItemPreviousyear’sutilization(no)Requirementfor currentyear (no)BalanceAvailable(no)Netrequirementwith bufferstock1 2 3 4Entomological/Biological Section(a) Vehicle Gypsy Nil 2 Nil 2(b) Microscopei) Binocular Comp. Nil 4 nos. Nil 4 nos.ii) Stereoscopic simple Nil 2 nos. Nil 2 nos.iii) Simple Dissecting Nil 4 nos. Nil 4 nos.microscopeiv) Light trap(CDC) Nil 10 nos. Nil 10 nos.JE/Dengue Sentinel Site JN Hospital / Mac Elisa (IgM) test Kit and Apex ReferralLab.RIMSa) Dengue Nil 384 test Nil 384 testb) J.E. Nil 384 test Nil 384 testc) Refrigerator Nil 2 no. Nil 2 no.d) Rapid test Kits for Dengue Nil 1500 tests Nil 1500 tests.e) Centrifuge machine Nil 2 nos. Nil 2 nos.f) Vacutainer Nil 1000 Nil 1000Training equipments1) Portable screen Nil 10 nos. 1 10 nos.2) LCD Projector Nil 10 nos. 1 10 nos.3) Laptop Nil 12 nos. 1 12 nos.4) UPS Nil 10 nos. Nil 10 nos.5) Computer Printer1020 HP LaserJetNil 1 no. Nil 1 no.I. (a) Bazar articles to be purchased locallySl.No.ItemsRequirement for currentyear (no)1. Polythene sheet 1000 metre2. Plastic Mug (1 litre) 100 nos.3. Plastic bucket (10 litres) 100 nos.4. Candle stick (big) 500 pkts.5. Enamel tray 100 nos6. Tissue paper 500 Rolls7. Long cloth (cotton) 1000 metre8. Rubber hand glove (Surgical) 100 pairs9. Hand glove ( Garden type) 100 pairs10. Apron (Cotton) 100 nos.11. Face Mask (Cotton) 50012. Rain coat 60 nos.13. Gum boots 60 nos14. Torchlight, 3 celled 50 nos15. Torch light cell, dry cell 500 nos.16. White Chalk 100 pkts.17. Hand bag (cotton) 100 nos.18. Absorbent Cotton(50gm) 5000 Rolls19. Toilet Soap 100 nos.20. Filter cloth 1000 mtrs.21. Electric bulb 100 w 30 nos.22. Tube light with Chalk & Starter 20 nos.Manipur State Integrated NRHM PIP 2008-2009 170

Sl.No.ItemsRequirement for currentyear (no)23. Stand fan 3 nos24. Odonil (air punfier) 100 pkts.25. Lock and Key(Click type) 10 nos.26. Phenyl soln. 20 bottles.27. Duster 6 nos.28. Thermo flax ( half litre) 10 nos.29. Clinical Thermometer( for ASHA) 2900 nos.I. (b) Stationery :Sl.No.Items1. Register no.20 60 nos.2. Stock Register No.30 6 nos.3. Xerox JK bone A4 size 30 reams.4. Xerox JK bone Legal size 20 reams.5. File cover with board 200 nos.6. Calculator 20 nos.7. Carbon Paper 20 pkts.8. Erasing Fluid(White) 12 nos.9. Stapler machine No.12 12 nos.10. Alpin 12 box11. Puncher machine6 nos.(Single hole)12. Puncher machine3 nos.(double hole)13. Stapler machine pin No.10 20 pkts.14. Stapler machine pin No.24/6 20 pkts.15. Clip file 20 nos.16. Computer ink17. Table Top glass (2x3) ft. 2 nos.18. Envelop 9”x4” 3000 nos.19. Type ribbon (Black) 5 nos.20. Gum bottle (700ml) 6 Bottles21. Cello gel(Blue, Black & Red) 4 Doz.22. Scale 1 Doz.23. Big Steel Almirah ( Godrej) 12 nos.24. White Board with stand (4x3) sq. ft. 11 nos25. Peon book 3 Doz.Requirement for currentyear (no)Manipur State Integrated NRHM PIP 2008-2009 171

J. Training:Sl.No.TrainingsCostperBatchPreviousyear(no)Q1(no)Q2(no)Q3(no)Current yearQ4(no)Total(no)Total Cost(Rs.)1. Medical specialistsat District Hospital2. Medical Officers 1,00,000 3 5 2 - 3 10 10,00,0003. LaboratoryTechnicians(induction)4. LaboratoryTechnicians(reorientation)75,620 - - - - 2 2 1,51,24075,620 3 2 3 - 2 7 5,29,3405. Health Supervisors 30,000 6 5 - - 6 11 3,30,000(M)6. Health Supervisors 30,000 - 1 5 5 10 3,00,000(F)7. Health Workers(M) 10,000 13 3 3 3 1 10 1,00,0008. Health Workers (F) 10,000 0 5 5 5 5 20 2,00,0009. ASHA 10,000 8 26 26 26 26 104 10,40,00010. CommunityVolunteers otherthan ASHA (FTD/DDC)11. Others specifya) 2 Day compositeTraining : RR Teamof District10,000 40 10 10 10 10 40 4,00,0001,00,000 - 1 - - 1 2 2,00,000b) One Day Trg. AWW 10,000 - 10 10 10 10 40 4,00,000c) One Day Trg. SHG 10,000 - 40 40 40 40 160 16,00,000(Women)d) One Day Trg. 30,000 - 10 - 10 12 32 9,60,000School Teachers(including Ashram &Tribal)e) One Day Trg. ofFWsUMS10,000 1 - - 1 1 10,000f) Trg. of MTS 20,000 - - - 1 - 1 20,000g) One Trg. Quality 50,000 2 2 1,00,000Ass.Total Rs. 73,40,580(Rupees seventy three lakh forty thousand five hundred eighty) onlyManipur State Integrated NRHM PIP 2008-2009 172

IEC Strategy on Vector Borne Disease Control Program :The State shall set up a team at the State HQ NVBDCP Manipur comprisingof (a) The Regional Director (H & FW) Government of India, Imphal (b) The StateProgram Officer¸ NVBDCP Manipur (c) State Biologist (d) State Entomologist (e)IEC consultant (GFATM) (f) Media representative/Representative of DIPR(Directorate of Information & Public Relation, Govt. of Manipur.The team will be responsible for the following activities:1. To develop IE strategy, policy and guidelines both at the State andDistrict level in conformity with the guidelines of the NVBCP, GOI.2. To monitor and supervise the IEC activities undertaken by the State aswell as the DVBDCS.OBJECTIVES:3. To design and develop the contents of IEC materials.1. To raise awareness, improves knowledge and understanding among thegeneral population about Vector Borne Diseases, routes of transmission,methods of prevention and importance of Early Diagnosis and PromptTreatment (EDPT).2. To promote desirable practices such as sleeping under bed-nets during dayand night time, wearing of full sleeve shirts and long pants from dusk to thetime of going to bed, avoidance of misuse of DDT as means of pests controlin agriculture etc.3. To mobilize all sectors of society to integrate massages on control andprevention of Vector Borne Diseases (Malaria, JE and Dengue) into theirexisting activities.Components of IEC Strategy :The following components will be utilized for raising awareness, behaviourchange and social mobilization.- use of Mass Media (Print & Electronic)- Advocacy at various level- Intersectoral Collaboration- Training- Involvement of NGOs- Research/Monitoring & EvaluationManipur State Integrated NRHM PIP 2008-2009 173

K. BCC/IEC including Anti Malaria MonthSl. Activities Unit Cost (Rs) Previous Current yearNo.year (no) Q1(No.)Q2(No.)Q3(No.)Q4(No.)Total(No.)1. Wall posters (Multi-colour) 24 20,000 - - - - 25,0002. Hoardings10000 - - - - - 50(5 each in Reporting units)3. TV Campaignsa) Documentary inManipuri on IRS, ITBN,Source reduction,20,000- - - - - 4Larvivorous fishb) Spots in Local cable net Production =Rs 93,000work on JE, Dengue and Telecast = Rs 1,80,000Malaria x 6 monthsc) Bottom line scrolld) Panel discussionQuiz CompetitionAIRa) Radio spot (Malaria, JE,Dengue)Rs 400.00Rs. 15,000Rs. 45,000Production = 15,000Broadcast = 19,200Production = 40,000Broadcast = 48000Total Cost(Rs)b) Short play in 4 tribaldialectsManipur State Integrated NRHM PIP 2008-2009 174

Sl. Activities Unit Cost (Rs) Previous Current yearNo.year (no) Q1(No.)Q2(No.)Q3(No.)Q4(No.)Total(No.)4. Health camps 5000 220 50 50 50 50 4005. Community mobilizationmeetings for IRS@ Rs 2000a) State Hq- - - - -b) HR sub center areas62 46 45 - - 916. Sensitization meetings ofVillage Health & Sanitation3000 - 19 19 19 19 76Total Cost(Rs)Committee7. Short Tele Film8. Street plays9. Pre and Post BCC survey 1,00,000 1 Pre 1 - - Post 1 - 2,00,000i) Advocacy Meetinga. State Hqb. Districtc. PHCii) Inter SectoralSensitizationa) State Hqb) Districtiii. Health Mela at PHCiv. School awarenesssessiona. Studentb. Teacherv. District level Quiz, Spotpainting & Essayvi.One day AwarenessSessiona. Stateb. District20,00010,00010,00020,00010,00010,00010,00010,00030,0005,0005,000110-1105010010102100Manipur State Integrated NRHM PIP 2008-2009 175------42---110-1107325102150--73---25--75-------50-75110-110731004210230020,0001,00,0007,30,00020,0001,00,0007,30,00010,00,0004,20,0003,00,00010,00015,00,000

vii. UMSa. Advocacy meeting (2x26 wards)b. Advocacy cumWorkshop ofMunicipalCouncilorc. Advocacy meeting ofPolitical leadersof 8constituenciesd. Awarenessprogramme formigrantlabourerse. Awarenessprogramme forStudentsOrganisationf. AwarenessProgramme forSchoolTeachers5,00020,00030,00010,00010,00010,000--------1--10181----18-----16--1015211101102,60,00020,00030,0001,00,00010,0001,00,000g) Observance ofCleanlinessmonth ( Rs.3000 x 26wards)1 st Prize2 nd Prize3 rd Prize300010,0007,0005,000- - 26 - - 261,00,000Manipur State Integrated NRHM PIP 2008-2009 176

Sl.No.Activities Unit Cost (Rs) Previous Current yearyear (no) Q1(No.)Q2(No.)Q3(No.)Q4(No.)Total(No.)Total Cost(Rs)h) IEC materials 5,00,0005,00,000Total 1,13,94,400Rupees One core thirteenlakh ninety four thousandfour hundred onlyColour codexxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxBudget HeadDomestic Budget headIMCPEACManipur State Integrated NRHM PIP 2008-2009 177

L. Private Public PartnershipSl.No. Schemes Previousyear(No.)Planned inCurrent Year(No.)Cost1. Scheme I (DDC/FTD) Nil 2 6,00,000=002. Scheme II (Micros.& Nil 1 2,85,000=00treatment/referral)3. Scheme III (Hospital Nil Nil NilBased complicatedtreatment)4. Scheme IV (ITBN in HR Nil Nil NilAreas)5. Scheme V (LarvivorousFish)Nil 44,00,000=00Total Nil 7 12,85,000=00Sl.NoM. Larvivorous FishDistrictSeasonal waterbodiesPerennial waterbodiesWaterbodiesreleasedwith fishpreviousyear(no)Planned inCurrentyear(no)HatcheryMaintenanceCost(Rs)Cost ofConstruction1. Imphal 2 120 36 Nil Nil 20,000East2. Imphal 2 98 50 35 Nil 20,000West3. Bishnupur 3 210 150 22 Nil 30,0004. Thoubal 3 180 100 Nil 30,0005. State HQ Nil 1(One) 2,00,000Total 10 608 336 57 Nil 1,00,000 2,00,000Manipur State Integrated NRHM PIP 2008-2009 178

URBAN MALARIA SCHEMEBackground Information:Urban Malaria Scheme, Imphal sanctioned in May 1979 has beenoperating in the Imphal Municipality area having 26 Municipality wards with anarea of 29.57 Sq. km. It covers a part of both Imphal West and Imphal EastDistricts.Name of the UMS town : Urban Malaria Scheme ImphalArea: 29.57 Sq.kmPopulation : 3.37 Lacs (2006)Altitude: 790 mtreTemperature: Ranges from 2˚C to 39˚CImplementation:For operational convenience the town under Urban Malaria Scheme isdivided into 2 (Two) zones namely East and West zone. Each zone is againdivided into 6 (Six) sectors and each sector covers 2 or 3 Municipality wardsdepending upon the size of the ward.Allocation of Municipality Wards to Zones and Sector:ZONE SECTOR MUNICIPALITY WARD NO.Sector no. 1 Ward no. 1 & 26Sector no.2 Ward no. 2,3 & 4East ZoneSector no. 3 Ward no. 5 & 6:Sector no. 4 Ward no. 7 & 8Sector no. 5 Ward no. 9 & 10Sector no. 6 Ward no. 11,12 & 13Sector no. 7 Ward no. 14 & 15Sector no.8 Ward no. 16 & 17West zoneSector no. 9 Ward no. 18 & 19Sector no. 10 Ward no. 20 & 21Sector no. 11 Ward no. 22 & 23Sector no. 1 2 Ward no. 24 & 25Health Infrastructure in the UMS Area:Medical collegeReferral state HospitalUrban Health Centre (State Government)PHSC within the jurisdiction of UMS: 1 (One): 1 (One): 1 (One): 2 (Two)Manipur State Integrated NRHM PIP 2008-2009 179

Private Hospitals/InstitutionsManpower of UMS Imphal :OfficerInspectorInsect collectorMPHWField Workers: 9 (Nine): 1(One): 2(Two): Nil: 16 (Sixteen): 20 (Twenty)URBAN MALARIA SCHEMEManipur State Integrated NRHM PIP 2008-2009 180

Manipur State Integrated NRHM PIP 2008-2009 181

Epidemiological data of Urban Malaria Scheme Imphal for the Year 2007(Jan - Dec):Town: Imphal; State : Manipur; Area : 29.57 Sq.km ; Popl : 3.37 LacsMontPCD From Private Institutions Total RT DeathProgressih BS BS PO Pf Pf(F BS BS PO Pf Pf(F BS BSE PO Pf Pf( give sve totalC E S ) C E S ) CSF) n if anyJan. 5 5 0 0 0 30 30 6 2 1 35 35 6 2 1 6 0 6Feb. 2 2 0 0 0 66 66 3 0 0 68 68 3 0 0 3 0 9Mar. 3 3 0 0 0 6 6 3 2 1 9 9 3 2 1 3 0 12Aprl. 10 10 1 0 0 7 7 3 2 1 17 17 4 2 1 4 0 16May. 8 8 1 0 0 10 10 3 1 0 18 18 4 1 0 4 0 20Jun. 4 4 1 0 0 31 31 3 1 0 35 35 4 1 0 4 0 24Jul. 12 12 3 0 0 26 26 1 0 0 38 38 3 0 0 3 0 27Aug. 5 5 1 0 010 10110 0 09 94114 1 0 0 1 0 28Sept. 5 5 0 0 014 14143 0 04 49149 3 0 0 3 0 31Oct. 4 4 0 0 014 14141 0 01 15145 1 0 0 1 0 32Nov. 2 2 0 0 015 15155 2 07 79159 5 2 0 5 0 37Dec. 0 0 0 0 0 99 99 3 2 2 99 99 3 2 2 3 0 39MONTH-WISE MOSQUITO DENSITY PER 10 MAN HOURSMonth *Anopheles Ae. C.quinquefasciatus C.ArmijeresaegyptitritaeniorhyncusJan - - - - -Feb - - - - -Mar 10.0 0.6 136.0 1.0 60.0Apr 3.5 0 185.0 1.7 191.0May 2.0 1.2 127.0 0 60.9Jun 3.5 2.3 93.5 6.1 12.1Jul 1 5.5 3.0 102.0 12.2 125.0Aug 3.0 6.4 9.2 22.0 162.0Sep 4.5 0 66.0 17.7 46.3Oct - - - - -Nov - - - - -Dec - - - - -* No vector species encounteredAccording to GR survey carried out during January 2005 there are about780614 Sq. mtres of water surface in the town which may increase during rainyseason. The Imphal town area does not have proper drainage system, As suchthere are innumerable breeding places which could not properly be recordedduring the GR survey. Proper mapping of breeding places also could not beManipur State Integrated NRHM PIP 2008-2009 182

done. Anti- larval operation alone can not bring down the adult vector density inthe town. Due to lack of infrastructures and basic amenities to be provided by theGovernment to the public like proper drainage system, sewage plans etc. theMunicipal Health bye laws could not be framed.ACTIVITIES:Anti - larval Operation:1) Spraying of larvicides on weekly basis throughout the year fromJanuary-December2) Minor Engineering Works - Source reduction in the form of landdevelopment is to be done wherever feasible from time to time byengaging skilled workers on payment basis.3) Desilting, Deseeding & Canalization- To be done by regular staffs.Malathion Fogging :Malathion fogging as an anti-adult measure on fort-nightly basis startingfrom the month of April to August to bring down the mosquito adult density will bedone routinely since anti-larval measures alone could not bring down density ofmosquito to a desirable level.I.E.C. : (A)Advocacy meeting1) Advocacy meeting of member of CBOs. (Total 2 nos. x 26 Wards)2) Advocacy cum workshop of Municipal Councillors.3) Advocacy meeting of Political leaders of 8 (eight) constituenciesunder Municipality area.4) Advocacy meeting of School teachers5) Awareness Programme of Migrant Workers/Labourer6) Awareness Programme of Students’ Organization.(B)(C)Hatchery:Logistics:Budget:Observation of cleanliness month during Anti-Malaria MonthCleanliness drive will be conducted in all Municipal wards throughlocal CBOs/Clubs in a competitive way and one CBO/Club will beawarded prize in each ward on the basis of proper observation ofcleanliness month.Print and Electronic media will be extensively engaged for IECcampaign.A mother – hatchery will be constructed at State HQ., Lamphel.Shown in Commodity requirement columnReflected in State Total budget for all items.Manipur State Integrated NRHM PIP 2008-2009 183

ACTION PLAN ON QUALITY ASSURANCE SCHEME ON LAB. DIAGNOSIS ONMALARIA1. All positive Slides from (76 PHCs + 16 CHCs + 7 DHs + 10 PNH / Clinics + 20 P.Labs.) =129 Centres and 10% Negative slides will be collected on monthly basis bythe concerned/ microscopist and submitted to the respective DHQ Lab. forascertaining the quality of the Slide & smear preparation and confirmation of the Lab.diagnosis. Similarly, the Blood slides from the DHQ will be sent to the State HQ lab.and then to the Lab. of Regional Director(ROH & FW), Government of India, Imphal.2. Reports of the examination and finding at each level will be sent to the ApexLab Regional Director(ROH & FW), Government of India, Imphal separately inconcealed separate sheets for cross checking & giving feedback by the RegionalDirector (ROH & FW) to the levels of the respective originating centres.3. Blood slides from the peripheral private labs. and Nursing homes/clinics shall becollected by identified Health Workers or Supervisor of the area for onwardsubmission to the DHQ, State HQ and Regional Director (ROH & FW), Government ofIndia, Imphal Lab. under the arrangement of State Programme Officer.4. Logistics supply shall be made available from State HQ.PHCs identified for submission of Blood Slides direct to the State HQ Lab.on thebasis of convenience and as they are located far from the District HQ than State HQSl.No. Name of District Name of PHC/CHC1. Imphal East a) CHC Jiribamb) PHC Borobekra2. Ukhrul a) PHC Kasom Khullen3. Chandel a) PHC Morehb) PHC Tengnoupalc) PHC Machid) PHC Chapikarong4. Tamenglong a) PHC Tameib) PHC Haochongc) CHC Nungbad) PHC Nonehe) PHC Tousemd) PHC Khoupum5. Kangpokpi SD (Senapati District)a) PHC Saikulb) PHC MaphouCOSTING: (Budget)1. TA/DA of Staff :@ Rs.100 x 115(including St.HQ) = Rs.11,500 x12 months = Rs. 1,38,000@ Rs.200 x3 Days x15 PHC/CHC = Rs.9,000 x12 months = Rs. 1,08,0002. Contingencies (Reports and Returns)@ Rs.500/month x129 Centres x 12 months. = Rs. 7,74,000Total = Rs.10,20,000Manipur State Integrated NRHM PIP 2008-2009 184

FLOW CHARTA. PHC Labs.(All '+' ve&10 % of Neg)DHQLabs.St.H.Q.Labs.RD (ROH& FW)Labs.B. Private LabClinics/NursinghomeFeed backC. Remote P.H.Cs(All '+'ve slidescollected byH.Workers /SupervisorsABCDHQLabs.St. H.Q.Labs.Manipur State Integrated NRHM PIP 2008-2009 185

ACTION PLAN FOR PREVENTION AND CONTROL OF JAPANESEENCEPHALITIS AND DENGUE DURING 2008-09The state had experienced an outbreak of Dengue at Moreh Town inChandel District, Manipur during the month of October and November 2007 forthe first time. The outbreak had in fact, caught napping the State authoritybecause of its unexpected occurrence. The reporting of cases of Denguecontinued till the end of November 2007. Out of 275 cases of blood sampletested for IgM Dengue antibody at RMRC Dibugrah 51 sample were foundpositive. Though the cases were minimal in the State, Authority felt the need tostrengthen the existing SSH Lab. at the Microbiology Department JN Hospital,Imphal a Sentinel surveillance site of Japanese Encephalitis. JE outbreak hasalso been occurring in the valley district of the State sporadically.The Government has strengthened SSH Lab. JN Hospital with theprovision of ELISA Reader, Washer and Printer etc. in 2007-2008, where bothserological surveillance and confirmation of JE and Dengue can be done easilywith the supply of MAC ELISA IgM antigen kits.RIMS Hospital is at present, not having facilities for serosurveillance andconfirmation of JE and Dengue although it is one of the referral hospitals in theNorth Eastern Region. It is proposed to identify and strengthen the MicrobiologyDepartment, RIMS Hospital, Imphal as one of the Apex Referral Laboratories inthe country specially for the North Eastern States.1. Epidemiological data of Japanese Encephalitis in Manipur for the last5(five) years.EPIDEMIOLOGICAL INFORMATION ON J.E. FOR THE YEAR FROM 2003-07Year No. of Districts Cases Confirmed Deathsaffected2003 Nil Nil Nil Nil2004 4 66 Nil 1(Suspected)2005 Nil Nil Nil Nil2006 Nil Nil Nil 1(Suspected)2007 7 65 1(One) NilManipur State Integrated NRHM PIP 2008-2009 186

ACTION PLAN FOR PREVENTION AND CONTROL OF DENGUE ANDJAPANESE ENCEPHALITIS DURING 2008-09Sl. Item Particulars details etc. Total No. RemarksNo.1. Diagnostic facility a) Total no. of Apex ReferralLaboratoryNil 1(one) need to beidentified &established at RIMSb) Total no. of SentinelSurveillance Hospitals (SSH)identified & functioning1 (One) Microbiology Dept.JN Hospital,Porompat,Imphal East -795001during 07-08c) Additional SSH required Nil N.A.with justificationd) SSH not having ELISA Nilreader & washere) Requirement of Dengue & JEAnnexure-I2. Monitoring &Evaluation3. Epidemicpreparedness4. Hand operatedfogging machine5. Capacity building(category wisetraining load, totalNo. to be trainedwith cost6. IEC and Socialmobilization of thecommunity7. Operationalresearch project8. Any other withjustificationtest kits.POL/Hiring of vehiclesReview meetings at State HQ Twice in ayearTotal available 2Additional requirement with 2 in eachjustificationDistrict x10 units +St.HQ 5= 25Hiring of Privatevehicles withestimated POLrequirement shownin budgetApril and MayAll district are withoutfogging machine.Buffer stock at theState HQ.Medical Officers 40 MOs Annexure-IIDistrict level Programme 10 POs. (Budget cost)OfficersOthers, RIMS-5, JNH-3, St.HQ-3 11 participantsState LevelDistrict levelName of the project/agency tothe involved. Vector surveillancein each district by the team ofEntomologist, Biologist andRMRC Dibrugarh4 nos. invalleydistricts.5 nos. inHilldistrictsAnnexure-IIIAnnexure-IVVector surveillance in9 (Nine) districts.Annexure-VManipur State Integrated NRHM PIP 2008-2009 187

Requirement of Dengue/JEANNEXURE-IA) Month wise requirement of MAC ELISA IgM KitSSH (Microbiology Department, JN Hospital, Porompat, Imphal East)Month JE Kit IgM Dengue (IgM)May 2008 192 wells 192 wellsN.B. One time supply of 192 wells (192 test) can meet the requirement of theSSH JN hospital for the period from May to October. In case of additionalrequirement of test kits provision for ready supply through RMRC Dibrugarhmay be made by the Dte. NVBDCP, GOI.B) Apex Referral Laboratory (Microbiology Department, RIMS Hospital)(i)Month wise requirement of MAC ELISA IgM and IgG Kit for JE and Dengue ofApex Referral Laboratory to be identified and established at the MicrobiologyDepartment, RIMS Hospital.Month JE Kit IgM Dengue (IgM)IgM IgG IgM IgGMay 192 192 192 192JuneJulyAugustSeptemberOctoberN.B. - One time supply of 192 wells (192 tests) can meet the requirementof the Apex Referral Laboratory for the period from May to October. Incase of additional requirement of test kits provision for ready supplythrough ICMR Dibrugarh may be made by the Dte. NVBDCP, GOI.ii)Equipments required to be suppliedElisa Reader – IElisa Washer- IPrinter – IManipur State Integrated NRHM PIP 2008-2009 188

ANNEXURE-VOPERATIONAL RESEARCHonVector Surveillance in each District by the teams of Entomologist and BiologistDuration of Study: 1) 7 days each in 4 valley districts2) 12 days each in 5 hill districtsManpower: 1) Biologist-12) Entomologist-13) Insect collector-44) Driver-2Logistics:1) POL/Hiring of vehicle -a) Rs.1000/day x 7 days x 4 districts = Rs. 28,000/-b) Rs.3000/day x 12 days x 5 districts = Rs.1,80,000/-2) TA/DAa) Officers –(i) Rs.400x2 Officers x 7 days x 4 valley districts = Rs. 22,400/-(ii) Rs.400x2 Officers x12 days x 5 hill districts = Rs. 48,000/-b) Staff -(i) Rs.200x6 staffs x 7 days x 4 valley districts = Rs. 33,600/-(ii) Rs.200x6 staffs x 12 days x 5 hill districts = Rs. 72,000/-3) Contingency- Stationery,Entomological materials and others= Rs. 1,16,000/-Total Budget estimate POL + TA/DA+ Contingency = Rs. 5,00,000/-Manipur State Integrated NRHM PIP 2008-2009 189

ESTIMATED BUDGET FOR THE FY 2008-09Sl.NoActivitiesDBS(INR)IMCP(INR)EAC(INR)Total(INR)1 IMCP2 a) Human Resource 3060000 30600003 b) Planning & Admn 2050000 20500004 c) Monitoring Evaluation 1877200 18772005 d) Operational Cost (ITBN) 7200000 72000006 Training 1100000 3580580 2660000 73405807 BCC 4436400 5510000 958000 109044008 Salary: 19 Contractual MPWs XIth 13,68,000 13,68,000Plan9 Quality Assurance scheme of Lab.1020000 1020000Diagnosis10 IRS 1551544 155154411 Vector Mapping 500000 50000012 Insecticide susceptibility test 50000 5000013 Chloroquine Resistance Study 160000 16000014 Incentive to ASHA for CT 200000 20000015 Out break Management 140000 14000016 Incentives to Major Stakeholders 60000 6000017 Incentives to peripheral private72000 72000labs18 Meeting of MOs PHCs with DMO 240000 24000019 Maintenance of Hatcheries 112000 11200020 Const. of Mother hatcheries at200000 200000State HQ21 UMS fogging expenses 20000 2000022 POL & Maintenance of vehicle 500000 50000023 Annual Maintenance Contract 100000 10000024 Lab items 5000000 500000025 Bazar articles 2000000 200000026 Training Equipments 1410000 141000027 Mobile connectivity for MIS 672000 67200028 Public Private Partnership1285000 1285000(Scheme wise)29 VCM Impact evaluation 200000 20000030 Incentive to HW/CV of inaccessible 200000 200000areas in surveillance31 Incentive to FTDs in HR areas250000 250000(IRS left out)32 Monthly meeting of MO PHCs with 984000 984000MPWs/FHWs/ASHAs33 Procurement of 14 Motor cycle for700000 700000MTS34 Office expenses 600000 600000 600000Total 2,34,10,944 2,45,77,780 51,28,000 5,31,16,724Manipur State Integrated NRHM PIP 2008-2009 190

STATEMENT OF EXPENDITURE (SOE) UNDER IMCP-GFATM FOR QUARTER ENDEDDECEMBER 2007 OF MANIPURComponents1. Human resources1.1 Salary for the staff ofState Project MonitoringUnit (PMU)1.2 Honorarium toAccountant for ProjectDistrictsExpenditure uptill date Jan. 2008 & expected expenditure up to June 2008Expendituretill Dec.2007Expenditurein Jan.2008Expenditureexpectedupto 31-3-08Expenditureexpected upto30 June 2008Total ExpectedExpenditureupto June 2008(a) (b) (c) (a+b+c)90,000 10,000 20,000 30,000 60,000Sub Total 90,000 10,000 20,000 30,000 60,0002. Training2.1 Training of CommunityVolunteers in used of RDT,drug distribution andbednet treatment detaillarvivorous fish.4,05,000 Nil Nil 1,00,000 1,00,0002.2 Training for Medical 3,40,000 Nil 4,00,000 Nil 4,00,000Officers2.3 Training forNil Nil 3,01,620 Nil 3,01,620Lab.Technicians2.4 Other Training MPWs, 67,000 Nil 1,00,000 Nil 1,00,0002.5 Spray Supervisor 1,95,000 Nil Nil 1,00,000 1,00,0002.6. Field Worker 37,000 Nil Nil Nil Nil2.7 ASHA Nil Nil 10,40,000 Nil 10,40,000Sub Total 10,44,000 Nil 18,41,620 2,00,000 20,41,6203.Planning & Administration3.1 Office expenses forState Level1,50,000 50,000 2,50,000 1,50,000 4,50,0003.2 Office expenses for9,00,000 1,00,000 2,00,000 3,00,000 6,00,000district level3.3 Accounting andNil Nil 2,50,000 Nil 2,50,000Auditing cost3.4 Bank Charges3.5 Other cost associatedwith the planning andadministrationSub Total 10,50,000 1,50,000 7,00,000 4,50,000 13,00,0004. Monitoring & Evaluation4.1 Hiring of vehicles forfield visit and supervision4.2 Travel relatedexpenses (TA/DA)4.3 Review meeting ofStates/ District4.4. Other cost associatedwith the Monitoring and10,40,000 1,20,000 2,40,000 3,60,000 7,20,0001,08,000 12,000 28,800 46,800 87,600Nil Nil 18,000 Nil 18,0001,77,000 30,000 60,000 51,000 1,41,000Manipur State Integrated NRHM PIP 2008-2009 191

EvaluationSub Total 13,25,000 1,62,000 3,46,800 4,57,800 9,66,6005. IEC5.1 Health Camps / Mela 10,580 25,00,000 25,10,5805.2 IEC Awareness through 11,61,796 Nil 9,00,000 10,00,000 19,00,000NGOs/CBOs/PanchayatSub Total 11,61,796 Nil 9,10,580 35,00,000 44,10,580ComponentsExpenditure uptill date Jan. 2008 & expected expenditure up to June 2008Expendituretill Dec.2007Expenditurein Jan.2008ExpenditureexpectedExpenditureexpected uptoTotal ExpectedExpenditureupto June 2008upto 31-3-08 30 June 2008(a) (b) (c) (a+b+c)6. Operational expensesfor treatment of bednets6.1 Through Health System 5,03,000 Nil 10,00,000 10,00,000 20,00,0006.2 ThroughNGOs/CBOs/PanchayatRaj and other privatepartners5,03,000 Nil 10,00,000 10,00,000 20,00,000Sub Total 10,06,000 Nil 20,00,000 20,00,000 40,00,0007. Interest on GrantRelease7.1 Bank Interest Earned 11,466 Nil Nil Nil NilSub Total 11,466 Nil Nil Nil Nil8. Over Heads & OtherMisc. ExpensesSub Total Nil Nil Nil Nil NilGRAND TOTAL 56,76,796 3,22,000 58,19,000 66,37,800 1,27,78,800Manipur State Integrated NRHM PIP 2008-2009 192

Components1. Human resources1.1 Salary for the staff ofState Project MonitoringUnit (PMU)1.2 Honorarium toAccountant for ProjectDistricts1.3 Salary for MTS underGFATM1.4 Salary for LTS underSTATE ACTION PLAN IMCP, MANIPURACTION PLAN FOR IMCP - GFATM FOR YEAR 2008-09Total FundsReceivedRs.Requirement of funds for the year 2008-09Expenditure Balance likely Requirement oflikely to be to be on 31- funds for theincurred 03-08 year 2008-09upto March31, 2008Rs.RsRs.Manipur State Integrated NRHM PIP 2008-2009 193Total9,82,000 Nil 9,82,000 9,84,000 9,84,0001,20,000 1,20,000 Nil 1,20,000 1,20,000Nil Nil Nil 10,92,000 10,92,000Nil Nil Nil 8,64,000 8,64,000GFATMSub Total 11,02,000 1,20,000 9,82,000 30,60,000 30,60,0002. Training2.1 Training of CommunityVolunteers in used ofRDT, drug distributionand bednet treatmentdetail larvivorous fish (20batches per course)4,05,000 4,05,000 Nil 4,00,000 4,00,0002.2 Training for MedicalOfficers7,40,000 7,40,000 Nil 10,00,000 10,00,0002.3 Training forLab.Technicians3,01,620 3,01,620 Nil 6,80,580 6,80,5802.4 Training for MTS Nil Nil Nil 20,000 20,0002.5 Other Training/Workshop (Specify…….)ASHA- 10,40,000 10,40,000 Nil 10,40,000 10,40,000Health Supervisor 1,95,000 1,95,000 Nil 3,30,000 3,30,000MPW 1,67,000 1,67,000 Nil 1,00,000 1,00,000F. Ws/Ento. Assist 37,000 37,000 Nil 10,000 10,000Sub Total 28,85,620 28,85,620 Nil 35,80,580 35,80,5803.Planning & Administration3.1 Office expenses for state4,50,000 4,50,000 Nil 6,00,000 6,00,000level3.2 Office expenses fordistrict level12,00,000 12,00,000 Nil 12,00,000 12,00,0003.3 Accounting and Auditingcost2,50,000 2,50,000 Nil 2,50,000 2,50,0003.4 Bank Charges3.5 Other cost associatedwith the planning andadministrationSub Total 19,00,000 19,00,000 Nil 20,50,000 20,50,0004. Monitoring & Evaluation4.1 Hiring of vehicles forfield visit and14,00,000 14,00,000 Nil 14,40,000 14,40,000Rs.

supervision4.2 Travel related expenses(TA/DA)4.3 Review meeting ofStates/ DistrictComponents4.4. Other cost associatedwith the Monitoring andEvaluation/InformationDissemination,1,48,800 1,48,800 Nil 1,87,200 1,87,20018,000 Nil Nil 50,000 50,000Total FundsReceivedRs.Requirement of funds for the year 2008-09Expenditure Balance likely Requirement oflikely to be to be on 31- funds for theincurred 03-08 year 2008-09upto March31, 2008Rs.RsRs.Total2,67,000 2,67,000 Nil 2,00,000 2,00,000Sub Total 18,33,800 18,33,800 Nil 18,77,200 18,77,2005. IEC5.1 Health Camps / Mela 10,580 10,580 Nil 25,00,000 25,00,0005.2 IEC Awareness throughNGOs/CBOs/Panchayat5.3 Other IEC activities(Specify…..i) Awareness session20,61,796 20,61,796 Nil 15,10,000 15,10,000Nil Nil Nil 10,00,000 10,00,000of school childrensii) IEC materials Nil Nil Nil 5,00,000 5,00,000Sub Total 20,72,376 20,72,376 Nil 55,10,000 55,10,0006. Operational expensesfor treatment of bednets6.1 Through Health System 15,03,000 15,03,000 Nil 35,00,000 35,00,0006.2 Through NGOs/CBOs/Panchayat Raj and otherprivate partners15,03,000 15,03,000 Nil 35,00,000 35,00,000Sub Total 30,06,000 30,06,000 Nil 70,00,000 70,00,0007. Over heads and othermiscellaneousbudgetary itemsAdvance notification onNil Nil Nil 2,00,000 2,00,000ITBNSub Total Nil Nil Nil 2,00,000 2,00,000Grand Total 1,27,99,796 1,18,17,796 9,82000 2,32,77,780 2,32,77,780Rs.Manipur State Integrated NRHM PIP 2008-2009 194

IMCPPlan for placement of 12 Lab. Techs/ Microscopists sanctionedunder GFATMSl.No. Name of District Name of PHC No. ofPost1. Ukhrul PHC Kasom Khullen 12. Thoubal PHC Kakching KhunouPHC Sugnu113. Imphal East PHC Borobekra 14. Chandel Chandel District Hospital 15. Tamenglong PHC TameiPHC OinamlongPHC TousemPHC Waichong11116. Kangpokpi SD Saikul 17. Imphal West PHC KakwaPHC Sekmaijin11Total 12Plan for placement of 14 MALARIA TECHNICAL SUPERVISOR (MTS)UNDER GFATMSl. Name of District No.of Block Designated MU No.of PostNo.Centre1. Tamenglong 4 nos.Tamei, TousemTamenglongNungbaTamenglong-1Nungba-12 nos.2. Churachandpur 6 nos.Parbunmg, ThanlonHenglep, CCPSamulamlan andSinghat3. Imphal East 4 nos. Jiribam,Sawombung andKeiraomaktingThanlon-1CCP-1Singhat-IJiribam – 1Sawombung-1Keiraomakting-13 nos.3 nos.4. Bishnupur 2 nos. Moirang,BPR Bishnupur-1 1 no.5. Senapati 3 nos.Tadubi, PurulPaomataTadubi-11 no.6. Chandel 5 nos.Chandel, MachiMoreh, Khingjoy andChakpikarong7. Ukhrul 3 nos. KamjongChingoi, Ukhrul8. Thoubal 2 nos.Kakching, ThoubalChandel-1Moreh - 1Ukhrul-1Thoubal-1Total2 nos.1 no.1 no.14 nos.Manipur State Integrated NRHM PIP 2008-2009 195

Proposal for placement of 19 (Nineteen) Male MPWs to be appointedon Contractual basis under XI Plan with the Financial Assistance ofthe Government of IndiaSl.No.Name ofDistrict(HR)Name ofPHC/CHCName of SubCentreNo. ofplacement1. Imphal East, 1) CHC Jiribam Chandranathpur 1Jiribam SD 2) PHC Borobekra Durgapur 12. Ukhrul 1) CHC Kamjong ChammuChahong112) PHC Phungyar T.HundungSingkap113) PHC Somdal TuinemTolloi114) PHC Chingai Chingjaroi 13. Churachandpur 1) PHC Senvon Leisen 12) PHC Patpuimun NampabungPhailenthangChingmun1114. Senapati,Kangpokpi SD1) PHCManidara 1T.Waichong2) PHC Maphou Salam Patong 13) PHC Saikul Gangpikon 1111Total 195. Tamenglong 1) PHC Haochong NurathelNaga ChingThingraManipur State Integrated NRHM PIP 2008-2009 196

(CALENDAR OF ACTIVITY OF THE STATE OF MANIPUR ON NVBDCP FORTHE YEAR 2008-2009)Sl.No.Activity Jan Feb Mar April May June July Aug Sept Oct Nov Dec1. Trg. of ASHA + + + + + + + + + + + +2. Trg.of MOs.+ + + + + +Lab.Tech.HS, FW3. Trg.of FHW/CV/ + + + + + + + + + + + +CBOs/NGOs4 MTS/Lab.Tech.Co+ +ntract5. Training of+ + + + + + + + + + + +MHW/FHW6. Training of AWW + + + + + + + + + + + +7. Training of SHG + + + + + + + + + + + +8. Training of School + + + + +Teacher9. IRS+ IRS I RDII11/9a)Advancenotification15/3 13/5 IRS14/7b) DDT Dumping +10. AMM + +11. Vector Mapping + + + + + + + + + + + +JE/Dengue/Malaria13. Insecticide+ + + +suspectibity Test14. UMSa)Antilarval+ + + + + + + + + + + +operationb)Fogging+ + + +malathion15. Seeding of+ + +Larvivorous Fish16 ITBN + + + + + + + + + + + +17. IEC + + + + + + + + + + + +18. VCM Impact+ + + + + +evaluation19. Review of District + + + + + + + + + + + +by State Monthly20 Review of District+ +byState (HLY)21. Workshop of+Private Hospital/Diagnostic Centre22. 1 Day meeting of+Private Local labs.with MO, PHCs23. Composite+Training of ERRT24. Seminar/Worksho+p Inter-SectoralConvergence25. Trg. Quality Ass. +26. Quality assurance + + + + + + + + + + + +27. Pre and Post BCCsurvey+ +Manipur State Integrated NRHM PIP 2008-2009 197

Area selection of IRSAreas selected for IRS is based on the criteria laid down in MAP 1995.1. Amongst the selected High risk area, prioritization for IRS emphasizes to :- (a) accessibility of the selected villages. (b) Wide acceptance of thespray by the community.2. Human dwelling (HD) are targeted for spray, animal shed is not to besprayed.3. Strict monitoring and supervision is to be insured. Supervision is to becarried out under PRI in the valley and village council in hill areasrespectively.4. The area specific calendar is already formed and made available to allDistricts. The District-wise total number of villages along with householdsto be sprayed is as given below.District No. of villages No. of householdsImphal East 94 9783Ukhrul 56 8117Churachandpur 265 10538Chandel 81 7744Kangpokpi Sub-Div 219 12312Tamenglong 147 10515Total 862 59,009Manipur State Integrated NRHM PIP 2008-2009 198

National Program on Prevention and Control ofDeafness (NPPCD)Background: NPPCD was implemented on trial basis in Imphal East and ImphalWest Districts in 2007-08. Basic infrastructure development in terms ofaudiometry and audiologists were tried. Also capacity development of MOs wasdone with ENT Department of RIMS identified as the State Nodal Agency forTraining. Further capacity development of paramedics was taken up through “Recreation”,a voluntary agency (Spastic Society of India) which was identified asthe Implementing Agency.Aim: To expand the Program in all 05 hilly Districts of the State 2008-09.The various activities and budgetary support needed (Rs. in lakhs) will be asgiven below.Sl. No. Activities Amount1 05 Contractual audiologist in DHs @ Rs. 10,000/- 6.00per head per month2 Procurement of 05 audiometry machine @ Rs. 2.500.50 Lakhs per unit3 Re-orientation Trg. of 50 MOs of CHC/PHC in 10.00batches of 5 @ Rs. 1.00 Lakh per batch4 Re-orientation training of 100 MPWs in batches of 2.0025 @ Rs. 0.50 per batch5 Mobility support for Screening program in schools 10.006 Program Management Cost 2.007 Medicine support in 05 DHs @ Rs. 0.25 lakh 1.25Total 33.75Manipur State Integrated NRHM PIP 2008-2009 199

INTEGRATED DISEASE SURVEILLANCE PROJECT:MANIPUR.INTRODUCTIONThe Integrated Disease Surveillance Project (Phase II) has been implemented in the Statesince 19 September 2005. This five year project is implemented through the State &District Societies as an autonomous body.The objectives of the project are:(i)(ii)To establish a decentralized state based system of surveillance forCommunicable and Non Communicable diseases and their risk factors sothat timely and effective public health actions can be initiated in responseto health challenges in the state and national levels andTo improve the efficiency of the existing surveillance activities of diseasecontrol programs and facilitate sharing of relevant information with thehealth administration, community and other stakeholders so as to detectdisease and risk factor trends over time and evaluate control strategies.The State Surveillance Committee IDSP under the chairmanship of Principal Secretary(H/FW) is the empowered committee and administratively responsible for projectactivities in the State while the State Surveillance Unit, with the Joint director (PH) as theState Surveillance Officer would implement the activities under IDSP.In the District, the District Surveillance Committee chaired by the Deputy Commissioneris responsible for regular implementation of the Project. And activities under IDSP isexecuted by the District Surveillance Unit Headed by the Deputy Commissioner asChairman, the CMO, as Vice Chairman and one of the Public Health Trained DistrictProgram Officer as District Surveillance Officer/ Member-Secretary,DSC.The main project activities are: 1- Up gradation of Laboratories.2- IT & Communication.3- Human Resource & Development.4- Operational activities & response.5- Monitoring & Evaluation.In the coming years IDSP will remain the System of Public Health in the Country as wellas in the State of Manipur.Manipur State Integrated NRHM PIP 2008-2009 200

SITUATION ANALYSIS:Though IDSP was implemented in the State from September, 2005, there has been verylittle progress of the project activities. Most of the activities are either progressing veryslowly or stuck up somewhere due to lack of awareness at all levels involved in thesystem.The IT and communication facilities are not fully operational at all the Districts and theState Head quarter.The EDUSAT facilities are installed and functioning at the SSU Hq, Imphal, DSUsexcept DSU Imphal East (due to want of building) and the RIMS, Lamphel.And BSNL Broad band connection is available under IDSP at SSU Head quarter &RIMS,Lamphel while the remaining districts will be getting this facility during the First quarterof the FY 2008-09.All the back logs and constraints are prioritized for immediate correctional actions,through regular monthly review meetings of the State Surveillance Committee forimmediate action for smooth implementation of the project in the State. And from thecoming FY 2008-09 the Project will be on its right track.Manipur State Integrated NRHM PIP 2008-2009 201

INTEGRATED DISEASE SURVEILLANCE PROJECT, MANIPUR.PLAN OF ACTIONS FOR 2008-09.TIME LINE2008-09Sl.NoOBJECTIVE ACTIVITIESQ1 Q2 Q3 Q4APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MARPERSON (S)RESPONSIBLE1To stream linefunctioning ofIDSPi-redeployment/identification ofaccountant toDSUsii- appointmentof contractualstaffsiii- posting ofepidemiologist/PH trainedMHS officers toDist.iv- formation ofbudgetcommittee.________DHS, CMOs,DSOsSSC/ DSCPrincipal Sec.(H/W)/ DHS.SSU/ FINANCECONSULTANTManipur State Integrated NRHM PIP 2008-2009 202

V-BudgetCalendar- preparation ofbudget for nextFY/ revision ofbudget forcurrent FY________vi-FMRsubmission from _ _ _ _ DSO/AccountantDSU to SSU(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)vii- Hiring of 4Wdrive vehicle forSSU____________________________________SSU2 To maintainQuality andeffectivemaintenanceofSurveillanceactivitiesi- Sensitizationworkshops ofpolicy makers/administratorsDCs/communityleaders etc atState level &Dist. level_____SSU/ DSUsManipur State Integrated NRHM PIP 2008-2009 203

ii- Training:SST/DST/MOsDLT/LTs/ HWHS_________Trg. Consul.STT/ DTT3 To utilize IT& communicationfacilityinsurveillanceactivitiesiii-monthlyreview meetingSSC/SSU, DSUs . . . . . . . . . . .Training toData mangers/DEOs..__SSU/ DSUSSU(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)procurement ofRequired lab _____fixture &furniture labs4 To improvequality &accessibilityto labs.(1) (2)procurement ofReqd. lab eqpt.& supplies(3)_____(4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)SSU/ DSUsSSU/ DSUsManipur State Integrated NRHM PIP 2008-2009 204

5 To monitorand evaluatethesurveillanceactivities.Labtechnicniciansposted at DistHq to work inthe Dist.Hospital labirrespective oftheir programsBy usingstandardIndicators______________________________________DHS / CMOs.MOs , DSO,CMO & SSOManipur State Integrated NRHM PIP 2008-2009 205

Integrated Disease Surveillance Project, ManipurActivity wise details with financial estimatesPart-ANon recurring:1 Renovation & Repairs:1.1 State Surveillance Committee Room:In connection with minor repairing and renovation of the committee meetingroom it is estimated to cost about a sum of Rs.140,000.00 one lakh forty thousandwill be required.2-Furniture and Fixture - Furniture and furnishing of the committee meeting roomis estimated to cost a sum of Rs.930, 000 as one time investment during the currentfinancial year 2008-09.And unused balance of Rs. 6000.00(six thousand only) has already been earmarked toutilize by April 2008.Details of the fixture and furniture requirement are as follows:2.1- SSU1. Purchase of 25 deluxe chairs (steel with arms, cushion and wheel)2. Conference Table “U” Shaped3. Floor mate (15”X25”)4. Podium – OneEstimated Cost @Rs 1, 40,000/ Unit2.2- DSU1. Purchase of 15 deluxe chair (with arms, cushion and wheel)2. Conference Table for 15 persons3. Podium - 1Estimated Cost @Rs 70,000/Unit Total No. of Unit – 9Total = Rs. 630,0002.3 Periphery (CHC)Estimated Cost @Rs 10,000/Unit Total No. of Unit – 16Total = Rs 1, 60,000Grand total = 930,000(rupees nine lakh thirty thousand only).3- Office Equipment:The unused balance of rs.210, 000 has been already earmarked for purchase of 10 Airconditioners, one each for SSU and 9DSUs and procurement process will becompleted by April, 2008.4-Minor laboratory Equipment:The unused balance of rs.1, 220,000 has been earmarked to procure equipments andto be spent by July 2008. The equipments to be procured are for 16 Nos of L1, 9 Nos.of L2 and 1 No. of L3:i-Lancet for L1, L2, L3.( quantity as per work load)Manipur State Integrated NRHM PIP 2008-2009 206

ii-Ice box -26 Nos. (16 + 9+1)iii-Stool Transport carrier 26 nos. (16+9+1)iv-Test tube rack- 26 nos.v-Table top centrifuge – 26nos.vi-Refrigerator- 26 nos.vii-Sprit lamp- 26 nos.viii-smear transporting box- 26 nos.ix- incubator- 10 nos. (9+1)x – incubator- 10 nos (9+1)xi - water bath- 10nos.( 9+1)xii-inoculating loop – quantity as per work load.xiii- Pasteur pipettes- quantity as per work load.xiv- Vortex mixer – 10 nos (9+1).1- Laboratory Material and supply:Part- B.1.1-The following laboratory materials and supply( requirements list enclosed) arerequired at State Laboratory, 9 District Laboratories and 16 peripheral laboratories atCHCs and the unspent amount of Rs.250,000(two lakh fifty thousand only) has been earmarked and procurement will be completed by April, 2008.And the annual requirements for the 3 levels of laboratory are as follows:a)- State lab @ Rs 200,000 per unit = Rs.200,000.b) - Dist lab 9 nos. @100,000 per unit = Rs.900, 000.c) - Peripheral lab. 16 nos @ 10,000/ unit = Rs.160, 000.Total of part B - 1: = Rs.1, 260,000.2-I.E.C: Budget for listed activities for I.E.C under IDSP is as below:SSU2.1 - Sensitization workshop Rs 30,0002.2 – Review Meeting Surveillance Committee Rs 20,0002.3 – Press Advertisement Rs 40,0002.4 – Print Media Rs 40,0002.5 – Telecasting of TV Sports Rs 130,0002.6 - Broadcasting on Radio Rs 40,0002.7 – Printing of Case definition & Filed Manual Rs 95,000DSU & PERIPHERY (CHC)2.8 – Sensitization Workshop @ Rs 40,000 / Unit X 9 = Rs 270,0002.9 - Review MeetingSurveillance Committee @ Rs 10,000/Unit X 9 = Rs 90,0002.10 – Press Advertisement @ Rs 20,000/ Unit X 9= Rs 180,0002.11 – Print Media @ Rs 20,000/ Unit X 9= Rs 180,0002.12 – Others/indigenous Methods @ Rs 20,000/ Unit X 9= Rs 180,000Total of part B - 2: Rs 1,295,0003 Training – Though State Level and District level training of the Medical Officers hadbeen done during 2006-07 most of the trained hand are not clustered at their originalplace of posting due to recent rationalization of the posts. Hence, most of the staffs needsre training.Manipur State Integrated NRHM PIP 2008-2009 207

Fund for conducting the training are as follows:3.1- Health worker (M/F) in 25 batches @ Rs.15, 500/ batch = Rs.387, 500.3.2- Lab Asstt 1 batch @ Rs.18, 000/batch = Rs. 18,000.3.3- MO/PP 8 batch @ Rs.36, 500/batch = Rs.657, 000.3.4- Dist.Lab.tech. 1 batch @ Rs.62, 000/batch = Rs. 62,000.3.5- Data Manger/DEOs 1 batch @ Rs.62, 000/batch = Rs. 62,000.3.6- SST/DST 1 batch @ Rs.140, 000/batch = Rs.140, 000.3.7- HS 6 batch @ Rs. 15,500/batch = Rs. 93,000.Total of part B - 3:= Rs.1, 419,500.The unused balance ( part B – 3 ) of the sum of Rs.40, 415. has been already earmarked and will be fully utilized during the month of April, 08.4- Salary:The Total numbers of contractual staffs are 23 i.e. five numbers for SSU and two staffseach for nine Districts.Budget required for payment of these staff for year is as below:SSU4.1- Administrative asstt. 1 no. (5000X1X12) = Rs. 60,000.4.2- Finance consultant 1 no. (10,000X1X12) = Rs.120,000.4.3- Training consultant 1 no. (20,000X1X12) = Rs.240,000.4.4- Helper 1 no. (3000X1X12) = Rs. 36,000.4.5- DEO 1 no. (6000X1X12) = Rs. 72,000.DSU.4.6- Administrative asstt. 9 nos. (5000X9X12) = Rs. 540,000.4.7- Helper 9 nos. (3000X9X12) = Rs. 324,000.Total of part B -4:= Rs, 1,392,000.The unused balance ( part B – 4 ) of the sum of Rs.1, 000,000. has been ear markedand will be fully utilized during the current financial year.5-Operational cost.The requirements of fund for the activities enumerated under Operational cost are asbellows:SSU.5.1 - Travel cost & POL = Rs 100,0005.2 – Hiring of One 4W drive Vehicle = Rs 240,0005.3 – Office Expense on phone, FaxElectricity etc. = Rs 60,0005.4 – Office stationary & other consumable = Rs 60,0005.5 – DA to Officers/staffs engaged under IDSP = Rs 80,0005.6 – Misc. Including contingencies = Rs 50,000DSU5.7 – Travel cost, POLMaintenance of Vehicle = Rs 360,000Manipur State Integrated NRHM PIP 2008-2009 208

5.8 – Office expense-telephone /fax /electricity = Rs 180,0005.9 – Office Stationary & other consumables = Rs 180,0005.10 – DA to Officers/staffs engaged under IDSP = Rs 270,0005.11 – Misc including contingencies = Rs 180,000Peripheral5.12 – Travel Cost/POL/Vehicle Hiring = Rs 80,0005.13 – Office Expense- telephone/ fax /electricity = Rs 64,0005.14 – Office Stationery & Other consumables = Rs 32,0005.15 – DA to Officers/staffs engaged under IDSP = Rs 48,0005.16 – Misc. including contingencies = Rs 16,000Total of part B - 5: Rs 2000,000The unused balance ( part B – 5 ) of the sum of Rs.1, 000,574. has been ear markedand will be fully utilized during the current financial year.Grand Total ( Part A + Part B ) = Rs.140,000 + Rs.930,000 + Rs.1,260,000 + Rs1,295,000 + Rs,1,419,500 + Rs,1,392,000 + Rs 2,000,000. = Rs. 8,436,500.(Rupees Eighty four lakh thirty six thousand five hundred only)Note : The unutilized amount of Rs 2,827,744 (Rs Twenty eight lakh twenty seventhousand seven hundred forty four only) are already earmarked to be utilizedwithin September 2008.Manipur State Integrated NRHM PIP 2008-2009 209

BUDGET ESTIMATES FOR PHASE II IDSP-MANIPUR DURING 2008-09.SNO COMPONENT PHYSICALUNSPENTBALANCE2005-06FUNDRECEIVED2006-07REQUIREMENTDURING2007-08 2008-09R E M A R K SA Non-recuringSSU1 Renovation & Repair1.1State Coomittee meetingRoom 140,000 Renovation of State Committee Meeting RoomSub Total A1: 140,000Unspent amount will expended by April'082 Fixture & Furniture 6,0002.1 SSU 1 140,000 State Committee Meeting room Furnishing2.2 DSU 9 630,0002.3 Periphery 16 160,000Sub Total A2: 930,0003 Office Equipment 210,0004 Minor Lab.Equipment 1,220,000sub Total: Sub Total A3&4: 0Unspent amount will expended by April'08Purchase process started & will be spentbyJuly'08Grand Total Part A: 1,070,000B Recurruing:1 Laboratory Material 250,000 Unspent balance will be utilized fully by April'08& Supply1.1 STATE LAB 1 200,0001.2 Dist. Lab 9 900,0001.3 periphery 16 160,000Sub Total: 1,260,0002 I.E.C 755 Unspent balance of 755 will be utilizedManipur State Integrated NRHM PIP 2008-2009 210

SSU2.1 sensitization workshop 30,0002.2 Review meetingSurveillance Committees 20,0002.3 press advertisement. 40,0002.4 Print media(pamplet/brouchers) 40,0002.5 Telecasting of TV spots(SSU) 130,0002.6 Broadcasting on Radio(SSU) 40,0002.7 Printing of Case definition&Field mannual.10,000 copies. 95,000 Contd-9DSUs2.8 sensitization workshop 270,0002.9 Review meetingSurveillance Committees 90,0002.1 press advertisement. 180,0002.11 Print media(pamplet/brouchers) 180,0002.12 Others/indigenious method 180,000Subtotal B2: 1,295,0003 Training 40,4153.1 HW(M/F) 387,500 Training batch 25 nos.3.2 Lab.Asstt. 18,000 - do- 1 no.3.3 MO/PP 657,000 - do- 8 nos.3.4 Dist.Lab Tech. 62,000 - do- 1 no.3.5 Data Managers,DEO 62,000 - do- 1 no.3.6 State/District Surveillance Team 140000 - do- 1 no.3.7 HS 93,000 - do- 6 nos.Sub Total B3: 1,419,5004 Contractual Staff Salary: 1,000,000SSU4.1 Administrative Asstt. 60,000 Salary for 1AdmAsstt for 1yr4.2 Finance consultant 120,000 Salary for 1Finance consultant for 1yr4.3 Training Consultant 240,000 Salary for 1 Trg.Consultants for 1Yr.Manipur State Integrated NRHM PIP 2008-2009 211

4.4 Helper 36,000 Salary for 1Helper for 1 yr.4.5 Data entry operator 72,000 Salary for 1 DEO for 1 yr.DSUs4.6 Administarive Asstt. 540,000 Salary for 9 Adm Asstt for 1 yr4.7 Helper 324,000 Salary for 9 helper for 1 yrSub Total B4: 1,392,000Unspent Rs.100574 will be fully utilized by June5 Operational Cost 100,574.002008SSU detail enclosed5.1 Travel Cost & POL 100,0005.2 Hiring of 1 4 Wheel drive vehicle 240,0005.3 Office expense on phoneFax,Electricity etc 60,0005.4 Office stationary& other consumable 60,0005.5 DA to Officers/staffs engaged under IDSP 80,0005.6 Misc. including contingencies. 50,00010Contd.-DSUs detail enclosed5.7 Travel cost,POLMaintenance of Vehicles 360,0005.8 Office expense-telephone/fax/electricity 180,0005.9 Office Stationery& other consumables 180,0005.1 DA to Officers/staffs engaged under IDSP 270,0005.11 Misc. including contingencies 180,000Peripheral level detail enclosed5.12 Travel cost/POL/or veh. Hiring 80,0005.13 Office expense-telephone/fax/electricity 64,0005.14 Office Stationery& other consumables 32,0005.16 DA to Officers/staffs engaged under IDSP 48,0005.17 Misc. including contingencies 16,000Sub Total B5: 2,000,000Manipur State Integrated NRHM PIP 2008-2009 212

Total Part B: 7,366,500GRAND TOTAL (Part A+B) 2,827,744 8,436,500(rupees eighty four lakhs thirty six thousand and five hundredonly)Note: The un utilized amount of Rs.28, 27, 744( Rs. Twenty eight lakhs twenty seven thousand seven hundred forty four only) are already earmarked to be utilized within June 2008The total budgetary support needed (Rs. in Lakhs) for Part “D”will be as shown below.Sl. No. Programs Amount1 RNTCP 531.172 NLEP 60.103 NPCB 32.804 NIDDCP 36.655 NBVDCP 233.006 NPPCD 33.757 IDSP 84.37Total Rs. 1011.84Manipur State Integrated NRHM PIP 2008-2009 213

Manipur State Integrated NRHM PIP 2008-2009 214

WITH DEPARTMENT OF WOMEN AND CHILD DEVELOPMENT1. Village Health & Nutrition DayAnganwadi Centres (AWC) will serve as the focal point for all health andnutrition services. A Health Day (Wednesday) is fixed every month at the AWC toprovide antenatal, postnatal, family planning and child health services, includingimmunization. On that day, an ANM and preferably an MO from the PHC will be inattendance. AWW, ASHA and other community volunteers would be responsible forensuring that all children 0-6 years, pregnant women and lactating women, andchildren needing immunization and other health services are brought to the AWC onthat fixed day. Monitoring of Growth Charts for U-5 Children will be done by AWW onthe VHND and children needing care in addition to Supplementary Nutrition will betaken care by the MO/ ANM.2. Coordination between AWW and ASHAAWWs will be mentors of ASHA and will work in tandem for counselingPregnant Women to have institutional delivery, attend home deliveries as secondattendant, motivate newly married on family planning, participate in RoutineImmunization Strengthening and NIDs and facilitate referral for institutional delivery.The compensation package for the above mentioned activities are alreadydiscussed under Part “B”.3. Interdepartmental coordinationRepresentatives from WCD are to be made members in all the Societies andCommittees starting from State level to the Village level. Monitoring and Supervisionof the different activities may be facilitated through joint review meetings andcommon reporting formats.WITH PRI1. Empowerment of PRIs through assured availability of adequate funds:Untied funds may be made available to Village Health Committees and allSubcentres to be deposited in a joint Account operated by ANM and PRIrepresentative.Manipur State Integrated NRHM PIP 2008-2009 215

2. Partnership with PRIsPRI representatives are to be made members in all Societies and Committeesviz. State and District Health Mission Societies, Rogi Kalyan Samitis, SubcentreCommittees and Village Health Committees.3. Empowerment during selection of ASHAASHA are to be selected by the PRI after facilitating by a trained facilitator.4. Community monitoring: PRI will be involved for monitoring theattendance and performance of Additional ANMs. Also PRI should monitorthe observation of the Village Health & Nutrition Days.WITH DEPARTMENT OF AYUSHThere is yet no separate Department of AYUSH in the State. An AYUSH Cellexists under the Directorate of Health Services, Manipur.1. Mainstreaming AYUSHThe services of the existing 74 AYUSH units run by contractual AYUSH staffsco-located with CHCs and PHCs will be continued. These AYUSH staffs are to bemainstreamed into RCH services specially in providing BCC and other communitymobilization activitiesCivil works needed, other infrastructure up-gradation; medicine etc of theAYUSH Centres will be supported by AYUSH under CSS.WITH MANIPUR AIDS CONTROL SOCIETY (MACS)The services of MACS counselors posted at District Hospitals, CHCs and 24/7PHCs are to be utilized for the common goal of MACS, Maternal & Child Health andAdolescent Health. Also in places where trained counselors under MACS are notavailable, ANMs or Female Health Supervisors will be trained for counseling. TheDistrict Mobile medical Units will have trained counselors provided by MACS. TheIntegrated RCH out-reach camps also will have trained counselors.Lab. Techs recruited under MACs as well as recruited under NRHM will beused both for RTI/STI and HIV testing services.Manipur State Integrated NRHM PIP 2008-2009 216

RTI/STI Clinics in District Hospitals and identified CHCs will also be run in acoordinated manner along with MACS. RTI/STI drugs up-to District Hospital level willbe borne by MACS. For Sub-District level NRHM will bear it.Also the Blood Storage Centres at the FRUs will be made functional withcoordination with MACs e.g. reagents consumables will be supplied by MACS.Trainings of SBAs and health providers for Adolescent Health/ School Healthand ASHAs will also have components under HIV/AIDS. Also the periodic training ofASHAs will have a chapter on PPTCT.Further IEC activities at Districts will be planned in an integrated manner withMACS.Finally, coordination meetings will be held monthly between the State RCHCommittee and MACS so that further areas for coordination can be identified andtaken up. Also the State Project Director of MACS will be a member of the StateHealth Society formed under NRHM.WITH PUBLIC HEALTH ENGINEERING DEPARTMENT/PUBLIC WORKS DEPARTMENTTo bring about better Sanitation and Safe Drinking Water Supply available tothe community and also to overcome transport problems regarding approach roadsto the health institutions, the PHED/PWD representatives are to be made membersin all the Societies and Committees starting from State level to Village level. Thusjoint planning and implementation of relevant activities will be sought.Manipur State Integrated NRHM PIP 2008-2009 217